The color photographic scheme of ambulance cars - white with red - was first fixed by Goste USSR in 1962.

Since 1968, according to Guest, an orange flashing lighthouse was installed on ambulance cars. Unlike a blue lighthouse (modern "flasher"), he did not give advantages over other participants in the movement.

The fastest ambulance in soviet history and among serial cars was "Volga" gas 24-03, maximum speed which was 142 km / h, which is 2 km / h more than in Spevtobus ZIL-118M "Youth" with the V8 motor.

In the 1970s, minibuses RAF-22031 were the first to get a blue glimpical lighthouse on the roof. Similar UAZ ("Tablets") due to confusion with GOSTs for many more years were produced with an orange lighthouse.

Fashion apply inscriptions on the front of emergency services in mirror mapping came from the West. The driver of a car who goes ahead could read the inscription in the mirrors in normal form and give way to the road.

According to the reviews of drivers - veterans ambulance the most reliable medical cars There were modifications of "Volga" GAZ-22. Mileage in a million kilometers for 8-10 years was ordinary for them.

Emergency siren differs in a tonality of both police and fire. Machines such as winters, "victory" and "Volga" GAZ-22 have not been equipped with sirens.

The single telephone number of emergency emergency call "03" was introduced throughout the USSR in 1965 at the same time as emergency rooms of militia and fire protection.

Do you know what happens when you dial "03" on the phone? Your call automatically falls into the central dispatching point of the republic. The tube removes the reception and calling specialist ...

1. Almost all outgoing calls to the numbers "03", "103" come to a single dispatch service of the Republican ambulance station. The station serves more than 75 percent of the republics of the Republic: about a hundred service brigades per day go to challenges over a thousand times. Work here around the clock.

2. When on the phone you ask for help, then the first to hear, there will be a dispatcher voice. The duty officer will start asking you special questions. Unfortunately, false calls happen quite often.

3. It may seem that it shows indifference, but with the help of clarifying issues determines the state of the patient and which brigade to send to the aid (challenges of citizens are divided into ambulance and emergency).

4. Coordinates the work of the sign of the Senior doctor. Meet Irina Serov, senior doctor of emergency medical care.

5. Before her eyes are two monitors on which incoming calls are displayed in priority. In practice, experienced patients already know that it is necessary to say that it is the ambulance: "make a mistake" at the age of decreasing, hide the chronic nature of the disease, aggravate the symptoms. The word "dying" works best.

6. All you say is clogged into a computer, all calls are recorded. Technical innovations have reduced to a minimum number of missed and non-losing calls, optimally distribute resources to maintain calls.

7. The whole process takes about two or three minutes. The data is processed, and, depending on your location, the call enters the ambulance substation, as a rule, to the one that is closer to the victim.

8. With the help of the GLONASS system in real time, the movement of ambulance crews is monitored: location, time staying at the address and even speed in the process of movement.

9. Each parameter is recorded, analyzed, which helps in further work, for example, in controversial situations, if any.

10. From the moment of calling to arrival, there should be about twenty minutes. With the help of dispatching services, the ambulances are brought by a sharp patient in that clinic, where he can quickly assist.

11. The building of the republican ambulance station has its own ambulance substation, which mainly serves urban challenges. For physicians working on emergency calls, there are no holidays or weekends.

12. At the substation all conditions have been created. Work schedule - day after three. There is a rest room here, where in free from calls time, you can relax a bit.

13. Dining room. Here you can warm up the food and eat in the break from the departure.

14. Medicinal preparations in sufficient quantities are stored in special lockers at a certain temperature.

16. In addition to the analgin, Nitroglycin and Validol, the ambulance brigades have the most modern drugs that are able to help in a matter of minutes in heart attacks and strokes.

17. So looks like an outbound medical bag of ambulance brigades. It weighs about 5 kilograms and there are not only a sufficient number of painkillers, but also narcotic ones.

18. The most peak of calls by numbers "103" or "03" occurs in 10-11 in the morning and from 17 pm to 23 hours. Calls are provided by "ambulance" carriages, equipped with everything necessary.

19. And there is also a simulation center equipped with special mannequins, as much as possible imitating vital functions of the human body. Thanks to the conditions created, the future doctors and ambulance headsers are honored their first aid skills.

The work of the doctors is not the easiest, try to help emergency staff as your strength: do not terrorize false and trifle calls, to give way to the road on the track, behave adequately upon the arrival of the "Emerior" team.

The ambulance is a great school, which is advisable to go through any future doctor. She teaches to make decisions quickly, fight for squeezing, gives invaluable behavior experience in non-standard situations.

What happens when you dial on the phone "03"? Your call automatically enters the central dispatching point of the city or district center. The handset removes the params of receiving and transmitting calls. Before him, the monitor, where the algorithm is highlighted, on which he asks questions. All you say Feldsher scores into a computer. The data is processed, and, depending on your location, the challenge goes to the regional paramedic. There are several substations at the disposal of the region - the call falls towards the one that is closer to the victim. The whole process takes about three minutes.

Not so long ago ambulance I left for all calls without exception.

If a person scored "03", it means that he already got sick, "says Irina, the Feldsher of Moscow ambulance with thirty-year-old experience. - just because no one will call, right? Previously, doctors came to us from around the world to see how our system works. Our system - she was like an exhibition of achievements of the national economy.

From January 2013, a root reconstruction began at the "exhibition of achievements".

Technical re-equipment: Two sticks, and between them the tarpaulin is stretched

But you need to start a step earlier. At the beginning of 2013, the Vice-Mayor of Moscow Leonid Protnikov said that in two years, mortality in Moscow decreased by almost 18%. This is practically a miracle. High mortality - pain and shame of our country. It seemed that such things change slowly along with the common social and economic situation - and then a grand decline in a short time. Now in this indicator the capital at the level of many European countries and 36% better than the rest of Russia.

This achievement was discussed at many seminars - including we tried to understand how it is possible. It turned out that, most likely, the reason not only in improving the overall level of health, but also in very concrete and, it would seem simple things: emergency equipment and medicines, allowing you to quickly start therapy - primarily the cardiovascular diseases that contribute the greatest Contribution to mortality. The second simple thing: Sourids should bring a sharp patient in that clinic, where he can quickly assist - and here is important to the reasonable management of the clinics system (hence the idea of \u200b\u200btheir consolidation and staff level and equipment). That is, the situation with mortality affects the re-equipment and a change in the organization of the receptions of hospitals.

It is still called the reception entrance, "says Alexander in Chelyabinsk. - Have you seen at least in the TV shows, how do American clinics work? There is no peace, everyone runs! Some specialists are starting to work with patients, time from the bridge before the start of therapy is minimal.

With this, put, not all well and in the capital. There are cases when a person, for example, after a stroke, the ambulance quickly pleases to the hospital, but this is Saturday, and the doctor does not turn out to be a doctor who could take the right decision within three hours when effective therapy is still possible. Nevertheless, fast in Moscow are well equipped, and this probably proves that it is possible to sharply reduce mortality in the country. If in Moscow it turned out, why can not be everywhere?

In Karet, we have everything, "says Irina from Moscow ambulance. - They are equipped with full. Breathing apparatus - two. Drugs are quite enough. If a qualified health worker arrives, then he has everything to assist in the desired volume. But in the regions the situation is not so pleasant.

About sixty cars with one hundred percent wear, - Tamara complains, the doctor is ambulance from Ufa, - forty cars are more or less normal. Well, God with him. Wheels are spinning - people go. However, the Chamber of Completion has established that we have morally outdated equipment. Cardiology and resuscitation are well equipped, and in conventional machines, the equipment is old - you have to work with rare machines for pulmonary ventilation.

To some regions, apparently, the modernization of medicine did not get.

I do not know what your reform is there, but even our stretcher is ashamed to pull out. Two sticks, and between them the tarpaulin is stretched, "says Feldsher district ambulance from the Vladimir region Dmitry. - Machine Gazelle We still have nothing, I myself replete it more or less anything, and somehow I planted me in someone else's shift on Uzik, so it was scary. While "swinging" the patient, went out the light, the battery rank - you need to carry a person to the hospital, and the car does not start. We with the driver with a car with a pusher, and the patient dies. Machines for heavy patients are not equipped at all. We put diagnoses on the cardiogram, but it is so difficult to see the microinfarct. To diagnose a microfarct, for example, there is a test for troponin, which in twenty minutes shows the exact result, but we do not have it. There are no defibrillators, there is even a bag of "AMBU" for artificial ventilation of the lungs.

In such a situation, it is not necessary to be the Nobel laureate in economics and an outstanding managers in order to significantly reduce mortality. Increasing financing for re-equipment and re-equipment would give an effect in any case - how, apparently, has given effect in Moscow. Of course, it would be nice to have ways to properly manage finance, the official is not always able and motivated to distribute money wisely. But medicine costs accurately reduce mortality. The problem is that the reform passes against the background of the overall reduction of allocations for medicine, by 2015 they will be reduced by 17.8%, so reformers hope to "increase efficiency", and not for additional funding.

Three Magic letters OMS: all reduced

The reform revolution consists primarily that the state has stopped direct financing of the ambulance service from the budget. Imply included in the basic compulsory medical insurance program.

What changed for doctors and patients? Today in Russia there is one-channel financing of medicine - all the money that is allocated by the state for these purposes come to the OMS Foundation. This fund acts as a buyer of that medical care, which is provided to citizens for free.

The OMS is a huge organization, but it is unlikely to help her full-fledged service of such a structure, as ambulance, "said Irina from the Moscow ambulance. - She was very expensive by the state, but we had a lot of specialized brigades - cardiologists, toxicologists, traumatologists. This system was created for years. Now they have been reduced everyone.

After inclusion in the OMS system, the payment of the work of employees came to be made on the basis of accounts charged to the insurance company. The unit of measurement was the challenge of a citizen of the ambulance brigade, for which there is a fixed value. The challenge is paid from the funds of the OMS Foundation. Accounts are inspected for compliance with the volume, quality and cost of assistance rendered. According to the results of the check, the money is transferred to doctors. In patients, new financing rules have not been reflected. Even if a person who caused an ambulance, for some reason, cannot present a policy of the OMS, to refuse him to help the physician not entitled.

It was assumed that the quality of the provision of services would even rise, because the assessment of the work of the physicians from now on to themselves insurance companieswhich theoretically may refuse to pay the challenge if the patient appealed to them with a complaint. But in fact, additional money - with an OMC system or without it - to take it now, but the doctors hit the complex monetary motivation system. Moreover, these motivations require new formalities, and not to improve work.

Paper Tools: Error in the figure - and the call will not pay

When the ambulance was included in the OMS system, it was assumed that the costs of medical care of patients not included in this system will take on regions. But regional budgets, as you know, are not rubber. Therefore, this norm in most cases does not work.

If the patient did not find the patient when calling the policy, it means that the challenge will not pay, "says the doctor of Tula ambulance Julia. - Our salary depends on the number of calls. No polis - no call.

Returning to the database, doctors fill patient maps - it is now fundamentally important for their salary. Error in the letter of the last name or in the figure of the CHA policy - and the challenge will not be paid either. The usual picture - near the Cabinet of the Senior Doctor always someone enters the number and name of the drugs, there is not enough time at the site.

We have a lot of medical records, "says a renexcatalog of the Tula ambulance substation, - and it takes a gigantic amount of time. The deliberation of situations is that we can bring an agonizing patient - and we are told: "And where are the accompanying documents? And how did you carry it without documents? " And we are all the way - one shook, the other breathing!

The fact that doctors regularly underpaid due to errors in document flow, in the order of things. The bosses explain it with negligence in filling the cards - they say, the doctors will not get used to the scrupulousness of the insurance system, and the insurance company quit for each little thing in order not to pay.

Increased load: without compatibility Do not survive

The ideologists of reforms were promised three years ago that the salaries of doctors will increase by 60-70% of interest and they will not have to be engaged in part-time, which does not affect the quality of medical services. In fact, the basic salary of doctors and paramedics ambulance in the regions are still humiliatingly small, and without part-time, they still do not survive.

Regulatory - a day after three, "says the doctor of the Tula East Julia," but many people come out in a day, and even for two days in a row.

All now combine: at the ambulance and in the dispatch, at the state ambulance and in private, in the ambulance and in hospitals. For example, a surgeon for five days a week operates in the hospital, two or three nights it works among the week at ambulance and takes another day on the weekend. Someone choose patients here for private practice.

And young doctors do not go out at all, - she continues, - to earn. Get experience and leaving to Moscow. There at ambulance three times more salary, and the work is the same. It's hard, of course, ride there: three hours on the road, a day at the ambulance and three more hours. Doctors there not only from Tula - from Ryazan, Kaluga, Vladimir, Tver.

Mikhail is just from those young doctors who leave to work in Moscow. Only he was already driving. I got up at five, I sat down behind the wheel, nine was at work. And so four years. Tired.

I am the wrong doctor, "he says. - I am a psychiatrist narcologist, retrained in a resuscitator. I have a doctor doctor, she discouraged me, but I still went.

Well, why?

Vocation.

Feldscher Lena from Tula says that today went to work for two days, and the next shift will work in a paid ambulance.

It used to worked in the hospital, it is even harder. Here you can even lie down and eat, and there is the whole shift in the post, and I have 23 children - everyone needs a tablet to give at the right time, check that everyone can get. At a paid ambulance I accept calls, there I can call at least to answer. I also combine with the function of the deputy director and when you need - I leave for calls.

And how long have you been working in this mode?

Since 2005.

And if you leave only one job?

I herself can be a daughter, still helping parents. If I left only one job - it is 15 thousand. 15 thousand can hardly live. And so I will work until my daughter finished the institute. So far enough enough.

Separation of ambulance and emergency assistance: double work

As a result of the reform, the challenges of citizens of "03" are divided into ambulance and emergency. The ambulance goes to acute states when the patient needs urgent hospitalization and the bill goes for a minute - this is including sharp abdominal pain, heart attack, injury, accidents. From the moment of calling to arrival, there should be about twenty minutes. Emergency care is characterized by the fact that there is one doctor here and it mainly leaves for so-called home calls - this is, for example, hypertensive disease, chronic diseases. Emergency departure time to the patient - on average two hours.

What are minuses? If the patient's condition is harder than expected, it is necessary to repeat the ambulance and wait again, because the emergency has no right to hospitalize. In addition, for physicians is a double job.

Now the system is arranged so that the urgent ceases its work at 20.00, "says the Nurse of the Cardiology Brigade of the Ambulance of the city of Ufa Svetlana, - and all the load falls on the ambulance. There are patients who, in principle, should be evaluated, but they are specially waiting until the evening so that the challenge automatically fell to us - because we have more qualified doctors.

The system of separation in theory is needed in order to remove unnecessary load, social challenges, calls without risk for life. It is reasonable. But in practice, experienced patients already know what you need to say, to come exactly the ambulance: "mistaken" at the age of decreasing, hide the chronic nature of the disease, aggravate the symptoms. The word "dying" works best.

Reducing specialized brigades: no challenge time

Before the reform in the ambulance system existed cardiological, toxicological, traumatological and neurological brigades. For example, in Moscow there were five specialized toxicological brigades on special machinesequipped with a chemical laboratory. Now such a brigade is one, and it was converted to a common profile brigade, which is obliged to travel to all challenges. Here, everything seems to be resting into the system of the OMS, because the savings for the state is obvious. The cost of calling a specialized toxicological brigade on the tariff agreement between doctors and insurers - 8 thousand rubles, and the challenge of the usual brigade is only 3 thousand.

But how does such savings affect patients in critical condition?

If earlier, let's say, a challenge with an acute violation of cerebral circulation was received, the neurological brigade had an additional charge, and a neurologist could immediately determine the hemorrhage center, "explains Moscow Feldsher Irina. - Now the equipment remains, but specialists who used to work in these brigades became simple linear doctors.

Most of all is alarming the tendency to reduce cardiology brigades.

We have six large substations in Ufa and two small, "says Tamara's doctor," and if earlier there were two cardajd orders on each substation, now for one car on four substations. In order to increase the efficiency of specialized brigades, you have to go to the challenges of other substations - on average it is three challenges per night. If we went out only in our profile challenges, we would think I managed. But here, for example, we recently went to a challenge to a child who swallowed silicone balls, and only because there were no other machines. In the nearest children's hospital there was no doctor who makes fibrogastroscopy, and we had to take a child to another hospital. As cardiologists, we fell out of the process for an hour and a half. Moreover: In the future, cardiology brigades are going to cut down in general, while coronary disease around the world is recognized as a disease that is in the first place of mortality.

In Tula, ambulance subjugated to the urban hospital. Here, too, from cardiological and resuscitation brigades made universal, cardioreanimatives.

And what is so better?

Yeah, - the Feldsher Alexei covers his mouth with his hand, so as not to say superfluous.

Optimization?

Has long been.

As a result of optimization on the entire substation, one children's team remained in Tula. Now she is sent only to the smallest, up to the year. And at the same time, now a children's team, which is headed by an elderly experienced doctor, on challenges for six hours in a row.

Over the past six months, two brigades have been reduced from four, "says Feldsher district ambulance from the Vladimir region Dmitry. - We serve our settlement and 88 villages. When I carry a patient to Vladimir, it is 70 kilometers there and back, I do not have two hours. And if the second brigade leaves, the challenge enters the substation in Petushki - if there is a free car, go from there. On average, it is thirty-forty minutes, and there are such states when the bill goes for seconds. If we were returned to four cars and equipped more or less decently, I think we would cope. And so, most likely, we will simply be closed soon and passed to the substation of the cocks. Driving from there and time for challenges when the road takes forty minutes, it will be unrealistic.

Reduction of the composition of the Brigad: the place of doctors will occupy paramedic

A couple of years ago, a doctor has always arrived at the ambulance team and a qualified medical assistance was provided at the pre-hospital stage.

Now, due to low salaries and high load, doctors do not carefully go on this job.

Medical brigades left units, we are mostly paramedic, "says the doctor of Tamara from Ufa. - With our salary, doctors do not go to us. If the doctor works at the rate and sits in a clinic, he does not run on the floors and does not listen to rudeness, and we have every fifth patient considers it my duty to specify which we are bad.

The reality is that the replacement of doctors on the paramedics occurs in all regions, and, according to doctors, everything goes to the fact that doctors will generally exclude from this link.

How can this affect patients?

Now, in almost all major cities of Russia, there are well-equipped cardiological and neurosurgical centers, where the patient may be saved from the infarction, stroke or the effects of injury, if the staff will rate the correct diagnosis and take the patient on time. Including the timely delivery of patients in such specialized centers managed to reduce mortality from infarction and strokes in Moscow to the level of Eastern Europe. But this is in the capital, where the salaries of physicians are sometimes three times higher than the wages of their colleagues in the regions and the staffing of the doctors above, including due to the inflow of personnel from the regions.

Will it be possible to achieve a decrease in mortality from heart attacks and strokes in Russia as a whole, when in the submission to the reduction of specialized brigades, the place of doctors will take paradise? After all, the Feldscher is still not a doctor, he may incorrectly assess the situation and instead of a specialized center to take the patient to a regular hospital - and then the outcome will be completely different. Especially since the system is arranged in such a way that when Feldsher stands up for work, he is obliged to go to the challenge of any complexity, regardless of experience and experience. At the same time there are manipulations that have the right to spend only the doctor. For example, when the patient has no peripheral vessels and you need to introduce the drug under the worship.

According to the surveyed "PR" of doctors, the problem would not be so acute if the training system was debugged and improving the qualifications of medical personnel.

I believe that a good doctor and a good paramedic is equal, "says Irina from Moscow ambulance. - Other Feldsher knows more physician and better makes a diagnosis. It all depends on a person - if he wants, he will ask, be interested in and will learn to quickly. Alas, for the most part, people who are not interested in professional development come. For example, a challenge: a patient in abdominal pain, and this is an abdominal form of infarction. If a paramedic arrives at such a challenge, to which everything to the light bulb, he may simply not figure out or collect the wrong history. Naturally, they call, consult, but one thing - when a patient specialist sees, and another - when consultation is correspondence. Previously, we had a school of young professionals, now she is also there, but there is no time to do this. When I was a senior paramedic, we collected the young people, told about the ambulance structure, checked how they write down recipes, checked the knowledge of the equipment - these were peculiar mini-exams. Now no one does anything. I judge in my substation. Yes, and a special desire to learn from young, I must say no. You can plant a young paramedic with adults and teach, but do not pay extra and few people are ready for it.

The tendency to reduce the numerical composition of the brigade to one (!) Medica also looks quite alarming.

The brigade consists of a driver and paramedic, "says Feldsher Dmitry. - We have no choice, the Feldsher is responsible for everything here. I am 21 years old, my shiftier - 24.

Today, one Medic travels in the composition of the ambulance brigade. But if the situation occurs when the patient needs intensive care, for the necessary actions of two hands is missing.

Recently, Muscovite rode a quad bike and crashed into a tractor, "Dmitry continues. - brain injury, traumatic coma. I put on the stretcher - gives a stop of the heart. At this moment you need two doctors. One begins the heart massage, the second is artificial ventilation of the lungs. If I had even a bag of "Ambo" for artificial ventilation, it is physically impossible to carry out a full resuscitation alone. That patient eventually died.

Consequences of hospital enlargement: the ambulance plugs all the holes

The overall reduction of hospitals, which has been occurring in Russia for several years, is explained by the fact that many hospitals, in addition to therapeutic, perform social functions - for example, a care function. Now the bed of intensive treatment, which are paid from the OMS, are released from these jointly. In addition, non-district, and regional hospitals should be treated in order to improve the quality of services. At the site of closed hospitals, Feldshera items must appear on the village, the office of general practitioners and at best there are several day hospital beds.

I am against the fact that small hospitals close, "says the doctor of the Tula ambulance Julia. - Of course, in the Big Center and the equipment is better, and doctors. But the grandmother will not go, even a few kilometers. That's all collapsed on ambulance. How many chronic sick people now cause us! They say that if they call a district doctor, he will not help anything. And you and the injection, and talk. We do not have psychological assistance to the population - we also provide such. Now even Cardajandads, as the heads, drive not only at arrhythmia, but also for purely polyclinic challenges. It turns out that there are holes in health care, and the ambulance will now boil. We are for the clinic, and for the hospital. Because in the polyclinic, patients will first cover a three-story mat. If the ECG is necessary - in a month they will be recorded. And we arrived - and the cardiogram did, and the sugar fell.

Formalism instead of humanity: step to the right - explanatory

Once I came to the challenge, the woman complained about the shortness of breath, "says Feldsher district ambulance from the Vladimir region Dmitry. - Made a cardiogram, and her extensive myocardial infarction with pulmonary swelling. Vivid it in intensive care. It was seen that the patient is heavy. The resuscitator comes out, asks what pressure, and says: "The pressure allows - Vesy to Vladimir." I say: "She will die in the car." "No, Vise." She brought her to Vladimir, the doctor comes out and says: "Are you a fool? Such responsibility for yourself to take - still ten minutes, and she would have died. " With a heart attack, 7, 14 and 21 days. The woman I brought to Vladimir was alive, from resuscitation it was transferred to the usual chamber, she went on amendment, but died for 21 days - because the complication went. If we were brought to the hospital in time, perhaps the heart attack would be able to prevent, but since we rode, the result is such. I recently bring a patient with asthma - the doctor comes out: "Vesui in Petushki." I have already learned, I say: "Only in your accompaniment." I laid the patient, the doctor heard that he was complaining about his breath. "No," says, "I will not go." Uploaded the patient back, spent three hours a total of three hours. Doctors take responsibility afraid and hang it on us.

Financial incentives that are being introduced through the OMS, often work well - a doctor and hospital is beneficial to "provide a medical service", especially simple. But in cases of responsibility and risk, small salaries for which still need to fight reporting are killed in doctors the most important thing that should be, the desire to save lives.

Feldscher Irina from Moscow soon says that in former times for physicians the human factor was in the first place. The doctor himself chose how much time to spend on the patient. Now according to new standards, the ambulance must reach the patient in twenty minutes. To assist in the call, it is allocated thirty minutes. During this time, the doctor must write the patient's data, collect history, listen, see, make a cardiogram, measure sugar.

Of course, we stay on the challenge as much as you need, "says Irina. "But if you're more than half an hour, you have to leave, report what you are doing." Take the situation: you came to the challenge and work alone, you are engaged in patients, make an intravenous injection. The medicine is introduced slowly, and you begin to call: "What are you doing there?" This control distracts. It is necessary to think not about the patient, but that not to forget to call back. Frames are a lot, and doctors in such a voltage whole day. Retreated from the algorithm, the step to the right is explanatory. Permanent struggle for the indicators, all the time you think how to meet within the deadline. If a person has enough moral and spiritual reserves, then, of course, he and in such a situation will be able to fulfill his work and will try to do it qualitatively, without prejudice to patients. But the conditions are really quite complicated, many doctors are now angry, they say: "How can we take care of patients if no one cares about us?"

For repeated calls, we no longer pay us, and here everyone decides itself, - Irina continues. - And in any area there are patients who, for some reason, cause an ambulance more often and re-. We have in the area, for example, two of all two, and we know them according to the names - the hare and the shellish, both, by the way, former doctors. They lived to the ninety years, and they had no friends left, nor relatives. They call an ambulance to them just come to talk to them. You come other than once to such a grandmother, and she says: "I only causing a second time." "Is it really? - I answer. "Tatiana Leonidovna, I have already for the fourth time per day." So what? I will go and talk. Will not lose. In medicine, people go from great love for people and to neighbor. And if this is not, it is better to immediately choose another profession.

What do medical unions do?

November 30 in Moscow will host a procession of physicians against health reform organized by trade unions

Trade unions consider the mistake of the introduction of single-channel financing and the principle of receiving the work of state and municipal medical institutions. After all, now the wages of doctors stopped being a secure article in the structure of health expenditures. And regional authorities seek to reduce their participation in the financing of the territorial programs of the OMS and approve of obviously reduced work of medical institutions. For example, according to the Action Trade Union, the tariff of the ambulance station of the city of Ufa for 2014 was understated by 5%, which led to a decrease in financing by 70.2 million rubles. As a result, the salary of ordinary employees fell about 20% in June.

In this regard, trade union leaders offer to abandon the insurance medicine for state and municipal institutions and return to the estimated-budget model of the health care organization, which will allow you to strictly control the costs and limit the arbitrariness of employers in the distribution of salary funds. In addition, it is proposed to deprive insurance companies to control the work of medical institutions, since in reality they control not the quality of medical services, but the correctness of the documentation. As a result, health workers spend time not to treat patients, but on increasingly thorough compliance with paper formalities.

Revelations A ambulance: death, dangerous patients and saved lives

We often see them on the streets of cities. Cars of medicine disasters or simply reanterate ambulance. Few seed them from the inside, as a rule, itselves doctors and patients. But the patient reanimobile usually not to interiors and equipment, would live, and doctors, too, with reluctance, expose pictures from the inside. But interesting.

Therefore, we will pass inside as the reader. It is better to look now than with the case.
Here is a car for resuscitation brigades. Further equipment.


Many light, a lot of space. If you wish in the car, you can maintain two victims at once.
FROM rear doors Patients fall into the car, so let's go with the side.


The left side of the reanimobile is completely engaged in medical equipment, equipping and drugs.


Used all free space, For example, on the handrails, the lathers are on the neck, the electric fuel hangs on the right.


The resuscitation monitor, connects to the patient and displays information, pulse, heartbeat, temperature and several other parameters. Have you seen in the movies? The cap is dressed on a finger and patient under control.


The device of artificial ventilation is lungs, it is both on-board, but you can use and autonomously, there are cases when you have to carry out an IVL blocked in a car.
And at the bottom right, a syringe dispenser is visible. Not all medicines can be introduced inkjet and fast or drip.
Here the syringe is inserted and the medicine enters the body at a certain speed. Doctors at this time are engaged in the patient.


Defibrillator monitor. Well, he was just seen in the cinema. With the help of a defibrillator, you can remove the cardiogram.


Anesthenous breathing apparatus. He is also portable.


This apparatus doctors call "one-room apartment" - worth the same.
The device of artificial ventilation LTV-1200. It can work completely autonomously, does not depend on the cylinder of compressed oxygen, as the IVL apparatus above.
LTV-1200 produces air mixture for breathing immediately.


There is another interesting thing while the detector of pain stress is rarely found in Russia.
The device can identify whether to a person, even if it is under anesthesia, or unconscious. You can connect and see not to enhance any anesthesia.
Gas analyzer exhaled air. Almost chemical laboratory. You can determine than a person poisoned and what kind of help to render it.
System of intraoscience. It is not always possible to put an injection in Vienna. Veins can hide at low pressure, the patient can also be clamped somewhere.
For this, it is quickly and reliably in a pinch of medicines directly into the bone.


Red resuscitation suitcase, there is a lot of things.


All for injection, all at hand.




There is also an obstetric set, the guys can freely accept childbirth. There are toxicological sets, in the case of poisoning, rinse the stomach and so on.
Surgical instruments. Quickly sew, cut, shave. Sets for tracheostomy and puncture of the pleural cavity


Well, except for the tires, blankets, cylinders with oxygen, nitrogen and other, a pair of shelves with medicines, a few suitcases that they have not shown. In general, there are many things, that's just I do not advise you to use it all! Take care of yourself!