OPTIONS OF INFORMATION SUPPORT OF DIAGNOSTIC AND TACTICAL DECISIONS OF THE DOCTOR AT THE PRE-HOSPITAL STAGE: OPPORTUNITIES AND PROSPECTS

Kishkentaev K.K., Dubitsky A.A.

Station of an emergency medical service of the city of Astana

Medical university Astana, Kazakhstan

Multidimensional specifics of a pre-hospital stage of sharply current diseases are predetermined by three main deficiencies: time, information, resources. In the conditions of these deficiencies there are preconditions for diagnostic and tactical mistakes with prevalence of the last. Mistakes are most frequent at cordial, plevropulmonal and syncope syndromes [1].

The difficult nature of errors of a pre-hospital stage is still insufficiently studied and partly caused by difficulties of recognition of the earliest manifestations of emergency pathology.

Oligosimptoms, an atypical, dynamic change of clinic, a situational stress and already mentioned deficiencies - here that reality which the emergency doctor faces, first of all, and before all.

In the reasons of tactical miscalculations and the missed opportunities of the correct diagnostics at a pre-hospital stage ethical, deontological, legal and social and economic aspects of contact of the emergency doctor with the patient, especially in social and dangerous cases [2] can be looked through also.

The stated stabilizes a problem of adoption of medical decisions at a pre-hospital stage.

Thus, the range of options of decision-making is rather wide – from council of more skilled colleague (including in the form of consultation of the doctor of specialized crew directly at departure to the patient or according to information transferred the doctor, the paramedic on channels of telemetric communication: electrocardiography, etc.), a methodical grant or the algorithm pocket directory and before dialogue in the on-line mode with interactive computer system of information decision-making.

Two main directions of information decision-making in line with computer technologies are possible:

1) development focused on emergency pathology and well structured database or the information retrieval system executed in architecture "client server" and placed on the central substation with the corresponding terminals on other substations;

2) providing ambulance crews with modem communication and pocket personal computers or personal "laptop" computers with the compact systems of information decision-making placed on them and problem-oriented expert systems.

Condition of effective operation of system of information decision-making is efficiency of access and searches of the necessary data, meeting the requirements of real time scale, and also possibility of integration in structure of a database or the intellectual systems, realizing logic-heuristic the analysis of diagnostic information.

Also pocket personal computers and laptops have to have access to the centralized database.

Also experiments on logic-heuristic modeling of adoption of diagnostic decisions in urgent cardiology were made. Results of experiments are realized at the level of a research prototype in the form of expert consulting and diagnostic systems "Urgent Cardiology" and "Arrhythmias".

Encouraging results of trial operation (90% of the correct conclusions) allow to recommend the technology of logic-heuristic identification of emergency conditions developed by us for creation of computer systems of information decision-making at a pre-hospital stage.

It should be noted, however, that irrespective of the future prospects of process of information decision-making, computer technologies are urged not to replace decision-making by the doctor, and to help to avoid mistakes because schemes as B.E.Votchal noticed still, are necessary, "when there is no time to think or there are nothing to think" [3].

Literature.

1. Vertkin A. L. "emergency medical service" manual for doctors, paramedics of ambulance. – Moscow, 2005. – 458 pages.

2. Dubitsky A.A. Improvement of a control system of quality of rendering emergency medical service. - Messenger of MTs UDP RK. - No. 1(44). – 2012 . – Page 134-136.

3. Dubitskiy A. Use simple information technology in work of the first help. Moderni vymozenosti vedy – 2012. Materialy VIII mezinarodni vedesko-praktiska conference. 27 ledna-05 unora 2012 roku. - Dil 21. - S. 11-13 . - Praga. Chech. Resp.