Relevance. Extreme work conditions of firefighting personnel contribute to the overstrain of the functional body reserves and may determine increased rates of industrial injuries.

Intention. To analyze the circumstances of work-related injuries and deaths of personnel (employees with special military ranks and workers) of the Federal Fire Service (FFS) of the EMERCOM of Russia in 2010–2020.

Methodology. We compiled an analytical statistical dataset of industrial injuries (including fatal outcomes) regarding the personnel of the FFS of EMERCOM of Russia, which covered the period of 11 years, from 2010 to 2020. We used the statistical data from the industry resources, which included the indicators of morbidity, injury, disability and death in the personnel of the EMERCOM of Russia. We calculated the work-related injury rates by 14 types of circumstances as mentioned in statistical reports, per 10,000 firefighters; on-duty death rates were calculated per 100,000. The arithmetic means and their errors (M ± m) are presented. Industrial injuries and death rates among firefighters were compared vs workforce in the Russian economy.

Results and Discussion. The average annual rate of industrial injuries in firefighters was (11.10 ± 1.84) per 10 thousand firefighters vs (15.09 ± 1.21) per 10 thousand Russian workforce. Decreasing rates of work-related injuries among firefighters and overall in Russia have been observed. There was a high consistency in the trends of industrial injuries among workers in Russia and among the firefighters, which may indicate the influence of unidirectional factors. Among industrial injuries of firefighters, fire-fighting operations accounted for 40.5 % of cases, daily activities – for 39.7 %, professional training and sports events – for 19.8 %. The average annual death rates in firefighters were (7.30 ± 0.65) per 100 thousand, including firefighting operations (4.86 ± 0,51), daily activities (2.44 ± 0.26). The work-related death rate among workers in Russia – (6.75 ± 0.48) per 100 thousand. The dynamics of a decrease in the death rate of firefighters and workers in Russia has been revealed. The consistency of the trends in the deaths of Russian workers and firefighters is moderate and positive, but statistically unreliable. The leading circumstances of industrial injuries among firefighters were personal negligence (40.1%), falls from height (13.5 %), road traffic accidents (12.6 %), structural failures and collapses (10.7 %), exposure to extreme temperatures (4.1 %). The above circumstances accounted for 81% of the industrial injuries. The major circumstances of death were fatal injuries associated with structural failures and collapses (24.6 %), road traffic accidents (22 %), poisoning by combustion products (12.9 %), with explosion of gas cylinders or gas-air mixture (11.3 %) and falls from height (9.5 %). These circumstances accounted for 80.3 % of total on-duty deaths of firefighters.

Conclusion. With exact and accurate recording of all injuries, traumatism is a manageable process. Analysis of the types of activities and circumstances of injury (including fatal outcomes) will help prevent industrial injuries among firefighters and reduce on- duty death rates.

Relevance. During firefighting, in addition to harmful physical factors, there are toxic combustion products, including dioxins – a group of dangerous chemicals capable of accumulating in adipose tissue. At the same time, the first target of dioxins on the path of detoxification of xenobiotics is the liver.

Intention. To identify the features of the formation of non-alcoholic fatty liver disease in firefighters of Federal Fire Service (FFS) of Emercom of Russia, depending on blood lipid concentrations of dioxins.

Methodology. There were examined 121 firefighters (63 of them with fatty liver dystrophy at various stages) and 125 other employees of the Emercom of Russia (65 of them with fatty dystrophy) not involved in firefighting. The indicators of carbohydrate and fat metabolism, dioxins in the blood, metabolic syndrome and some liver parameters were assessed.

Results and Discussion. Based on the analysis, effects of dioxins on the formation of non-alcoholic fatty liver disease indicate different pathogenesis in firefighters vs other employees of the Emercom of Russia not affected by toxic combustion products. Firefighters with non-alcoholic fatty liver disease had significantly lower levels of glucose, insulin resistance index, body mass index and atherogenicity coefficient vs other employees (high values of the above parameters are typical for the metabolic syndrome). At the same time, alanine transaminase activity was higher in firefighters with non-alcoholic fatty liver disease vs other employees, thus indicating greater liver damage.

Conclusion. Based on the results obtained, it can be assumed that non-alcoholic fatty liver disease in firefighters is mainly caused by toxic combustion products, including dioxins.

Relevance. Epidemiological studies indicate an extremely high incidence of traumatic brain injury (TBI) in Russia, Europe and the USA. The main cause of TBI is road traffic injuries. Chronic catabolic processes, typical for patients with long-term impairment of consciousness due to TBI, can interfere with the recovery process and improvement of the functional state of the brain. The organization of nutrition for this category of patients requires an individual approach based on calculations of metabolic needs, as well as timely and adequate substrate supply of nutrients.

Intention. To evaluate the effectiveness of specialized nutritional supplements for enteral nutrition vs pureed diet and to develop technologies for nutritional support for victims in emergencies with a long-term impairment of consciousness due to TBI.

Methodology. Between 2016 and 2020, in the Department of Physical and Rehabilitation Medicine of the Nikiforov Russian Center of Emergency and Radiation Medicine the study included 126 patients with long-term impairment of consciousness due to TBI. The main group (n = 84) received specialized nutritional supplements for enteral nutrition, the control group (n = 42) – a pureed diet. Evaluation of the effectiveness of specialized nutritional supplements for enteral nutrition and a pureed diet was carried out, followed by the development of nutritional support technology for victims of emergencies with long-term impairment of consciousness due to TBI.

Results and Discussion. The data obtained indicated the effectiveness of nutritional support with specialized nutritional supplements for enteral nutrition in comparison with a pureed diet. Statistically significant differences were revealed when comparing trophological status indicators depending on the types of food provided (BMI (p = 0.03), shoulder circumference (p < 0.001), shoulder muscle circumference (p < 0.001), deviation of the actual body weight from the recommended body weight (p = 0.03), total serum protein (p < 0.001), serum albumin (p < 0.001), absolute lymphocyte count (p = 0.03)). A significant decrease in the number of patients with moderate and severe protein-energy malnutrition (PEM) (p = 0.013) in the main group was revealed.

Conclusion. The proposed algorithms and scientifically grounded technologies of nutritional support for victims of emergencies with long-term impairment of consciousness due to TBI, which are based on the assessment of the effectiveness of specialized nutritional supplements for enteral nutrition and a standard hospital pureed diet help to diagnose malnutrition, realize feeding and improve indicators of the trophological status.

Relevance. The development of computer technology in recent years is increasingly being introduced into the medical field. Modern programs make it possible to perform imitation modeling of a medical unit in the mode of daily activities and in emergency situations, allow predicting the required number of personnel and bed capacity.

Intention. To study the possibilities of computer simulation to optimize the work of an inpatient emergency department in emergency conditions.

Methodology. With the help of software, a simulation model of a real inpatient emergency department was developed, experiments were carried out with the formation of emergency situations, the results were compared with data obtained in practice.

Results and Discussion. Upon admission of 50 patients per hour, the optimal solution was the conversion of 5 beds of the dynamic observation ward into intensive care beds and the placement of 10 additional beds in the waiting room, as well as the allocation of additional personnel in case of an emergency: 8 doctors, 6 nurses and 2 paramedics, 4 medical registrars. In the experiment of work in the conditions of the first wave of the COVID-19 pandemic, the capacity of the department was sufficient to admit 164 patients in 24 hours, the duration of their stay in the department was (110.0 ± 4.6) minutes. The second wave demonstrated the need to apply simulation modeling as a whole for the entire medical institution, and not just for individual structural units.

Conclusion. Planning the work of an inpatient emergency department in an emergency requires preparedness for massive admission of patients. In this case, it is advisable to solve tactical issues in advance, using modern technologies, such as computer simulation.

Relevance. One of the important principles of medical evacuation support for the affected population in emergency situations (ES) is the maximal approaching of medical care to the focus of mass sanitary losses. This can be achieved by recruiting various medical staff as part of supernumerary units (SUs) within the Disaster Medicine Service (DMS). During SU training, chiefs of medical organizations (military medical organizations) face some various clinical and organizational problematic issues.

Intention: To identify and study relevant problematic issues of the professional practice of medical staff recruited in various SUs of the DMS of the Russian Ministry of Defense for the elimination of the ES medical and sanitary consequences, and to determine the hierarchy of these issues by their significance among medical workers.

Methodology. 440 medical professionals who participated in DMS SU activity were surveyed. Initially, 10 diverse questions were defined with answers rated from 1 to 3: not an important problem – 1 point; an important problem – 2 points; a very important problem – 3 points. The results of the survey were evaluated and a factor analysis of the significance of the studied problematic issues was carried out.

Results and Discussion. The most significant problematic issues were “the lack of supply of supernumerary units with the necessary medical equipment” and “the poor training of medical staff in providing the assistance abroad”. During the factor analysis, 3 factors were defined, the total dispersion of which was 52.7 %. The 1st factor (30.3 % of the dispersion) included the problems of insufficient supply of supernumerary units with necessary medical equipment, poor training of medical personnel, non-compliance with their working conditions and protection of interests during their activity in the emergency zone, which is related, inter alia, to a lack of basic regulatory documents. The 2nd factor was defined as a poorly developed procedure for the functioning of supernumerary units. The contribution of the second factor to the total variance of baseline traits was 12.3 %. The 3rd factor with a share of 10.1 % grouped questions on low theoretical and practical readiness of specialists from non-staff DMS formations to operate in emergency situations.

Conclusion. The used methodology for studying the topical problematic issues of the professional activities of medical personnel in supernumerary units of the DMS allowed us to reliably establish their structure and propose methodological approaches to their resolution. The first approach is to improve the organization of DMS SU activities with a focus on the most significant problematic issues. The second approach is to conduct more in-depth research in this area with involvement of a wide range of specialists (experts) at various levels. The third approach includes training interactions of DMS SU personnel when performing actual tasks and solving problematic issues under study. Timely response of DMS medical authorities to the existing requests from SU medical personnel involved in the elimination of the medical and sanitary consequences of ES will boost their effectiveness and will have a positive impact on the overall system of medical and evacuation support of the AllRussian DMS.

Relevance. Effective operation of the evacuation transport and the ambulance team implies fast and high-quality assistance, including fast delivery of medical forces and assets to patients, all necessary treatment for emergency and urgent indications on the spot and also along the evacuation route, and prompt evacuation of patients to hospitals for preventing severe pathogenetic complications.

Intention. To study effectiveness of emergency medical services during medical evacuation both in a megalopolis and in remote settlements; to identify the main problems and shortcomings of the modern medical evacuation system at the prehospital stage; and to justify the need to develop and implement new types of air ambulance for intra-city and inter-point operating conditions to help emergency medical teams.

Methodology. Domestic and foreign publications devoted to the development of air ambulance and medical evacuation have been studied.

Results and Discussion. Based on literature analysis, the main problems of emergency medical services within “the golden hour” are revealed. The analysis was carried out and the low efficiency of the current system of medical evacuation measures for emergency medical indications at the pre-hospital stage, especially in the conditions of a megalopolis, was demonstrated. Both advantages and problems and significant disadvantages in the wide use of the capabilities of modern air ambulance are identified.

Conclusion. In the near future, small aircrafts based on new principles of air transportation will become an alternative to conventional sanitary and medical evacuation transport worldwide. Of particular interest are experimental unmanned aerial vehicles for urban passenger needs developed by foreign and domestic authors. Besides, similar aircrafts are proposed for the needs of disaster medicine. Their implementation will fundamentally increase the efficiency and improve the quality of medical care for the population of cities and villages, regardless of road traffic conditions, both in emergency situations and daily life at the pre-hospital and inter-hospital stages of medical care.

Relevance. Currently, studies aimed at increasing the resistance of the respiratory system to hypoxic loads are relevant both for clinical, rehabilitation medicine, and for medical and psychological support of specialists who carry out their professional activities in extreme conditions.

Intention – To evaluate the long-term effects of hypoxic training in a filter gas mask on the functions of external respiration.

Methodology. A spirometric assessment of changes in the functions of the external respiration system and an analysis of physical performance were carried out in two groups of students, including 50 people each. The first group used filter gas masks during physical exercises for hypoxic training, and the second group performed similar loads without gas masks.

Results and Discussion. In a group of students using gas masks during physical exercises, vital capacity of the lungs statistically significant increased in the middle and end of the academic year. Besides, 100 meter race time and numbers of repetitions when lifting the body from the prone position during examinations in the middle and end of the academic year indicate better fitness of students who used gas masks during physical exercises.

Conclusion. The use of a filtering gas mask as a hypoxicator when performing exercises during the academic year significantly increased functional reserves of the body, in particular vital capacity of the lungs and the physical fitness.

Relevance. Head injuries in Russia are the most significant cause of death in emergencies and road traffic accidents, as well as disability of victims. Neurospecific proteins such as glial fibrillary acidic protein (GFAP) are markers of neural tissue damage and blood-brain barrier dysfunction. Blood serum GFAP analysis can become a possible noninvasive method to assess brain injury severity and prognosis.

Intention. To analyze GFAP levels in blood serum of patients having central nervous system traumas of varying severity as well as the injury outcomes.

Methodology. GFAP levels were measured in the blood serum of 47 patients with traumatic brain injury before their treatment and in 42 apparently healthy donors using immunoenzyme method (Human GFAP ELISA, BioVendor, USA).

Results and Discussion. GFAP detection frequency was 38.3 % (18 out of 47 people) for the group of patients with traumatic brain injury, while the marker was nearly undetectable in the control group. There were statistically significant differences in serum GFAP levels depending on severity and outcome. The basal average marker concentration in the group with poor outcome was 10 times higher than in patients with a favorable outcome.

Conclusion. GFAP is a potential marker to assess severity and prognosis of traumatic brain injur

Relevance. Taking into account the increasing probability of exposure to ionizing radiation in humans (including emergencies, occupational and medical exposure), it became obvious that it is necessary to increase the technical capabilities of biodosimetric laboratories to estimate radiation doses for various exposure scenarios. Therefore, it is necessary to develop calibration curves for using different methods of biological dosimetry and to introduce these methodological approaches into the practical activities of the laboratory.

Intention. To develop calibration curves for determining the radiation dose using different cytogenetic methods: analysis of dicentrics chromosomes, micronucleus test with cytochalasin B and the analysis of prematurely condensed chromosomal fragments (PCC) after gamma irradiation.

Methodology. Dependence of the frequency of chromosomal aberrations detected in peripheral blood lymphocytes from the external radiation dose after gamma in vitro irradiation of blood samples in the dose range of 0-6 Gy was evaluated. Equations of the dose dependence of the frequency of aberrations were obtained. Based on that calibration curves were created that let to determine the biological dose of radiation.

Results and Discussion. As a result of analysis of chromosomal aberrations induced in vitro by ionizing radiation (dicentric chromosomes, micronuclei in binuclear cells, and PCC fragments), dose–dependence equations have been obtained. The equations have been validated by determining the radiation dose of a blood sample irradiated in vitro, which confirmed the adequacy of the developed models. Control levels of analyzed cytogenetic parameters were revealed. In patients suspected of being overexposed during medical research using ionizing radiation (CT studies), using the obtained calibration curve for assessing the absorbed radiation dose by the number of dicentric chromosomes, radiation doses indicating the absence of overexposure were established.

Conclusion. Developed equations for the dose dependence of the frequency of dicentric chromosomes, micronuclei in binucleated cells, and PCC fragments make it possible to efficiently estimate the biological dose of radiation in persons exposed to ionizing radiation. The use of a battery of cytogenetic tests expands the laboratory’s capabilities in the field of biological dosimetry in various exposure scenarios.

Relevance. Occupational activities of Russian Emercom employees in the Arctic zone are associated with prolonged nervous and emotional overload due to physical and climatic factors, as well as nutrition features. Taking into account regional peculiarities of different Russian territories, in particular, the prevalence of microelementoses of natural and man-made origin, it becomes obvious that research is needed to identify disorders related to micronutrient availability of essential bioelements and the load of toxic chemical elements in Russian Emercom employees working in the Arctic zone of the Russian Federation.

Intention. To establish regional features of the bioelement status in Russian Emercom employees working in the Arctic zone with such manifestations as deficiency of essential bioelements and incorporation of toxic elements.

Methodology. Bioelements were assessed in hair samples via inductively coupled plasma mass spectrometry (Agilent 7900 ICP-MS). In total, 110 Russian Emercom employees aged from 20 to 60 years took part in the study (Group 1). Changes in metabolism of chemical elements were analyzed by age (20–30 vs 31–39 vs 40+ years) and the length of service in the Arctic zone (< 4 vs 5–9 vs 10+ years). A control group comprised 104 Emercom employees working in St. Petersburg and Leningrad region.

Results and Discussion. No bioelement differences were observed in Group 1 between fire-fighters (n = 30) and rescue workers (n = 80). When assessing the bioelement status in Russian Emercom employees, Group 1 showed deficiencies of cobalt, iodine, magnesium and selenium as well as excessive content of such toxic elements as nickel (in 9 % of employees), cadmium (10 %), silver (10 %), arsenic (5 %), aluminum (11 %) and lead (9 %). With age, toxic elements (aluminum, arsenic and lead) tended to accumulate, especially after 40 years. There were established increasing deficiencies of iodine, magnesium and selenium along with accumulation of aluminum, arsenic and lead in employees with 10-year and longer service in the Arctic zone.

Conclusion. Based on the bioelement data from Russian Emercom employees working in the Arctic, it is reasonable to take vitamin and mineral complexes containing iodine, magnesium, selenium and cobalt to prevent diselementoses. Besides, sorbents and high-fiber foods can help faster remove excess toxic elements. Assessment of chemical elements in biological material (hair) should be included in the follow-up examinations of employees working in the Far North. This will be especially relevant in case of long-term work and age 40+ years for adequate identification of risk groups and individual correction of metabolic disorders.

Relevance. Risk factors of emotional distress in medical professionals during the COVID-19 pandemic should be identified for development of the effective system for prevention of mental disorders and emotional burnout.

Intention. Investigation of factors related to the severity of distress and emotional burnout in medical professionals during the pandemic of new coronavirus infection.

Methodology. The online cross-sectional study, conducted from August 2020 to April 2021 involved 359 medical workers (doctors of various specialties – 172, nurses – 134, medical psychologists – 40, nurses – 3, medical workers who did not indicate their profession – 10). The following methods were used: semi-structured interview; K. Maslach Professional Burnout Inventory adapted by N.E. Vodopyanova and E.S. Starchenkova; visual analogue scales specially designed for this study. Statistical processing of the data included dispersion analysis; the Kraskel–Wallis method; Mann–Whitney U-test; t-test; Spearman correlation coefficients.

Results and Discussion. In the general sample of medical professionals, a high level of emotional burnout was identified. The most severe emotional distress, exhaustion and depersonalization were found in doctors compared to nurses and psychologists. The “Subjective feeling of high risk of COVID-19 infection” acts as a core characteristic associated with various manifestations of emotional distress and burnout in medical professionals and can be considered as a central indicator of distress severity. The characteristics of the professional activities, age, level of education and workload, as well as the nature of family relations are related to the severity of manifestations of emotional distress and burnout during the pandemic period and should be taken into account when creating programs to provide psychological assistance to medical personnel. Severe anxiety due to a possible COVID-19 infection in a loved one and worsening financial situation could be the potential sources of stress in health professionals.

Conclusion. Targeting situations that potentially cause severe anxiety, as well as factors contributing to addictive forms of behavior in health workers during the pandemic could be beneficial in prevention programs for medical personnel.