Relevance. Extreme activities of firefighters contribute to the deterioration of health or even death. Increased morbidity and injuries of firefighters are associated with persistent health impairments and disability.

Intention. To analyze disability rates and cause-of-disability structure in employees of the Federal Fire Service of Russian EMERCOM and in Russian young population (18–44 years) over 10 years, from 2006 to 2015.

Methodology. The average annual number of examined employees of the FFS of the EMERCOM of Russia was (99.3 ± 5.6) thousand people, i. e. at least 80% of the personnel of the FFS of the EMERCOM of Russia with special military ranks. Cases were identified and disability was calculated per 10 thousand employees of the FFS of EMERCOM of Russia. Causes of disability were classified via the International Statistical Classification of Diseases and Health Problems, the 10th revision (ICD-10) and disability indicators were compared to that of a cohort of the population of young working age (18–44 years), according to the Federal Bureau of Medical and Social Expertise of the Ministry of Labor of Russia (Moscow).

Results and Discussion. Newly recognized disability cases averaged (15.98 ± 0.99) per 10 thousand employees of the Federal Fire Service of the EMERCOM of Russia vs (25.51 ± 1.19) cases per 10 thousand population of Russia aged 18–44 (1.6-fold; p <0.001). Mean age of employees of the Federal Fire Service of the EMERCOM of Russia with disability was (37.8 ± 0.7) years. The main causes of disability in firefighters were circulatory system diseases (ICD-10 chapter IX), injuries, poisonings and other effects of external causes (chapter XIX), neoplasms (II), diseases of the musculoskeletal system and connective tissue (ICD-10 chapter XIII), diseases of the digestive system (XI). Disability rates due to these causes per 10 thousand employees per year were 4.58 ± 0.59, 1.80 ± 0.17, 1.66 ± 0.20, 1.63 ± 0.24 and 1.12 ± 0.26, respectively; in the structure of disability causes – 28.7, 11.3, 10.4, 10.2 and 7.0%, respectively.

Compared with the population of Russia aged 18–44, in employees of the Federal Fire Service of the EMERCOM of Russia a significantly greater contribution to disability was identified for circulatory system diseases (ICD-10 chapter IX), respiratory diseases (X) and diseases of the digestive organs (XI), a smaller one – for some infectious and parasitic diseases (I), neuropsychiatric disorders (V + VI), injuries, poisoning and other external influences (XIX). Meanwhile, the proportion of Injury, poisoning and certain other consequences of external causes (ICD-10 chapter XIX) in cause-of-disability structure increases.

Conclusion. Disability rates in employees of the Federal Fire Service of the EMERCOM of Russia were statistically significantly lower than in the population of Russia aged 18–44 years. On one hand, this suggests optimal work strategies in firefighters, on the other – high disability rates among the adult population of Russia. For a number of causes of disability in firefighters, there is a significant contribution of occupational factors, which require further research. 

Relevance. The high incidence of diseases of the liver and other organs of digestion in employees of State Fire Service of EMERCOM of Russia results from exposure to harmful chemical factors when performing professional tasks. Currently, the growing interest of the medical scientific community and practitioners is the nutritional support for the treatment of diseases of the digestive system. Therefore, the study aimed at substantiating the effectiveness of nutritional support in the treatment of liver diseases is certainly relevant.

Intention. To scientifically substantiate effectiveness of enteral nutrition in the treatment of patients with liver diseases. Method. From 2015 to 2018, 237 patients, middle-aged men (56.4 ± 9.4) years, with liver diseases and trophic insufficiency of moderate severity were examined. All subjects were divided into 2 groups, the first group consisted of 121 people receiving enteral nutrition with Nutricomp HEPA liquid, the second group consisted of 116 people treated without enteral support. To assess the effectiveness of enteral nutrition in the treatment of liver diseases, the following were analyzed: trophological status, biochemical parameters of the protein fraction of peripheral blood, proteins of the blood coagulation system and the activity of transaminases. The indicators of self-assessment of quality of life before and after treatment were also analyzed.

Results and Discussion. Nutraceuticals, compared to no enteral nutrition, significantly reduced the concentrations of ammonia, increased concentrations of albumin, product of protein metabolism, indicators of blood coagulation and the activity of transaminases. They have significantly increased body mass index, and body mass deficit decreased. After treatment with enteral nutrition in patients, self-assessment of quality of life was significantly higher than in the group not receiving enteral nutrition.

Conclusion. Thus, the use of nutraceuticals for enteral support of patients with reduced trophological status can significantly improve the effectiveness of therapy, promotes faster recovery and reduces time spent in hospital. 

Relevance. When solving military-professional tasks during the period of reforming the Armed Forces of Russia, military servicemen under contract (sergeants, foremen, privates and sailors) are given a special role, and in a number of units they must replace conscripts.

Intention To analize medical and statistical morbidity indicators of military personnel under contract in the Navy and the Land Forces of Russia.

Methods. We studied medical reports on the state of health of personnel and medical service activity according to Form 3 / MED of military units, in which about 60% of the total number of servicemen of the Russian Armed Forces served from 2003 to 2018. Morbidity indicators were correlated with the International statistical classification of diseases and related health problems, 10th revision (ICD-10).

Results and Discussion. As a rule, the military personnel under contract in the Russian Navy had lower morbidity rates with high dismissal rates. In particular, the indicators were as follows: the average annual overall morbidity rates were (855.0 ± 65.3) and (946.9 ± 49.7) ‰ in the military personnel under contract in the Russian Navy and in the Land Forces of Russia, respectively; primary incidence, (384.8 ± 19.3) and (472.0 ± 22.8) ‰, respectively (p < 0.01); need for follow-up, (92.8 ± 9.9) and (74.3 ± 4.7) ‰, respectively; hospital admission rates, (205.8 ± 39.2) and (235.2 ± 13.2) ‰, respectively; working days lost, (4,038 ± 203) and (3.944 ± 196) ‰, respectively; dismissal rates, (6.82 ± 0.57) and (4.40 ± 0.61) ‰, respectively (p < 0.01); mortality rates, (112.13 ± 9.91) and (111.76 ± 7.80) per 100,000 military personnel under contract. It is possible that this phenomenon was determined by the peculiarities of professional activity, the organization of medical support and the high demands placed on the state of health of the Russian Navy servicemen. A significant part of the leading disease blocks with a share of 0.5% or more in the structure of medical and statistical morbidity indicators, were similar between the military personnel under contract in the Navy of Russia and the Land Forces of Russia. In the structure of the assessed military-epidemiological significance of disease blocks among the military personnel under contract of the Russian Navy, acute infections of the upper respiratory tract (J00– 06 by ICD-10) ranked 1st, diseases of the esophagus, stomach and duodenum (K20–K31) ranked 2nd, followed by injuries involving several areas of the body (T08–T14), head injuries (S00–S09), ischemic heart disease (I20–I25). In the military personnel under contract in the Land Forces of Russia, these were the following diseases, from the most to least significant: acute infections of the upper respiratory tract (J00–J06), injuries involving several areas of the body (T08–T14), head injuries (S00–S09), diseases of the esophagus, stomach and duodenum (K20–K31), and infections of the skin and subcutaneous tissue (L00–L08).

Conclusion. Prevention of the leading groups of disaeses will contribute to improving the health status of servicemen under contract, and taking data on morbidity into account will help organize diagnostic and treatment assistance and optimize the personnel and material resources of military medical organizations. 

Relevance. The available unique experience of elimination of medical and sanitary consequences of emergency situations of natural, technogenic and social nature proves that the effectiveness of rendering medical care within or on the border of emergency area depends on timely arrival and actions of non-staff healthcare professionals of the All-Russian service for disaster medicine – crews for specialized medical care, physician-and-nurse crews. Directly during training and practical activities non-staff healthcare professionals face problematic issues affecting their readiness and quick response.

Intention. To define the most significant problematic issues influencing work of non-staff healthcare professionals of the Service for disaster medicine of the Ministry of Defense of the Russian Federation on elimination of medical and sanitary consequences of emergency situations.

Methodology. Content analysis of the facts and trends in the documents regulating activities of non-staff healthcare professionals of emergency formations was performed. Non-staff physicians were surveyed on problematic issues of training, practical activities and professional competence and importance of these issues ranked: “not important” – 1, “important” – 2, “very important” – 3 with assigning respective points.

Results and Discussion. In the military-medical organizations of the central subordination, including the Kirov Military Medical Academy, emergency formations of Service for disaster medicine of the Ministry of Defense of the Russian Federation exist to strengthen (special-purpose) medical groups and medical institutions responsible for admitting casualties from emergency areas. An “average portrait” of a non-staff healthcare professional was as follows: male surgeon of 38.7±1.1 after a clinical internship, with an academic degree and experience in subject domain of 13.4 years. He has served (worked) at the Kirov Military Medical Academy and carried out functional duties on a constant basis, with experience more than two years as a part of physician-nurse or specialized medical care (thoracoabdominal) crew, with sufficient experience in elimination of medical and sanitary consequences of emergencies. At the same time during training and practical activities he faces a number of issues, such as labor relations and quality assessment of performance during elimination of medical and sanitary consequences of emergency situations, unsatisfactory resource and organizational support and also low readiness of all the non-staff members of the crew.

Conclusion. Besides problematic issues of labor relations in emergency formations, the factors influencing training, performance and professional competence of non-staff healthcare professionals were defined, i.e. special equipment for medical evacuation (sanitary aviation); unsatisfactory facilities intended for elimination of medical and sanitary consequences of emergencies; medical equipment in emergency areas. As a result of the analysis, all the problematic issues were limited to 3 fundamental internal (hidden) factors influencing training, performance and professional competence of healthcare professionals at the Kirov Military Medical Academy: “Basic resources” (22.05%), “Shortcomings in daily activities” (11.9%), “Readiness for actions” (10.4%). To minimize the specified problematic issues, various (alternative) options are suggested. 

Relevance. The relevance of the problem is determined by the importance of rail transport in Russia for supporting a diversified economy and implementing socially important services for transportation of goods, baggage and passengers. A system of rapid response and medical assistance to victims in large-scale emergencies on the railway also exists due to large numbers of victims and remoteness of emergency areas from large settlements.

Intention. To develop an algorithm for predicting irretrievable and sanitary losses depending on the nature and conditions of railway accidents.

Methods. A comprehensive analysis of the 200 most significant railway accidents in the world from 1960 to 2018. Using statistical procedures, the determinants of the number of victims were assessed.

Results and discussion. The average data, the dispersion of the number of victims in emergency situations on the railway were determined depending on the nature of accidents. The factors influencing the number of sanitary and irretrievable losses are identified. A predictive algorithm to determine the number of victims depending on the nature and conditions of railway accidents. The structure of injuries in victims depending on the nature and conditions of railway accidents is described.

Conclusion. The data obtained in the study will help in making decisions on the elimination of emergency situations on the railway. 

Relevance. Arrangement of the medical support for the EMERCOM of Russia specialists and employees needs constant monitoring and analysis of activities of the Nikiforov Russian Center of Emergency and Radiation Medicine, EMERCOM of Russia (NRCERM) as the leading multidisciplinary medical institution of the EMERCOM of Russia.

Intention – To analyze NRCERM activities (2012–2017) on specialized primary care, including high-tech care, at outpatient, day-time and inpatient hospitals.

Methods. Results of health care and treatment in the NRCERM were assessed (2012–2017): 787,057 out-patient cases, 3,782 day-time cases, and 79,572 inpatient cases.

Results and Discussion. In 2017, volumes of specialized primary care in outpatient hospitals was 156.6 % compared to that in 2012. The proportion of this type of health care paid for by the federal budget varied from 44.3 to 57.0 %. The most popular types of specialized primary care were internal medicine, neurology, gastroenterology, otolaryngology, ophthalmology, gynecology, surgery, urology and dentistry. The proportion of individuals who underwent preventive physical examinations in 2012–2017 amounted to 22–23 % among the whole number of outpatient visits, with 95.4 % of them were EMERCOM of Russia employees and 4.6 % – patients who paid themselves or were paid for. NRCERM mobile medical teams performed prevention physical examinations of employees of the EMERCOM of Russia in the Republic of Crimea and the city of Sevastopol: 1431 and 2070 individuals were examined in 2015 and 2016, respectively. The number of patients in the day-time NRCERM hospital increased to 1059 individuals in 2017. In 2017, volumes of specialized primary care increased to 191.9 % compared to 2012, with maximums in 2015 and 2016. Inpatient specialized primary care within the federal budget decreased from 63 % in 2012 to 28 % in 2017. Volume of inpatient care increased progressively due to programs of obligatory and voluntary medical insurance and self-paying. The proportion of surgery patients among all the in-patients increased from 35 % in 2012 to 58.4 % in 2017. In the NRCERM as a whole, the average duration of patient’s stay in a hospital decreased from 9.9 days in 2012 to 8.0 days in 2017, which is considerably less than in the Russian Federation (11.7 days) and Saint Petersburg (11.3 days). The bed turnover in the NRCERM increased owing to both therapy and surgery departments, with maximums in 2015 (29.0) and 2016 (28.8). This parameter increased in 2017 compared to 2012 (27.5 vs 13.9; 197.8 %). In 2017, number of operations increases compared to that in 2012 up to 258.6 %, with related increase in anesthesia procedures up to 274.1 %. High tech surgeries considerably increased (3.5-fold) in 2017 compared to 2012. The proportion of high tech surgeries was 14.2 % in 2012 and 18.7 % in 2017. The NRCERM mortality rates in 2012–2017 were 0.4–0.5 % which is considerably less than in the Russian Federation (1.77 %) and in Saint Petersburg (2.49 %). In cause-of-death structure, the following diseases dominated: circulatory diseases (40.3 %), neoplasms (29.8 %) and, third, traumas (10.4 %) – a total of 80.5 %.

Conclusion. Within NRCERM activities, volumes of specialized primary care increased, including high tech care, in outpatient, day-time and inpatient settings. Besides, intensity of medical-diagnostic process increased, with low hospital mortality rate due to optimized organizational structure of medical institution, improved performance of outpatient and inpatient departments, introduction of innovative medical technologies.

Relevance. Diseases of the nervous system considerably complicate professional performance of military men. Employees of the EMERCOM and other military are constantly engaged in stressful activities; hence, pathology of the nervous system is often associated with sexual dysfunctions. Intention – To study sexual and emotional dysfunction and personality accentuations in themilitary with diseases of the nervous system.

Methods. The research was focused on a group of 146 men 25–55 years old with pathology of the nervous system. Standard clinical and neurological examination was carried out with assessment for sexual dysfunctions using questionnaires “Male sexual function” and “Male copulative function”. Emotional sphere was assessed via psychological tests: Well-being– activity–mood, Eysenck Personality Inventory, State-Trait Anxiety Inventory, Leonhard–Schmieschek questionnaire.

Results and Discussion. Associated sexual dysfunctions (decreased neurohumoral, mental, erectile and ejaculatory components of copulation cycle) were found in 60.3 % of patients irrespective of specific neurologic pathology, age or sexual constitution. Statistically significant (p < 0.05) decrease in overall well-being and mood, as well as high state and trait anxiety and neuroticism were revealed in those with sexual dysfunctions. A direct link between sexual dysfunctions and emotive, pedantic, dysthymic person accentuations are noted. At patients with sexual dysfunctions gradual decrease in health status, activity, mood and increase of situational and personal anxiety, and also a high level neuroticism in comparison from patients without sexual frustration is revealed. Personality accentuations, such as stuck, pedant, exalted, emotive, demonstrative, were most common in patients with sexual dysfunctions, that is consistent with data of other authors. However, they result from a combined influence of adverse factors, rather than personality disorders.

Conclusion. Sexual dysfunctions significantly aggravate a course of neurological diseases, are associated with affective disorders and increased personality accentuations. For effective treatment of neurological diseases, it’s important to reveal and timely correct psychological and sexual dysfunction in the military. “Male copulative function” questionnaire is optimal for rapid diagnosis of male sexual disorders. 

Relevance. Currently, damage control surgery (DCS) is actively used in polytrauma. However, data on the effectiveness of this tactic for combined radiation-mechanical injuries (CRMI) in the available literature was not found.

Objective. To develop a model of CRMI on small laboratory animals (rabbits), which allows studying the effectiveness of the use of DCS in comparison with the early total care surgery tactics.

Methods. A model of a severe CRMI was proposed. The animals were subjected to a generally uniform short-term gammairradiation, and then they suffered a liver injury on the background of blood loss of 40% of the blood volume and hypothermia. After modeling the lesion, a comparison was made of the effectiveness of the tactics of the DCS and the early total care surgery tactics. During the study, the following indicators were evaluated: the average life expectancy and mortality of animals, changes in the cellular composition of peripheral blood, features of behavioral reactions to irradiation, the amount of blood loss during the implementation of the surgical intervention.

Results and their analysis. The experiment showed that the tactics of the DCS have an advantage over the traditional tactics of a one-time exhaustive operation in the case of the CRMI. When performing DCS, there was no death of rabbits on the 1st day after the operation, when implementing early total care surgery - 3 rabbits died, besides, the mortality was absolute, while with DCS one rabbit survived (12.5%). The final operation at the DCS occurs prior to the beginning of the acute period of CRMI, which corresponds to the requirements of the instructions for the treatment of CRMI. In the course of the study, it was found that the proposed model of CRMI contributes to the formation of the phenomenon of mutual burdening and, as a result, complicates both the radiation and mechanical components of the lesion occurs.

Conclusion The proposed experimental model for the application of severe CRMI helps to explore DCS tactics in the treatment of this pathology. DCS is a promising method of surgical treatment of CRMI, however, for more accurate extrapolation of data from animal to human, additional research on large laboratory animals is required. 

Relevance. In connection with the development of nuclear energy, many aquatic ecosystems have been exposed to radioactive substances. Fish, as an element of biota, is capable to accumulate radionuclides. However, fish is a traditional food. The control of the technogenic radionuclides accumulation level in the ichthyofauna is an important link in ensuring human security.

Intention. To analyze the long-term data on the content of long-lived technogenic radionuclides 90Sr and 137Cs in the ichthyofauna of the Ob-Irtysh river system for the period from 2004 to 2016 and Beloyarsky pond for the period from 1977 to 2018.

Methodology. Fish as a food product was assessed according to two criteria: a) permissible levels of specific activity of radionuclides (SanPiN 2.3.2.1078-01); b) using the indicator of conformity B and the uncertainty of its definition В (GOST 32161-2013 and GOST 32163-2013).

Results and Discussion. Fish of all species that live in the river Tetcha, is not suitable for food use according to the criteria of SanPiN 2.3.2.1078-01, GOST 32161-2013 and GOST 32163-2013. The fish of the Ob-Irtysh river system, the habitat of which is located outside the Tetcha, meets the requirements for fish products. In the period from 1977 to 1989 in the Beloyarsk pond the accumulations of technogenic radionuclides in fish in quantities exceeding sanitary and hygienic standards were possible. Currently, the fish of the Beloyarsky pond fully complies with the sanitary and hygienic requirements for the radiation factor and is safe for human consumption.

Conclusion. In the ponds exposed to the atomic energy enterprises, it is necessary to continuously monitor the content of long-lived technogenic radionuclides in fish and assess their amount in accordance with the requirements of SanPiN 2.3.2.1078-01 and using the conformity indicator В and the uncertainty of its determination В. 

Relevance. Professional activity of firefighters and rescuers refers to dangerous, stressful and heavy types of work associated with significant risk to life and health. Injuries, disability and mortality among the personnel of the Ministry of emergency situations directly depend on working conditions, occupational activities, the nature of the functions performed.

Intention. To demonstrate effects of software products in the field of fire safety on meeting the information needs of managers and employees performing the tasks of prevention, extinguishing and elimination of consequences of fires and emergencies. Timely prevention and mitigation of fire and emergency consequences reduces material damage as well as the number of dead and injured people.

Methodology. The article presents a brief description of the software products available in the Fund of computerized algorithms and programs of EMERCOM of Russia in the field of fire safety, which are designed to help in solving social and psychological problems of safety of the population and territories in emergency situations. The software products are designed to provide the heads of the subjects of the Russian Federation with the possibility of automating the planning of measures for the prevention and elimination of fires and emergencies. Software products contain information and references on prevention and elimination of fires and emergencies as well as guidance on the actions of officials and the population in emergency situations, both natural and man-made, and also regulatory and methodological documents for making decisions in the field of safety of the population and territories in emergency situations.

Results and Discussion. Software products actually increase effectiveness of safety measures in emergency situations, preparedness of units of he State fire service, as well as help to make informed decisions in the field of social protection of employees. Based on one of the software products, the possibility of automating the presentation and analysis of statistical data on the number of fires, the number of fire fatalities, injuries and related direct material damage is shown.

Conclusion. The use of software products in the field of fire safety ultimately reduces the risk of injury and death, the level of material losses from fires and other emergencies.