Model and principles of organizing emergency specialized medical care for children at the stage of medical evacuation

Relevance. The problem of organizing specialized medical care in emergency forms for children is caused by three groups of reasons: the presence at the junction of several adult and pediatric medical specialties, the medical and geographical features of the country and the lack of a unified regulatory framework.
Intention. To increase the availability of medical services and reduce regional inequality in their distribution. A model of organizing a single operational service of specialized medical care for children and the basic principles of its functioning on the territory of the Russian Federation are proposed.
Methodology. Statistical data, features of legislation, ways of solving the problem in certain regions and the achievements of initiative groups of specialists are analyzed.
Results and Discussion. Since 2000, the number of hospital beds for children, the number of emergency medical stations has decreased, and the number of diseases and conditions requiring specialized emergency care for children has increased. Infant mortality rates in remote and hard-to-reach regions exceed the national average by 1.5–2.6 times. At the same time, the current statistics of medical evacuations of children are not accurately reflected in any of the official sources. The regulatory framework for medical evacuation of children includes three “ Procedures for providing medical care “in the profile “ambulance”, “neonatology” and “obstetrics and gynecology” and Federal Law N 323. The law implies the presence of mobile teams in hospitals and departments of different profiles that are not related to each other, but there is no structure that unites them and analyzes the results of work at the federal level.
Conclusion. To solve the problem, it is necessary to create a federal operational service and a “hotline” that can be contacted by any resident of the country, to form a federal medical register of critical conditions in children, to develop and implement common principles of diagnosis and treatment. The presented model and principles contribute to the development of a three-level system of emergency medical care and correspond to the goals and objectives of the Ministry of Health of the Russian Federation set out in Letter N 14-3/n/2-2339 of 20.03.2019.

1. Aleksandrovich Ju.S., Gvak G.V., Kuznecova I.V. [et al.]. Problemnye voprosy okazanija reanimatologicheskoj pomoshhi novorozhdennym [Problematic issues of providing resuscitation care to newborns]. Vestnik anesteziologii i reanimatologii [Messenger of Anesthesiology and Resuscitation]. 2009. N 2. Pp. 23–28. (In Russ.)

2. Bagnenko S.F., Lobzhanidze A.A., Razumnyj N.V. Izuchenie mnenija medicinskih rabotnikov central’nyh rajonnyh bol’nic Leningradskoj oblasti ob organizacii raboty dogospital’nogo jetapa skoroj medicinskoj pomoshhi i priemnyh otdelenij bol’nic [Sociological poll of medical employees working in central regional hospitals of Leningrad area about the organization prehospital emergency care and reception departments of hospitals]. Skoraya meditsinskaya pomoshch’ [Emergency medical care]. 2014. N 2. Pp. 13–18. (In Russ.)

3. Bagnenko S.F., Miroshnichenko A.G., Shlyafer S.I. [et al.]. Rezul’taty raboty skoroi meditsinskoi pomoshchi vne meditsinskikh organizatsii i v statsionarnykh usloviyakh v Rossiiskoi Federatsii [Results of inpatient and outpatient emergency care in the Russian Federation]. Mediko-biologicheskie i sotsial’no-psikhologicheskie problemy bezopasnosti v chrezvychaynykh situatsiyakh [Medico-Biological and Socio-Psychological Problems of Safety in Emergency Situations]. 2020. N 1. Pp. 5–11. DOI: 10.25016/2541-7487-2020-0-1-05-11. (In Russ.)

4. Baranova N.N. Meditsinskaya evakuatsiya postradavshikh: sostoyanie, problemy. Soobshchenie 1 [Medical evacuation of victims: their State, Problems. Report 1.]. Meditsina katastrof [Disaster Medicine]. 2018. N 4. Pp. 37–40. (In Russ.)

5. Belyaeva L.A. Regional’naja raznorodnost’ urovnja zhizni naselenija [Regional differentiation of living standards]. Mir Rossii. Sotsiologiya. Etnologiya [Universe of Russia. Sociology. Ethnology]. 2006. N 2. Pp. 42–61. (In Russ.)

6. Garmash O.A., Banin I.N., Popov V.P. [et al.]. Organizacija okazanija jekstrennoj konsul’tativnoj medicinskoj pomoshhi i provedenija medicinskoj jevakuacii [Provision of emergency counselling medical care and medical evacuation]. Moskva. 2014. 174 p. (In Russ.)

7. Goncharov S.F., Bobii B.V., Akin’shin A.V. Sluzhba meditsiny katastrof Minzdrava Rossii: osnovnye itogi deyatel’nosti v 2019 g. i zadachi na 2020g. [Service for Disaster Medicine of Ministry of Health of Russian Federation: Main Results of Activities in 2019 and Tasks for 2020.]. Meditsina katastrof [Disaster Medicine]. 2020. № 1. Pp. 15–27. DOI: 10.33266/2070-1004-2020-1-15-27 (In Russ.)

8. Goncharov S.F., Bobii B.V., Bystrov M.V. [et al.] Osnovnye itogi deyatel’nosti Sluzhby meditsiny katastrof Minzdrava Rossii v 2015 g. i zadachi na 2016g. [Main Results of Activities Service for Disaster Medicine of Ministry of Health of Russian Federation in 2015 and Tasks for 2016]. Meditsina katastrof [Disaster Medicine]. 2016. N 1. Pp. 5–13.

9. Zdravoohranenie v Rossii [The health care in Russia]. Moskva. 2019. 170 p. (In Russ.)

10. Kapinosov A.A. Sovershenstvovanie modeli okazanija reanimacionnoj pomoshhi detjam, nuzhdajushhimsja v mezhgospital’noj transportirovke (na primere Murmanskoj oblasti) [Improvement of the model of resuscitation care for children in need of inter-state transportation (using the example of Murmansk region)] : Abstract dissertation PhD Med. Sci. Sankt-Peterburg. 2009. 20 p. (In Russ.)

11. Keshishyan R.A. Detskij dorozhno-transportnyj travmatizm (problemy i puti resheniya). Voprosy sovremennoj pediatrii [Current pediatrics]. 2009. Vol. 8, N 4. Pp. 18–22. (In Russ.)

12. Kuvshinov K.E., Sushil’nikov S.I., Yakovlev S.V. [et al.] Organizatsiya sanitarno-aviatsionnoi evakuatsii v Vooruzhennykh Silakh [Organization of sanitary and aviation evacuation in the Armed Forces]. Voenno-meditsinskii zhurnal [Military Medical Journal]. 2017. N 4. Pp. 4–11.

13. Medik V.A., Jur’ev V.K. Obshhestvennoe zdorov’e i zdravoohranenie [Public health and health care]. Moskva. 2012. 214 p. (In Russ.)

14. Morozova N.Ya., Yakirevich I.A., Popov A.S. [et al.] Sanitarno-aviatsionnaya skoraya meditsinskaya pomoshch’ novorozhdennym [Sanitary aviation emergency medical care for children in the neonatal period]. Neonatologiya: novosti, mneniya, obuchenie [Neonatology: News, Opinions, Training.]. 2017. N 1. Pp. 39–44.

15. Nazarova I.B. Zdorov’e i kachestvo zhizni zhitelei Rossii [Health and quality of life of residents of Russia]. Sotsiologicheskie issledovaniya [Sociological Studies] 2014. N 9. Рp. 139–145.

16. Prokhorov B.B. Mediko-demograficheskoe prognozirovanie [Medical and demographic forecasting] Moskva. 2011. 360 р. (In Russ.)

17. Rossiiskii statisticheskii ezhegodnik [Russian Statistical Yearbook]. Moskva. 2019. 708 p. (In Russ.)

18. Rumyantsev S.A., Spiridonova E.A., Sharshov F.G. [et al.]. Osobennosti dogospital’nogo etapa okazaniya meditsinskoi pomoshchi detyam s tyazhelymi travmami [The specific features of prehospital medical care to children with severe injuries] Rossiiskii vestnik perinatologii i pediatrii [Russian Bulletin of perinatology and pediatrics]. 2011. N 2. Pp. 99–105. (In Russ.)

19. Spiridonova E.A., Pavlenko V.L., Rumyantsev S.A. [et al.]. Effektivnost’ sistemy konsul’tativnogo obespecheniya statsionarov kvalifitsirovannogo etapa okazaniya ekstrennoi meditsinskoi pomoshchi po napravleniyu tyazheloi pediatricheskoi travmy [Effectiveness of the system of the consultative medical aid at qualificated stage for children with severe traumatic injuries in the hospitals]. Meditsinskii vestnik Severnogo Kavkaza [Medical news of the North Caucasus]. 2011. N 1. Pp. 58–61. (In Russ.)

20. Spiridonova E.A., Rumyantsev S.A., Sharshov F.G. [et al.]. Sovershenstvovanie sistemy okazaniya ekstrennoi meditsinskoi pomoshchi detyam s tyazheloi travmoi [Improvement of emergency medical care for children with severe trauma]. Vestnik intensivnoi terapii [Annals of critical care]. 2012. N 1. Pp. 74–80. (In Russ.)

21. Suvorov S.G., Ezel’skaya L.V., Rozinov V.M. [et al.]. Organizatsiya spetsializirovannoi meditsinskoi pomoshchi detyam, postradavshim v rezul’tate dorozhno-transportnykh proisshestvii na territorii Moskovskoi oblasti [Organization of specialized medical care for children affected by traffic accidents in the Moscow region]. Anesteziologiya i reanimatologiya [Russian Journal of Anаеsthesiology and Reanimatology]. 2009. N 1. Pp. 34–36. (In Russ.)

22. Shabalov N.P., Aleksandrovich Yu.S. Eduard Kuz’mich Tsybul’kin – osnovopolozhnik detskoi reanimatologii v Leningrade–Sankt-Peterburge: 80 let so dnya rozhdeniya [Eduard Kuzmich Tsybul’kin the founder of critical and emergency care for children in Leningrad–Saint-Petersburg (the 80th anniversary of his birth)]. [Pediatr]. 2018. Vol. 9, N 5. Pp. 131–138. DOI: 10.17816/PED95131-138 (In Russ.)

23. Sharshov F.G., Pavlenko V.L., Spiridonova E.A. [et al.]. Analiz napravlenii gospitalizatsii detei s travmaticheskimi povrezhdeniyami na territorii Rostovskoi oblasti [Analysis of admissions to the hospitals of children with traumatic injuries in the rostov region]. Meditsinskii vestnik Severnogo Kavkaza [Medical news of the North Caucasus]. 2011. N 2. Pp. 75–78. (In Russ.)

24. Sharshov F.G. Sovershenstvovanie okazaniya ekstrennoi meditsinskoi pomoshchi detyam s tyazhelymi travmaticheskimi povrezhdeniyami [improving emergency medical care for children with severe traumatic injuries] : Abstract dissertation Dr. Med. Sci. Moskva. 2011. 62 p. (In Russ.)

25. Shmakov A.N., Aleksandrovich Yu.S., Pshenisnov K.V. [et al.]. Okazanie reanimatsionnoi pomoshchi detyam, nuzhdayushchimsya v mezhgospital’noi transportirovke: proekt klinicheskikh rekomendatsii [Intensive care of children who require interhospital transport (a clinical guideline draft) ]. Al’manakh klinicheskoi meditsiny [Almanac of Clinical Medicine] 2018. Vol. 46, N 2. Pp. 94–108. DOI: 10.18786/2072-0505-2018-46-2-94-108 (In Russ.)

26. Sjkuatsii) [Critical neonatal conditions (remote counseling and evacuation technology)]. Novosibirsk. 2007. 168 p. (In Russ.)

27. International Trauma Life Support: prehospital care for injuries. Eds.: D.E. Campbell, R.L. Alson. Krakow. 2018. 446 p. (In Russ.)

28. Coakes J., Gain C., Craig G. Сritical care for children in a district general hospital: a review of the caseload and outcomes. Journal of the Intensive Care Society. 2011. Vol. 12, N 4. Рр. 313–315.

29. Harmsen A.M., Giannakopoulos G.F., Moerbeek P.R. [et al.]. The influence of prehospital time on trauma patients utcome: a systematic review. Injury. 2015. Vol. 46, N 4. Рр. 602–609. DOI: 10.1016/j.injury.2015.01.008.

30. Hebb M.O., Clarke D.B., Tallon J.M. Development of a provincial guideline for the acute assessment and management of adult and pediatric patients with head injuries. Can. J. Surg. 2007. Vol. 50, N 3. Рp. 187–194.

31. Hindocha R., Beringer R., Handel J. District general hospital’s experience of critically ill children. Journal of the Intensive Care Society. 2008. Vol. 9, N 1. Рр. 63–65.

32. Mtaweh H., Bell M.J. Management of pediatric traumatic brain injury. Curr. Treat. Options Neurol. 2015. Vol. 17, N 5. Рр. 348. DOI: 10.1007/s11940-015-0348-3.

33. Paul R., Melendez E., Stack A. [et al.]. Improving adherence to PALS septic shock guidelines. Pediatrics. 2014. Vol. 133, N 5. Рр. 1358–1366. DOI: 10.1542/peds.2013-3871.