Abstract Relevance. Professional firefighters are engaged in one of the ten most dangerous jobs. Extreme conditions of activity contribute to excessive strain of the functional reserves in specialists and can result in health disorders or even death.

Intention. To analyze the morbidity with job absenteeism in employees of the State Fire Service (SFS) of the EMERCOM of Russia over 20 years from 1996 to 2015.

Methods. Annual morbidity with job absenteeism was studied using sick notes in 108,000 firefighters who accounted for no less than 80 % of all employees with special military ranks at the SFS of Emercom of Russia. Unification of accounting and analysis of morbidity was achieved using the classification of diseases, injuries and causes of death of the International Statistical Classification of Diseases and Related Health Problems, the 10th revision (ICD-10). Levels of morbidity with job absenteeism were calculated per 1000 employees (‰). Health indicators over time were assessed by the method of analysis of dynamic series, with a second-order polynomial trend.

Results and Discussion. Average annual levels of job absenteeism cases among employees of SFS of the EMERCOM of Russia in 1996–2015 were (525.4 ± 38.7) ‰, job absenteeism days – (6520.6 ± 460.4) ‰, day / case ratio – (12.5 ± 38.7) days.  Polynomial trends with high coefficients of determination showed a decrease. Compared to 1996, cases of job absenteeism in 2015 decreased by 363.5 ‰ (or 49.2%), days of job absenteeism – by 4082 ‰ (or 46.3 %). Strong correlations were revealed between the number of cases of job absenteeism and professional workload (i.e. the number of fires, r = 0.90, p < 0.001) and the macroeconomic situation in the country (i.e. gross domestic product, r = –0.95, p < 0.001). The leading classes in the structure of cases of job absenteeism were Class X (46.9 %), XIX (12.5 %), other (10 %), XIII (9.2 %), XI (4.9 %), and in the structure of days of job absenteeism – Class X (34.2 %), XIX (20.1 %), other classes (11.3 %), XIII (10.3 %) and XI (6.1 %). The levels of morbidity by regions of Russia are presented. The epidemiological significance of diseases and injuries by ICD10 classes is determined. The first most significant ICD-10 class for morbidity with job absenteeism was Class X (respiratory diseases), then Class XIX (trauma, poisoning and some other consequences of external causes), other classes of diseases, Class XIII (diseases of the musculoskeletal system and connective tissue), and Class XI (diseases of the digestive system).

Relevance. Extreme conditions of military labor contribute to the risks of morbidity and even death in officers of the Russian Armed Forces.

Intention. To study the role of major diseases in the formation of health abnormalities in officers of the Russian Armed Forces in 2003–2016.

Methodology. The morbidity was studied in officers who served in 2003–2016. 60 % of annual reports on the health of personnel and the activities of the medical service (Form 3/MED) were analyzed in military units. The standard indicators were calculated for the classes of diseases by International Statistical Classification of Diseases and Related Health Problems, 10th revision (ICD-10).

Results  and Discussion. The average annual level of the overall morbidity in officers of the Russian Armed Forces in 2003– 2016 was (1152.0 ± 63.9) ‰, primary morbidity (448.2 ± 29.7) ‰, the need for follow-up (124.0 ± 6.1) ‰, hospitalization (181.3 ± 9.5) ‰, labor loss in days (4334 ± 167) ‰, dismissal for health reasons (8.81 ± 1.10) ‰, death rate (128.6 ± 5.4) deaths per 100 thousand officers per year. Polynomial trends with low coefficients of determination showed tendencies to increased overall and primary morbidity, hospitalization, days of labor losses and reduced follow-up, dismissal and mortality. Leading diseases (groups of classes according to ICD-10) were determined as those accounted for more than 60 % of the share of listed morbidity parameters and resulted in their growth. The greatest military-epidemiological significance for the officers was attributed to acute upper respiratory tract respiratory infections (J00–J06 by ICD10); diseases associated with high blood pressure (I10–I15); ischemic heart disease (I20–I25); diseases of the esophagus, stomach and duodenum (K20– K31); trauma of different locations (S00–T98) and deforming dorsopathies (M4–M43).

Conclusion. Prevention of these diseases will improve the health of officers.

Relevance. The history of the medical service of the Ministry of Internal Affairs (MIA) of Russia is presented in domestic publications unsystematically.

Intention. To present the stages of development of the medical service of the MIA of Russia. Methods. Domestic publications on the development of the medical service of the MIA were studied based on the Russian National Library and the Russian Scientific Citation Index of the Scientific Electronic Library.

Results and discussion. To eliminate medical consequences of the mass epidemics and according to the Edict of the Empress Catherine II dated August 12, 1775, the Moscow Chief Policeman was instructed to «establish a special hospital and almshouse under the authority of the local police.» The opening ceremony of the Catherine’s Hospital took place on June 19, 1776. By 1810–1811, the structure of the main ministries and departments was basically formed in the Russian Empire. The central agency for managing medical and pharmacological activities was the Medical Department of the Ministry of Internal Affairs and its Medical Council, which carried out medical and sanitary control. Locally, there were administrations with subordinate county and city doctors as part of police institutions. Much attention was paid to the creation and development of hospitals personally by the Minister of Internal Affairs Count V.P. Kochubey. By 1855, there were 533 hospitals in Russia with 18,866 beds, although the status of the clinics was considered unsatisfactory due to a lack of funds, medicines and medical personnel. After October 1917 the medical service of the police (as rear units of the army) was carried out by agencies of the Chief Sanitary Directorate of the Workers ‘and Peasants’ Red Army. By order of the Chief of the Main Directorate of the Militia of the People’s Commissariat of Internal Affairs of the RSFSR No. 314 / s of October 12, 1921, «reception rooms» were organized within the departments to provide medical assistance to personnel and to carry out sanitary and preventive measures. Later in 2007, it was the day of October 12 that was declared the Day of Medical Service of the Ministry of Internal Affairs of Russia. In 1992, on the basis of the Medical Directorate of the Ministry of Internal Affairs of the USSR, the Medical Directorate of the Ministry of Internal Affairs of Russia was created, and since 2011 – the Medical Support Department of the Department for Material-Technical and Medical Support of the Ministry of Internal Affairs of Russia. In the medical institutions of the Ministry of Internal Affairs of Russia, about 2.3 million people are serviced, 28.9 % of them are employees of internal affairs agencies, 7.8 % – servicemen and employees of the Federal Service of National Guard troops, 5.4 % – employees of the Federal Service for the Execution of Sentences, 4 % – employees of the State Fire Service of the Ministry of Emergency Situations of Russia. Annually more than 186 thousand patients receive medical care in departmental hospitals, more than 13 million medical visits are conducted in outpatient departments.

Сonclusion. Positive trends in the development of departmental health in recent years make it possible to predict stable health indicators in employees of the Ministry of Internal Affairs of Russia in the near future.

Relevance. Mortality and unsatisfactory results of polytrauma treatment are still high since no effective system of organizing specialized medical care for this category exists.

Intention. To study effectiveness of organizing specialized medical care for polytrauma in trauma centers in St. Petersburg.

Methods. Тen trauma centers provide specialized medical care to polytrauma patients in St. Petersburg, including six Level I and four Level II centers. Level I trauma centers have central and Level II trauma centers – peripheral location (in satellite towns). Annually, they treat and examine about 3000 patients. Most polytraumas result from traffic accidents. Polytrauma treatment at trauma centers of St. Petersburg was analyzed. Annual reports of trauma centers were studied, and surveys of their medical personnel were conducted with a selective study of case records of polytrauma patients. The following parameters were considered: time to trauma center admission, ambulance profile, types and volumes of specialized medical care provided at a specific trauma center. Death and complication rates along with total duration of inpatient treatment were assessed vs health care at the prehospital stage.

Results and Discussion. Presently, an advanced effective system of specialized medical assistance to polytrauma patients has been created in St. Petersburg. The whole arsenal of diagnostic and treatment facilities along with healthcare professionals of multidisciplinary hospitals helps to decrease mortality and complications rates. Mortality rates in patients with polytrauma in St. Petersburg are about 12 % at Level I trauma centers and about 19 % at Level II trauma centers, which is significantly lower than in other cities of Russia and slightly higher than in Moscow. Ambulance resuscitation teams and their adequate interventions at the prehospital stage play an important role. This article discusses the problems of trauma center underfunding, wider use of modern high-tech minimally invasive medical and diagnostic technologies (traumatology, endoscopy, endovascular, endovideosurgical ones), polytrauma monitoring, improving medical care at the prehospital stage, creating a rehabilitation system etc.

Conclusion. Based on the analysis of literature and own research, the main principles of polytrauma treatment were established, the need for connecting all the municipal trauma centers to the cloud server for statistical purposes was determined thus enabling proper resource allocation and timely treatment of patients with polytrauma.

Relevance. To assess the state of combat readiness of personnel of the EMERCOM of Russia it is extremely important to regularly monitor their health status. Since health disorders can be associated with various causes – morbidity, traumatism, disability, death, – there is a need for a comprehensive assessment of the state of health.

Intention. Develop an integral indicator of health disorders in personnel of the EMERCOM of Russia for regular monitoring, taking into account the likely risks associated with the specifics of Russia subjects and activities of the EMERCOM subdivisions.

Methods. Information on the health status of the personnel of the EMERCOM units (the Federal Fire Service (FFS), the State Inspectorate for Small Boats, rescue military detachments and search and rescue units) was analyzed. Using the methods of statistical analysis, frequency distribution analysis, data equalization methods and mathematical modeling, an integral index of health disorders in the personnel of the EMERCOM of Russia was proposed.

Results and Discussion. Parameters of the integral index of health disorders of personnel in the Emercom divisions have been estimated. Based on the example of FPS EMERCOM Russia, the proposed indicator for subjects of Russia and EMERCOM services was tested. An average risk of health impairment for FFS personnel was 18  10^–3 per year, an optimal risk  was less than 12  10^–3, allowable– 12–24  10^–3 and an unacceptable risk was more than 24  10^–3. The proposed indicator  aloow easy comparisons of health disorders in Emercom personnel between Russia subjects and various Emercom units.

Conclusion. The proposed integral index for health disorders in Emercom personnel can be used for a differentiated prevention of health disorders in Emercom personnel and assessment of combat readiness of the EMERCOM divisions.

Relevance. The introduction of special sound installations into security systems necessitates a medical and biological assessment of the impact of sound signals.

Intention. The purpose is to evaluate the safety of a special sound signal (high-intensity mid-frequency noise changing with a frequency of 7 Hz tonality).

Methods. In the laboratory, experiments were conducted with the participation of volunteers at sound levels of 94, 110 dBA and 20 minutes exposure (including personal protection equipment (PPE) for the hearing organ).

Results and discussion. The impact on a human of a special sound signal with a sound level of 94 dBA for 20 minutes does not have a significant effect on the condition of the hearing organ and does not cause a deterioration in overall well-being. A sound level of 110 dBA is established to be subjectively tolerable. However, after this exposure for 20 minutes, the overall wellbeing of volunteers worsened, accompanied by a subsequent sleep disturbance, which persisted a day after the exposure. The increase in the thresholds of sound perception at frequencies of 3000, 4000 and 6000 Hz reached 50–55 dB with a delay of their recovery up to 5 days. It was established autoexperimentally that the sound level of 126 dBA is voluntarily intolerable and forces a person to leave the affected area or to close his ears with his hands. Effective means of individual hearing protection preclude deterioration of overall health when exposed to a sound level of 110 dBA for at least 40 minutes.

Сonclusion. Based on the results of the research, the safe time of exposure to the special sound signal of up to 120 dBA is established, as well as characteristics of individual hearing protection devices providing an effective level of protection.

Relevance. Human survival in emergencies is often accompanied by the formation of post-traumatic stress disorder (PTSD) as a result of acute mental trauma.

Intention. To study behavioral signs of experimental posttraumatic stress disorder (PTSD) and effects of ghrelin and its antagonist in the experiments on rats exposed to an acute psychoemotional stress.

Methods. PTSD was modelled by placing a group of rats to a tiger python who seized and swallowed one of them, others experienced unescapable stress. Then ghrelin (20 µg in 20 µl) or its antagonist [D-Lys3]-GHRP-6 (10 µg in 20 µl) were administered intranasally daily for 7 days. On 7th day after stress and administration of drugs, the behavior of rats was studied using open field, elevated plus maze and intruder-resident tests.

Results and Discussion. Ghrelin antagonist [D-Lys3]-GHRP-6 demonstrated mainly anxiolytic effect (open field and intruder-resident tests) but increased behavior signs of python-induced stress in the elevated plus maze. At the same time, ghrelin did not alter PTSD signs (elevated plus maze) or exerted sedative (suppressive) action (open field and intruder-resident tests).

Conclusion. Therefore, the data support the involvement of ghrelin system in controlling motor and emotional behavior during PTSD development.

Relevance. In emergency situations, cases of crush syndrome with extensive ischemic damage of soft tissues often occur due to prolonged compression from damaged buildings, structures, rocks, damaged transport, mines, etc. Unmet medical need for providing care to victims with severe compression trauma determines the importance of research on the development of new pathogenetically justified treatments of postischemic disorders. The positive role of multipotent mesenchymal stromal cells has been proved in the process of posttraumatic regeneration of skeletal muscles.

Intention. To reveal morphological features of skeletal muscles in severe compression trauma after the introduction of multipotent mesenchymal stromal cells in the hyaluronic acid gel into the damaged tissues.

Methods. The object of the study was an experimental model of a continuous (7-hour) static compression (squeezing force 10–12 kg/cm²) of the soft tissues of the hip by metal vices in sexually mature white outbred male rats with body mass of 300– 340 g. Three hours after the vices removal, rats in the experimental group received a single fan-shaped injection of suspended cultured multipotent mesenchymal stromal cells of human adipose tissue (1.5 • 10⁶ cells) in 0.5 ml of 1.75 % hyaluronic gel solution (Aestetic Dermal S.L., Spain) intramuscularly into the compression region. Control animals under similar conditions were injected with an 0.9 % solution of sodium chloride. For reference parameters, biomaterial from intact rats was used. In 7, 14 and 28 days after decompression by the light-optical method, the histological sections of the biomaterial from the compression region were examined.

Results and Discussion. It has been established that implantation of cultured multipotent mesenchymal stromal cells in soft tissues damaged by mechanical compression contributes to an early reduction of necrobiotic changes in the zone of muscle compression, accelerated recovery of microcirculation and reparative regeneration of muscle fibers with an active new growth of muscle tissue. Seven, 14 and 28 days after exposure, the relative area of muscle fibers was 23 35.6 % (p<0.05) higher than in control animals and achieved 62.4–85.6 %.

Conclusion. It has been suggested that cultured multipotent mesenchymal stromal cells in a cellular carrier locally transplanted into the lesion region can be considered as a fruitful way to create effective concentrations of interstitial growth factors and cytokines that regulate severity of the inflammatory reaction, angiogenesis and reparative processes resulted from massive mechanical compression of soft tissues.

Relevance. The relevance of this study is determined primarily by the fact that the assessment of managerial competence is an important task of the human resources management system, especially in the activities of specialists in the extreme profile, which include the professional activities of the heads of the units of State small vessels inspectorate (SSVI) of EMERCOM of Russia. This, in turn, determines the requirement for individual specialists to identify individual psychological characteristics of the personality that affect the effective performance of professional activities.

Intention. To compile a generalized psychological description of division heads of the SSVI EMERCOM of Russia on the basis of the identified individual psychological characteristics forming managerial competence.

Methods. The object of the research were the heads of divisions of the SSVI EMERCOM of Russia for federal subjects of Russia (72 persons). To determine the individual psychological characteristics forming the managerial competence of the heads of the divisions of the SSVI EMERCOM of Russia, the content and specificity of their professional activity was studied, a psychodiagnostic survey was carried out, and the results were mathematically and statistically processed. As an external criterion for professional effectiveness, an external expert evaluation was obtained for each examined specialist.

Results and discussion. Individual psychological characteristics of managerial competence of the SSVI division heads were obtained for the first time. In particular, differences in characteristics between groups of more vs less effective heads of the SSVI divisions were determined.

Conclusion. Emphasized individual psychological characteristics along with compiled generalized psychological characteristics of the SSVI division heads can determine psychological aspects of appointing higher managers within the SSVI Emercom of Russia during attestation.

Relevance. The question of the appropriateness of using data obtained through questionnaires of subjective assessment of the psychological and somatic condition for the purpose of diagnosing the functional state of EMERCOM of Russia experts is the subject of many years of discussions among psychologists working with this contingent.

Intention. To study the possibility of using the data of the Giessen questionnaire of psychosomatic complaints and the SUN test with the purpose of assessing the functional state of EMERCOM specialists in the course of medical and psychological rehabilitation.

Methods. 111 specialists of the EMERCOM units were examined within the framework of medical and psychological rehabilitation based on results of monitoring or postexpedition surveys. A detailed psycho-physiological exam was conducted, including a psychological interview, a battery of psychophysiological techniques using Psychophysiologist and Reakor complexes, blood pressure measurements, Martine’s test and subjective state assessment methods (well-being – activity – mood and Giessen questionnaire of psychosomatic complaints). Functional indices of objective and subjective methods as well as correlations between them were studied before and after rehabilitation measures.

Results and Discussion. There are statistically significant differences in the results of the surveys before and after rehabilitation, as well as statistically significant correlations between the indicators of subjective assessment of the condition and objective data on psychophysiological follow-up and the effectiveness of rehabilitation.

Conclusion. Statistically significant correlations between the parameters of subjective questionnaires and the objective data on the functional state of the nervous and cardiovascular systems, as well as the adaptive abilities of the organism confirm feasibility and effectiveness of prenosological assessment of the functional state of EMERCOM professionals during medical and psychological rehabilitation if complex diagnostic equipment is lacking.

Relevance. A concept of the cumulative state of patients is introduced to obtain sufficient samples and reliably assess the clinical situation, establish significant deviations and take clinical measures.

Intention. To suggest a diagnostic and prognostic approach based on statistically processed parameters from severely burnt patients.

Methodology. The data from 1300 patients treated in 1980–2010 at the clinic of thermal lesions were assessed. The patients were aged (48 ± 12) years and had superficial burns of more than 30 % and deep burns of more than 10 % of the body surface. For data processing, statistical methods including assessment of the distribution of random variables as well as histograms were used.

Results and Discussion. Diagnostic parameters are random, thus precluding from unambiguous conclusions on the condition of patients, and should be investigated statistically. Preliminary step of such research is to assess the statistical distribution functions for parameter values. Statistical correlations between parameters can be found only if they are distributed similarly. Studies have shown that magnitudes of most diagnostic parameters are distributed normally. Those deviating from the normal distribution can be explored as normally distributed for large samples.

Conclusion. Patients’ condition is a dynamic process and variations of diagnostic parameters are random, i.e. have a noise bias. Therefore, reliable predictions in the course of treatment are impossible. Methods of mathematical statistics help to resolve this problem. Statistical analysis in the treatment of burned is particularly topical and should become a working tool in the practice of diagnosis and prognosis of patients’ condition.