Relevance. Russia has high mortality rates in general and among the working-age population, with dominating effects of external causes.

Intention – To study rates and structures of the medical-statistical indicators of mortality due to diseases and the effects of external causes in the employees of the State Fire Service of the EMERCOM of Russia over 20 years from 1996 to 2015.

Methods. Annual population under study averaged (108.8 ± 6.2) thousand people, or about 80% of all the employees of the State Fire Service of Russia who had special military ranks. Operating staff comprised 53.4%, other employees – 46.6%. Mortality rates were calculated per 100 thousand employees of the State Fire Service of Russia. Data on the mortality of working-age men in Russia was obtained on the website of the Federal Statistics Service of Russia (Rosstat) [http://www.gks.ru/]. The unification of accounting and analysis of indicators was achieved using the International Statistical Classification of Diseases and Related Health Problems, the 10th revision (ICD-10). Results and Discussion. Mortality rate among employees of the State Fire Service of the EMERCOM of Russia in 1996–2015 was (116.9 ± 5.7) deaths per 100 thousand employees per year vs 11 times higher mortality rate among the working-age male population of Russia: (1063.9 ± 33.7) deaths per 100 thousand men (p < 0.001). The mean age of the deceased employees of the State Fire Service of Russia was (44.5 ± 0.3) years, with overall mean age (36.9 ± 1.6) years (p < 0.001). The leading causes of death among employees of the State Fire Service of Russia (from more to less significant) were injuries and other effects of external causes (ICD-10 chapter XIX), diseases of the circulatory system (chapter IX) and neoplasms (II), diseases of the digestive system (XI) and diseases of the respiratory system (X). Mortality rates from these causes per 100 thousand employees per year amounted to (63.3 ± 33.7), (32.6 ± 2.7), (7.1 ± 0.6), (5.3 ± 1.0) and (5.0 ± 0.9) deaths; in cause-of-death structure – 54.2, 27.9, 6.0, 4.5 and 4.3%, respectively. The mortality rate from suicide among working-age Russian men was 6.4 times higher than that of firefighters – (66.0 ± 4.1) and (10.3 ± 1.1) deaths per 100 thousand men, respectively. However, in the overall cause-of-death structure, this cause accounted for a larger share in employ ees of the Russian State Fire Service (6.2 vs 8.8%). Statistically significant difference (p < 0.05) was found when comparing occupational fatalities among the operating personnel of the State Fire Service of Russia and working population in Russia: (14.9 ±1.4) deaths per 100 thousand employees per year vs (11.6 ± 0.7) deaths per 100 thousand workers per year. Mortality rates of firefighters were calculated in the Federal districts and regions of Russia. For a number of causes of death in firefighters, there is a significant contribution of occupational factors, which require further research.

Conclusion. There is a low alertness for identifying neoplasms and crisis conditions in firefighters. Focusing on the leading diseases, behavioral disorders, prevention of injuries, poisoning and other effects of external causes will improve health and reduce mortality of employees of the State Fire Service of Russia.

Authors declare the absence of existing and potential conflicts of interest concerning the article publication. 

Relevance. The development of the Arctic territories of Russia determines the need to protect civilian and military facilities and improve the provision of emergency specialized medical care to servicemen in remote garrisons.

Intention. To study the organization of medical evacuation of military personnel with community-acquired pneumonia from remote garrisons in the Arctic zone of Russia for 2013–2017.

Methodology. We conducted a retrospective analysis of all cases of medical evacuations of military personnel from remote Arctic garrisons. In addition, we studied data from 87 case histories, medical evacuation cards for military personnel with moderate and severe community-acquired pneumonia transferred to the 1469th Naval Clinical Hospital of Severomorsk and the central military medical organizations from 2008 to 2010 and from 2013 to 2017.

Results and Discussion. In 20% and 20–30% of cases, medical evacuation was performed, respectively, due to injuries and community-acquired pneumonia. A structural-functional model of the provision of emergency specialized medical care to servicemen with community-acquired pneumonia in remote Arctic garrisons has been formed using the forces and means of emergency forces of the Disaster Medicine Service of the Northern Fleet of Russia. The results of optimization of the organization of medical evacuation of patients with severe community-acquired pneumonia are presented.

Conclusion. To improve the effectiveness of emergency medical care in patients with community-acquired pneumonia, it is advisable to include in the system of special training of medical staff and nursing staff a training course on the organization of medical evacuation in the Arctic zone of Russia.

Relevance. Participation in military conflicts, long-term vital threat, irregular working hours, frequent moving to new places of residence impose negative imprints in the form of various functional disorders and even the formation of psychogenic diseases on employees of various law enforcement agencies.

Intention. To assess the impact of organized summer holidays under different climatic conditions on the functional state of the veterans of law enforcement agencies previously engaged in activities under extreme conditions.

Methodology. 65 retired men soldiers of different law enforcement agencies aged 45 to 54 years were examined before and after organized summer holidays under different climatic conditions. Hemodynamic parameters, mobility of nervous processes and current mental state were assessed.

Results and Discussion. After a river cruise in the North-West and mid-latitudes of Russia, decreased tension of the functional circulatory system as well as improved mobility of nervous processes and current mental state were reported. On the contrary, increased tension of the functional circulatory system, decreased mobility of nervous processes, well-being, activity, mood and increased anxiety were reported after holidays at low-latitude resorts.

Conclusion. Thus, the functional state of veterans of law enforcement agencies who survived repeated mental trauma and vital threat, was effectively restored after a river cruise in the North-West and mid-latitudes of Russia.

Relevance. Health maintanance and professional longevity are primary objectives of medical and psychological support for personnel of EMERCOM of Russia. Information about the state of health of military personnel and civilian personnel of rescue military units of Emercom of Russia, as well as military units for radiation, chemical and biological protection was not found in the available literature.

Intention. Clarify data on the state of health of military personnel and civilian personnel of rescue military units of Emercom of Russia for developing evidence-based preventive and rehabilitation measures in the future.

Methodology. The health status of the personnel of rescue military units of Emercom of Russia was studied on the model of the Federal State-Owned Institution Nevsky Rescue Center of Emercom of Russia (Kolpino, St. Petersburg) based on the results of periodic medical examinations in 2015–2016.

Results and Discussion. The overall prevalence of diseases revealed in military and civilian personnel during the annual medical examination was similar, including the main classes of diseases, and averaged 2 diseases per 1 person. The overall prevalence of diseases in the older age group (30–44 years) of military personnel 1.2–1.4-fold (p = 0.021) exceeded that of the younger (18–29) age group of military personnel as well as of both age groups of civilian personnel. No convincing impact of professional experience on the prevalence of diseases was revealed.

Conclusion. The levels and structure of pathology revealed during periodic medical examinations in military personnel and civilian personnel of the Nevsky Rescue Center had no statistically significant differences, suggesting the fundamental similarity of the nature and intensity of occupational factors. At the same time, age rather than the duration of professional activities influenced the frequency of the revealed pathology in the studied sample. Weighted indicators of public health over a longer period of time (5+ years) will help eliminate stochastic effects and make reasonable conclusions about the prevalence of diseases in various military rescue specialists.

Relevance. The realities of modern life do not exclude the risks of terrorist attacks. During explosion, heterogeneous factors simultaneously affect the body, thus involving organs and systems in various combinations in the pathological process.

Intention. To analyze results of the treatment of victims with severe explosive wounds resulted from the terrorist attack of April 3, 2017 in the train car of the St. Petersburg metro.

Methodology. As a result of the terrorist attack, 10 passengers and the terrorist himself died on the spot, 102 people were recognized as victims. On April 4, 2017, 57 wounded were admitted to the city hospitals, of which four did not survive. Twenty five wounded in the terrorist attack in the St. Petersburg metro car were admitted to the St. Petersburg Research Institute of Emergency Medicine n.a. I.I. Dzhanelidze within the “golden hour”. In 15 of them, injuries were combined with surface thermal burns.

Results and Discussion. Five cases with the most severe injuries are described. It was established that multifactorial, combined and multiple of injuries were typical for this pathology. Most victims had severe cranial-brain trauma, shrapnel wounds of soft tissues and gunshot bone fractures. Specialized medical care at the Level I Trauma Centers was characterized by simultaneous admission of several seriously injured, the need to organize several surgical teams, Damage control approach, multidisciplinary and a long-term, multi-stage and very expensive treatment with the participation of surgeons and doctors of various specialties.

Conclusion. To achieve the best results, victims with severe explosive injuries should be sent as soon as possible to the Level I Trauma Centers, where up-to-date treatment and diagnostic technologies (spiral-computed tomography, magnetic resonance imaging, angiography, selective arterial embolization, computerized 3D modeling, etc.) and comprehensive rehabilitation measures are available.

Relevance. Currently, there is no universally recognized standard method for diagnosis of sepsis in patients with burn injury, which causes many variations when recording septic conditions and also high mortality of such patients. Traditionally, patients in intensive care units are assessed using the clinical scales SOFA, APACHE II-IV or SAPS II-III. However, most of the known clinical scales cannot always be used to assess the severity of burn injuries. Therefore, unrecognized sepsis can lead to the multiple organ dysfunction syndrome that is the main cause of death in burn patients. The definition, systematization and standardization of new criteria for sepsis and predictors of its development can significantly improve the medical care for patients in this category and reduce the level of mortality.

Intention. To review the studies of burn sepsis biomarkers using publications from the National Center for Biotechnological Information and the Scientific Electronic Library (eLIBRARY) over 2003–2017.

Methodology. This article provides an overview of the most promising clinical and laboratory markers of sepsis with high predictive and diagnostic value that can be used to predict and assess the severity of burn injuries.

Results and their analysis. Over the past 15 years, many potential biomarkers of burn sepsis have been studied. The most promising of them are: tumor necrosis factor-alpha, interleukin-6, interleukin-8, interleukin-10, interleukin-27, presepsin, endotoxin of gram-positive bacteria, lipopolysaccharide-binding protein, soluble receptor of urokinase-type plasminogen activator, trigger receptor expressed on myeloid cells, and myeloperoxidase. The most topical current method for laboratory diagnostics of these biomarkers can be the enzyme-linked immunoassay in the biochip format.

Сonclusion. Integrated and simultaneous measurements of the sepsis markers reviewed in this article within one study can be useful for diagnosing sepsis in severely burned patients in the future.

Relevance. Compared with economically developed countries, Russia has a high risk of fires. In 2005–2017 in (175.8 ± 9.0) thousand fires were reported in Russia annually, with (81.1 ± 5.3) thousand people rescued, (12.6 ± 0.9) thousand died and (12.1 ± 0.4) thousand injured. The average annual direct damage from fires was (13.4 ± 1.1) billion rubles. The experienced extreme and emergency situations have a particularly significant impact on the functional status and health of an older person.

Intention. The purpose of this work is to identify the features of the components of postural balance in older women who have survived a fire.

Methodology. 94 women aged 60–69 years were examined. The study group included women who, as a result of the fire, lost (in part or in full) their possessions and housing (fire victims). The comparison group randomly included women without any extreme situations (fire hazard, crime, road traffic, as well as the death of close relatives) over the past two years. To assess the quality of the equilibrium function, posture control strategy and sensory organization of postural control, we conducted the Sensory Organization Test (SOT) of the computer dynamic posturographic complex Smart Equitest Balance Manager.

Results and discussion. Based on the SOT analysis, it was found that stressful situations associated with extreme or emergency situations experienced by older women influence the components of their postural balance. These changes included a decrease in the quality of the equilibrium function in functional tests 1, 2, 3, 5, 6 for fire victims; a decrease in the postural strategy in tests 5 and 6; a decrease in the resulting assessments of both the quality of the equilibrium function and the strategies for maintaining the posture of the entire SOT, as well as the degree of participation of vestibular information in the balance control.

Conclusions. In female fire victims, the components of postural control change: the quality of the equilibrium function decreases, the strategy of maintaining posture deteriorates.

Relevance. Inhalation administration of compounds with peptide and protein structure may be promising in provision of emergency medical assistance in emergency situations, including radiation injuries. The development of inhalation dosage forms for compounds with peptide and protein structure requires the selection of excipients to increase their bioavailability.

Intention. To assess effects of permeability enhancers on the effectiveness of a model biologically active substance of protein nature (insulin) by inhalation.

Methods. The experiments were carried out in outbred white male rats with initial weight of 180–220 g. To assess the effectiveness of insulin and permeability enhancers, they were administered via intranasal and intratracheal routes using a MicroSprayer® IA-2B instillation probe (Penn Century, USA). The list of biological membrane permeability enhancers under investigation (Sigma-Aldrich, USA) includes the following substances: methyl-β-cyclodextrin, dimethyl-β-cyclodextrin, 2-hydroxypropyl-β-cyclodextrin, Tween-80, sodium methyl oleate, oleic acid, sodium taurocholate, sodium glycocholate, Pluronic F-68, tesit, Brij-35, saponin, cetylpyridine.

Results and Discussion. Insulin bioavailability without permeability enhancers does not exceed 0.5% when administered intranasally. When assessing effects of multiple doses of permeability enhancers on food and water consumption in animals over time, decreased parameters under study were observed in the control and experimental groups compared to intact animals. Multiple intratracheal administration of solutions to rats can lead to some infectious complications.

Conclusion. Such excipients as sodium taurocholate, dimethyl-β-cyclodextrin and Тween-80 in a concentration of 5 % increase bioavailability and intensity of biological effects of insulin when administered intranasally. The surfactants Brij-35, Тween-80 and sodium taurocholate in a concentration of 0.25 % increase the duration of biological effects of insulin when administered intratracheally. Sodium taurocholate and Tween-80 in a concentration of 0.25 % have the lowest toxicity during multiple intratracheal administration.

Relevance. The basis of modern rationing of noise and assessing its safety is the principle of equal energy: regardless of the source, effects are equal. However, this approach is not valid for impulse noise reaching the external auditory canal through the means of individual hearing protection. This issue needs further research.

Intention. To assess effects of impulse noise when anti-noise devices are used on the auditory sensitivity and safety of military personnel.

Methods. Effects of impulse noise of equal energy without anti-noise devices and reaching the external auditory canal through the means of protection was carried out in two groups of volunteers aged 18–23 years without contraindications for working under noise conditions. Shooters from the 1st group (12 persons) fired from an AK74M assault rifle (150 shots) in a free acoustic field. Shooters from the 2nd group (13 persons) used 6M2 noise protection headsets when shooting (330 shots).

Results and discussion. The equivalent level of impulse noise affecting the hearing organ of the shooters from both study groups amounted to 99.4 dBA. Impulse noise filtering through a 6M2 noise protection headset led to a shift in the noise spectrum to the low-frequency region, therefore the maximum increase in hearing thresholds was noted not at high (as without anti-noise devices), but at low frequencies – 250 and 500 Hz. At the same time, the hearing thresholds restored after shooting without anti-noise devices within a day, and after shooting with noise protection headsets – in two hours.

Conclusion. It was established that the impulse noise from small arms of the same equivalent level when reaching the external auditory canal through the anti-noise headphones is less dangerous in terms of hearing restoration than after direct exposure.

Relevance. In case of emergency due to large-scale radiation accidents, biological dosimetry becomes a critical tool for early radiation dose assessment and enables identification of individuals exposed to ionizing radiation and facilitates further medical follow-up decisions.

Intention. To assess the feasibility of a number of biological markers for bioindication and biodosimetry purposes based on literature data.

Methodology. Literature sources were searched in MEDLINE databases, PubMed, CyberLeninka, elibrary.ru, using the terms: radiation, irradiation, biodosimetry. The review presents the results of studies from full-text sources of literature in English.

Results and Discussion. Depending on an accidental exposure scenario, various biodosimetry techniques should be used to assess radiation doses with optimal accuracy and speed. In addition to physical methods and clinical techniques used to assess radiation doses, biological dosimetry defines a level of ionizing radiation exposure for certain individuals and is useful in making decisions about medical treatment strategy. To date, combined use of several biological markers within a biodosimetry system providing reliable radiation dose estimates.

Conclusion. Analysis of the data presented in the review showed that combined use of several biological markers and development of a complex biodosimetric system will provide a more accurate estimate of doses, which is especially important in case of radiation accidents and incidents when physical dosimetry data are not available.

Relevance. Occupational activity of employees of EMERCOM of Russia in the Arctic region is associated with continuous operating response, physical and psycho-emotional stress, increased social and professional responsibility, and vital threat.

Intention. To determine the level of self-actualization as a determinant of the professional development of EMERCOM of Russia employees with various professional experience in the conditions of the Arctic region.

Methods. The study involved 226 men – employees of the EMERCOM of Russia, who were divided into 4 groups depending on their professional experience and region of residence. The level of self-actualization of the EMERCOM of Russia staff was assessed using the “Self-Actualization Test” (CAT), which is based on the personal orientation questionnaire by E. Shostrom.

Results and Discussion. The results of the study showed that the EMERCOM of Russia employees with professional experience of up to 5 years in the Arctic region (1st group) have an average level of self-actualization; employees of the EMERCOM of Russia with professional experience of 5 to 10 years in the Arctic region (2nd group), with professional experience of over 10 years in the Arctic region (3rd group) and professional experience of over 10 years in Voronezh (4th group) have high level of self-actualization.

Conclusion. According to the study results, self-actualization as a determinant of the professional development of EMERCOM of Russia employees in the 1st group is manifested as self-esteem, acceptance of aggression, synergy, spontaneity; in the 2nd group – value orientation, ideas about human nature, orientation in time, self-acceptance; in the 3rd group – support, cognitive needs, self-acceptance, sensitivity, contact, acceptance of aggression, self-esteem, flexibility of behavior, orientation in time; in the 4th group – creativity, ideas about human nature, flexibility of behavior, synergy, self-acceptance, contact, spontaneity, sensitivity, cognitive needs.

Relevance. According to the Federal Statistics Service (Rosstat), (315.8 ± 8.5) thousand thermal and chemical burns or (220.6 ± 6.5) burns per 100 thousand people of the country’s population were recorded annually in Russia in 2005–2015. These injuries account for 2.4 % of the structure of all injuries in Russia.

Intention. Analysis of the content of scientific journal articles of domestic authors on burn injuries

Methodology. We conducted a search in the electronic database of the Scientific Electronic Library, which made it possible to identify in 2005–2017 1649 scientific journal articles of domestic authors. The average annual number of articles on burn injury indexed in the Russian Science Citation Index was (127 ± 13). There is an increase in the interest of researchers to the problems of burns. The content of the articles correlated with the developed classifier for burn injury.

Results and Discussion. General questions of burn injuries were described in 1.6 %, problems of organization of medical care for burn victims – in 4.9 %, characteristics of burn injuries – in 42.9 %, information on diagnostics, treatment, probable complications and rehabilitation of victims – in 41.3 %, experimental studies of burn injury in animals – in 9.3 % of publications. The presented indicators reflected the content of the articles, and, to some extent, objective data. For example, superficial and limited burns were studied to a lesser extent, although they actually prevail. As a rule, the object of research was complex cases that could be of increased interest among readers. The weighted average impact factor of the journals in which the articles were published was 0.304, the average number of citations per article was 1.42, 42.6 % of the articles were cited at least once, Hirsch index was 15. Some authors used inadequate study design. When preparing publications, the groups of authors were often redundant, which resulted in a significant decrease in the number of articles and citations per 1 coauthor.

Conclusion. The study helps optimize research in the field of burn injuries. Among the created array of articles, 74.2 % of publications had a full text, 69.4 % of articles were provided free of charge to registered readers of the Scientific Electronic Library.