SNAP AND SAVE

Medicine / MEDICINE

It would be unfair to say that the state is not at all puzzled by the problems of the ambulance. Puzzled in the framework of the national health project. By December 15, GAZ is to complete the delivery of 6,723 ambulances. Government order for this...

It would be unfair to say that the state is not at all puzzled by the problems of the ambulance. Puzzled in the framework of the national health project. By December 15, GAZ is to complete the delivery of 6,723 ambulances. The state order for this year is 4 billion rubles, the price of a new car is 20 thousand dollars, a foreign analogue costs almost three times as much.

Will the renewal of the ambulance fleet affect the efficiency of the service itself?

According to the logic of things, it should affect, that is, of course, improve this very help. But this is in principle. But in fact, cars among those who have to work on them cause conflicting emotions.

The fact is that a real car for an ambulance is, in the last place, a vehicle, that is, a banal transportation; in the first place, it is a place where people are rescued and resuscitated. And, of course, they are transported with care.

The ambulance doctor, who arrived at my call, first of all asked: “Can I not fulfill the Hippocratic oath?” "To what extent?" I made sure, just in case. He grinned and began to unwind the wires of a portable electrocardiograph.

The next morning I found the text of the oath on the Internet. The modern edition of the text read: "I will honorably and conscientiously fulfill my professional duties ...". The doctor knew what to warn about - there was no necessary medicine in his suitcase, and he advised to quickly drive to the pharmacy.

It is unlikely that the same phrase will be perceived by the patient as not the best joke of a tired doctor when he does not have a nembulizer to relieve bronchospasm or a ventilator (artificial lung ventilation) at hand in a critical situation.

With this little optimistic thought, I walked along the stands of the 7th International Medical Specialized Exhibition "Ambulance-2006".

On the one hand, each booth of the exhibition showed the highest level achieved in the production of instruments and equipment, with the help of which people are saved. On the other hand, he was the embodiment of the black envy of an ordinary doctor from a provincial substation. On the third, he multiplied in the head of every rare non-professional visitor the number of missed chances in saving his loved ones.

This contraption (defibrillator. - N.Ch.) could help dad, but this one (nembulizer. - N.Ch.) could save the girl from the next entrance, who suffocated from severe bronchospasm. But it's better not to remember.

The defibrillator cost $7,000. Portable nebulizer - $120.

Portable defibrillators, according to a representative of the company "Ripple", abroad hang at every station. And if misfortune happened, every passer-by, without waiting for the ambulance, can help, because an elementary school student is able to understand the instructions for this device. At the current exhibition, there were two buyers for the defibrillator. The head offices of Gazprom and BP - Bbritish Petroleum - were bought for senior employees.

Another defibrillator, fully automatic, manufactured in the USA, already designed for resuscitation, allows you to monitor the patient continuously and perform automatic defibrillation in the absence of a doctor. Can also be used in manual mode. An indispensable device for cardiac resuscitation, especially here in Russia (where the human factor, if we mean the doctor, remains both the most reliable and the most vulnerable at the same time). In Europe, there is in every cardiology center. We have four out of eighty in the whole country. Novosibirsk ordered one copy at the exhibition. Again, I can’t resist about the cost - 9 thousand USD.

If we are puzzled by a simple arithmetic operation and, say, five years of continuous operation of the device in intensive care, divided by the number of automatic defibrillations that prevented cardiac arrest, then we will get the price, if not of life in the full sense - resuscitation is an intermediate place - then still the price of postponing death. What will come out at cost? Ten dollars? Let the experts correct me if I think it's unprofessional.

Near each booth (and everything needed for ambulances, resuscitation and disaster medicine was presented at the exhibition) I asked one question: are there many orders? They answered the same way: the interest is colossal, but, judging by experience, several dozen customers will buy it. Expensive equipment in state medical institutions will generally go piece by piece. These acquisitions are not financed by the state budget. Buy when there is a sponsor.

A girl at a booth advertising an automated ambulance control system manufactured in Kazan proudly announced that their system was already in operation in twelve Russian cities. This means that in twelve cities a phone call to an ambulance will be registered in the database, promptly transferred to the brigade, its movement can be monitored on a computer and the optimal route can be suggested from the control room. ACS excludes an error in receiving a call and allows you to raise the archive if necessary.

She also talked about how the relatives of the deceased man won the trial (which is a rarity in the practice of criminal cases with a “diagnosis” in Russia), proving the dispatcher’s guilt with the help of a recording of negotiations removed from the archive. The dispatcher claimed that on the other end of the wire they said: "The man is feeling bad." In fact, they said: "The man feels bad, he turned blue." In this case, the brigade had to leave immediately, and not after almost half an hour. The price of this system is about two thousand dollars. Is this a lot of money for the budget of an average regional city, even if you do not ask for a favor from the federal treasury? This is the money of approximately one city holiday - traditional and meaningless.

Of all the potential consumers of "emergency" services, newborns were the most fortunate at the exhibition (there is still the highest justice). The Ministry of Health has ordered 100 Brazilian-made transport incubators. The battery systems of the incubator are built into the case so it can be carried around. This means that premature babies can be resuscitated already in an ambulance in another hundred cities. And then 500 grams of live weight in a premature baby is not a reason to put an end to it. Literally.

In addition to the exhibition part, the program "Ambulance-2006" also included a scientific forum. His materials were published in a separate booklet. The materials are purely practical and scientific, not intended for the average consumer of "emergency" services. But there was one article there, from which the relationship "ambulance - the state" became as understandable as an accidentally peeped episode of a showdown between decent people is understandable. They seem to speak quietly, and do without harsh vocabulary, and the arguments are convincing ... But all the same - a dead end.

An article titled "The case of effective provision of emergency assistance to a victim with a gunshot wound to the heart" was written by employees of the ambulance station of the Satka district .... N. Fursenko and A. Nikhonoshin. From a brief medical retelling of the episode, which makes sense to translate into everyday language, it followed: a brigade from a rural substation went to a call to a citizen shot from Makarov; bandaged on the spot, put on a drip, gave an oxygen mask; to the hospital - the central medical unit in Satki was taken, operated on; then operated on by specialists from the regional. The details of the operation are on two pages in small text.

Now focus on the corrected diagnosis: “Gunshot wound. Damage to the heart, diaphragm, left lobe of the liver, through wound of the stomach, wound to the spleen, lower lobe of the left lung. After 18 days, the patient was discharged in a satisfactory condition.

In summary, the authors of the article concluded the following: “Even line teams should be equipped with all the necessary medical equipment, up to portable ultrasound, even in the outback there are highly qualified personnel who can save the lives of the victims.”

The logic of people chronically tired of financial hopelessness, who, showing the highest professionalism, seem to be asking for favors from the authorities.

Help "New"

Toronto Ambulance takes calls in 142 languages.

In Maryland, telediagnosis has been introduced on 36 ambulances.

In Turin, paramedics do part of the journey in the subway.

The city of Norwich (England) has a service of paramedics on bicycles. The medical bike costs £900. It is equipped with a flasher with a siren, a defibrillator, a resuscitation kit, catheters, a blood pressure monitor, and medicines.

Help "New"

Every third citizen of the country seeks medical care for emergency conditions every year, every tenth is hospitalized for emergency reasons, more than 60% of inpatient care is provided on an emergency basis, emergency pathological conditions, injuries and poisonings rank first among the causes of death among people of working age .

According to the Department for the Development of Medical Care and Resort Affairs of the Ministry of Health and Social Development, over the past ten years, the number of ambulance calls has tripled and increased from 15 million to 50.

Doctors themselves believe that up to 70% of those injured in road accidents die due to poor equipment of ambulances.

I am not WWW.RU

DO NOT REACH THE PATIENT

And then came that day of mourning, when they wrote off our joy - "Mers-310", which served us faithfully for 13 years ... We pushed around a little and got a new generation ambulance purchased by the station within the framework of the national project "Health".

All members of the eighth brigade, savoring the joy of the meeting like a boy, burst into the car, and ... tears welled up in our eyes when we realized that we had to work on THIS ...

We opened the door, looked at the ceiling of the car, but there was no damper in the hood, direct access to the street. For now, it means that the way is ordered to the line ...

Do not turn on the stove from the cabin.

A little about fixing the equipment and actually about the work. Full control over the operation of the respiratory equipment is impossible, not to mention the defibrillator. Try to reach the "irons" to the patient, set the discharge value and see the readiness of the device at the same time. And now imagine: you need a "defi" at the address (in principle, it should always be with you), and you fly into the car after it - and it starts ....

1. We remove the irons from the mounts on the wall.

2. We tear off the "Velcro" fasteners from the handle of the device.

3. We remove 10 kilos from the shelf.

4. We fasten the irons from the sides of the "defi" and run to ... the corpse.

And here is the suction. As planned - removable, having built-in power from the battery and from the on-board network. Strange - sucking at the feet, the question is: what are we going to suck? And in order for the stretcher to get into the latch, you must manually turn the rear wheels to one side (it’s good if they are clean).

The antenna is mounted on an unthinkable piece of iron, taped on top and smeared with sealant. Tires - four sets (arm-leg), 2 adults and 2 children. They are made of corrugated plastic with a thickness of 3-4 mm. I wonder how many hours they will last?

I understand that the Gazelle was not developed under "03" and that the national project "Health" is tantamount to the slogan "support the domestic manufacturer." But I just can't understand why those on whom the national project depends, if something happens, will go to the hospital in a warm, differently equipped Ford, or Merc, or in a powerful Chevrolet. And our municipal brother - in felt boots, a sheepskin coat and a hat with earflaps. To ride them in their native "gazelle" in the fierce cold on a stretcher, maybe they would be surprised ...

Paramedic BIT of substation No. 27 SAVOSTYANOV Denis

This text was posted on the informal website of the ambulance - Feldsher.Ru. The paramedic of the intensive care team (ICU) shared his impressions of the new machine with colleagues.

We publish only a small part of the responses on the forum ...

Dr. Guevara

By the way, did you pay attention to the fact that the converters are non-working: the voltage of 220 V in their sockets exists only when the car is in the garage and connected to an external network? And what will happen when the batteries in the suction, defibrillator and ventilator fail? From the network, they do not work ...

Dr. asst. Raimonds

Where are the seat belts? It's the same with any, even a small accident, you turn your neck. You can't let her out on the line!

Angry_Pepper

As prof. F.F. Preobrazhensky: “In such conditions I cannot and have no right to work! Therefore, I close the clinic and leave for Sochi! And I'll leave the keys to Shvonder - let him operate ... ".

The ventilator hoses are very short, we had to bring our own and lengthen them. It is not clear why there is no vacuum mattress or hip splint.

DoctorAlex

The cardiographer goes to them disgusting, very capricious about the correct application of the electrodes, he writes all the time about the breakage of one of them. It takes a lot of time until you achieve that he "allowed" to record an ECG. In addition, he refuses to write without the application of chest electrodes, which is extremely inconvenient if he suddenly has to be resuscitated, and it takes a very long time to switch him to the monitor mode. Management through the menu is inconvenient and ill-conceived, in emergency situations it is very annoying. In general, this freak cannot be cured, it can only be killed. Who will allow...

Valery

Half of the equipment died within a week (cardiograph, pulse oximeter, glucometer, etc.), the rest was faulty initially - the ventilator does not breathe out patients ... What pleased me was the thermos packing, which would be something to treat hypothermia.

Goodbye

For 3 months of work, the door in the cabin has already taken off, somehow, when turning, a side chair with a bench came off. Well, I am silent about the temperature in the cabin, we are waiting for winter with horror (we have an average air temperature of -300 C).

someone else

The cardiograph from the new gibberish did not work for me even a day - it was sent for repair. Those who worked for such people say that all the electrodes must be hung up, otherwise they won’t write - it’s very “convenient” during resuscitation ...

nativpet

I read ... it became ill.

I'm getting this in a week.