Relevance. Russia is among countries with the highest risks of death and injuries (including poisoning) in population due to fires. Intention. The purpose of research - to study fire-related risks of death and injury in rural and urban population of Russia over 20 years (1996-2015). Methods. The object of research was Federal databank «Fires» [https://sites.google.com/site/statistikapozaro/]. Polynomial trends have been plotted for fire quantities, direct material damage, the number of fatalities and injured. For the urban and rural population, the following risks were calculated: R , - fire exposure, R₂ - death (injury) in fires, R₃ - the individual risk of death (injury). Results and Discussion. Fires in urban areas amounted to (64.9 ± 0.7)%, direct material damage (60.5 ± 1.6)%, fire fatalities (54.8 ± 0.7)%, injured (69.3 ± 0.3)% of total relevant indicators for Russia. In the cities, there was a significant downward trend in the number of fires along with growing direct material damage. The number of fatalities and injured (poisoned) also decreased. Unlike cities, fire quantities and number of deaths in fires significantly increased, however direct material damage significantly decreased in rural areas. The main fire risks in rural areas were significantly higher (p <0.001) than in the cities. For example, R , in rural areas was 1.3 times higher than in urban areas [(1.93 ± 0.07) • 10^-3 vs (1.49 ± 0.07) • 10^-3 fires / person / year, respectively]; R₂ (death) 1.6 times higher [(9.06 ± 0.27) • 10^-2 vs (5.84 ± 0.19) • 10^-2 deaths / fires, respectively]; R₃ (death) 2.3 times higher [(17.49 ± 0.63) • 10^-5 vs (7.71 ± 0.44) • 10^-5 deaths / person / year]; R₃ (injury) 1.2 times higher [(10.50 ± 0.12) • 10^-5 vs (8.65 ± 0.19) • 10^-5 injures / person / year, respectively]. Conclusion. Information on the main socio-geographical and personality-related reasons for high fire risks in Russia is useful for improving fire safety in rural areas.

Relevance. In 2000-2014, 8588 emergency situations (ES) took place in Russia, with 14.8 thousand injured and 5 million 841 thousand fatalities. In 1995-2014, (1300 ± 70) thousand of injuries, poisonings and other external causes were reported annually in Russia; these represent about 12 % of the disease incidence, 6 % of the disease prevalence, 11 % of cases without days away from work and 18 % of days away from work in population. Intention. To justify the concept of organizing emergency trauma care for injured in emergencies using operational resources of EMERCOM of Russia. Methods. Based on methodological principles of scientific specialty «Safety in Emergency Situations» (medical sciences, emergency medicine, disaster medicine), as well as the methodology of health care and management theory, the concept of organizing urgent trauma care for injured in emergencies using operational resources of EMERCOM of Russia has been justified and presented. Results and Discussion. The theoretically based concept of organizing urgent trauma care for injured in emergency situations is presented. It includes 7 basic principles and structural-functional model, which are described at the level of content of its components (elements). Using the data obtained, the leading directions of implementation and development of the system of organizing urgent trauma care for injured in emergency situations were identified, including recommendations on the first aid to injured rescuers and firefighters, the development of teaching materials, distance learning, simulation centers for paramedical and medical staff including aeromedical crews, establishment of universal health care and aviation units along with relevant medical and technical requirements, the development of special evacuation means for injured within the system of the Emercom of Russia, innovative technologies of providing specialty and high-tech medical aid to victims in emergency situations. Conclusion. Implementation of the developed concept will optimize the use of human, intellectual, material and financial resources to provide urgent trauma care for injured in emergencies

Relevance. In the setting of ongoing military conflict, an important task is to design organizational principles of providing healthcare to the population suffered due to combat actions, as well as primary reconstitution of the destroyed health system, including creation of disaster medicine service. Intention. To analyze activity of the Republican Centre of Lugansk emergency medical care and disaster medicine (Center) created from the emergency medical service (EMS) during the armed conflict in the south-east of Ukraine. Methods. The study was based on a multi-stage selection using continuous involvement and sampling. This study derived data from the official statistics. The object of research was organization of health care for the population under ongoing armed conflict; and the subject of investigation was Centre’s activity in the setting of complicated emergency. Results and Discussion. The data on EMS activity in Luhansk region (Ukraine) before the local military conflict in Donbass (2014-2015) and in the newly formed Luhansk People’s Republic (LPR) under complicated emergency allowed identification of gaps in the organization and operation of the emergency services due to absence of a single management center and common clinical protocols, as well as differences in staffing and underfunding of stations. After the Centre initiation, the proportion of people consented for hospitalization after health care at spot has increased 1.5 times and the frequency of futile calls decreased almost 4 times; the mortality rate in the presence of an ambulance team has fallen from 9.4 to 5.7 %; the quality of work has been ranked higher (reduced time of waiting for emergency teams, improved service quality). Conclusion. Within the first year of operation, the Centre has proved useful to convert EMS into a single structure in the setting of continuous military conflict.

Relevance. In case of artificial injures of eyes during armed conflicts, open traumas are quite common, especially with deficiency of cornea tissue, as well as cornea burns and ulcers complicated with descemetocele and punching, which demand urgent surgical interventions on the cornea, often with keratoplasty. Intention. To study opportunities of using keratoplasty for urgent ophthalmologic assistance in case of artificial injures of eyes. Methods. Object of research were 81 wounded man, injured and patients admitted to ophthalmologic clinics of St. Petersburg (Leningrad) during military conflicts (Syria, 1983; Afghanistan, 1984-1985; the Chechen Republic, 1994-1995), who underwent keratoplasty. Two keratoplasties in Afghanistan (Bagram, 1984) were performed in an operating room tent. Results and Discussion. If other organ systems or limbs were damaged, the keratoplasty was performed only after life threat elimination. If necessary, surgeries were performed on the auxiliary and other structures of eyes in addition to keratoplasty. In all cases of surgical processing with keratoplasty, both curative and optical results were good. Conclusion. Keratoplasty can be used much more widely at rendering urgent ophthalmologic assistance, if adequate stocks of corneal transplants (corneal banks) are available.

Relevance. Every year, up to 450 thousand victims with burns seek medical assistance; of them, more than 120 thousand receive treatment in specialized burn, trauma and surgical departments of hospitals. Up to 40 % of those with thermal injury are children; there is an increase of burns in children of younger age. Intention. To analyze patients with burns treated in the Krasnodar region within 6 years from 2010 to 2015. Methods. Statistical documents of Regional Clinical Hospital N 1 named after Prof. S.V. Ochapovsky (Krasnodar) were analyzed along with performance indicators of Russian burn departments / centers according to equirements of the Russian public organization «Association of combustiologists ‘World without burns’’’ [http://combustiolog.ru/]. Results and Discussion. Within 6 years (2010-2015), 19,121 patients with burns were treated in the Krasnodar region, including 9,516 (or 49.8 %) children. Every year, (3190 ± 170) those with thermal injury received medical care, including (1590 ± 80) children. Patients treated in the Region amounted to 0.71 % of the total number of victims with burns in Russia. With a high determination ratio (R2 = 0.96), polynomial trend shows growth in the number of victims with burns in the region. Generally, 11,551 operations for burns were performed in the Krasnodar region, and in the burn center - 10,299 (89.2 %). In general, proportions of patients treated at the burn center of the Krasnodar region and in specialized units (burn centers) of Russia were similar in terms of burn areas. There were no significant differences in mortality of both children and adults in the burn center of Krasnodar region vs Russia. Compared with the specialized departments (burn centers) of Russia, the burn center of Krasnodar region had significantly better efficiency of burn beds (average bed-day, their turnover and utilization). Conclusion. Results of the study will allow for the optimization of medical care for burn patients in the Krasnodar Region.

Relevance. Analysis of the literature showed a high detection rate of acid-related diseases and pathology of the musculoskeletal system in rescue workers; the relationship of osteopenic syndrome and deficiency of sex hormones, vitamin D has been proved. However, a process of reducing bone mineral in young rescue workers was not studied yet. Intention. To assess frequency of lower bone mineral density in chronic diseases of the stomach in rescuer workers of EMERCOM of Russia. Methods. 30 rescuer workers aged from 23 to 54 years (including 26 (87 %) persons under 40 years) were examined. In the structure of diseases, 25 (83 %) patients had acid-related diseases of the stomach. Results and Discussion. Decrease mineral density of bone tissue was detected in 12 (40 %) examined rescuers, including osteoporosis in 2 (6.7 %), osteopenic syndrome in 10 (33 %). Those with osteoporosis and osteopenic syndrome had concomitant gastroesophageal reflux disease, chronic gastritis and dyskinesia of the gallbladder. Conclusion. The established relationship between decreased bone mineral density and biochemical markers of bone remodeling (osteocalcin, pyrilinks D) necessitates bone remodeling control in young men with acid-related diseases.

Relevance. Management activities of the leading staff of the EMERCOM of Russia take place in difficult and emergency situations with increased responsibility for the result of the activity; therefore, decline in the functional reserves of the body and acceleration of aging processes can be potentially observed. Intention. To examine the impact of professional activity factors on the health status of the management team of EMERCOM of Russia, depending on age and length of service. Methods. A total of 331 managers of EMERCOM of Russia were examined. Clinical observation was used along with analysis of the results of an in-depth medical examination. Results and Discussion. The structure, the level and dynamics of morbidity by main groups of chronic diseases were studied in the management team of EMERCOM of Russia depending on profession, age and length of service. The high prevalence of chronic diseases was reported with effects of the age and length of service. The basic nosologies for relevant classes of chronic diseases were identified. Conclusion. The basic methodological approaches are suggested to assess the state of health and prevent diseases, as well as to preserve, strengthen and restore health in the management team of EMERCOM of Russia

Relevance. The extreme conditions of military operations pose a risk of acute or chronic health disorders or even death. The Russian Science Citation Index indexed 584 domestic scientific papers on various aspects of health status in servicemen within 10 years (2006-2015). A detailed analysis of health status in officers of the Armed Forces (AF) of Russia over a long period was not performed. Intention. To analyze health indicators and mortality in the Russian Armed Forces (AF) officers over 2003-2014. Methods. The object of the research were reports about the health of the personnel and activities of the medical service (Form 3/MED) in military units from different military districts and troops, with about 60 % of the total number of AF officers. The analysis of morbidity, dismissal and mortality in AF officers over 2003-2014 is provided by classes of diseases and causes of death (International statistical classification of diseases and related health problems, X revision (ICD-10)). Results and Discussion. Marked increase in the primary disease incidence was reported: annual incidence was (414.8 ± 20.4) %o. According to the annual follow-up, (120.5 ± 4.7) %o of officers required regular follow-up. The number of health-related dismissals reduced: (9.47 ±1.16) %o annually. Annual mortality rates significantly decreased to (1.29 ± 0.06) %o annually. As expected, compared with the civilian population of working age in Russia the officers mainly died due to external causes (XX class). Therefore, AF officers performed their activity under extreme conditions. General health of officers depended on the diseases of circulatory system (class IX), digestive system (class XI), injuries, poisoning and certain other consequences of external causes (class XIX), respiratory diseases (class X), nervous system (class VI) , the musculoskeletal system and connective tissue (class XIII). These 6 classes of diseases accounted for 79 % of total abnormal health indicators. Conclusion. Focusing on prevention of these diseases classes will improve health of the Russian AF officers.

Relevance. Degenerative-dystrophic diseases of the spine occupy a leading place in the structure of causes of chronic back pain in patients aged 25 to 55 years, i.e. the most able-bodied population. Due to a lack of noticeable effect from conservative therapy, a significant portion (37 %) of patients with herniated intervertebral disks are forced to resort to surgery, about 19 % of patients with degenerative spine lesions also need surgery. Intention. To assess outpatient rehabilitation results in EMERCOM employees with degenerative-dystrophic spine lesions complicated by intervertebral disc herniation, who underwent surgery Methods. Treatment results from 40 patients with degenerative-dystrophic spine diseases complicated with intervertebral disc herniation who underwent surgery between 2014 to 2016 were analyzed retrospectively using outpatient and follow-up charts from the Central polyclinic N 72, EMERCOM of Russia (Moscow). Results and Discussion. According to the study results, the neurological service of the Central polyclinic N 72, EMERCOM of Russia timely reveals patients with degenerative changes of intervertebral disks and refer them to neurosurgeons. Existing follow-up system provides their effective treatment, rehabilitation and appropriate employment, with 85 % of employees continuing their work in the EMERCOM of Russia after surgery. Conclusion. The existing follow-up system assures effective treatment, rehabilitation and adequate employment assistance for patients.

Relevance. It is very important to prevent mental disorders in future students of military universities since withdrawal rates due to mental disorders identified during the learning period are high (up to 14.8 %). Intention. To improve a psychoprevention model currently used for selecting candidates for enrollment in military universities. Methods. Based on dynamic and retrospective study of health in 571 military university students, the model of primary psychoprevention was developed for preliminary selection in the military commissariats and examination of military university applicants. Results and Discussion. The model provides a multi-axis assessment of the health status using four diagnostic axes: clinical, phenomenological, tiered, somatic, functional, psychosocial. Diagnostic axes correlate with the forces and resources available at the selected stages and combined into modules (multidimensional screening, integrated forecast of mental health and evaluation of psychosomatic comorbidity); the latter can be used as distinctive diagnostic systems, if necessary. Conclusion. The model requires no additional organizational or financial resources, while improving effectiveness of current psychoprevention system by more than 30 %.

Relevance. According to the previous studies, discirculatory encephalopathy in Chernobyl accident liquidators is observed more commonly than in the general population of Russia. Intention. To evaluate brain white matter in Chernobyl accident liquidators at the remote period. Methods. Main Group (MG) comprised 45 liquidators of the Chernobyl accident, Control Group (CG) - 49 patients of the same age and gender without a history of radiation-induced lesions. Discirculatory encephalopathy severity was similar in both groups. Assessments were performed using high-field MRI (Magnetom Verio tomography with 3T magnetic field). Results and Discussion. Morphological changes of the brain in MG were more pronounced than in CG. In particular, external compensatory hydrocephalus was visualized statistically more often in MG than in CG (84 vs 65 %, respectively; p < 0.05), mixed hydrocephaly - in 51 vs 16 %, respectively (p < 0.005). In 14.2 % of CG patients there was no expansion of cerebral fluid spaces or ventricular system. Lacunar infarction consequences represented by cysts in basal nuclei, surrounded by gliosis areas, were found in both groups. But in MG those changes were more frequent than in CG (p < 0.05). Conclusion. High-field MRI is the most relevant for discirculatory encephalopathy assessment and prognosis in Chernobyl accident liquidators at the remote period. It helps to adjust treatment and rehabilitation processes.

Relevance. In servicemen, performance degradation is observed during extreme activities with increased energy expenditures. It is necessary to establish a contribution of body armor to military labor characteristics. Intention. To evaluate the physical performance and energy expenditure of the military men when using body armor during submaximal exercises. Methods. 10 military men were examined - apparently healthy men aged (31 ± 2) years, mean height (176.1 ± 1.5) cm, body weight (73.2 ± 2.5) kg, body mass index (23.6 ± 0.5) kg/m2, wearing sports and casual uniforms and body armor of the second generation battle suit. Physical exercise was simulated by running on the treadmill T-2100 (General Electric, Germany). Continuous load was used with step-like power increase until refusal from exercise due to physical fatigue. Results and discussion. According to the study results, a body armour as part of the equipment is associated with reduced amount of work performed, as well as increased energy expenditures and load on the cardiovascular system in military personnel. The information value of blood lactate as one of the markers for modeling the dosed fatigue has been shown. It has been found that the weight of the body armor influences significantly not only duration of the training and combat tasks but also the functional state of the body. Conceptual approaches and promising areas to improve ergonomic, medical and technical characteristics of body armor were described, as well as their contribution to health maintenance and performance (combat capability) improvement when performing training and combat tasks in emergency situations. Conclusion. It is necessary to improve the ergonomic characteristics of the body armor, to reduce weight via novel protective materials, and, last but not least, to improve the physical fitness and endurance of the military personnel.

Relevance. The causative agent of epidemic typhus is R. prowazekii with body lice as its vectors. The presence of body lice on sick persons from risk groups (refugees, the homeless, etc.) can lead to epidemic spreding. For example, more than 5 million people died from this disease over 1914-1921. Intention - To assess R. prowazekii as a potential source of biological and social emergencies. Methods. Meta-analysis of publications on the epidemic typhus. Results and Discussion. Results of epidemiological research of typhus epidemic process are presented to facilitate decision making on prevention and mitigation of biologic and social emergencies. The proposed diagnostic criteria can be recommended for parasitologists and epidemiologists working in typhus areas. Individual approach to protection against biological adverse effects of bloodsucking by lice enables prevention of parasitic typhus via atermal (chemical) method for destructing their vectors as well as a total elimination of pediculosis. Conclusion. Given the current state of national healthcare system, timely diagnosis of the disease and destruction of vector as well as the containment of Rickettsia prowazekii strains are necessary and sufficient to prevent spreading of rickettsiosis prowazekii.

Relevance. The psychological impact of high terrorist threat refers to the number of powerful stressors related to an immediate threat to life, which can lead to a wide range of neuro-emotional, physiological, and clinical changes that persist over years. Intention. To assess peculiarities of basic metabolism and hormonal regulation disorders in women exposed to a high terrorist threat during puberty. Methods. Case histories and medical records of 280 women of childbearing age from various districts of the Dagestan Republic (Russia) were analyzed. 162 women lived in areas exposed to the threat of terrorism and occupation by terrorists in September 1999. Parameters of the endocrine and immune systems as well as biochemical homeostasis were comparative described in women suffered psychological trauma associated with life threat vs women not suffered such traumas. Results and Discussion. Significant weight contributions to the structure of gynecological diseases in areas subjected to illegal occupation by terrorist forces It were revealed for dysmenorrhea, premenstrual syndrome and hyperprolactinemia syndrome. Metabolic disorders in women survivors of trauma in adolescence manifested as increased glucose level and decreased high density lipoproteins. Reproductive dysfunctions in women suffered psychological trauma due to a high terrorist threat are associated with increased concentrations of cortisol, prolactin and decreased concentrations of luteinizing hormone and estradiol. A key mechanism of the reproductive pathology is proved to be dysregulation of the endocrine system. Conclusion. For reproductive health, it is necessary to conduct psycho-corrective activities in women suffering psychological trauma associated with life threat.