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Ambulance doctor revelations: death, dangerous patients and saved lives

There are many questions to domestic medicine, as well as claims that every second expresses at any convenient and inconvenient occasion. Often among them, dissatisfaction with the work of the ambulance also slips, but few people think about how it looks on the other side - through the eyes of doctors. We talked with one of them about why people do not want to go to medicine, how many false calls are received per day and what to do with dying patients.

About career

I have been working in the ambulance for over 20 years. We have a local division of teams: linear, pediatric, cardiological, intensive care and neuropsychiatric. I started out as an orderly at the line, then switched to cardiology, became a nurse, returned to the line, became a doctor - and again switched to cardiology.

We also work as an intensive care team - in principle, it replaces everyone except neurologists. We visit both ordinary patients and various accidents and mass road accidents. Usually there are two to three people in the carriage plus the driver.

I can say that a huge percentage of doctors who are now employed in various fields started with an ambulance. If you take the third city or regional hospitals, then many local specialists have passed this school.

Most often they come here as students, as for temporary work - there is something exotic here, you can learn something, for example, make decisions quickly. And the schedule is more or less free, not tied to a place. It used to be that way.

I stayed on this service a little longer than others. They call me to the hospital, but I don’t want to leave - this work is to my liking.

About problems

Recently, the number of calls has been growing, the intensity has been increasing, but the number of teams has been decreasing. Previously, there were 10 teams per 100,000 population, but now there are about seven teams for the same number of patients.

At one time, it was believed that the norm for a cardiological team was eight calls per day. Now 10 calls are already considered an "easy" day, 12 - an average number. Basically, there are 14-16 trips per shift. Additional load is not paid.

Because of this, not everyone wants to work for the ambulance, and we are getting smaller and smaller. Now there are doctors average age which are more than 40 years old. There are very few young doctors. The problem with the medical staff in the ambulance comes first.

About challenges

There is an unspoken order that all calls are recorded and an ambulance is sent to them. That is, we have no right to refuse, even if help is not actually required. Theoretically, this should be determined by a dispatcher who has a secondary specialized medical education - he is a paramedic with the highest category. Of course, I don’t like it - to skate in vain, it’s stupid, but what can I do.

Calls can be conditionally divided into those that require help, communication with the patient, are refused, and cases where the patient is not found. Well, for example, compassionate people call and say that somewhere a drunk man has fallen and lies. We arrive, but he is no longer there. Well, or he is, but sends us far, far away. You can't leave him, because another grandmother, passing by, will call us again.

In such situations, the police come later, and sometimes they themselves call us to determine the severity of the intoxication. It sometimes comes to scandal. Recently there was a situation when a major called us, we arrived, put a conclusion and left. After a while, he calls again and says that he will not pick up the person, because he cannot get to the car. Passers-by have already helped and brought the peasant to a police "bobby". In general, we do not conflict with other services, because we work in one liaison with the Ministry of Emergency Situations, the police, the traffic police.

Now there are many patients who cannot go to the hospital. Because of the queues and the initial appointment, it is sometimes possible to get to the therapist only after a few days. I believe that this is the scourge of domestic medicine, when people do not have the opportunity to immediately go to the clinic and they have to wait. But the fact is that there are fewer doctors and more paperwork. And we are called by those patients who think that the arrival of an ambulance can replace the initial appointment with a therapist. This is not true.

There are many false calls - several dozen per day. A large percentage is drug overdose, but while the crew is traveling, many call and cancel the call. They are also people on the street who fell somewhere. Recently there were three calls in a row, we accompanied a woman who walked home and fell at every corner. And people called us every time. As a result, we reached her entrance, and she refused to help.

Very often grandmothers who suffer from loneliness call. They also need help, but psychological. As a rule, they are abandoned by relatives and children, who come once a week at best. And they also need communication. It's worse when they call us at night. They say, "I'm afraid to stay with my sore at night." Although she endured all day. It seems like it's scary to die at night. In such cases, we also come, of course. If you say two or three kind words, you measure the pressure - and it feels like the tonometer has cured her, it became better.

About violent and strange patients

As a rule, the most violent patients- these are people in a state of alcoholic intoxication. Even drug addicts are more relaxed about doctors. In drunken people, the stage of arousal is more pronounced. Sometimes you have to swear and conflict with them. But if the conversation is right, they calm down quickly. There were also fights with such comrades, but, to be honest, I don’t want to talk about it.

But I cannot remember any strange challenges. Situations when, say, a person puts a light bulb in his mouth for an argument are quite common. Or when someone gets a burn of the whole body in the bath - also, although it seems wild. He just rips off the taps and the person is scalded. There are three or four such cases a year.

There are, of course, hypochondriacs who call an ambulance for any reason. As a rule, all brigades already know them. I remember some addresses by heart.

Of course, there are those who really have some kind of serious illness, but they also call an ambulance for every trifle. This is what is bad: you come to a person six to seven times a month, and on the eighth, knowing in advance that he has nothing, you can really miss the real problem if it suddenly appears or becomes aggravated. This also happens. Of course, both doctors and patients are to blame. The first - because they reacted carelessly, the second - because they do not want to be properly treated and panic about every occasion.

About the traffic situation

Recently, drivers have become more loyal to ambulances. By the way, they miss more often. imported cars, not our UAZs. The logic of people is clear: if an UAZ is driving, then it is most likely a linear team, the patient can wait. Although this is not true, because a general-purpose team can also carry a seriously ill patient.

Rudeness happens, but rarely. There were times, of course, when you had to get out of the car and talk to make way. Most often, such situations occur with taxi drivers who drive into the yards, and then they need to turn around, they are a rod and do not want to hand over a couple of entrances back to let help pass. Literally in the fall, it was like this - we could not leave the taxi driver and went to the desired house on foot.

About death

One has to deal with death quite often. Several times a week, sometimes per shift. Deaths are also different - both before the arrival of the brigade, and with it. In the first case, these are either clinical patients or patients with sudden acute illnesses who later went to the ambulance. It also happens that the doctors do not have time to get there. But more often than not, people turn up late. While others call the doctors for every little thing.

There is also such a thing as "predictable death", when you know that the patient will die soon - it's easier. But there is also a sudden one, when it is not even possible to establish the cause, then it is difficult.

I don't remember the first time I faced death. But I clearly remember an incident that made an indelible impression on me. It was about 20 years ago, I guess. A family was driving along the highway - the husband and child were sitting fastened in front, and the wife was in the back seat. During the accident, she flew through windshield her car, and then the same car ran into her. We only managed to take her to the Crystal Hotel when she died. She had multiple injuries: fractures of the chest, pelvis, base of the skull. Of course, it’s better not to remember.

In general, there is such a law that patients must die in the hospital. But older people tend to want to leave life in their own bed. I believe that this is a normal desire - if without torment, then why not. Perhaps this is correct. My grandparents at one time also refused to go to the hospital and stayed at home.

But here is a double-edged sword: we cannot forcibly hospitalize a patient against his will, but from a legal point of view, a person at such moments is not always able to adequately assess his condition. On the spot, it is difficult to determine how sane the patient is. As a rule, in hospitals, such decisions are made at councils. And in the ambulance, every time you make a decision at your own peril and risk.

About the specifics of work

Emergencies, when there are more than three victims, or fatalities do not happen so often, but emotionally they are, of course, more difficult than everyday work. But at such moments you understand why you are needed.

Of course, each doctor decides for himself whether to provide assistance on the spot or quickly take it to the hospital. In the first case, you need to understand that the person will be able to be hospitalized later, quickly assess the risks, weigh the pros and cons. It is only in films that they show that doctors can do something on the way, but the reality is that, moving along our roads, the patient cannot be helped. If he is already intubated or has catheters, then you can change bottles or put solutions on the go - but that's all.

A kind of burnout also happens - as a rule, such moments occur before vacation, when you know that you will soon be resting, and it is already hard to look at patients. It may be ugly, but it is. You understand that this is wrong, but you cannot do anything with yourself. You start to work like a machine, and abstract from people.

About medical humor

Doctors joke about everything - even death and cancer. There is no other way. Sometimes, when we return to the station, we need to shout out loud and laugh right there. It happens in our staff room - it helps to relieve tension.

Doctors have a lot of rude and obscene jokes, but this is the specificity of our work, without them nowhere. It helps us hold on.

We often see them on city streets. Disaster medicine cars or simply ambulances. Few have seen them from the inside, as a rule, they are doctors and patients themselves. But the patient of the ambulance usually has no time for interiors and equipment, I would live, and doctors are also reluctant to expose pictures from the inside. But it’s interesting.

So let's go inside as a reader. Better to look now than on occasion.
Here's a car for the resuscitation teams. Further equipment.

Lots of light, lots of space. If desired, two victims can be serviced in a car along the way.
Patients get into the car from the back doors, so let's go from the side doors.

The left side of the ambulance is completely occupied with medical equipment, equipment and medicines.

Everything is used free space, for example, on the handrail there are latches on the neck, an electric blanket hangs on the right.

The resuscitation monitor connects to the patient and displays information, pulse, heart rate, temperature and a few more parameters. Have you seen in the movies? The cap is put on the finger and the patient is under control.

An artificial lung ventilation device, it is like an onboard one, but it can also be used autonomously, there are cases when a person who is locked in a car has to be ventilated.
And at the bottom right is a syringe dispenser. Not all medications can be injected in a stream and quickly or drip.
Then a syringe is inserted and the medicine enters the body at a certain speed. The doctors are busy with the patient at this time.

Defibrillator monitor. Well, everyone saw him in the movies. With the help of a defibrillator, you can also take a cardiogram.

Anesthetic and respiratory apparatus. It's also portable.

Doctors call this apparatus "one-room apartment" - it costs the same.
Artificial ventilation device LTV-1200. It can work completely autonomously, does not depend on a compressed oxygen cylinder, like the ventilator above.
The LTV-1200 produces breathing air immediately.

There is one more interesting thing, a pain stress detector, which is rarely found in Russia so far.
The device can determine whether a person is in pain, even if he is under anesthesia, or unconscious. You can connect and see if the anesthesia is intensified.
Exhaled air analyzer. Almost a chemical laboratory. You can determine what a person has been poisoned with and what kind of help to provide.
Intraosseous access system. It is not always possible to give an injection into a vein. Veins can hide at low pressure, the patient can also be pinched somewhere.
To do this, you can quickly and reliably inject drugs directly into the bone.

Red resuscitation case, there are a lot of things.

Everything for injections, everything at hand.

There is also an obstetric kit, the guys are free to give birth. There are toxicological kits, in case of poisoning, rinse the stomach and so on.
Surgical instruments. Sew up, cut, mend quickly. Sets for tracheostomy and pleural puncture

And besides, tires, blankets, cylinders with oxygen, nitrogen and other things, a couple of shelves with medicines, several suitcases of things that were not shown. In general, there is a lot of everything, but I just do not advise you to use it all! Take care of yourself!

People have been sick for centuries, and they have been waiting for help for centuries. Oddly enough, the proverb "Thunder will not strike - the man will not cross himself" refers not only to our people. ... Despite the abundance of well-equipped clinics, many victims (with burns and injuries) could not receive medical care for more than a day. The foundation of the Society was Professor Jaromir Mundi, a surgeon who witnessed the fire, and the ambulance teams included doctors and medical students. And you can see the ambulance transport of Vienna in those years in the photo.

The next ambulance station was created by Professor Esmarch in Berlin (although the professor is remembered more from his circle - the one for enemas ... :). In Russia, the creation of an ambulance began in 1897 in Warsaw. Naturally, the appearance of the car could not pass by this area of human life. Already at the dawn of the automotive industry, the idea of using self-run wheelchairs for medical purposes appeared. However, the first motorized "ambulances" (and they appeared, apparently, in America) had ... electric traction. Since March 1, 1900, New York hospitals have been using electric ambulances.

According to Avtomobili magazine (# 1, January 2002, photograph dated from 1901), this ambulance is an electric Columbia (11 mph, 25 km range) that brought US President William McKinley to the hospital after By 1906, there were six such machines in New York.

In Russia, they also realized that ambulance stations need cars. But in the beginning horse-drawn "carriages" were used.

Interestingly, from the very first days of the Moscow Ambulance, a type of brigade was formed, which has survived with small "variations" to this day - a doctor, a paramedic and a nurse. Each Station had one carriage. Each carriage was equipped with a box with medicines, instruments and dressings.

Only officials - a policeman, a janitor, a night watchman - had the right to call an ambulance. 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 the Prechistensky fire station. The service radius was limited to the boundaries of its police unit. The first carriage for transporting 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-horse carriages, 4 pairs of hand stretchers and everything necessary for first aid delivery. 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 (ambulance) aid 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 the provision of ambulance.

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

In 1907, the factory of P.A. Frese, one of the creators of the first Russian car, exhibited an ambulance of its own production on a Renault chassis at the International Motor Show in St. Petersburg.

A car with the body of the Ilyin factory (designed by Dr. Pomortsev) on the La Buire 25/35 chassis, suitable for transporting patients and for surgical care in a military field hospital.

In St. Petersburg, 3 ambulances from the Adler company (Adler Typ K or KL 10/25 PS) were purchased in 1913, and an ambulance station was opened at 42 Gorokhovaya. The large German company Adler, which produced a wide range of vehicles, is now forgotten ...

Sanitary bodies for the Petrograd detachment of the IRAO were made by the well-known carriage-body factory "Yves Braytigam"

Ambulance La Buire

With the outbreak of the First World War, it took ambulances... Moscow motorists (from the First Russian Automobile Club in Moscow and the Moscow Automobile Society), and volunteers from other cities (on the right - photo of Russo-Balt D24 / 35 of the Petrovsky Voluntary Firefighting Society from Riga) formed ambulance columns from their cars converted for medical needs, organized hospitals for the wounded using the funds raised. Thanks to the cars, tens, if not hundreds of thousands of lives of soldiers of the Russian army have been saved. Only the motorists of the First Russian Automobile Club in Moscow from August to December 1914 transported 18,439 wounded and injured people from railway stations to hospitals and infirmaries.

In addition to the Russian sanitary squads, several foreign volunteer sanitary squads operated on the eastern front. The Americans were very active. The photo on the left is a Ford T of the American ambulance squad in Paris. Pay attention to the dress code of the people who gathered for the war - white shirts, ties, boaters.

Cars Pierce-Arrow (Pierce-Arrow 48-B-53) with the inscription "named after EIH Grand Duchess Tatyana Nikolaevna American detachment. American Ambulance in Russia". The photographs give an idea of the number of ambulances used for medical support of military operations in those years.

French and British volunteer ambulance columns also operated on the eastern (Russian) front, and the Russian Volunteer Corps ambulance detachment operated in France.

In the photo, the English Daimler Coventry 15HP with the inscription Ambulance Russe on board

Renault (Renault), on the right - the British ambulance Vauxhall, which was also supplied to Russia.

Unique (Unic C9-0) of the French red cross in Odessa, 1917 (chauffeur in French military uniform), a Russian soldier stands in a group of people.

Ambulance vehicle of the Russian army Renault (Renault)

After the revolution, at first, old or captured equipment was used.

In the first post-revolutionary years, not only the ambulance station, but also hospitals, as well as the Petrograd fire brigade, were provided with road medical transport. The goal is obvious - to speed up the provision of medical assistance to victims of fire. Unidentified car make in 1920s photograph.

In the early years after the revolution Ambulance in Moscow she 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 passenger 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. Subsequently (1936) this service was transferred to a specialized psychiatric ward under the guidance of a city psychiatrist.

Obviously, it was impossible to cover the needs for sanitary transport of such a huge country as the USSR at the expense of imports. With the development of the domestic automotive industry, the cars of the Gorky Automobile Plant became the basic machines for the installation of specialized bodies. In the photo - sanitary car GAZ-A at factory tests. Whether this car was mass-produced is unknown.

The second chassis suitable for re-equipment for the needs of an ambulance in the 30s was the "one and a half" GAZ-AA. For specialized bodies, cars were altered in many obscure workshops. The photo shows an ambulance from Tula.

In Leningrad, it looks like GAZ-AA was the main ambulance in the 1930s (left). In 1934, the standard body of the Leningrad ambulance was adopted. By 1941, the Leningrad ambulance station consisted of 9 substations in various regions 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 substation.

In the Moscow ambulance, GAZ-AA was also used. And at least several types of cars. On the left is a photo dated 1930. It may be a Ford AA).

In Moscow, the conversion of Ford-AA into an ambulance was carried out according to the project of I.F. German. The front and rear springs were replaced with softer ones, hydraulic amotisers were installed on both axles, the rear axle was equipped with single wheels, due to which the car had a narrow rear track. The car did not have its own name or designation.

The growth in the number of substations and calls required an appropriate fleet of cars - fast, spacious and comfortable. The Soviet limousine ZiS-101 became the basis for the creation of an ambulance. The medical modification was created at the plant according to the project of I.F. German with the active assistance of doctors A.S. Puchkov and A.M. Nechaev.

These machines worked in the Moscow ambulance in the post-war period.

The specifics of the work make special demands on the ambulance car. A specialized car was designed and built in the garage of the Moscow ambulance.

Before the war, specialized GAZ-55 vehicles were produced from 1937 to 1945 by a branch of GAZ (from 1939 it became known as the Gorky Bus Plant) (based on the GAZ-MM truck - a modernized version of GAZ-AA with engine GAZ-M). The GAZ-55 could carry 4 bedridden and 2 sedentary patients or 2 bedridden and 5 sedentary or 10 sedentary patients. The machine was equipped with an air heater powered by exhaust gases, and a ventilation system.

By the way, you probably remember the ambulance in the movie "Prisoner of the Caucasus". It was her driver who swore: "Yes, so that I still get behind the wheel of this vacuum cleaner!" This is a GAZ-MM with a handicraft sanitary body.

In total, more than 9 thousand cars were produced. Unfortunately, not a single one was left "alive".

An interesting history of medical buses - most often converted from mobilized passenger transport cities. Left ZIS-8 (bus on the ZIS-5 chassis). ZIS produced these buses only in 1934-36, later buses according to the drawings of the plant were produced on the chassis of ZIS-5 trucks by many enterprises, bus fleets and body shops, in particular, by the Moscow plant "Aremkuz". The 1938 ZIS-8 bus shown in the photo, owned by the Mosfilm film studio, was filmed in the film "The meeting place cannot be changed."

City buses ZIS-16 were also based on the ZIS-5 chassis. A simplified modification - a medical bus - was developed even before the war and was produced since 1939 under the name ZIS-16S. The car could carry 10 bedridden and 10 sedentary patients (not counting the driver's and nurse's seats).

In the first post-war years (since 1947), the ZIS-110A (sanitary modification of the famous ZIS-110 limousine), created at the plant in close cooperation with the heads of the Moscow ambulance station A.S. Puchkov and A.M. Nechaev, became the basic ambulance car. using the experience gained in the pre-war years. It's clear that backdoor opened together with rear window, which is much more convenient than it was on the ZIS-101. A box is visible to the right of the stretcher - apparently, there was provided for its "regular place".

The car was equipped with an eight-cylinder inline engine six-liter volume, 140 hp, thanks to which it was fast, but very voracious - fuel consumption of 27.5 l / 100 km. At least two of these cars have survived to this day.

In the 50s, the GAZ-12B ZIM vehicles came to the aid of the ZISs. Front seat separated by a glass partition, in the rear of the cabin there were a retractable stretcher and two folding seats. The six-cylinder GAZ-51 engine in the forced version reached 95 hp, was somewhat "quicker" in terms of dynamic qualities than the ZIS-110, but consumed noticeably less gasoline (A-70, which was considered high-octane in those years) -18, 5 l / 100 km.

There was also a medical modification of the famous "Victory" GAZ-M20.

In the car, a folding stretcher was located somewhat obliquely. Left half of the back rear seat could recline, making room for a stretcher. A similar design is used before today... The main ambulance cars of cities (the so-called linear) in the 1960s were specialized cars RAF-977I (produced by the Riga car factory on the units of the "Volga" GAZ-21).

Do you know what happens when you dial 03 on your phone? Your call automatically goes to the central dispatch center of the republic. A specialist in reception and transmission of calls picks up the phone ...

1. Almost all outgoing calls to numbers "03", "103" are received by the unified dispatching service of the Republican ambulance station. The station serves more than 75 percent of the republic's residents: about a hundred service brigades make calls more than a thousand times a day. They work here around the clock.

2. When you ask for help on the phone, the first person you hear is the voice of the dispatcher. The doctor on duty will start asking you specific questions. Unfortunately, false calls happen quite often.

3. It may seem that he is showing indifference, but with the help of clarifying questions, the patient's condition is determined and which team to send to help (calls from citizens are divided into an ambulance and an ambulance).

4. The senior doctor coordinates the work of the duty shift. Meet Irina Serova, Senior Emergency Physician.

5. Before her eyes there are two monitors on which incoming calls are displayed, ranked by priority. In practice, experienced patients already know what to say in order for the ambulance to arrive: “make a mistake” in the age of decreasing, hide the chronic nature of the disease, aggravate the symptoms. The word “dying” works best.

6. Everything you say is logged into the computer, all calls are recorded. Technical innovations made it possible to reduce to a minimum the number of missed and unhandled calls, optimally allocate resources for servicing calls

7. The whole process takes about two to three minutes. The data is processed and, depending on your location, the call goes to the ambulance substation, usually to the one closest to the victim.

8. With the help of the Glonass system, the movement of ambulance crews is monitored in real time: location, time spent 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 the call to the arrival of the ambulance, it should take about twenty minutes. With the help of dispatching services, ambulances bring an acute patient to the very clinic where they can quickly provide assistance.

11. The building of the Republican Ambulance Station has its own ambulance substation, which mainly serves city calls. There are no holidays or weekends for doctors working on emergency calls.

12. All conditions for work have been created at the substation. The work schedule is three days later. There is a rest room here, where, in your free time from calls, you can relax a little.

13. Dining room. Here you can warm up food and eat during a break from the trip.

14. Medicines in sufficient quantities are stored in special cabinets at a certain temperature.

16. In addition to analgin, nitroglycerin and validol, ambulance teams have the most modern drugs that can help in a matter of minutes with heart attacks and strokes.

17. This is how the ambulance emergency medical bag looks like. It weighs about 5 kilograms and contains not only a sufficient amount of painkillers, but also narcotic ones.

18. The peak of calls to numbers "103" or "03" occurs at 10-11 am and from 5 pm to 11 pm. Calls are provided with ambulances equipped with everything necessary.

19. And there is also a simulation center, equipped with special mannequins that maximally imitate the vital functions of the human body. Thanks to the conditions created, future doctors and ambulance paramedics hone their skills in first aid.

The work of doctors is not the easiest, try to help the ambulance staff as best you can: do not terrorize with false and trifling calls, give way on the highway, behave adequately upon the arrival of the ambulance team.

An ambulance is an excellent school, which is desirable for any future doctor to go through. She teaches you to make decisions quickly, to fight disgust, gives you invaluable experience of behavior in non-standard situations.