At the scene of the incident and during transportation, the victim must be given an optimal (advantageous) position that affects the function of vital organs. This situation depends on the type of injury and the severity of the victim’s condition:

In victims who are unconscious due to traumatic brain injury, poisoning, cerebrovascular accident, etc., there is always a danger of tongue retraction, and due to suppression of cough and swallowing reflexes, blockage of the airways with vomit, saliva, sputum, foreign bodies, blood (especially if the victim is on his back). This inevitably leads to impaired lung function in the form of asphyxia (suffocation). To prevent this, the victim must be immediately placed in a stable lateral (drainage) position (Fig. 9).

Fig.9 Drainage position to prevent asphyxia

1. Remove the victim's glasses (if any).
2. Kneel at the victim's side. Make sure his legs are straight and his arms are at his side.
3. Take the victim's arm closest to you at a right angle to the body, bend it at the elbow so that the palm is directed upward.
4. Place the hand farthest from you diagonally on the victim’s chest; Place the back of the victim’s hand on the victim’s cheek closest to you.
5. With your other hand, grab the victim’s leg farthest from you, under the knee; Turn the victim toward you so that the victim's bent knee and foot rest on the ground.
6. Straighten the victim's head so that the airway remains clear. If necessary, adjust the position of the palm on which the patient's head rests so that the airway remains clear.
7. Monitor the victim's breathing.

Before turning the body, to prevent the risk of displacement of the cervical vertebrae (if they are fractured), it is advisable to fix the cervical spine with a cervical splint (Fig. 10).

Fig. 10 Neck splint

The “frog” position is used if injury to the pelvis or lower extremities is suspected. The victim is placed on his back with his knees and knees apart and half bent. hip joints limbs that rest on the bolster in the popliteal region (Fig. 11).

Fig. 11 “Frog” position for injury to the pelvis and lower extremities

A patient with spinal injuries is placed in a supine position with a cushion placed on them (Fig. 12).

The horizontal position of the body with the legs elevated by 30 - 40 cm is used for massive blood loss and ongoing internal bleeding (Fig. 14).

Stable lateral position (SLP) is a position in which a person is placed in an unconscious state, but with breathing, while awaiting the arrival of an ambulance.

Why is the stable lateral position performed?

When a person loses consciousness, all muscles relax. Lying on his back in this state, a person may suffocate due to the tongue retracting into the throat or choke on vomit. A stable lateral position prevents tongue retraction, allows breathing and helps remove saliva and vomit.

When to use a stable lateral position

• With or loss of consciousness.
• During a coma unknown origin.
• In case of poisoning drugs.
• Able alcoholic coma.
• During stroke or heart attack.

Algorithm for performing a stable lateral position

Preparing to turn

1. If the patient wears glasses, take them off.
2. Make sure the patient's legs are straight, lying together and in line with the body.
3. Kneel next to the victim.
4. Place the arm closest to you at a right angle to your body and bend it at the elbow near your head, palm up.
5. Take your other hand, move it to your side and place the back of your hand on your ear. Holding it in this position will help reduce the movement of the cervical vertebrae as the victim turns, which will reduce the risk of aggravating a possible neck injury.
6. With your other hand, grab the victim's opposite leg behind the knee. Lift it up without lifting your foot off the ground—this allows you to use your foot as a “lever” to make turning easier.
7. Without changing the position of your arms and legs, move away from the patient and get ready to turn the patient on his side.

Turn

1. Pull the raised leg toward you and place the victim on their side.
2. Pull your hand out from under the patient's head, holding the victim's elbow to prevent any head movements.

Stabilization

1. Adjust the position of your legs - your hip and knee should be at right angles.
2. Holding the head with one hand, open the patient’s mouth with the other and check for breathing.

Stable side video position

Giving the victim stability lateral position

Special cases

Pregnant women and obese people stack on left side- to reduce the risk of compression of the inferior vena cava. It is responsible for collecting venous blood, not enriched with oxygen, from lower parts bodies. When this vein is compressed, there is a risk of worsening the patient’s condition.

If the patient lies on his stomach- make sure he is breathing and stabilize his position.

Observation of the victim

Before the ambulance arrives, it is necessary to carefully monitor changes in the victim’s condition:

• Control vital functions: breathing, pulse, consciousness.
• Watch for changes in external signs: the appearance of sweat, pallor or cyanosis of the skin.
• When the patient's condition changes let me know and clarify information for the ambulance.
• Even if the patient is unconscious, talk to him and calm down his.
• Protect from the weather- heat, cold, rain and wind.
• If the victim feels better and regains consciousness - wait for the doctors to arrive and examination by a doctor.

The manual of the Ministry of Emergency Situations of Russia will help participants in road accidents and eyewitnesses of a heart attack in a sick person not to get confused in a difficult situation. The book also lists algorithms for providing first aid for traumatic injuries and emergency conditions. Such as external bleeding from injuries, abdominal wounds, penetrating chest wounds, bone fractures and thermal burns, as well as hypothermia and frostbite. Readers will learn how to behave correctly in order to actually help someone who has been electrocuted, or has swallowed water in a river, or perhaps has become a victim of serious poisoning. The manual also contains recommendations for help in case of injuries and chemical burns of the eyes, bites of poisonous snakes, insects, as well as heat and sunstroke.

1. Priority actions when providing first aid to sick and injured people

First of all, assistance is provided to those who are suffocating, who have profuse external bleeding, a penetrating wound to the chest or abdomen, who are unconscious or in serious condition.

	Make sure that you and the victim are not in danger. Use medical gloves to protect the victim from body fluids. Carry (lead) the victim to a safe area.
	Determine the presence of a pulse, spontaneous breathing, and the reaction of the pupils to light.
	Ensure patency of the upper respiratory tract.
	Restore breathing and cardiac activity by using artificial respiration and chest compressions.
	Stop external bleeding.
	Apply a sealing bandage to the chest for a penetrating wound.

Only after stopping external bleeding and restoring spontaneous breathing and heartbeat, do the following:

2. Procedure for performing cardiopulmonary resuscitation

2.1. Rules for determining the presence of a pulse, spontaneous breathing and the reaction of the pupils to light (signs of “life and death”)

Proceed to resuscitation only if there are no signs of life (points 1-2-3).

2.2. Sequence of artificial ventilation

	Ensure patency of the upper respiratory tract. Use gauze (handkerchief) to remove in a circular motion fingers from the oral cavity mucus, blood, and other foreign objects.
	Tilt the victim's head back. (Lift the chin while holding the cervical spine.) Do not perform this if a fracture is suspected. cervical region spine!
	Pinch the victim's nose with your thumb and forefinger. Using a mouth-device-mouth artificial lung ventilation device, seal the mouth cavity and make two maximum, smooth exhalations into his mouth. Allow two to three seconds for each passive exhalation of the victim. Check whether the victim’s chest rises when inhaling and falls when exhaling.

2.3. Rules for closed (indirect) cardiac massage

The depth of chest compression should be at least 3-4 cm, 100-110 compressions per minute.

	- for infants, massage is performed using the palmar surfaces of the second and third fingers; - for teenagers - with the palm of one hand; - in adults, the emphasis is placed on the base of the palms, the thumb is directed towards the head (legs) of the victim. The fingers are raised and do not touch the chest.
	Alternate two “breaths” of artificial pulmonary ventilation (ALV) with 15 pressures, regardless of the number of people performing resuscitation.
	Monitor the pulse in the carotid artery, the reaction of the pupils to light (determining the effectiveness of resuscitation measures).

Closed cardiac massage should only be performed on a hard surface!

2.4. Removal of a foreign body from the respiratory tract using the Heimlich maneuver

Signs: The victim suffocates (convulsive breathing movements), is unable to speak, suddenly becomes cyanotic, and may lose consciousness.

Children often inhale parts of toys, nuts, and candies.

	Place the baby on the forearm of your left hand, and clap the palm of your right hand 2-3 times between the shoulder blades. Turn the baby upside down and pick him up by the legs.
	Grab the victim from behind with your hands and clasp them in a “lock” just above his navel, under the costal arch. Press sharply with force - with your hands folded into a “lock” - into the epigastric region. Repeat the series of pressures 3 times. For pregnant women, apply pressure to the lower parts of the chest.
	If the victim is unconscious, sit on top of the hips and sharply press on the costal arches with both palms. Repeat the series of pressures 3 times.
	Remove the foreign object with your fingers wrapped in a napkin or bandage. Before removing a foreign body from the mouth of a victim lying on his back, he must turn his head to the side.

IF, DURING RESUSCIVATION, INDEPENDENT BREATHING, HEARTBEAT DOES NOT RECOVER, AND THE PUPILS REMAIN WIDE FOR 30-40 MINUTES AND THERE IS NO HELP, IT SHOULD BE CONSIDERED THAT THE BIOLOGICAL DEATH OF THE VICTIM HAS OCCURRED.

3. Algorithms for providing first aid to victims of traumatic injuries and emergency conditions

3.1. First aid for external bleeding

	Make sure that neither you nor the victim is in danger, put on protective (rubber) gloves, and take the victim out of the affected area.
	Determine the presence of a pulse in the carotid arteries, the presence of spontaneous breathing, and the presence of pupillary reaction to light.
	If there is significant blood loss, place the victim with his legs elevated.
	Stop the bleeding!
	Apply a (clean) aseptic dressing.
	Keep the injured part of the body immobile. Place a cold pack (ice pack) on the bandage over the wound (sore area).
	Place the victim in a stable lateral position.
	Protect the victim from hypothermia by giving plenty of warm, sweet drinks.

Pressure points of arteries

3.2. Methods for temporarily stopping external bleeding

Clamp the bleeding vessel (wound)

Finger pressure on the artery is painful for the victim and requires great endurance and strength from the person providing assistance. Before applying a tourniquet, do not release the pinched artery so that bleeding does not resume. If you start to get tired, ask someone present to press your fingers on top.

Apply a pressure bandage or pack the wound

Apply a hemostatic tourniquet

A tourniquet is a last resort measure to temporarily stop arterial bleeding.

	Place a tourniquet on a soft pad (elements of the victim’s clothing) above the wound as close to it as possible. Place the tourniquet under the limb and stretch.
	Tighten the first turn of the tourniquet and check the pulsation of the vessels below the tourniquet or make sure that the bleeding from the wound has stopped and the skin below the tourniquet has turned pale.
	Apply subsequent turns of the tourniquet with less force, applying them in an upward spiral and capturing the previous turn.
	Place a note indicating the date and exact time under the tourniquet. Do not cover the tourniquet with a bandage or splint. In a visible place - on the forehead - make the inscription “Tourniquet” (with a marker).

The duration of the tourniquet on the limb is 1 hour, after which the tourniquet should be loosened for 10-15 minutes, having previously clamped the vessel, and tightened again, but not more than for 20-30 minutes.

Stopping external bleeding with a tourniquet (a more traumatic way to temporarily stop bleeding!)

	Place a tourniquet (tourniquet) made of narrowly folded available material (fabric, scarf, rope) around the limb above the wound on top of clothing or placing the fabric on the skin and tie the ends with a knot so that a loop is formed. Insert a stick (or other similar object) into the loop so that it is under the knot.
	Rotating the stick, tighten the tourniquet (tourniquet) until the bleeding stops.
	Secure the stick with a bandage to prevent it from unwinding. Every 15 minutes, loosen the tourniquet to avoid necrosis of the limb tissue. If bleeding does not return, leave the tourniquet loose, but do not remove it in case rebleeding occurs.

3.3. First aid for abdominal wounds

	Prolapsed organs should not be placed into the abdominal cavity. Drinking and eating are prohibited! To quench your thirst, wet your lips.
	Place a roll of gauze bandages around the prolapsed organs (to protect the prolapsed internal organs).
	Apply an aseptic bandage over the rollers. Without pressing the prolapsed organs, apply a bandage to the abdomen.
	Apply cold to the bandage.
	Protect the victim from hypothermia. Wrap yourself in warm blankets and clothes.

3.4. First aid for penetrating chest wounds

Signs: bleeding from a wound on the chest with the formation of blisters, air being sucked through the wound.

	If there is no foreign object in the wound, press your palm against the wound and close the access of air to it. If the wound is through, close the entry and exit wound holes.
	Cover the wound with an airtight material (seal the wound), secure this material with a bandage or plaster.
	Place the victim in a half-sitting position. Apply cold to the wound using a cloth pad.
	If there is a foreign object in the wound, secure it with bandage rolls, a plaster or a bandage. It is prohibited to remove foreign objects from the wound at the scene of the incident!

Call (by yourself or with the help of others) an ambulance,

3.5. First aid for nosebleeds

Causes: nose injury (blow, scratch); diseases (high blood pressure, decreased blood clotting); physical stress; overheating.

	Sit the victim down, tilt his head slightly forward and let the blood drain. Squeeze your nose just above your nostrils for 5-10 minutes. In this case, the victim must breathe through his mouth!
	Invite the victim to spit out the blood. (If blood enters the stomach, vomiting may occur.)
	Apply cold to the bridge of your nose (wet handkerchief, snow, ice).
	If the bleeding from the nose does not stop within 15 minutes, insert rolled gauze swabs into the nasal passages.

If the bleeding does not stop within 15-20 minutes, refer the victim to a medical facility.

3.6. First aid for broken bones

Call (on your own or with the help of others) an ambulance.

3.7. Rules for immobilization (immobilization)

Immobilization is mandatory. Only if there is a threat to the injured rescuer is it permissible to first move the injured person to a safe place.

	Immobilization is performed by immobilizing two adjacent joints located above and below the fracture site.
	Flat, narrow objects can be used as an immobilizing agent (splint): sticks, boards, rulers, rods, plywood, cardboard, etc. The sharp edges and corners of the splints should be smoothed using improvised means. After application, the splint must be secured with bandages or adhesive tape. For closed fractures (without damaging the skin), a splint is applied over clothing.
	For open fractures, do not apply a splint to places where bone fragments protrude.
	Attach the splint along its entire length (excluding the level of the fracture) to the limb with a bandage, tightly, but not too tightly, so as not to interfere with blood circulation. At a fracture lower limb apply tires on both sides.
	In the absence of splints or improvised means, the injured leg can be immobilized by bandaging it to the healthy leg and the arm to the body.

3.8. First aid for thermal burns

Call (on your own or with the help of others) an ambulance. Ensure that the victim is transported to the burn department of the hospital.

3.9. First aid for general hypothermia

Call (on your own or with the help of others) an ambulance.

If there are signs of your own hypothermia, fight sleep, move; use paper, plastic bags and other means to insulate your shoes and clothes; look for or build a shelter from the cold.

3.10. First aid for frostbite

In case of frostbite, use oil or Vaseline; rubbing frostbitten areas of the body with snow is prohibited.

Call (on your own or with the help of others) an ambulance and ensure that the victim is transported to a medical facility.

3.11. First aid for electric shock

Call (on your own or with the help of others) an ambulance.

	Determine the presence of a pulse in the carotid artery, the reaction of the pupils to light, and spontaneous breathing.
	If there are no signs of life, perform cardiopulmonary resuscitation.
	When spontaneous breathing and heartbeat are restored, place the victim in a stable lateral position.
	If the victim regains consciousness, cover and warm him. Monitor his condition until medical personnel arrive; repeated cardiac arrest may occur.

3.12. First aid for drowning

Call (on your own or with the help of others) an ambulance.

3.13. First aid for traumatic brain injury

Call (on your own or with the help of others) an ambulance.

3.14. First aid for poisoning

3.14.1. First aid for oral poisoning (when a toxic substance enters the mouth)

Call an ambulance immediately. Find out the circumstances of the incident (in case of drug poisoning, present the medicine wrappers to the arriving medical worker).

If the victim is conscious

If the victim is unconscious

Call (on your own or with the help of others) an ambulance and ensure that the victim is transported to a medical facility.

3.14.2. First aid for inhalation poisoning (when a toxic substance enters the respiratory tract)

Signs of carbon monoxide poisoning: pain in the eyes, ringing in the ears, headache, nausea, vomiting, loss of consciousness, redness of the skin.

Signs of household gas poisoning: heaviness in the head, dizziness, tinnitus, vomiting; severe muscle weakness, increased heart rate; drowsiness, loss of consciousness, involuntary urination, pale (blue) skin, shallow breathing, convulsions.

Call an ambulance.

4. Algorithms for providing first aid for acute diseases and emergencies

4.1. First aid for a heart attack

Signs: acute pain behind the sternum, radiating to the left upper limb, accompanied by “fear of death,” palpitations, shortness of breath.

Call and instruct others to call an ambulance. Ensure supply fresh air, unbutton tight clothes, give a semi-sitting position.

4.2. First aid for damage to the organs of vision

4.2.1. If foreign bodies enter

Ensure that the victim is transported to a medical facility.

4.2.2. For chemical burns to the eyes

The victim should only move hand in hand with an accompanying person!

In case of acid contact You can wash your eyes with a 2% solution of baking soda (add baking soda to a glass of boiled water on the tip of a table knife).

In case of contact with alkali you can wash your eyes with a 0.1% solution of citric acid (add 2-3 drops of lemon juice to a glass of boiled water).

4.2.3. For eye and eyelid injuries

The victim should be in a lying position

Ensure that the victim is transported to a medical facility.

4.3. First aid for poisonous snake bites

Limit the mobility of the affected limb.

If consciousness does not recover for more than 3-5 minutes, call (on your own or with the help of others) an ambulance.

4.6. First aid for heatstroke (sunstroke)

Signs: weakness, drowsiness, thirst, nausea, headache; increased breathing and increased temperature, loss of consciousness are possible.

Call (by yourself or with the help of others) an ambulance.

There are several options for optimal patient positioning, each of which has its own advantages. There is no universal situation suitable for all victims. The position should be stable, close to this side position with the head down, without pressure on the chest, for free breathing. There is the following sequence of actions to place the victim in a stable lateral position:

Remove the victim's glasses.

Kneel next to the victim and make sure both legs are straight.

Place the patient's arm closest to you at a right angle to the body, with the elbow bent so that the palm faces up.

Stretch your far arm across your chest, pressing the back of his hand to the cheek of the victim on your side.

With your free hand, bend the victim's leg farthest from you, grasping it slightly above the knee and without lifting his foot off the ground.

Keeping his hand pressed to his cheek, pull your far leg to turn the victim onto your side.

Adjust your upper leg so that your hip and knee are bent at a right angle.

Tilt your head back to make sure your airway remains open.

If you need to keep your head tilted, place your cheek on the palm of his bent hand.

Check for breathing regularly.

If the victim must remain in this position for more than 30 minutes, he is turned to the other side to relieve pressure on the lower arm.

In most cases, emergency care in a hospital is associated with fainting and falling. In such cases, it is also necessary to first carry out an inspection according to the algorithm described above. If possible, help the patient return to bed. It is necessary to make a record in the patient's chart that the patient fell, under what conditions this happened and what assistance was provided. This information will help your doctor choose treatment that will prevent or reduce the risk of fainting and falls in the future.

Another common cause requiring immediate attention is respiratory disorders. Their cause may be bronchial asthma, allergic reactions, pulmonary embolism. When examining according to the specified algorithm, it is necessary to help the patient cope with anxiety and find the right words to calm him down. To make the patient's breathing easier, raise the head of the bed, use oxygen pillows and masks. If the patient finds it easier to breathe while sitting, be present to help prevent a possible fall. A patient with respiratory problems should be referred for an x-ray, his arterial gas levels should be measured, an ECG should be performed, and the respiratory rate should be calculated. The patient's medical history and reasons for hospitalization will help determine the causes of breathing problems.

Anaphylactic shock- a type of allergic reaction. This condition also requires emergency care. Uncontrolled anaphylaxis leads to bronchoconstriction, circulatory collapse, and death. If a patient is receiving a blood or plasma transfusion at the time of an attack, it is necessary to immediately stop their supply and replace it with a saline solution. Next, you need to raise the head of the bed and carry out oxygenation. While one member of the medical staff monitors the patient's condition, another must prepare the adrenaline for injection. Corticosteroids and antihistamines can also be used to treat anaphylaxis. A patient suffering from such serious allergic reactions must always have with him an ampoule of adrenaline and a bracelet warning of possible anaphylaxis or a memo for emergency doctors.

Loss of consciousness

There are many reasons why a person may lose consciousness. The patient's medical history and reasons for hospitalization provide information about the nature of this disorder. Treatment for each individual is selected strictly individually, based on the causes of loss of consciousness. Some of these reasons are:

taking alcohol or drugs: Do you smell alcohol on the patient? Are there any obvious signs or symptoms? What is the reaction of the pupils to light? Is your breathing shallow? Does the patient respond to naloxone?

attack(apoplectic, cardiac, epileptic): have there been attacks before? Does the patient experience urinary or bowel incontinence?

metabolic disorders: Does the patient suffer from kidney or liver failure? Does he have diabetes? Check your blood glucose levels. If the patient is hypoglycemic, determine if the patient requires intravenous glucose;

traumatic brain injury: The patient has just suffered a traumatic brain injury. Remember that the elderly patient may develop a subdural hematoma several days after TBI;

stroke: if a stroke is suspected, a CT scan of the brain should be performed;

infection: whether the patient has signs or symptoms of meningitis or sepsis.

Remember that loss of consciousness is always very dangerous for the patient. In this case, it is necessary not only to provide first aid and further treatment, but also to provide emotional support.

Foreign body obstruction of the airway (choking) is a rare but potentially preventable cause of accidental death.

– Give five blows to the back as follows:

Stand to the side and slightly behind the victim.

Supporting the chest with one hand, tilt the victim so that the object that exits the respiratory tract falls out of the mouth rather than gets back into the respiratory tract.

Make about five sharp blows between your shoulder blades with the heel of your other hand.

– After each beat, monitor to see if the obstruction has improved. Pay attention to efficiency, not the number of hits.

– If five back blows have no effect, perform five abdominal thrusts as follows:

Stand behind the victim and wrap your arms around his upper abdomen.

Tilt the victim forward.

Make a fist with one hand and place it on the area between the navel and the xiphoid process of the victim.

Grasping your fist with your free hand, make a sharp push in an upward and inward direction.

Repeat these steps up to five times.

Currently, the development of cardiopulmonary resuscitation technology is carried out through simulation training (simulation - from lat. . Simulatio“pretense”, false depiction of a disease or its individual symptoms) – creations educational process, in which the learner acts in a simulated environment and knows about it. The most important qualities of simulation training are the completeness and realism of the modeling of its object. As a rule, the biggest gaps are identified in the area of ​​resuscitation and patient management in emergency situations, when the time for decision-making is reduced to a minimum and the refinement of actions comes to the fore.

This approach makes it possible to acquire the necessary practical and theoretical knowledge without harming human health.

Simulation training allows you to: teach how to work in accordance with modern emergency care algorithms, develop team interaction and coordination, increase the level of performing complex medical procedures, and evaluate the effectiveness of one’s own actions. At the same time, the training system is built on the method of obtaining knowledge “from simple to complex”: starting from elementary manipulations, ending with practicing actions in simulated clinical situations.

The simulation training class should be equipped with devices used in emergency conditions (respiratory equipment, defibrillators, infusion pumps, resuscitation and trauma placements, etc.) and a simulation system (mannequins of various generations: for practicing primary skills, for simulating elementary clinical situations and for practicing actions of the prepared group).

In such a system, with the help of a computer, the physiological states of a person are simulated as completely as possible.

All the most difficult stages are repeated by each student at least 4 times:

At a lecture or seminar class;

On a mannequin - the teacher shows;

Independent performance on the simulator;

The student sees from the side of his fellow students and notes mistakes.

The flexibility of the system allows it to be used for training and modeling a variety of situations. Thus, simulation education technology can be considered an ideal model for training in prehospital and inpatient care.

Medical deontology

It would seem that words such as “doctor”, “paramedic” or, unfortunately, the forgotten phrase “sister of mercy”, on the one hand, and the concept of “deontology”, on the other, should, if not be synonymous, then be in an inseparable logical communications. It would seem... In reality, everything is not so simple.

In addition to purely medical errors (therapeutic and diagnostic, tactical, etc.), it is customary to note deontological errors. They mean a violation of the rules of relationships between a doctor and a patient, as well as between doctors of the same or related medical institutions (unfortunately, this also happens!), as well as general ethical standards.

The control room is the place where the first meeting, albeit in absentia, between the caller and the ambulance takes place. And how it happens depends on whether the call will be accepted; if it is accepted, what priority will it receive, what psychological situation will the team meet with the patient. After Professor V.M. began studying the work of this ambulance unit. Tavrovsky, it turned out that the main thing a person thinks about when calling an ambulance is that they will not refuse to accept the call. Therefore, to the dispatcher’s question: “What happened?” instead of a specific answer, a lot of unnecessary information was dumped: about past and present merits, about participation in wars, about being attached to some “prestigious” hospital, etc. It is impossible to interrupt this “turbulent flow”, it will be regarded as disrespect to "merits". And although time was wasted, I had to put up with it. Only after this could the dispatcher proceed to “extracting” the necessary information. And in response to asked question to hear: “What are you interrogating, come quickly, you will see for yourself!” But it is still unknown whether it is necessary to come, especially “as soon as possible”, whether an ambulance is needed. Sometimes the dispatcher would engage in moralizing, which is generally unacceptable: “Where were you before, why are you just calling now?”

Proposing a new system for the control room, V.M. Tavrovsky recommended a completely different dialogue algorithm. The dispatcher must take the initiative “into his own hands,” and this can be done by making it clear to the caller that there are no problems with receiving the call. It is clear that when called to the street or to an apartment, the information about the patient cannot be the same. After the message about accepting the call, a recommendation is given, for example: “Sit (lay down) the patient, give nitroglycerin, if there is no effect, repeat after 3-5 minutes.” Now the waiting time will not be so painful. If the dispatcher is not sure about the need for an ambulance to arrive, he switches the caller to a senior doctor, who not only refuses to allow the team to leave, but gives advice on managing the patient and recommends where to go.

So, if the call was accepted, the team went to the patient. Having arrived at the place, a medical worker should under no circumstances start a conversation with dissatisfaction: why didn’t we meet you, why did you call, we were driving across the whole city, you are not in our area, the 9th floor, and the elevator is not working, etc. All this “verbal garbage” will immediately create a barrier and interfere with the main task: making a correct diagnosis and providing adequate assistance in accordance with it.

Particular attention should be paid to the situation when assistance has to be provided on the street, at an enterprise (workplace), in other similar points (shop, public transport, underground passage) - in a word, wherever a person is, he may need emergency medical care . The best thing that can be advised in this situation is not to pay attention to others and confidently do your job. Do not enter into discussions, do not respond to remarks. This distracts from work, even if the comments seem offensive. Rise above it. It is necessary to bring the patient’s condition to transportable as quickly as possible, take him into the car and leave this place (if we are talking about the street). After this, everyone around you will lose all interest.

The issue of hospitalizing a patient from a public place is decided unambiguously - leaving him on the street is prohibited. But if you don't yet know where you need to be hospitalized, you can drive around the corner, stop, finish the examination if you haven't done so before, and contact the hospitalization office.

For the patient and his relatives, hospitalization is, if not a tragedy, then in any case a disaster, especially if we are talking about a young person who is suspected (or diagnosed) with acute coronary syndrome (ACS). After all, just yesterday the patient led an active lifestyle, but today he is forced to lie down, reducing his activity to a minimum.

You need to understand the patient's condition. No “horror stories” are needed here. The effect from them will be the opposite of what was expected.

Even if the doctor is confident in the diagnosis of ACS and sees that the patient is afraid of this diagnosis, as a death sentence, you can tell him that there is no heart attack yet, there is only a threat of it, and to prevent it from developing, you need to do this and that. After such a conversation, you can hope that the patient will follow your recommendations regarding both treatment and the need for transportation on a stretcher. As a rule, the ambulance either does not have its own “manpower” or there is not enough of it: the team is mostly women. When deciding on hospitalization, the following dialogue often arises:

- Look for men, we have no one to carry!

– We have no one either. You have a driver, we will pay him!

- He can't leave the car!

A verbal duel, as a rule, leads nowhere. Try to start the conversation differently: “The patient needs to be carried on a stretcher, you see, we have only women, maybe you can help us find someone, we don’t know anyone here.”

This is how the conversation should go, or something like this. No categoricalness, no “stubbornness”, friendly, calm tone. Then you can count on success.

It is important to remember that no reason (narrow corridor, steep stairs, etc.) can be an excuse for violating the hospitalization procedure, especially when a stretcher is needed. Understanding this, a competent doctor or paramedic will always find a way out: a chair, a blanket, etc.

Here is another situation: when transporting on a stretcher from some floor, relatives (surroundings) may be confused as to why the patient is carried “feet first”, since he is still alive? In this case, the doctor or any member of the team should calmly, tactfully explain that this is not “feet forward”, but “feet down”. Because if you carry him head first, then he will end up head down on the stairs, which is unsafe for a seriously ill patient. That is why “feet down” and not feet forward.

But now the patient is placed in the car. He may be alone, perhaps with relatives or colleagues. The patient experiences what happened. Agree that any extraneous conversations will rightly be perceived as disrespect for his condition. Of course, no one demands that team members accompany the patient with mournful faces. However, any talk about things that are not related to “this topic” will rightly be interpreted negatively. As a result, the heroic work done on call, at the patient’s bedside, by you and your colleagues can be neutralized. We need to learn to empathize!

A sick person, due to his illness, has an altered psyche; he is exhausted by prolonged pain, perhaps repeated, and even fruitless, visits to medical offices. Ambulance is in a special position. Sometimes they call her without receiving a referral to a hospital from “their” local doctor or without waiting for a doctor from the clinic today... You never know what else! Even a conversation with the dispatcher preceding the arrival of the brigade can make a sick person lose his temper. And all the accumulated negative emotions will be thrown out on the one who is available and from whom you can get the most specific and real help.

But then they “attacked” you with a stream of claims to which you had nothing to do. Should you immediately start “defending yourself” when the patient or relatives are still heated? This energy will involuntarily be transferred to you (the mirror effect), you will get involved in a conflict, and it is possible that you will suffer from it. How to be? There is such a technique. Ask the essence of the complaint (knowing full well that it is not addressed to you) to be stated again, explaining that you did not understand something. (Just don’t interrupt the patient, let him speak. The time spent on this will pay off in preventing a conflict, maybe even a complaint, which will then take much more time and not one, but several people to sort out. Don’t forget to reflect this situation in the call card).

You will notice that there will be fewer emotions. As a last resort, you can ask to repeat once again some part of the entire claim. The conversation will be completely calm. You gave the patient the opportunity to “let off steam.” This is just one way to avoid conflict. There is a popular wisdom: “Of two arguing, the one who is smarter is to blame.” And since you naturally consider yourself smarter, try to make sure that the fire does not break out.

Try to ensure that members of your brigade do not take part in this fight. It will be easier for you. Here is the answer to the question: “Is it possible to be offended by a sick person?” Forgive him! He's sick. And leave your ambitions “for later.”

Providing emergency medical care at the prehospital stage involves medical measures not only on site, but also when transporting patients (injured) to the hospital. These features, in contrast to hospital conditions, require additional attention to moral and legal problems. These are the features.

The extreme nature of the situation requires urgent actions, often performed without proper diagnosis (lack of time).

Patients are sometimes in extremely serious, critical condition, requiring immediate resuscitation.

Psychological contact between a medical worker and a patient can be difficult or absent due to the severity of the condition, inadequate consciousness, pain, convulsions, etc. etc.

Providing assistance is often carried out in the presence of relatives, neighbors or simply curious people.

The conditions for providing assistance may be primitive (room, cramped conditions, insufficient lighting, lack of assistants or their absence at all, etc.).

The nature of the pathology can be very diverse (therapy, trauma, gynecology, pediatrics, etc.).

The listed features of work in emergency medicine create special ethical and legal problems, which can be divided into two main groups:

Due to the specific conditions of emergency care, as well as due to insufficient familiarity of medical workers with this problem, the rights of patients are often violated.

Errors in providing emergency assistance can occur mainly due to the extreme nature of the situation, sometimes due to criminal negligence.

Problems in the relationship between a medical professional and a patient can be built along two lines. One of them is ethical-deontological, when we are talking simply about the relationship between two people, which are regulated by moral and ethical frameworks and norms. The second line is legal. This is stated in the concept of informed voluntary consent (IVC). The most common reasons for violation of the rights of patients when providing emergency care: 1) lack of psychological contact with the patient (victim) and 2) extremeness of the situation. Sometimes the first may depend on the second, and more often both factors act simultaneously, which can lead to their mutual reinforcement. Unfortunately, we have to deal with another factor: 3) the medical worker’s ignorance of the patient’s rights.

When one sage was asked from whom he learned good manners, he answered: “From the ill-mannered. I avoided doing what they were doing." And finally, the wonderful thought of the French encyclopedist Denis Diderot: “It is not enough to do good, you must do it beautifully.”

APPLICATIONS

Appendix No. 1

1. Basic concepts and definitions in emergency medicine

Pre-hospital stage provision of medical care – the stage of providing medical care outside a hospital-type medical institution.

Ambulance Service– government agencies healthcare, emergency medical services (EMS) stations (departments), providing emergency medical care to sick and injured people at the pre-hospital stage using mobile ambulance teams.

Emergency (ambulance) medical care– urgent elimination of all urgent painful conditions that arose unexpectedly, caused by external or internal factors, which, regardless of the severity of the patient’s condition, require immediate diagnostic and therapeutic activity.

life-threatening condition– a health condition in which there is an immediate threat to life. It requires a set of urgent measures to restore the vital functions of the body at the site of emergency medical care and along the route to hospitalization.

condition that threatens the patient's health– a chronic disease (usually in elderly patients) that does not pose an immediate threat to life, but is fraught with the emergence of a threatening moment in the near future.

Mobile ambulance team– a doctor or a paramedic trained for independent work, having certificates that provide emergency medical care to sick and injured people at the scene of a call and in ambulance transport en route to a medical institution.

Standard "Emergency Medical Care"– a list of minimally sufficient emergency treatment and diagnostic measures in typical clinical situations corresponding to the level of mobile ambulance teams.

2. Regulations on the paramedic

TRAVELING BRIGADE

"EMERGENCY MEDICAL AID"

General provisions

1.1. A specialist with a secondary medical education in the specialty “general medicine”, who has a diploma and an appropriate certificate, is appointed to the position of paramedic of the “Emergency Medical Care” (EMS) team.

1.2. When performing duties to provide emergency medical services as part of a paramedic team, the paramedic is the responsible performer of all work, and as part of a medical team he acts under the direction of a doctor.

1.3. The paramedic of the emergency medical service team is guided in his work by the legislation of the Russian Federation, regulatory and methodological documents of the Ministry of Health of the Russian Federation, the Charter of the emergency medical service station, orders and instructions of the station administration (substation, department), and these regulations.

1.4. The paramedic of the mobile emergency medical service team is appointed to the position and dismissed in accordance with the procedure established by law.

Responsibilities

The paramedic of the mobile ambulance team is obliged to:

2.1. Ensure the immediate departure of the brigade after receiving a call and its arrival at the scene of the incident within the established time standard in the given territory.

2.2. Provide emergency medical care to sick and injured people at the scene of an accident and during transportation to hospitals.

2.3. Administer medications to sick and injured patients for medical reasons, stop bleeding, and carry out resuscitation measures in accordance with approved industry norms, rules and standards for paramedic personnel in providing emergency medical care.

2.4. Be able to use available medical equipment, master the technique of applying transport splints, bandages and methods of performing basic cardiopulmonary resuscitation.

2.5. Master the technique of taking electrocardiograms.

2.6. Know the location of medical institutions and station service areas.

2.7. Ensure that the patient is carried on a stretcher and, if necessary, take part in it (in the working conditions of the team, carrying a patient on a stretcher is regarded as a type of medical care in a complex of medical measures).

When transporting a patient, be next to him, providing the necessary medical care.

2.8. If it is necessary to transport a patient in an unconscious state or in a state of alcoholic intoxication, carry out an inspection for documents, valuables, money indicated in the call card, hand them over to the hospital reception department with a note in the direction for signature of the duty personnel.

2.9. When providing medical care in emergency situations, in cases of violent injuries, act in accordance with the procedure established by law.

2.10. Ensure infection safety (comply with the rules of sanitary and hygienic and anti-epidemic regime). If a quarantine infection is detected in a patient, provide him with the necessary medical care, observing precautions, and inform the senior shift doctor about the clinical, epidemiological and passport data of the patient.

2.11. Ensure proper storage, accounting and write-off of medications.

2.12. At the end of duty, check the condition of medical equipment, transport tires, replenish those used up during work medicines, oxygen, nitrous oxide.

2.13. Inform the administration of the EMS station about all emergencies that occurred during the call.

2.14. At the request of employees of the Department of Internal Affairs, stop to provide emergency medical care, regardless of the location of the patient (injured).

2.15. Maintain approved accounting and reporting documentation.

2.16. In the prescribed manner, increase your professional level and improve practical skills.

Rights

A paramedic of a visiting paramedic team of "Emergency Medical Care" has the right:

3.1. Call, if necessary, the emergency medical team for help.

3.2. Make proposals to improve the organization and provision of emergency medical care, improve working conditions for medical personnel.

3.3. Improve your qualifications in your specialty at least once every five years. Pass certification and recertification in accordance with the established procedure.

Responsibility

The paramedic of the mobile ambulance team is responsible in the manner prescribed by law:

4.1. For professional activities carried out in accordance with approved industry norms, rules and standards for paramedic personnel of the Emergency Medical Service.

4.2. For illegal actions or inaction that resulted in damage to the patient’s health or death.

3. Regulations on the paramedic (nurse) for receiving and transmitting calls to the station (substation, department) of the emergency medical service

General provisions

1.1. A specialist with a secondary medical education in the specialty “general medicine”, “nursing”, who has a diploma and an appropriate certificate, is appointed to the position of paramedic (nurse) for receiving and transmitting calls to the station (substation, department) of “Emergency Medical Care”.

1.2. The duty paramedic (nurse) for receiving and transmitting calls is directly subordinate to the senior shift doctor. He is guided in his work by service instructions, orders and instructions of the administration of the station (substation, department) of the NSR, and these regulations.

1.3. A paramedic (nurse) for receiving and transmitting calls to a station (substation, department) of the EMS is appointed to a position and dismissed in the manner prescribed by law.

Responsibilities

The paramedic (nurse) for receiving and transmitting calls to the station (substation, department) of the EMS is obliged to:

2.1. Receive and timely transfer calls to personnel of available field teams. Does not have the right to independently refuse to accept a call.

2.2. Provide operational management of all field teams in accordance with the territorial-zonal principle of service, know the location of the teams at any time during the shift.

2.3. Monitor the efficiency of the work of field teams: arrival time, call completion time.

2.4 Immediately inform the administration of the institution about all emergency incidents.

2.5. Communicate with local authorities, the Department of Internal Affairs, the traffic police, fire departments and other operational services. Know the emergency procedures.

2.6. Inform the population orally about the location of patients (victims) who received medical care.

2.7. Be able to use modern means of communication and information transfer, as well as a personal computer.

2.8. A paramedic (nurse) for receiving and transmitting calls to a station (substation, department) must know:

– city ​​topography;

– location of substations and healthcare facilities;

– locations of potentially dangerous objects;

– algorithm for receiving calls.

Rights

A paramedic (nurse) for receiving and transmitting calls from an emergency medical service station (substation, department) has the right to:

3.1. Make proposals to improve the work of emergency medical services.

3.2. Improve your qualifications at least once every five years.

3.3. Pass certification (re-certification) for the qualification category in the prescribed manner.

3.4. Take part in medical conferences, meetings, seminars held by the administration of the institution.

Responsibility

The paramedic (nurse) for receiving and transmitting calls to the station (substation, department) of “Emergency Medical Care” is responsible in the manner prescribed by law:

4.1. For professional activities carried out within the limits of their competence, independently made decisions.

4.2. For disclosure of information that is a medical secret.

4. Main types of violations of regulations by emergency medical personnel

All types of these violations are divided into three groups.

Group A. Violations of moral and ethical rules.

Group B. Violations of legal norms.

Group B. Violations of a mixed nature (moral and ethical + legal).

Group A includes:

violations of basic norms of culture and professional behavior;

conflictual relationships between emergency medical services workers;

mutual confrontation between the EMS doctor (paramedic) and the patient, provoked by: the EMS team or the patient, his relatives;

mutual confrontation between emergency medical services workers and other medical and preventive institutions (HCI), provoked by: emergency medical workers, healthcare workers;

some types of iatrogenics (therapeutic and psychological in nature).

Group B includes:

a combination of these types of ethical and deontological violations with each other, with defects in the diagnostic and treatment process (MDP) and (or) violations of a legal nature (of varying degrees of severity).

When seeking and receiving medical care, the patient has the right to:

1) respectful and humane attitude on the part of medical and service personnel;

2) the choice of a doctor, including a family doctor (general practitioner) and the attending physician, taking into account his consent, as well as the choice of a medical institution in accordance with compulsory and voluntary health insurance contracts;

3) examination, treatment and maintenance in conditions that meet sanitary and hygienic requirements;

4) holding, at his request, a council and consultations of other specialists;

5) relief of pain associated with the disease and (or) medical intervention, using available methods and means;

6) maintaining confidentiality of information about the fact of seeking medical help, health status, diagnosis and

other information obtained during his examination and treatment;

7) informed voluntary consent to medical intervention;

8) refusal of medical intervention;

9) obtaining information about one’s rights and responsibilities and state of health, as well as choosing persons to whom, in the interests of the patient, information about the state of his health can be transferred;

10) receipt of medical and other services within the framework of voluntary health insurance programs;

11) compensation for damage in the event of harm to his health during the provision of medical care;

12) access to him by a lawyer or other legal representative to protect his rights;

13) admission to a clergyman, and in a hospital institution to provide conditions for the performance of religious rites, including the provision of a separate room, if this does not violate the internal regulations of the hospital institution.

In addition to rights, the patient has responsibilities:

1) show respect when communicating with medical personnel;

2) provide the doctor with all the information necessary for diagnosis and treatment;

3) after giving consent to medical intervention, strictly follow all instructions;

4) comply with the internal regulations of health care facilities;

5) cooperate with a doctor in the provision of medical care;

6) immediately inform the doctor about changes in your health;

7) immediately consult a doctor if you suspect the presence of a disease that poses a danger of mass spread;

8) not take actions that could violate the rights of other patients.

5. Types of liability of medical workers

A.P. Zilber divides responsibility into the following types: “Directly or indirectly, all types of responsibility, except moral, are included in legal responsibility, which can be defined as state coercion to “fulfill the requirements of the law.”

Administrative liability is a type of legal liability for an administrative offense (offence), which is not regarded as strictly as the Criminal Code does.

Disciplinary liability is a form of influence on violators of labor discipline in the form of disciplinary sanctions: reprimand, reprimand, dismissal on appropriate grounds.

Civil, or civil liability, is a type of legal liability in which sanctions established by law or contract are applied to the offender.

Criminal liability is a type of liability that is regulated by the Criminal Code (CC).

We have already mentioned the stable side position several times. Today we will tell you in more detail about what this position is, as well as how and when it should be used.

Reading the material below will not make you an expert in first aid. This material is intended to stimulate interest in gaining knowledge in this area and help correct common mistakes. Practicing quality first aid skills requires the use of competent instructors, simulation material and dummies. Always seek qualified help in this matter!

The name itself suggests that a person lies on his side and it provides a certain level of stability, which serves the following purposes:

• A person lying in a stable lateral position is able to breathe freely even in an unconscious state. He is not in danger of tongue retraction, because even if the tongue moves under the influence of gravity, it will not block the airways. The chest is not loaded with the weight of the victim and can move freely during breathing movements.
• This position allows the victim to be comfortable using the ““ method, because you can easily bring your ear closer to the victim’s mouth and place your hand on his chest, checking the movements of the chest.
• A stable lateral position ensures freedom of movement, even in case of nausea or vomiting. If the victim were to vomit the contents of his stomach, the vomit would not accumulate in the mouth, blocking the airways. They will simply flow down one of the cheeks under the influence of gravity. Yes, the victim will not look very good, but he will be able to breathe, which is much more important for us.
• A stable lateral position provides a certain level of fixation for the victim and prevents further injury. The victim’s head is fixed, and the body, even in a completely relaxed state, does not shift or roll in any direction, which is very useful during transportation.

We may need the listed advantages in the following situations:

• Complete or partial loss of consciousness (confusion, risk of fainting).
• The victim is unconscious but breathing on his own.
• Suspicion or presence of head injuries, accompanied by dizziness and nausea.
• For some reason, you need to separate from the victim. In this case, a stable lateral position provides you with confidence that the victim will not suffocate due to tongue retraction, will not be injured by loss of consciousness, falling or displacement of the body, etc.

Perhaps the only situation when a stable lateral position cannot be used is injuries to the back and cervical spine, in which unnecessary movements (turning to one side) can only aggravate the situation.

To transfer the victim from a supine position to a stable lateral position, there is a method that uses a system of levers created from parts of the victim's body. This method allows you to turn over victims who are significantly larger than you in weight and size, without requiring excessive physical effort. To use this method, just follow a number of simple steps described below:

• Kneel to the side of the victim.
• Position the victim's arm closest to you at a 90-degree angle to the body and bend it at the elbow. The palm of the hand should be oriented upward.
• With your hand of the same name (right hand - right, left - left, depending on your location), take the victim’s hand farthest from you, palm to palm, locking your fingers. Move your far hand over chest the victim and place it on the victim’s cheek, which is closest to you. Hold it in this position.
• With your other hand, reach out to the victim’s leg farthest from you, and, grabbing it at the knee area, lift it relative to the victim’s body, bending it at the knee joint. The entire area of ​​the victim’s foot should rest on the ground.
• Keeping the victim's hand pressed to the cheek and using the victim's far leg bent at the knee joint as a lever, turn it towards you, while controlling the victim's head. He should turn on his side to face you.
• Position the victim's upper leg so that the hip and knee are bent at right angles.
• Place the victim's hand under the cheek so that the head remains tilted back and face down, which will allow free flow of fluid from the oral cavity.
• Tilt the victim's head back (if it was not possible to do this at the previous stage), thereby providing better relief.
• Remove vomit from the victim's mouth as necessary.
• Make sure that the upper hand does not lie on top of the lower one and does not cause compression of the soft tissues.
• Do not leave the victim unless there is a compelling reason, observe his condition and re-assess his breathing at least once every 5 minutes.

The title image of this publication illustrates all the stages of the algorithm described above.