How many divisible number 73. Little secrets of the "big bang theory"

In the event of an emergency, when a person urgently needs the help of a doctor, we habitually dial the well-known number 0-3 and wait for the arrival of an ambulance. We know for sure that the doctor will come and help. We can't even imagine what could be different. But, as you can imagine, this was not always the case.

This is now the ambulance service is a state institution, it is a network of branched out stations, small substations, hospitals, medical aviation, scientific institutes.

But such a familiar to everyone emergency medical care, whose history goes back to the Middle Ages, was formed over the years, until it took a modern, familiar to everyone form. Let's briefly recall the stages of the formation of such an important, necessary and most humane service.

How it all began?

The origins of this important medical service date back to the Middle Ages. More precisely, by the IV century, when the first points were created, where they provided assistance to travelers going to Jerusalem. Hospitable houses appeared along the roads, where they were provided with emergency medical care.

But the first real ambulance was created in 1881 after a fire in the Vienna theater, when a large number of people were left without the necessary medical assistance. Then, at the request of the Viennese doctor Jaroslav Mundi, a station was created, where medical volunteers were assisted. These were mainly students and doctors who worked for free on their own initiative, on a voluntary basis. This station was funded by benefactors.

Emergence of an ambulance in Russia

Back in 1826, the chief physician of Moscow prisons, F.P. Gaaz, filed a petition to organize in Moscow the post of a doctor with the authority to organize the care of patients who need urgent medical assistance. However, his request was rejected by high officials as unnecessary and useless.

Only in 1844 was the first hospital for homeless citizens opened in Moscow. She has not yet been the ambulance as we imagine it. These were the first attempts to organize doctors to help all those in need. The hospital did not have transport and did not go to the patients. There they provided assistance to those people who were brought there by relatives, passers-by or the police.

The first real ambulance stations were opened only in 1898. There were three of them, they had transport for departure (horse carriages), the necessary dressing material, simple medicines, stretchers, etc. A year later, five such stations were opened in St. Petersburg. They provided first aid and transported patients to hospital facilities.

All these stations were funded by philanthropists and the doctors in them worked on a voluntary basis. But they understood the necessity, the significance of such work. Therefore, the most advanced doctors of that time assisted the sick at the stations.

With the onset of the 20th century, similar medical institutions started operating in seven more different cities of Russia. All of them were equipped with equestrian transport and worked on a voluntary basis. The first cars appeared at stations only in the second half of the century.

After the October Revolution, the transformation and renewal of the entire healthcare system, including ambulance stations, began. As a result, a whole general developed system of emergency medical practice for all citizens of the country has emerged.

In addition, scientific institutes arose and successfully developed, leading both scientific and practical work to assist the sick. So, in 1928, the N.I. Sklifosovsky Research Institute for Emergency Medicine in 1932. These two institutions became pivotal in organizing and scientific development this important nationwide medical service.

Later, with the development of the ambulance, mobile medical teams appeared, which provided specialized care to patients. For example, teams of psychiatrists came on call. Outbound psychiatric care was organized by the very first in 1928. And only at the end of the 1950s, outbound teams of cardiologists, toxicologists, and pediatricians began to work in Moscow and Leningrad. Teams of doctors have appeared, specializing in visits to patients with severe injuries, in a state of shock.

All of them were provided by the state with modern cars and the best set of medicines, dressings, and equipment. Thanks to the good organization of their work, the ambulance, emergency medical care became as accessible as possible for each patient, which, of course, had the most positive effect on the results of subsequent treatment.

In the 70s of the last century, the entire unified ambulance service was reorganized. This improvement resulted in two parallel services. The first carried out emergency assistance to the victims in the streets, enterprises, public places. The second worked in polyclinics, and also went to the sick home.

This critical service is currently undergoing further development. Now it is a powerful service equipped with modern medical facilities (medicines, apparatus, technology). In the extensive network of the service, in the cities and towns of our country, more than 70 thousand doctors and mid-level medical workers work, who save the lives of more than 50 thousand citizens annually.

Emergency(SMP) - a type of medical care provided to citizens in case of diseases, accidents, injuries, poisoning and other conditions requiring urgent medical intervention.

History

The beginning of development, the beginnings, attempts to provide first aid belong to the era of the early Middle Ages. The most ancient institution that provided first aid can be attributed to "ksendochiy" - a shelter for travelers, the poor and the sick. Unlike the Pandoheyons and Mitats, which provided their services on a paid basis and were of an exclusively secular nature, the Xenodochies were philanthropic institutions based on the principles of Christian hospitality. Already at this stage “the patient was taken to the doctor”, and not, as later, “the doctor to the patient”. The prototype of the SMP is also seen in the activities of the hospitallers. The first equipped ambulance stations were created in 1417 in the Netherlands due to the presence of many channels and a large number drowning people. The main task of the stations was to rescue drowning people and help them. In 1769, similar stations were opened in Hamburg. Around this time, stations were established in Paris and London.

The starting point for the emergence of the ambulance as an independent institution was the fire of the Vienna Comic Opera, which happened on December 8, 1881. The massive incident, which killed 479 people, was a terrifying sight. In front of the theater, hundreds of burned people lay in the snow, many of whom received various injuries during the fall. The victims could not receive any medical assistance for more than a day, despite the fact that Vienna at that time possessed many first-class and well-equipped clinics. All this terrible picture completely shocked the professor-surgeon Jaromir Mundi, who was on the scene, who was helpless in the face of the disaster. He could not provide effective and appropriate help to people who were randomly lying in the snow. The next day, Dr. J. Mundi set about creating the Vienna Voluntary Rescue Society. Count Hans Wilczek (German. Johann Nepomuk Graf Wilczek) donated 100 thousand guilders to the newly created organization. This Society organized a fire brigade, a boat crew and an ambulance station (central and branch) to provide urgent assistance to victims of accidents. In the first year of its existence, the Vienna Ambulance Station provided assistance to 2,067 victims. The team included doctors and medical students.

Soon, like Vienna, a station in Berlin was created by Professor Friedrich Esmarch. The activities of these stations were so useful and necessary that in a short period in a number of cities European states similar stations began to appear. The Vienna station played the role of a methodological center.

The appearance of ambulances on Moscow streets can be traced back to 1898. Until that time, the victims, who were usually picked up by police officers, firefighters, and sometimes cabbies, were taken to the emergency rooms at the police houses. The medical examination required in such cases was not available at the scene of the incident. Often, severely injured people were kept in police homes for hours without proper assistance. Life itself required the creation of ambulances.

The ambulance station in Odessa, which began its work on April 29, 1903, was also created at the initiative of enthusiasts at the expense of Count M.M. Tolstoy and was distinguished by a high level of thoughtfulness in organizing assistance.

Interestingly, from the very first days of the Moscow Ambulance, a type of brigade was formed, which has survived with minor changes to the present day - a doctor, a paramedic and an orderly. Each Station had one carriage. Each carriage was equipped with a box with medicines, instruments and dressings. Only officials had the right to call an ambulance: a policeman, a janitor, a night watchman.

Since the beginning of the 20th century, the city has partially subsidized the operation of Ambulance Stations. By the middle of 1902, Moscow within the Kamer-Kollezhsky Val was served by 7 ambulances located at 7 stations - at Sushchevsky, Sretensky, Lefortovsky, Tagansky, Yakimansky and Presnensky police stations and Prechistensky fire station. The service radius was limited to the boundaries of its police unit. The first carriage for the transportation of women in labor in Moscow appeared at the maternity hospital of the Bakhrushin brothers in 1903. And nevertheless, the available forces were not enough to support the growing city.

In St. Petersburg, each of the 5 ambulance stations was equipped with two steam-powered carriages, 4 pairs of hand stretchers and everything needed to provide first aid. At each station there were 2 orderlies on duty (there were no doctors on duty), whose task was to transport the victims on the streets and squares of the city to the nearest hospital or apartment. The first head of all first aid stations and the head of the entire first aid case in St. Petersburg under the Committee of the Red Cross Society was G.I. Turner.

A year after the stations were opened (in 1900), the Central Station appeared, and in 1905 the 6th First Aid Station was opened. By 1909, the organization of first aid (ambulance) in St. Petersburg was presented in the following form: the Central station, which directed and regulated the work of all regional stations, it also accepted all calls for ambulance.

In 1912, a group of doctors of 50 people agreed to go free of charge when called by the Station to provide first aid.

Since 1908, the Ambulance Society has been established by enthusiastic volunteers with private donations. For several years, the Society unsuccessfully tried to reassign the police ambulance stations, considering their work insufficiently effective. By 1912, in Moscow, the Ambulance Society bought the first ambulance, equipped according to the project of Dr. Vladimir Petrovich Pomortsov, with collected private funds, and created the Dolgorukovskaya ambulance station.

Physicians - members of the Society and students of the medical faculty worked at the station. Help was provided in in public places and on the streets within the radius of the Zemlyanoy Val and Kudrinskaya Square. Unfortunately, the exact name of the chassis on which the car was based is unknown.

It is likely that the car on the La Buire chassis was created by P.P. Ilyin's Moscow Carriage and Automobile Factory, a company known for high-quality products, located in Karetny Ryad since 1805 (after the revolution - the Spartak plant, which subsequently assembled the first Soviet small cars NAMI -1, today - departmental garages). This company was distinguished by a high culture of production and assembled bodies of its own production on imported chassis - Berliet, La Buire and others.

In St. Petersburg in 1913, 3 ambulances from the Adler company (Adler Typ K or KL 10/25 PS) were purchased and an ambulance car station was opened at 42 Gorokhovaya.

During the year, the Station made 630 calls.

With the outbreak of the First World War, the personnel and property of the Station were transferred to the military department and functioned as part of it.

In the days of the February Revolution of 1917, an ambulance detachment was created, from which an ambulance and ambulance was again organized.

On July 18, 1919, the collegium of the medical and sanitary department of the Moscow Council of Workers' Deputies, chaired by Nikolai Aleksandrovich Semashko, considered the proposal of the former medical provincial inspector, and now the doctor of the post office, Vladimir Petrovich Pomortsov (by the way, the author of the first Russian ambulance vehicle - city ambulance model 1912) , made a decision to organize an ambulance station in Moscow. Doctor Pomortsov became the first station manager.

Three rooms were allocated for the premises for the station in the left wing of the Sheremetyevsk hospital (now).

The first departure took place on October 15, 1919. In those years, the garage was located on Miusskaya Square, and when a call came in, the car first took the doctor from Sukharevskaya Square, and then moved to the patient.

The ambulance then served only accidents in factories and plants, streets and in public places. The team was equipped with two boxes: a therapeutic one (which contained medicines) and a surgical one (a set of surgical instruments and dressings).

In 1920, V.P. Pomortsov was forced to leave his work in the ambulance due to illness. The ambulance station began to operate as a department of the hospital. But the available capacity was clearly not enough to service the city.

From January 1, 1923, the Station was headed by Alexander Sergeevich Puchkov, who had previously shown himself as an outstanding organizer in the post of head of the Gorevakopunkt (Center), which was engaged in the fight against the grandiose epidemic of typhus in Moscow. The center coordinated the deployment of the bed fund, organized the transportation of typhus patients to redesigned hospitals and barracks.

First of all, the Station was merged with the Center into the Moscow Ambulance Station. A second car was handed over from the Center.

For the expedient use of brigades and transport, the separation of truly life-threatening conditions from the flow of calls to the Station, the position of a senior doctor on duty was introduced, to which professionals who were able to quickly navigate the situation were appointed. The position has been retained to this day.

Two brigades, of course, were clearly not enough to service Moscow (in 1922, 2129 calls were served, in 1923 - 3659), but the third brigade was organized only in 1926, the fourth in 1927. In 1929, with four brigades, 14762 were served. call. The fifth brigade began to work in 1930.

As already mentioned, in the first years of its existence, an ambulance in Moscow served only accidents. The sick at home (regardless of the severity) were not served. An emergency room for suddenly ill at home was organized at the Moscow ambulance in 1926. Doctors went to the patients on motorcycles with sidecars, then on cars. Subsequently, emergency care was separated into a separate service and transferred under the authority of district health departments.

Since 1927, the first specialized team - a psychiatric team - has been working at the Moscow ambulance to visit "violent" patients. In 1936, this service was transferred to a specialized psychiatric ward under the supervision of a city psychiatrist.

By 1941, the Leningrad ambulance station consisted of 9 substations in various districts and had a fleet of 200 vehicles. The service area of ​​each substation averaged 3.3 km. Operational management was carried out by the personnel of the central city station.

In some cities, in the early 1980s, algorithms for the actions of the ambulance personnel were used.

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Ambulance service in Russia

Operations department

The largest and most important of all the divisions of large ambulance stations is operations department... All the operational work of the station depends on his organization and efficiency. The department is negotiating with those calling ambulance, accepts a call or refuses it, transfers orders for execution to mobile teams, monitors the location of teams and ambulances. The division includes:

• Senior Doctor on Duty or senior shift doctor supervises the duty personnel of the operational department and the station, that is, all the operational activities of the station. Only a senior physician can decide to refuse a call to a particular person. It goes without saying that this refusal must be motivated and justified. The senior physician negotiates with field doctors, doctors of outpatient and inpatient medical institutions, as well as with representatives of the investigation and law enforcement agencies and emergency response services (firefighters, rescuers, etc.). All issues related to the provision of emergency medical care are decided by the senior doctor on duty.
• Senior Dispatcher supervises the work of the dispatching office, manages dispatchers by directions, selects cards, grouping them by areas of receipt and by urgency, then he hands them over to subordinate dispatchers to transfer calls to district substations, which are structural divisions of the central city ambulance station, and also monitors the location of exit brigades.
• Dispatcher by directions communicates with the duty personnel of the central station and regional and specialized substations, transfers them the addresses of calls, monitors the location of ambulance vehicles, the working hours of field personnel, keeps track of the execution of calls, making appropriate entries in the call accounting cards.
• Hospital Dispatcher distributes patients to inpatient medical institutions, keeps records of vacant places in hospitals.
• Medical tow trucks or ambulance dispatchers receive and record calls from the population, officials, law enforcement agencies, emergency services, etc., the completed call records are handed over to the senior dispatcher, in case of any doubt about a particular call, the conversation is switched to the senior shift doctor. By order of the latter, one or another information is reported to law enforcement agencies and / or emergency response services.

Department of hospitalization of acute and somatic patients

This structure carries out the transportation of sick and injured at the request (referral) of doctors of hospitals, clinics, trauma centers and heads of health centers, to inpatient medical institutions, carries out the distribution of patients to hospitals.
This structural unit is headed by a doctor on duty, it has a registry and a dispatch service that manages the work of paramedics who transport sick and injured people.

Department of hospitalization of women in labor and gynecological patients

This unit carries out both the organization of the provision, directly the provision of emergency medical care and hospitalization, as well as the transportation of women in labor and patients with "acute" and exacerbation of chronic "gynecology". It accepts applications both from doctors of polyclinic and inpatient medical institutions, and directly from the population, representatives of law enforcement agencies and emergency response services. Here, from the operational department, information about "emergency" women in labor flows.

The outfits are performed by obstetric (the composition includes an obstetrician-obstetrician (or, simply, an obstetrician (midwife)) and a driver) or obstetric-gynecological (the composition includes an obstetrician-gynecologist, a paramedic-obstetrician (paramedic or nurse (nurse)) and a driver) located directly at the central city station or district or specialized (obstetric and gynecological) substations.

This department is also responsible for the delivery of consultants to gynecological departments, obstetric departments and maternity hospitals for emergency surgical and resuscitation interventions.

The department is headed by a senior physician. The department also includes registrars and dispatchers.

Infectious department

This department is engaged in the provision of emergency medical care for various acute infections and the transportation of infectious patients. He is in charge of the allocation of beds in infectious diseases hospitals. Has its own transport and mobile teams.

Department of Medical Statistics

This subdivision maintains accounting and development of statistical data, analyzes the performance indicators of the central city station, as well as regional and specialized substations that are part of its structure.

Communication department

It carries out maintenance of communication consoles, telephones and radio stations of all structural divisions of the central city ambulance station.

Inquiry Office

or, otherwise, information desk, information desk intended for issuance reference information about sick and injured people who received emergency medical care and / or who were hospitalized by ambulance teams. Such certificates are issued by a special telephone hotline or during a personal visit of citizens and / or officials.

Other divisions

An integral part of both the central city ambulance station and regional and specialized substations are: economic and technical departments, accounting, personnel department and pharmacy.
Immediate emergency medical care for the sick and injured is provided by mobile teams (see below Types of teams and their purpose) both of the central city station itself and regional and specialized substations.

Ambulance substation

District (in the city) ambulance substations, as a rule, are located in a solid building. In the late 70s - early 80s of the last century, standard designs of stations and substations of emergency medical care were developed, which provide premises for doctors, nurses, drivers, pharmacies, household needs, changing rooms, showers, etc.

A densely populated part of the city is most often chosen for the placement of general-purpose regional substations. Because it is from these places that the most requests for help come. Powerful lamps are installed to illuminate driveways and garage doors at night.

The staff of large regional substations includes manager, senior shift doctors, senior paramedic, dispatcher. defect, mistress sister, nurses and field staff: doctors, paramedics, paramedics-obstetricians.

• Manager carries out general management of the substation, controls and directs the work of field personnel. They report on their activities to the chief physician of the central city station.
• Senior substation change doctor carries out operational management of the substation, replaces the head in the absence of the latter, monitors the correctness of the diagnosis, the quality and volume of emergency medical care provided, organizes and conducts scientific and practical medical and paramedic conferences, promotes the implementation of the achievements of medical science into practice.
• Senior paramedic is the manager and mentor of the substation nursing and maintenance personnel. His responsibilities include:
  • scheduling of shifts for a month;
  • daily recruiting of mobile teams;
  • maintaining strict control over the correct operation of expensive equipment;
  • ensuring the replacement of worn out equipment with new ones;
  • participation in the organization of the supply of medicines, linen, furniture;
  • organization of cleaning and sanitation of premises;
  • control of the terms of sterilization of reusable medical instruments and equipment, dressings;
  • keeping records of the working time of the substation personnel.

• Substation manager accepts calls from the operational department of the central city station, the departments of hospitalization of acute surgical, chronic patients, the department of hospitalization of women in labor and gynecological patients, etc., and then, in the order of priority, transfers the orders to the visiting teams.

• Pharmacy defect takes care of the timely supply of the field teams with medicines and instruments. Every day, before the start of the shift and after each departure of the brigade, the defector checks the contents of the packing boxes, replenishes them with missing drugs. He is also responsible for the sterilization of reusable instruments.

• Sister-hostess in charge of issuing and receiving linen for personnel and service contingent, monitors the cleanliness of instruments, supervises the work of nurses.

Smaller and smaller stations and substations have a simpler organizational structure, but perform similar functions.

Types of ambulance teams and their purpose

Ambulance teams are divided into:

1. general profile (linear),
2. resuscitation, including pediatric,
3. specialized, providing emergency medical care in a certain profile
4. urgent.

General profile (line) brigades are paramedic and medical.

They are entrusted with the function of providing emergency medical care in non-life-threatening conditions: surges in blood pressure and temperature, hypertensive and hypotonic crises, heart attacks, common injuries and burns, "acute abdomen", etc.

In addition, they provide assistance, including the transportation of victims, to specialized resuscitation ambulance teams in the event of a major fire, mass traffic accident or other man-made accident or transport disaster.

According to existing federal regulations, general paramedic mobile ambulance brigade includes either two paramedics and a paramedic driver, or a paramedic, a nurse (medical brother) and a paramedic driver. General profile medical mobile ambulance team includes either a doctor, a paramedic and a driver, or a doctor, a nurse (medical brother) and a driver, or a doctor, two paramedics or a paramedic and a nurse (a medical brother) and a medical orderly driver.

However, as practice shows, due to the chronic shortage of medical personnel in the field, the paramedic team most often consists of only one paramedic and a driver-orderly, and the doctor's team - a doctor (paramedic acting doctor), paramedic (nurse or medical brother) and driver -sanitary.

To organize the activities of the general paramedic mobile ambulance brigade, an ambulance vehicle of class "A" or "B" is used. To organize the activities of a general medical mobile ambulance team, an ambulance vehicle of class "B" is used.

Resuscitation, including pediatric, and specialized teams are only medical.

Reanimobile based on GAZ-32214 "Gazelle" (traveled across Russia until 2013, soon replaced by a new reanimobile)

Specialized teams directly at the scene and in an ambulance carry out blood transfusions, stop bleeding, tracheotomy, artificial respiration, closed heart massage, splinting and other urgent measures, as well as perform the necessary diagnostic tests (ECG recording, determination of prothrombin index, duration of bleeding, etc. etc.). The ambulance transport in accordance with the profile of the ambulance team is equipped with the necessary diagnostic, medical and resuscitation equipment and medicines. Expansion of the volume and improvement of medical care at the scene of the accident and during transportation increased the possibility of hospitalization of previously non-transportable patients, and made it possible to reduce the number of complications and deaths during the transportation of patients and injured people to hospitals.

In addition, specialized teams carry out medical and advisory functions and provide assistance to medical (paramedic) teams, as well as district doctors of district polyclinics and paramedics of factory, factory and other institutional medical posts.

Resuscitation team of emergency medical care, it is also the team of anesthesiology-resuscitation, including pediatric, includes an anesthesiologist-resuscitator or pediatrician-anesthesiologist-resuscitator and two paramedics or one paramedic and one nurse (medical brother) - nurses (medical brothers) - anesthetists and an orderly driver. To organize the activities of such ambulance teams, an ambulance class "C" with appropriate equipment is used.

Specialized psychiatric team includes a psychiatrist, a paramedic or nurse (medical brother), an orderly, and an orderly driver. To organize the activities of such a brigade, an ambulance class "B" is used.

Specialized pediatric team includes either a pediatrician, paramedic or nurse (medical brother) and a driver-nurse. To organize the activities of such a brigade, a class "B" ambulance is used.

Field Emergency Advisory Team includes a specialist doctor of the emergency advisory ambulance department of a medical organization, a paramedic or nurse (medical brother) and an orderly driver. To organize the activities of such a brigade, an ambulance class "C" is used.

Aviation medical team includes at least one ambulance doctor (or other general specialty - a general practitioner or pediatrician) or an anesthesiologist-resuscitator, a paramedic and (or) a nurse (medical brother) - an anesthetist. To ensure the provision of medical care to the patient during medical evacuation, if necessary, other specialist doctors may be included in the aviation medical team.

Emergency medical teams they are also only doctors, but they consist of only one doctor and a driver, are attached to city, district and / or other local clinics and are on their balance sheet.

In some large cities of Russia and the post-Soviet space (in particular in Moscow, Kiev, etc.), the ambulance service is also entrusted with the transportation of the remains of the dead or deceased in public places to the nearest morgue. For this purpose, at the ambulance substations, there are specialized teams (popularly referred to as "corpse vehicles" or "hearses") and specialized vehicles with refrigeration units, which include a paramedic and a driver-nurse. In smaller cities, such brigades are attached to the city morgues and are on their balance sheet.

Ambulance hospital

An ambulance hospital (BSMP) is a comprehensive medical and preventive institution designed to provide round-the-clock emergency medical care to the population in the hospital and at the prehospital stage in case of acute illnesses, injuries, accidents and poisoning. The main tasks of emergency medical care in the service area are to provide emergency medical care to patients with life-threatening conditions requiring resuscitation and intensive therapy; implementation of organizational, methodological and advisory assistance to medical institutions on the organization of emergency medical care; constant readiness to work in emergency conditions (mass inflows of victims); ensuring continuity and interconnection with all medical and prophylactic institutions of the city in the provision of emergency medical care to patients at the prehospital and hospital stages; analysis of the quality of emergency medical care and assessment of the effectiveness of the hospital and its structural units; analysis of the needs of the population for emergency medical care.

Such hospitals are organized in large cities with a population of at least 300 thousand inhabitants, their capacity is at least 500 beds. The main structural divisions of the emergency hospital are a hospital with specialized clinical and diagnostic departments and offices; ambulance station (Ambulance); organizational and methodological department with an office of medical statistics. On the basis of emergency medical care, city (regional, regional, republican) centers of emergency specialized medical care can function. With her, a consultative and diagnostic remote center for electrocardiography is organized for the timely diagnosis of acute heart diseases.

In such large cities as Moscow and St. Petersburg, the Research Institute of Emergency and Emergency Medical Aid (- in Moscow, named after I.I.Dzhanelidze - in St. Petersburg, etc.), as well as the Research Institute of Emergency Pediatric Surgery and traumatology (Moscow), which, in addition to the functions of inpatient medical institutions of the first aid, are engaged in research activities and scientific development of issues of providing emergency medical care.

Emergency department

Emergency departments are now being created in Russian hospitals modeled on American ones (in the United States they are called emergency rooms). Such branches already exist in Naberezhnye Chelny, Krasnodar, Kazan, Voronezh, Lipetsk and a number of other cities. The total cost of the project is estimated at 500 million rubles.

Rural ambulance service

In settlements with a population of up to 50 thousand people, emergency departments are organized as part of the city, central district or other hospitals. In different rural areas, the ambulance service is structured differently, depending on local conditions. For the most part, the stations operate as a department of the central district hospital. Several ambulances based on UAZ or VAZ-2131 are on duty around the clock. As a rule, mobile teams consist mainly of a paramedic and a driver.

In a number of cases, when settlements are very remote from the regional center, ambulances on duty, together with teams, can be located on the territory of local hospitals and receive orders by radio, telephone or electronic means of communication, which is not yet available everywhere. Such an organization of the mileage of cars within a radius of 40-60 km brings aid much closer to the population. If the village is small, and the regional center is far away, then, it often happens that the role of an ambulance paramedic is performed by a paramedic who is in charge of a first-aid post in a particular village.

Technical equipment of stations

Operational departments of large stations are equipped with special communication panels with access to the city automatic telephone exchange. When dialing the number "03" from a landline phone or "103" from a landline or mobile phone a lamp on the remote control lights up and a continuous beep starts to sound. These signals cause the medical evacuator to flip the toggle switch (or telephone key) corresponding to the illuminated light bulb. And at the moment when the toggle switch is switched, the remote control automatically turns on the audio track on which the entire conversation of the ambulance dispatcher with the caller is recorded.

On the consoles, there are both "passive", that is, they work only "to the entrance" (this is where all calls to the telephone number "103" go), as well as active channels that work "to the entrance and exit", as well as channels that directly connect the dispatcher with law enforcement agencies (police) and emergency response services, local health authorities, emergency and emergency medical care hospitals and other inpatient institutions of the city and / or district.

The call data is recorded on a special form and entered into the database, in which the date and time of the call are necessarily recorded. The completed form is handed over to the senior dispatcher.

In ambulance cars, ultra-short-wave radio stations are installed to communicate with the control room. Using the radio station, the dispatcher can call any ambulance and send the team to the desired address. According to it, the team contacts the dispatch office in order to determine the availability of free space in the nearest hospital for the hospitalized patient, as well as in case of any emergencies.

When leaving the garage, a paramedic or driver checks the operation of the radio stations and navigation equipment and establishes communication with the control room.

In the operational department and at substations, they will equip city street maps and a light board showing the availability of free and occupied vehicles, as well as their location.

Ambulance vehicles

Ambulance

The main difference in the equipment of the machine for assisting newborns is the presence of a special box for a newborn patient - an incubator (incubator). This is a complex device, similar to a box with transparent plastic opening walls, which maintains a predetermined temperature and humidity, and with which the doctor can observe the vital functions of the child (that is, monitor), as well as, if necessary, connect a ventilator, oxygen and other devices that ensure the survival of a newborn or premature baby.

Usually, neonatology machines are "tied" to specialized nursing centers. In Moscow there are such machines at GKB No. 7, GKB No. 8 and GKB No. 13, in St. Petersburg - at a specialized consulting center.

Obstetric and gynecological

Not so long ago [ when?] still used conventional linear machines. V last years [when?] on the equipment of such teams appeared cars equipped with a stretcher (for the mother) and a special incubator / incubator (for a newborn).

Shipping

For transporting a patient from hospital to hospital (for example, for carrying out any special examination), the so-called. "Transportation". As a rule, these are the most worn out and oldest linear machines. Sometimes Volgas are used for this purpose. Higher quality vehicles can be used by private organizations providing emergency medical care.

Hearse

A specialized van designed to transport corpses to morgues. Designed to carry 4 corpses on a special stretcher. Externally, the car can be distinguished by the absence of windows on the body. There are also cars with a van located separately from the body.

In smaller cities, such brigades are assigned to the city morgues and are on their balance sheet.

Air transport

Also, as Vehicle ambulances use helicopters and airplanes, especially in areas with a low population density (for example, in the west of Scotland there is an Emergency Medical Retrieval Service), or, on the contrary, in cities to avoid traffic jams.

However, in Russia, practically, with rare exceptions, all air ambulances are concentrated in the Disaster Medicine Service.

Other modes of transport

Historically and in modern world there are known cases of using other types of transport in the ambulance service, sometimes even the most unexpected ones.

So, for example, in large cities during the Great Patriotic War, when most of road transport, including city trucks and buses, was mobilized to the front, and the main transport, both passenger and freight, became

It consists of ten times seven and three. Each of the numbers has its own impact on the life and character of a person. Ten is responsible for leadership qualities, an optimistic attitude and a confident look into the future.

She is a symbol of independence, original solutions and individual approach. The three is a symbol of joy, creative thinking and active communication. Its speakers are distinguished by excellent taste, well-developed intellect and human kindness.

The seven symbolizes all the experience accumulated by humanity over the years of its existence. This is a sign of faith, developed spirituality and enlightenment. Thanks to her influence, a person acquires mystical qualities and inner wisdom. The carrier of the seven is endowed with luck and disposition higher powers... He is often interested in religion, studying his inner world for years.

The mystical meaning of the figure

Seventy-three can be thought of as ten times seven. The number 10 is easily reduced to one, which contains the energy of material harmony and creation. In addition, there is a contradiction within it, located on both sides of the river of life. The famous mathematician Pythagoras was sure that this number included the energy of the Universe itself.

Present at 73, the seven endows its carrier with sincere concern for people. They are talented psychologists who can help solve most of life's problems. Frequent meeting with this number speaks of imminent positive changes and the beginning of a new life stage. It can also be viewed as a symbol. endless life and reincarnation of the soul into several entities. The number seven is a sign of good luck, and its carriers are under the supervision of higher powers.

Positive impact on the life path

Native 73 people value their freedom more than anything else. They try to live so as not to disturb others. They do not tend to impose their own opinions. They are loyal friends and reliable business partners, endowed with an excellent memory and well-developed intellect. They are recognized leaders who can lead a mass of people. They always achieve their goals, and skillfully cope with all the obstacles that arise.

Disadvantages caused by the influence of the number

Usually, Negative influence seventy-three manifests itself in people with low level intelligence and spiritual development... Leadership turns into common slickness and idle talk, and unrelenting energy is reduced to banal irascibility. The accumulated life experience becomes the reason for the reproaches of younger employees. Another significant drawback of the number is the goals set, disproportionate to the real capabilities of its bearer.

», As in any series made with a soul, there are many surprises hidden by the creators - gifts for the attentive viewer. We will tell you about seven of these "Easter eggs".

The magic of numbers

73 – Favorite number Sheldon, in addition, actor Jim Parsons was born in 1973. It is in the 73rd episode of the series that Sheldon shares his thoughts on which number he considers the best: “73 is the 21st prime number. Its mirror image 37 is the 12th, whose reflection 21 is the result of multiplication, don't fall, 7 and 3 ... In binary, 73 is also 1001001, which reads from right to left as 1001001. "

Sheldon and "OB1"

In Episode 18 of Season 3, waking up in the morning after a fun night out, Sheldon goes to Youtube to watch videos of her drunken antics yesterday. You hardly noticed that Sheldon's nickname - "ob1" is the encrypted "Obi-Wan Kenobi" character name Star Wars Obi-Wan Kenobi.

Photo on the fridge in Penny's apartment

If you look closely, you can see that there are photographs hanging on Penny's fridge, in which she happily squeezes some unknown people. This is not just a props - the members of the film crew of “Theory big bang».

And again about numbers

Actor Wil Wheaton has starred in many episodes of "". In one of the frames with his participation, you can see the number of the house in which he lives. 1701 is nothing more than a reference to his role in Star Trek. The Next Generation, which featured the USS Enterprise numbered NCC-1701-D.

Pi or not Pi? That is the question

Meanwhile, the number of Amy's apartment is 314. If you haven't forgotten everything from the school math curriculum, you probably know that 3.14 is Pi.

Scientific inaccuracies

If you've followed Season 4 closely, you may well have noticed the equation written on the board in the Minimize Raiders series. It is no longer news to fans of The Big Bang Theory that all the mathematical equations that appear in the series are authenticated by scientific consultant David Salzberg. The physicist was especially concerned about the inaccuracy of this record. Later it turned out that the equation written on the blackboard was stolen ...

Equation from Indiana Jones

If you compare these two equations, you will notice that they are absolutely identical. The only difference is that Indiana Jones, unlike The Big Bang Theory, did not have a dedicated consultant. That is why the equation does not make any sense mathematically.

Pss, guy! Would you like some secrets from How I Met Your Mother? Then you.

We reveal the little secrets of the series "The Big Bang Theory"! What do the numbers on the doors say, who is shown in the photo on Penny's refrigerator, what is Sheldon's nickname on the network, and much more.

1. Digital magic

Those who have watched the series carefully already know well why this number has a “separate place”. In Episode 73 of TBV, Sheldon Cooper reveals that this number is his favorite. And he gives this fact a completely logical explanation in the spirit of Sheldon Cooper: 73 is the twenty-first prime number on the account. The number 37 is a mirror image 73 is the 12th prime number whose mirror image 21 can be obtained by multiplying the digits "don't fall!" 7 and 3! If we translate the number 73 into a binary number system, we get 1001001, which reads the same from left to right and in the opposite direction. Among other things, the year of birth of actor Jim Parsons is 1973.

2. OB1 - Sheldon Cooper


The eighteenth episode of the third season shows us a disheveled Shadledon, who got drunk well the day before, and is now trying to find videos of his antics on Youtube. Sheldon's online nickname is ob1, which is the abbreviated name of Obi-Wan Kenobi, a Star Wars hero.

3. Photos from Penny


A large number of photographs are clearly visible on Penny's refrigerator. They depict Kaley Cuoco and other members of the cast of the series.

4. More about numbers ...


Wil Wheaton has become a fairly well-recognized character in The Big Bang Theory. In the series, Will lives in 1701, which is nothing more than a reference to the movie Star Trek. The Next Generation ”and his participation in it. Starship Enterprise is numbered NCC-1701-D.

5. Magic number Pi ...


Amy lives in apartment 314, and the number Pi, beloved by many scientists, as you remember, begins with these numbers (3.141592 ...).

6. Small inaccuracies in the equations


All formulas or equations, or other scientific objects are tested by the series consultant David Salzberg. In the fourth season, the episode "The Minimization Raiders" features an equation written on the scientist's board that puzzled David with its inaccuracy. It was later revealed that this equation was stolen from ...

7. Indiana Jones and the ill-fated equation


The two equations are exactly the same when you look closely. But at the time of filming "Indiana Jones" there was no practice of attracting mathematical consultants, which is why from the point of view of mathematics this equation is an absolute nonsense.