Relevance. Profession of firefighters is considered to refer to extreme activities, which have high risks of health disorders, injuries and even death.

Intention – to analyze occupational traumatism and deaths from injuries in Russian State Fire Service (SFS) (1996–2004) and the Federal Fire Service of EMERCOM of Russia (2005–2015) employees for 20 years and to compare these data with the indicators of Russian workers.

Methods. Information on occupational traumas and deaths of employees and response personnel of Russian SFS was gathered. The annual number of examined firefighters of special military ranks (officer, warrant officer, sergeant, common soldier) was (108.8 ± 6.2) thousand people, which was not less than 80 % of personnel of Russian SFS. The levels of occupational injuries, deaths from occupational injuries of Russian workers, mortality in the XIX Chapter of the International Statistical Classification of Diseases and Health Problems, 10th edition (ICD-10) of men of working age in Russia were received from the official website of the Federal Agency for Statistics. Database «FDB «Fires» was used for the distribution of fires in Russia over time periods. The dynamics of indicators of health disorders of firefighters and of fire distribution was evaluated by the method of time series analysis, which used a polynomial trend of the 2nd order.

Results and Discussion. The average annual level of occupational traumatism in 20 years (1996–2015) in Russian SFS staff amounted to (3.795 ± 0.390)‰, in response staff for 1999–2015 – (5.295 ± 0.644)‰. The level of occupational traumatism among Russian workers during these periods was (3.410 ± 0.351) and (3.000 ± 0.318)‰ respectively, which is significantly less than that of the response personnel (p < 0.05). A positive statistically significant relationship between the number of injuries and combat performances (r = 0.51; p < 0.05), the number of injuries and accident rate in the staff of Russian SFS with the complexity of fire-fighting tasks and number of use of personal respiratory protection (r = 0.53 and r = 0.46, respectively, p < 0.05). The cyclical nature of risks of traumatism in response staff of Russian SFS, depending on hours of the day, days of the week and months of the year, due to the nature of combat performance and other professional factors was found. This phenomenon requires additional research. The mortality rate of SFS staff from occupational injuries in 1996–2015 was (0.125 ± 0.011)‰, response personnel – (0.149 ± 0.014)‰. The mortality rate of Russian workers was statistically significantly less (0.116 ± 0.007)‰ compared to the response personnel (p < 0.05). There are decreases in occupational traumatism and deaths from occupational injuries in SFS staff and Russian workers.

Conclusion. In general, level of occupational traumatism and mortality from occupational injuries in employees and response personnel of the Russian SFS can be comparable with level revealed among the Russian workers. It indicates, on the one hand, the effective organizational and technological measures for the prevention of occupational injuries and the death of firefighters, and, on the other hand, high level of occupational traumatism of the Russian workers.

Relevance. The relevance of this study is determined by the need to correct hyperammonemia in patients with diffuse liver diseases at the pre-cirrhotic stage, since elevated levels of ammonia in the serum have toxic effects on the central nervous system, with the development of hepatic encephalopathy.

Intention. To evaluate current medication options for correction of hyperammonemia in chronic non-alcoholic steatohepatitis in the liquidators of the consequences of the accident at the Chernobyl nuclear power plant (NPP) and personnel of the Federal Fire Service (FFS) of the Emercom of Russia.

Methodology. 34 liquidators of consequences of the accident at the Chernobyl NPP nuclear power plant and 38 employees of the FFS of the Emercom of Russia underwent clinical and laboratory studies, including ammonia levels in blood plasma by enzyme method, evaluation of microbiota disorders, and liver fibrosis grade before and after treatment with L-ornithine-Laspartate (LOLA), as well as a combination of lactulose and a course of rifaximin.

Results and Discussion. After correction of hyperammonemia in patients with chronic non-alcoholic steatohepatitis – the liquidators of the consequences of the Chernobyl accident and personnel of the FFS of the Emercom of Russia, there was a decrease in the clinical manifestations of asthenovegetative and dyspeptic syndromes; the incidence of cytolytic and cholestatic syndromes. Besides, intestinal microbiota disorder decreased, as well as fibrotic changes in the liver, and the severity of intrahepatic hemodynamics disorder. In previous studies, the correction of hyperammonemia was mainly carried out with LOLA or lactulose.

Conclusion. All liquidators of the consequences of the Chernobyl accident and employees of the FFS of the Emercom of Russia with chronic non-alcoholic steatohepatitis and hyperammonemia should undergo its correction. LOLA is most effective in case of non-cirrhotic portal hypertension and the development of minimal hepatic encephalopathy, and a combination of rifaximin and lactulose is most effective if the intestinal dysbiosis prevails.

Relevance. Pelvic injuries are the most dangerous and complex in treatment injuries of the skeletal system with mortality rates up to 15–18 % and up to 65 % in hemodynamically unstable victims. Continuing massive pelvic hemorrhage is the main cause of unstable hemodynamics in victims with severe pelvic injuries and requires surgical hemostasis, including endovascular embolization.

Intention. To evaluate the effectiveness of diagnostic pelvic angiography (AG) and embolization as a method of surgical hemostasis in patients with polytrauma and pelvic injuries.

Method. We analyzed the results of treatment of 14 patients with polytrauma and mechanical injuries of the pelvic ring, who underwent pelvic angiography (AG) at the level I trauma center (St. Petersburg, 2013–2017). The effectiveness of surgical (endovascular) hemostasis was assessed based on the systolic blood pressure (SBP) over time, the basic composition of arterial blood (pH and lactate, buffer base deficiency (BE)), duration and volume of hemotransfusions.

Result and their analysis. There are statistically significant differences between the average volumes of replacement hemotransfusion before and after AG with endovascular embolization of damaged arteries, as well as between the mean lactate levels and the deficit of BE in the arterial blood. The overall mortality rate was 6 (42.8 %) cases. Three victims (21.4 %) died during the first 24 hours and 3 (21.4 %) – during the first two weeks after the trauma. The causes of death were irreversible blood loss – 3 (21.4 %), generalized infection – 1 (7.1 %), multi-organ failure – 2 (14.2 %). The average length of treatment was (52.5 ± 24.9) days.

Conclusion. Angiography gives little information in patients with low SBP, so direct surgical hemostasis like pelvic packing is preferrable and may be used as a “bridge” to AG with temporary stabilization of hemodynamics.

Relevance. The relevance of the topic is due to the increase in the number of starving children in the modern world and the increase in financial costs associated with the consequences of long-term starvation of children and adolescents.

Intention. To systematize ideas about the consequences of starvation in children and adolescents via reintroducing the materials on the Leningrad siege into scientific circulation.

Method. The available domestic and foreign sources of scientific literature and data of archival documents were studied.

Result and their analysis. Information on the immediate consequences of prolonged famine in children and adolescents is presented. The results of scientific works of scientists, studying the consequences of prolonged starvation of Russian children in the early XX century, during the years of Leningrad siege and after the end of the Great Patriotic War.  Long-term starvation of children and adolescents causes profound changes in various organs and systems, having different effects on the physical status of children of different sex and age, largely predetermines the poor health in the subsequent years of life.

Conclusion. The presented information is important for science and practice, since the occurrence of emergency situations in the modern world can be accompanied by prolonged famine or malnutrition of children.

Relevance. The probability of emergency situations in the Barents region determines the need of improvement of forces and means of rendering first and emergency medical care to victims. In September 2017 the large-scale international exercise of rescue services of Russia, Norway, Sweden, and Finland under the code name “Barents-Rescue 2017” was carried out in the Republic of Karelia. The exercise worked oved rendering first-aid and emergency medical care to victims of emergency situations.

Intention. To summarize experience in preparation, rendering and result assessment of first-aid and emergency medical care to victims of emergency situations in the framework of the international exercises.

Methods. Medical document analysis (hospital records, medical triage records, expert assessment records), statistical analysis of groups using Student’s t-test. The exercise involved 76 victims with injuries of various severity levels, among them 30 were of minor severity, 19 were of medium severity and 27 were of heavy severity. They received first-aid and emergency medical care by 42 rescuers and 67 health workers (doctors, paramedics, nurses) of rescue services of Russia, Norway, Sweden, and Finland. Results assessment was made on the basis of the developed hospital records, medical triage records and expert assessment records and also statistical analysis methods.

Result and their analysis. The average expert assessment of a first-aid rendered by rescuers was sufficiently high and was equal to 4.6 ± 0.1 on a 5-score rating system, where 5 points means providing full assistance in accordance with the established standards of its provision. A qualitative medical triage was provided competently, the ordering of evacuation was right, life-threatening damages and injuries were properly defined. At the stage of medical evacuation all the victims were provided with full assistance, there were no divergence of diagnoses, some differences from final diagnose were permissible at the stage of medical evacuation and had no effect on victim’s condition. In addition, a part of the victims in the hospital had medical cards, where was information about the diagnoses and the measures taken. These medical documents were also analyzed in terms of the timeliness and quality of the provision of specialized medical care to injured people in the hospital.

Conclusion. The results of expert assessment during the international exercise of rescue services of Barents Rescue 2017 showed that the quality of first-aid, medical triage and emergency medical care during the evacuation and also in the hospital is high enough, but there were some remarks too. Suggestions and comments were addressed to the Exercise organizing committee to improve the engagement during first-aid and medical care to victim of the emergency and they were included in the final report on the exercise.

Relevance. Persistent profuse external hemorrhage is known to be one of the main causes of death in combat casualties.

Intention. To evaluate experimentally the effectiveness of new chitosan-based topical hemostatic agents (THA) in various models of profuse external arterial hemorrhage.

Method. New hemostatic chitosan-based agents of Hemohit type in various pharmaceutical dosage forms (Hemohit powder, 20 g per package and Hemohit-applicator [fine chitosan powder Hemohit-A or chitosan granules Hemohit-AG 6 g in the syringe-applicator]) were assessed for effectiveness in the model of profuse external arterial hemorrhage (bevelled laceration of the femoral artery) in 10 large laboratory animals (pigs). Evaluation of the THA effectiveness was performed according to the following parameters: primary hemostasis – stopping of bleeding immediately after application of the 1st THA package and application of a pressure bandage; secondary haemostasis – stopping bleeding immediately after applying the 2nd THA package and applying a pressure bandage, if the 1st THA package is ineffective; final hemostasis – no bleeding within 3 hours of follow-up; absence / resumption of bleeding after the march test; total amount of blood loss during the experiment; survival.

Result and their analysis. It was experimentally found that in the case of external profuse arterial hemorrhage the powder and the syringe-applicator provided permanent hemostasis and 100 % animal survival. In two cases out of four, a second package of Hemohit powder was required for the final stop of bleeding. The bleeding stopped due to the formation of an edge thrombus in the area of the vascular wall defect.

Conclusion. Hemohit THA can effectively stop arterial bleeding. The effectiveness of applicator with local hemostats can be assessed in the proposed experimental model with a deep narrow wound canal and femoral artery damage.

Relevance. Depleted uranium (DU) is actively used in many industries. The problems of the safety of personnel employed at industrial facilities of this kind continue to remain relevant. Experimental studies have shown the toxicity of uranium compounds, especially its soluble forms.

Intention.  To identify immunological disorders developing after chronic exposure to low-dose depleted uranium.

Methods. The study involved 30 outbred rats and 60 mice CBA. Uranyl acetate dehydrate was used as a toxicant and administered intragastrically for 120 days. The relative number of T-lymphocytes, apoptotic and necrotic cells, the production of TNF-α, IL-1, -4, -6-β, the level of circulating immune complexes, the phagocytic activity of neutrophils, delayed-type hypersensitivity reactions, and production of immunoglobulins were assessed.

Results and Discussion.  According to the tests on rats, phagocytic-metabolic activity of neutrophils as well as TNF-α production increased, CD4+/CD8+ ratio decreased, and the early stage apoptosis of mononuclear cells was activated after chronic exposure to uranium salts. Most detected changes were dose-dependent. In experiments on mice it was shown that uranyl acetate dehydrate at a dose of 5 mg/kg had no effect on the functional activity of immunocytes, while the index of the delayed-type hypersensitivity reaction and IgG titers increased in animals which were administered DU at a dose of 10 mg/kg.

Conclusion. The results can be used to provide specialized medical care after chronic exposure to depleted uranium.

Relevance. Thermal decomposition of various polymeric materials occur in emergency situations associated with fires, with pulmonotoxicants releasing in the environment. During pyrolysis of polytetrafluoroethylene (Teflon), a highly toxic perfluoroisobutylene is produced.

Intention. To create an experimental animal model of toxic pulmonary edema due to products of thermal decomposition of polytetrafluoroethylene.

Methodology. Polytetrafluoroethylene underwent pyrolysys at 440–750 0С during 6 minutes. Toxic pulmonary edema was modeled on rats via inhalation of pyrolysis products of polytetrafluoroethylene. An amount of polytetrafluoroethylene burned under these conditions with resulting death of 50 % of rats during 1 day was (2.68 ± 0.60) g. The toxic pulmonary edema diagnosis was confirmed histologically and by lung/body ratio.

Results. In the pyrolysis products of polytetrafluoroethylene, highly toxic perfluoroisobutylene was found via gas chromatography with mass spectrometric detection, with relative content of 85.9 %. Such an exposure during 15 min increased (p = 0.01) lung/body ratio in laboratory animals in 3 hours. The toxic pulmonary edema diagnosis was confirmed histologically  (signs of alveolar edema). Animals started to die 7 hours after the pyrolysis products inhalation.

Conclusion. In the study on rats, toxic pulmonary edema was modeled via inhalation of pyrolysis products of polytetrafluoroethylene. This model can be used for searching etiotropic and pathogenetic therapy for poisoning with pulmonotoxicants.

Relevance. Liquidators of the consequences of radiation accidents have an increase in neuropsychiatric diseases. However, the structural and functional rearrangement of brain neurons under prolonged low radiation exposure remains virtually unexplored, which makes it difficult to assess the pathogenesis of these diseases.

Intention. To study morphological correlates of prolonged low radiation effects on brain neurons in the model of radiobiological experiment.

Method. 270 white outbred male rats aged 4 months were exposed to radiation-quanta of 60Co in equal portions in total doses of 10; 20; 50 and 100 cGy with a dose rate of 0.5 Gy/h over 5 days. Age control consisted of animals exposed to false radiation. Animal studies complied with GLP standards. Brain fragments were taken after 1 day, 6, 12, 18 and 24 months after irradiation. After a standard histological treatment, changes in the tinctorial properties of neurons, their morphometric parameters, total protein and nucleic acids were evaluated.

Results and their analysis. At the end of the observation period, the number of normochromic neurons decreased and the number of hyper and hypochromic cells increased, as well as their destructive forms. The neuro-cellular index decreased over time suggesting the death of some neurons, but without a statistically significant decrease in their number per area. In the post-irradiation period there were observed phase changes in the size of the cytoplasm, nucleus and nucleolus of neurons, as well as the content of protein and nucleic acids (RNA in the cytoplasm and nucleoli, DNA in the nuclei), more pronounced in irradiated animals and sometimes different from those observed in age control animals. As a result, a number of neuromorphological parameters in some periods of observation were not consistent with those in control animals, with a certain instability in the structural and functional organization of neurons.

Conclusion. Prolonged low-dose ionizing radiation does not cause significant organic changes in the brain. However, increased radiation exposure or other concomitant adverse factors can be associated with further instability of the structural and functional organization of neurons and serve as a material substrate for a number of deviations in the central nervous system.

Relevance. Despite the decrease in the absolute indicators of emergencies, accidents and catastrophes, and the reduction of related injuries in Russia, there is still a high level of mortality and injuries associated with the impact of external causes, surpassing similar indicators in the leading countries of the world. Therefore, research to optimize the provision of first aid and emergency medical care to the injured is needed.

Intention. To conduct a content analysis of domestic articles within the branch of knowledge “Disaster Medicine. Service of Disaster Medicine” and to reveal their scientometric indicators.

Methodology. The object of research was an electronic database of domestic publications (scientific articles, reviews and brief reports) indexed in the Russian Scientific Citation Index in 2005–2017.

Results and Discussion. During the electronic search, 2431 publications on the disaster medicine were found. The polynomial trend with a high coefficient of determination (R2 = 0.90) showed an increase in indicators. Over the research period, the average annual number of publications was (186 ± 23) articles. The general provisions of the disaster medicine were covered in 10.1 % , tasks and organization of the service of disaster medicine – in 5.8 %. forecasting and modeling of health consequences in emergencies – in 16.6 %, organization of health care – in 25.3 %, medical care and treatment of injured – in 13.5 %, medical control, examination and rehabilitation of rescuers – in 4.1 % , training of specialists in disaster medicine – in 9.4 %, biological problems – in 5.3%, psychiatric and psychological aspects – in 9.9 % of articles. The average weighted impact-factor of the journals in which the articles were published is 0.302, the average number of articles per 1 co-author was 0.40, the average number of citations per article is 1.54, for 1 co-author 0.55, the number articles quoted at least once, 43.8 %, the number of self-citations, 19.2 %, the Hirsch index was 19. The median of the chronology of citations was 4.5 years. Scientometric analysis of articles on leading authors, journals and organizations was conducted.

Conclusion. The performed analysis helps to optimize scientific research on disaster medicine. The electronic database of the Scientific Electronic Library provides great information opportunities, for example, on May 12, 2018, 70.5 % of articles within the created collection of publications had the full text, including 60.2% of articles that were provided free charge to registered readers of the library.