Relevance. The large-scale accident at the Chernobyl nuclear power plant raised the problem of overcoming its economic, medical, social and psychological consequences. This is extremely important for liquidators of the Chernobyl accident consequences (LACs) with more than 15 different somatic diseases that reduce their quality of life and coping resources, negatively affect the psychological status, the effectiveness of treatment and medical rehabilitation.
Intention. Assessment of psychological status and coping behavior in LACs in the remote period and justification of the need to provide them with psychological and psychotherapeutic assistance.
Methodology. Using psychological tests, 101 LACs undergoing inpatient treatment for somatic pathology were examined. The psychological status (health, activity, mood; state and trait anxiety, the impact of a traumatic event) and coping strategies were assessed. The results were compared with a control group using the Student’s t-test for different-sized unrelated samples.
Results and discussion. The features of the psychological status and coping behavior in LACs in the remote period are shown. Indicators of well-being, activity, mood are presented; state and trait anxiety, the impact of a traumatic event and coping strategies are comparatively assessed. The most significant markers of psychological disorders and maladaptive coping strategies are identified
Conclusion. The data presented in the article are an important basis for including psychological and psychotherapeutic assistance in the programs of specialized medical care for LACs in the inpatient settings within state guarantees of free medical care for citizens of the Russian Federation.

Relevance. Atherocalcinosis is a prognostically unfavorable pathology that is often found in the general population and, especially, in the liquidators of the consequences of the accident at the Chernobyl nuclear power plant. Its pathogenesis has not been sufficiently studied, as well as its treatment.
Intention: To establish relationship between the severity of coronary artery calcinosis and biomarkers of inflammation, bone metabolism and vascular calcification in liquidators of the consequences of Chernobyl accident at a remote period. Methodology. The study group was made up of 90 liquidators of the consequences of the Chernobyl accident – men aged 40 to 78 years, the median – 59 years, at the time of participation in emergency recovery work they were from 18 to 53 years old. Proteins of inflammation, osteocalcin,  mineral metabolism, osteopontin, osteoprotegerin, fetuin A in patients’ blood serum were analyzed. Expression of coronary vessel calcinosis was evaluated on the basis of multispiral computed tomography data with determination of calcium index by Agatston method, peculiarities of bone mineral density change depending on cardiac calcinosis severity in persons who participated in the aftermath of Chernobyl accident suffering from atherosclerosis.
Results and Discussion. Liquidators of the consequences of the Chernobyl accident with reduced bone mineral density were more likely to have a high and extremely high degree of coronary artery calcinosis (65 %) than patients without osteopenia (49 %). The serum level of osteocalcin in patients with reduced bone mineral density was significantly greater than in the subgroup with unchanged bone mineral density. It has been established that in liquidators of the consequences of the Chernobyl accident,  inflammation with high values  of C-reactive protein and leptin in the blood was associated with reduced fetuin A levels. In the liquidators of the consequences of the accident at the Chernobyl nuclear power plant with a calcium index of more than 400 points, osteoprotegerin was statistically significantly higher, and the level of fetuin was statistically significantly lower than in other patients.
Conclusion. Changes in calcium metabolism and bone mineral metabolism as well as systemic inflammation are closely related to the change in the calcium index in liquidators of the consequences of the Chernobyl accident with coronary heart disease and, along with instrumental diagnostic methods, may reflect the degree and severity of vascular injury. In addition, the study of the mechanisms of formation of cardiac calcinosis is extremely important due to the fact that they can be targets for pharmacological intervention, the effects of which will change the nature of atherosclerosis progression.

Relevance. In the zone of armed conflict (in the risk zone), people receive various injuries. The nature and severity of injuries depend on the combined impact of many damaging factors and the conditions of the medical situation. The number of medical units and institutions for providing medical assistance to those in need can be determined based on accurate forecast of the medical situation in the zone of armed conflict.
Intention: To present the methodology for calculating the sanitary losses of the population in the course of an armed conflict and to determine resources of civilian health care in the territories of military operations.
Methodology. Generalization and systematization of empirical, statistical and theoretical data are used, as well as traditional analysis of documents and literature on the topic of the study. The methodology is based on the following principles: multifactorial occurrence of sanitary losses; repeatability, multiple effects of damaging factors; the principle of uneven and nonsimultaneous occurrence of sanitary losses in the zone of armed conflict.
Results and Discussion. Existing methods of forecasting and assessing the medical situation in the zone of armed conflict have been analyzed. A new algorithm for complex analysis and assessment of the medical situation has been developed.
Conclusion. The data obtained can serve an important basis for organizing medical support for the population in the zone of armed conflict, protecting the life and health of those affected.

Relevance. Acute respiratory failure (ARF) and acute cardiopulmonary failure (ACPF) are unavoidable, and often – the leading syndromes in any critical condition, especially in case of multiple organ failure syndrome as a regular stage in the course of previously incurable conditions. Even a full range of intensive care measures in this category of patients does not always give the desired result. According to various authors, with the development of acute respiratory distress syndrome, the mortality rate reaches 80 %.
Intention is to determine the role of the aviation medical teams of the emergency medical service-disaster medicine in ensuring the timely availability of high-tech methods for patients who need them, regardless of the patient’s location.
Methodology. Activities of the aviation medical teams of the Scientific and Practical Center for Emergency Medical Care of the Moscow City Health Department for the medical evacuation of patients and victims in emergency situations with ARF and ACPF were analyzed.
Results and Discussion. There were analyzed interactions of aviation medical teams with the emergency medical response units of the territorial center for disaster medicine and with medical organizations during the medical evacuation of patients with ARF and ACPF. An algorithm and a scheme of interaction between air medical teams are proposed to optimize medical evacuation of these patients.
Conclusion. An analysis of the activities of air medical teams revealed their advantages in providing care for patients with ARF and ACPF.

Relevance. Injury indicators in military personnel reflect injuries and their consequences that occur in a certain period, as a rule, over a year. Injury indicators in the Armed Forces (AF) are important for assessing occupational safety.
Intention: To compare injury indicators in military conscripts between the Russian Armed Forces and the Republic of Belarus for 18 years from 2003 to 2020.
Methodology. We carried out a selective statistical analysis of medical reports on the health status of personnel and the activities of the medical service according to 3/MED form in military units where at least 80 % of the total number of conscripts of the Armed Forces of Russia and Belarus served. Groups (blocks) of injuries in Chapter XIX “Injuries, poisoning and certain other consequences of exposure to external causes” were agreed with the International Statistical Classification of Diseases and Related Health Problems, 10th revision (ICD-10). Injury data were calculated per 1000 military personnel or ‰, mortality rates – per 100 000 military personnel.
Results and their Discussion. In the Russian Armed Forces compared to the Belarusian Armed Forces, the average annual injury rates (primary morbidity) of conscripts were (15.91 ± 1.65) ‰ vs (20.23 ± 1.96) ‰, hospitalizations with injuries (14.16 ± 1.29 ) vs (14.50 ± 0.96) ‰, work days lost (303.4 ± 27.0) vs (303.4 ± 27.0) ‰, dismissal due to injuries (0.552 ± 0.066) vs (0.551 ± 0.051) ‰, injury-related mortality (21.96 ± 4.26) vs (24.18 ± 4.29) per 100 000, respectively. As a rule, polynomial trends with high determination coefficients showed a decrease in the levels of injury, hospitalization, work days lost and mortality. Dismissal trends showed decrease in the Russian Armed Forces and increase in the Belarusian Armed Forces. The conscripts of the Armed Forces of Russia and Belarus have a positive statistically significant congruence in indicators of injuries, hospitalizations, work days lost and mortality, which may indicate the influence of the same (unidirectional) factors in the formation of annual indicators. Injuries of the head (Group 1, Chapter XIX by ICD-10), shoulder girdle and upper limbs (Groups 5–7), the area of the hip joint and lower extremities (Groups 8–10), injuries, affecting several areas of the body (Group 11), and the consequences of injuries, poisoning and other external causes (Group 22) are of high military-epidemiological significance for conscripts in the Russian Armed Forces and the Belarusian Armed Forces. These injuries accounted for 78.7 % and 82.8 % of the generalized estimate in the Russian Armed Forces and the Armed Forces of Belarus, respectively.
Conclusion. Taking into account the indicators of injuries will allow the medical service to optimize the calculation of forces and assets for treatment and rehabilitation of servicemen with injuries. Injuries are not only a medical problem; it is necessary to involve more extensively military professionals from various services to analyze the cause-and-effect relationships of injuries and develop measures for their prevention.

Relevance. The problem of organizing specialized medical care in emergency forms for children is caused by three groups of reasons: the presence at the junction of several adult and pediatric medical specialties, the medical and geographical features of the country and the lack of a unified regulatory framework.
Intention. To increase the availability of medical services and reduce regional inequality in their distribution. A model of organizing a single operational service of specialized medical care for children and the basic principles of its functioning on the territory of the Russian Federation are proposed.
Methodology. Statistical data, features of legislation, ways of solving the problem in certain regions and the achievements of initiative groups of specialists are analyzed.
Results and Discussion. Since 2000, the number of hospital beds for children, the number of emergency medical stations has decreased, and the number of diseases and conditions requiring specialized emergency care for children has increased. Infant mortality rates in remote and hard-to-reach regions exceed the national average by 1.5–2.6 times. At the same time, the current statistics of medical evacuations of children are not accurately reflected in any of the official sources. The regulatory framework for medical evacuation of children includes three “ Procedures for providing medical care “in the profile “ambulance”, “neonatology” and “obstetrics and gynecology” and Federal Law N 323. The law implies the presence of mobile teams in hospitals and departments of different profiles that are not related to each other, but there is no structure that unites them and analyzes the results of work at the federal level.
Conclusion. To solve the problem, it is necessary to create a federal operational service and a “hotline” that can be contacted by any resident of the country, to form a federal medical register of critical conditions in children, to develop and implement common principles of diagnosis and treatment. The presented model and principles contribute to the development of a three-level system of emergency medical care and correspond to the goals and objectives of the Ministry of Health of the Russian Federation set out in Letter N 14-3/n/2-2339 of 20.03.2019.

Relevance. Currently, a significant number of approaches to the assessment of occupational risks as a result of exposure to harmful and dangerous factors of industrial activity are presented in the scientific, regulatory and legal literature. To assess occupational risks for the personnel of fire protection, risks of injury, morbidity, disability and mortality are calculated. However, no single method exists for calculating the integral index for final assessment of occupational health risk in personnel of Federal Fire Service (FFS) of EMERCOM of Russia.
Intention: To develop a mathematical model for assessing occupational risks for fire protection units including workdays lost related to health disorders severity.
Methodology. When developing a mathematical model for assessing occupational risks for the FPS of EMERCOM of Russia including workdays lost related to health disorders severity, risks to health and life of employees were directly assessed based on the following statistics (2015–2019): a) probability of hazardous situations; and b) the amount of health damage expressed as workdays lost. Coefficients of the health damage severity in the mathematical model are justified. For assessing rare occupational risks as well as in small groups, the continuity correction is proposed for injury and death risks.
Results and Discussion. Various methods of assessing occupational risks for industrial activity are considered. The mathematical model for occupational risk assessment in the divisions of the FPS of EMERCOM of Russia based on workdays lost related to health disorders severity helps predict occupational risks to life and health. Occupational risks are calculated in terms of workdays lost related to health damage severity for employees of the FPS of EMERCOM of Russia for 2015–2019.
Conclusion. Based on the mathematical model of occupational risks for the FPS of EMERCOM of Russia including workdays lost related to health disorders severity, specific occupational risks can be predicted for every specific workplace (position) in various regions of the Russian Federation.

Relevance. To date, there are no clear criteria and optimal logistic conditions for the use of helicopters for the air medical evacuation of injured victims from the scene and from the emergency zone.
Intention. To consider modern scientific views on the problem of using helicopters for air medical evacuation of victims from the place of injury.
Methodology. PubMed database and eLIBRARY.ru platform were searched for publications from 2015 to 2020.
Results and Discussion. The advantages of air ambulance evacuation by helicopters include shorter prehospital time, delivering victims from hard-to-reach areas directly to high-level trauma centers, and provision of extended prehospital care by highly qualified air medical teams. The use of helicopters is associated with risks to the life of the crew, requires significant financial costs and special equipment, and is limited by the lack of landing sites, weather conditions and at night. The effectiveness of the use of air ambulance helicopters depends on geographic and demographic factors, the level of injuries, the state of the road network in the region, the remoteness of ambulance stations, helicopter bases and trauma centers, the degree of interaction between rescue services and hospital specialists.
Conclusion. The evacuation of casualties from the scene of the accident by helicopters of medical aviation can significantly reduce mortality in case of severe injuries.

Relevance. From the point of view of using the advantages of both external fixation and internal osteosynthesis, the method “Bone transport over the nail” (BTON) deserves attention.
Intention: To compare the effectiveness of the BTON and Ilizarov method in the treatment of patients with post-traumatic defects of the long bones of the lower extremities.
Methodology. We analyzed 24 BTON cases and 47 cases of defects replacement via the Ilizarov method. The analysis included patients with segmental defects of the tibia, femur and knee joint bone defects complicated by chronic osteomyelitis.
Results and Discussion. The external fixation period in BTON group was 3 times less than in the comparison group, as was the external fixation index. In case of monolocal defect replacement, the external fixation period and external fixation index in the BTON group was 4 times less than in the Ilizarov defect replacement group. With bifocal replacement of the defect, the external fixation period was 2.5 times less, and the external fixation index was 2 times less. BTON interventions were associated with complications in 31 cases (129.2 %) vs 82 cases for the Ilizarov method (174.5 %). The most pronounced decrease (3 times) was noted for cases of transosseous elements inflammation.
Conclusion. The “Bone transport over the nail” technique reduces the external fixation period by an average of 3 times. This facilitates management of the outpatient phase and reduces the number of complications, especially the pin-tract infection. Cable technique combined with an orthopedic hexapod allows bifocal replacement of extended defects of the distal femur and knee joint applying the apparatus only to the lower leg. Risks of jamming the transported bone fragments by the intramedullary nail are thus excluded. To avoid breaking the traction cable, only designated devices should be used.

Relevance. According to the data of the international register, the use of extracorporeal membrane oxygenation (ECMO) with mechanical circulatory support in the cardiopulmonary-cerebral resuscitation complex can save up to 30% among patients with sudden cardiac death.
Intention. Analyze the main logistical and organizational problems of patient treatment identified over the two years of operation of the Center for the Treatment of Sudden Cardiac Death.
Methods. A retrospective analysis of patients admitted in the period from October 2017 to January 2020 in a state of clinical death to the Center for the Treatment of Sudden Cardiac Death of a university clinic was carried out.
Results and Discussion. In the course of the analysis, the criteria for connecting ECMO- cardiopulmonary resuscitation were developed. In most cases, the primary cause of death was cardiogenic factors (AMI, PE, fatal arrhythmias, etc.), while AMI was confirmed in 33 episodes. During the entire period of the Center’s operation, not a single patient has been admitted that fully meets the criteria for ECMO- cardiopulmonary resuscitation. However, the technology has been used as therapy for “despair” on six occasions. The main problem at present is long-term and multistage care outside the medical organization. The possibility of using ECMO posthumously was studied in order to preserve the organs of the corpse for subsequent transplantation. During two years of work, 11 effective donors were conditioned, thanks to which 22 kidney transplants and 2 liver transplants were successfully performed at the University.
Conclusion. The experience gained has shown the need to revise the algorithms for providing care to patients with sudden circulatory arrest outside the medical organization, in order to expedite transportation to the ECMO center. In the case of ineffectiveness of extended resuscitation in the clinic, it is possible to consider the use of post mortem technology for conditioning a potential posthumous donor for the preservation of organs for the purpose of their subsequent transplantation.

Intention. To study the possibility of predicting early burn sepsis based on the content of proinflammatory cytokines in the peripheral blood of patients with extensive burns.
Methodology. The study included 60 patients (of them 37 men) aged 21 to 58 years (mean age 46.8 ± 9.3 years) with extensive skin burns (Degree III burns by ICD 10 from 20 to 60 %, average 34.1 %, of the body surface). Depending on the skin area affected and the course of burn disease, the patients were divided into three groups, each of 20 patients: group 1 - the course of burn disease without early sepsis, burn area from 21 to 40 % of the body surface; group 2 - the course of burn disease without early sepsis, burn area from 41 to 60 % of the body surface; group 3 - the early burn sepsis, burn area of 20 to 60 % of the body surface. To achieve the goal of the study, all the patients underwent sequential peripheral blood sampling 24 and 72 hours after a burn injury. The levels of IL-1β, IL-6, IL-10, and TNFa were analyzed in the obtained samples. Data were processed using Microsoft Office Excel 2007 and IBM SPSS 20.0 by methods of descriptive and non-parameter statistics
Results and Discussion. The analyzed indicators statistically significantly correlated with the severity of burn injury and the likelihood of burn sepsis. Decreased concentrations of IL-1β, IL-6 and TNFα within Days 1-3 after getting a burn suggest a relatively favorable course of burn disease. No significant positive dynamics of these laboratory parameters may indicate a high probability of developing early burn sepsis.
Conclusion. Concentrations of IL-1β, IL-6 and, especially, TNFα in the peripheral blood make it possible to predict early burn sepsis.

Relevance. Spreading of the COVID-19 epidemic highlighted a number of new challenges related to protecting the health of first-line emergency and specialized medical personnel, as the high incidence of COVID-19 among healthcare workers can lead to risks of health system collapse. At the same time, in the interests of personnel safety, robotic technologies can be applied for heavy and dangerous works of air disinfection in enclosed medical environments.
Intention: To present current views on robotic air disinfection of enclosed medical environments based on the analysis of robot prototypes developed to counteract the spread of the SARS-CoV-2 virus.
Methodology. Analysis of tasks related to maintaining a safe working environment for healthcare professionals was based on the description of the functionality and specifications of robots designed to decontaminate the working environment of medical personnel deployment. When systematizing solutions for robot design, the main criteria used were the selection of control modes (Automatic, Supervisory, Manual and their combinations), hardware for disinfection in the external environment and in premises, and features of Human-Machine interaction for the safety of robotic support in enclosed medical premises.
Results and Discussion. The features of using service (disinfection) robots are formulated based on epidemiological knowledge of the primary transmission routes and methods of disinfection of premises. It is shown that the tactical and technical characteristics of existing models of Autonomous mobile robots are mainly aimed at implementing unmanned technologies. Solving problems of massive processing of objects of the external environment, as well as vast areas of airports, stadiums, hypermarkets, warehouses, vehicles in a reasonable time involves automatic modes and/or Supervisory control of such robots by the operator in remote mode. The use of disinfection robots in enclosed medical premises requires additional consideration of the factor of introducing robots into the social environment. From these positions and on the basis of the selected prototypes, the prospects are considered for using a group of small mobile robots equipped with systems that enhance sensory and communication capabilities in the work environment.
Conclusion. Using robots to reduce risks of the SARS-CoV-2 contamination opens the way to improving the working conditions of healthcare professionals who are at risk of COVID-19. The proposed methods of robotic disinfection of medical premises also help reduce the mental strain of being in a dangerous environment by expanding robotic support for decontamination of premises and flexible response to changes in the environment

Relevance. Currently, great importance is attached to the medical and psychological rehabilitation of military personnel performing combat missions in conditions of armed local conflicts. For improving medical and recreational activities, comprehensive approach seems promising.
Intention – to study the dynamics of the indicators of the mental status in servicemen with prior exposure to combat stress in the process of medical and psychological rehabilitation in an outpatient clinic and to assess the clinical effectiveness of a complex of medical and recreational measures.
Methodology. The study involved 330 servicemen exposed to combat stress factors. Of the total number of those surveyed, 54 servicemen with a reduced adaptive potential by Baevsky were selected and divided into experimental and control groups. Patients in the experimental group underwent medical and psychological rehabilitation in an outpatient clinic including audiovisual stimulation and progressive muscle relaxation according to E. Jacobson; patients in the control group received standard treatment. Research methods: clinical diagnostics, anthropometry, physiometry, psychodiagnostic testing, mathematical and statistical data processing. The median, upper and lower quartile (Me [Q1; Q4]) are presented.
Results and Discussion. According to the State-Trait Anxiety Inventory by Ch. D. Spielberger, servicemen exposed to combat stress factors and having reduced adaptive reserves showed a decrease in trait anxiety both in the experimental and control group: from 29 [27; 31] to 26 [22; 29] (p = 0.001) and from 29 [25; 35] to 27 [22; 33] (p = 0.025), respectively. Depressive symptoms in both groups were within reference limits, and their dynamics in the process of medical and psychological rehabilitation did not reach statistical significance. In the structure of the integral indicator of post-traumatic stress disorder in servicemen exposed to combat stress, the symptoms of hyperactivation were of the greatest importance. The results of the analysis of the dynamics of this indicator in the experimental group revealed its statistically significant decrease from 20 [18.5; 22] to 17 [14.5; 21] at p = 0.015.
Conclusion. As a result of the study, based on the analysis of the dynamics of the indicators of the mental status in servicemen exposed to the factors of combat stress, the clinical effectiveness of the proposed organizational model of medical and psychological rehabilitation in an outpatient setting was proved.