Lushkina I.P.

Republican scientific center of emergency medical service

IMPROVEMENT OF SPECIALIZED SERVICE OF AMBULANCE AND EMERGENCY MEDICAL SERVICE

AT THE PRE-HOSPITAL STAGE

Important stage of improvement of service of an emergency medical service of the capital of Kazakhstan of Astana was its specialization which was carried out for the first time in July, 1972 when the specialized crew for assistance to patients with a sharp coronary syndrome was organized.

Over time their number grew, and the profilnost was narrowed [1].

At the moment the station of ambulance and emergency medical service has 5 substations and has 65 mobile teams from which 20 - specialized crews (8 – cardiological crews, 4 – resuscitation crews, 2 – children's resuscitation crews, 1 – toksiko-neurologic crew and 1 – gynecologic), i.e. almost every fifth crew is specialized.

In improvement of specialized ambulance and emergency medical service at a pre-hospital stage creation of crews of the intensive therapy intended for rendering the highly skilled emergency help to seriously ill patients and victims was new. Creation of such crews was dictated by that narrow specialization of crews not completely satisfies to requirements of health care of the city. Besides, specialized crews of an emergency medical service aren't always used directly, carrying out and so-called "non-core" calls at the level of linear crews [2, 3].

Practice showed that the tendency of reduction of "non-core" calls and aspiration to use specialized crews directly in compliance with narrow specialization leads to considerable decrease in their average daily loading. For 2008 all specialized crews executed 29,8% from total number of departures of an emergency medical service. Average daily loading of specialized crews was 1,4 times lower, than at linear (14,7 and 21,5 respectively) [4].

It should be noted that creation of specialized service of a pre-hospital stage didn't help to solve completely a problem of assistance needing it. Forces of resuscitation crews served only 38,6% of victims with road transport traumas, 61,4% received the help from other specialized crews at which level of diagnostic mistakes made 4,45±1,1% and was 2,2% higher, than at resuscitation crews. The quantity of "non-core" calls in the last two years made on toksiko-neurologic crew – 62,1%, on obstetric and gynecologic – 65,8% and only on cardioresuscitation crew of-31,7% (because of considerable prevalence among the reasons of calls of diseases of heart and vessels). In too time the profilnost of work of four crews of intensive therapy made more than 69,9%. That from a terminal condition, traumatic and cardiogenic shock more than 18,8% of patients and victims were removed testifies to efficiency of their work.

In our opinion, narrow specialization of crews of an emergency medical service isn't always justified.

First, it is acceptable only in the large cities with the population more than 700-750 thousand people, and secondly as long-term practice of work of specialized crews showed, their use for rendering the emergency help to patients with serious warmly vascular illness and neurologic frustration is most expedient.

All other types of emergency medical care to adult population can and have to appear crews of intensive therapy. Expansion of their network at the expense of systematic and systematic preparation of doctors of linear crews and replacement of part of crews of specialized medical care by crews of intensive therapy will allow, except improvement of rendering ambulance to the population at a pre-hospital stage, to receive essential economy of material resources of ambulance.

The economy will develop at the expense of smaller (almost for 25%) costs of 1 call of crews of intensive therapy in comparison with the cost of a call of specialized crew and more their intensive use. The additional economy will be reached also at the expense of more rational use of specialized motor transport.

Calculation of annual economic effect of replacement of a number of specialized crews by crews of intensive therapy can be carried out on a formula:

N = (В: C) · P · TO + (SB: L) · N + Ed;

where: N – annual economy (one thousand tenges), В – quantity of the calls which are carried out by crews of intensive therapy, С – specialized crew, P – a difference in the cost of one call of specialized crew and crew of intensive therapy (one thousand tenges), TО – quantity of the calls which are carried out by reorganized specialized crews in a year, SB – number of the round-the-clock specialized crews subject to replacement by crews of intensive therapy, L – total of motor transport serving station of an emergency medical service, N – the settlement size of annual economy from rational (on areas) uses of specialized motor transport (one thousand tenges), Ed – additional unaccounted types of economy (one thousand tenges).

Practice of rendering emergency specialized medical care showed to the population of Astana that by expansion of a network of crews of intensive therapy it is possible to reduce existing specialized crews, having left on one nursery and the adult resuscitation crew, two cardiological crews and one toksiko-neurologic crew (only 5-6 specialized crews).

The call of specialized crews has to be carried out not by 103 phone, and the dispatcher of an operations section at the request of the doctor of linear crew or crew of intensive therapy, excepting cases of emergency situations.

Expansion of a network of crews of intensive therapy is possible only by continuous and systematic preparation and improvement of doctors of linear crews and crews of intensive therapy. Training of specialists has to be under construction as follows.

After the termination of medical institute the doctor passes internship on ambulance and becomes the doctor of linear crew. Then it consistently studies specialization on local clinical bases on preparation of doctors of crews of intensive therapy and a cycle in urgent cardiology. Further specialization takes place in institute of improvement of doctors on cycles on rendering the emergency help at a pre-hospital stage (1-2 months) and on anesthesiology and reanimation (1-2 months). Only after a successful conclusion of these types of preparation the doctor can head crew of intensive therapy.

In summary it should be noted that replacement of part of specialized crews by crews of intensive therapy not only will increase quality of rendering the emergency help to the population of Astana, but also will promote more rational use of material and personnel resources.

LITERATURE:

1 . Suleymenova B. A. Dubitsky A.A. To "Service of an emergency medical service of the city of Astana of 70 years". – Astana, 2002. – 86 pages.

2 . Suleymenova B. A. Dubitsky A.A. "The principles of the organization of ambulance and emergency medical service in the Republic of Kazakhstan at a pre-hospital stage". - Astana, 2001. – 160 pages.

3 . "The management for emergency doctors" (under the editorship of Mikhaylovich V.A. ) . – L. 2005 . – 496 pages.

4 . The statistical analysis of SMP station of the city of Astana for 2010-2012.