Introduction. Nuclear accidents are rare, however, today they cannot be entirely excluded. Thereupon the wealth of global experience is of particular value for prediction of outcomes that potentially follow short-term exposures to ionizing radiation at high dose rates.

The objective is to describe clinical simptoms and signs in workers exposed to acute gamma-neutron radiation.

Methodology. This paper considers healths effects after radiation exposure due to a critical accident that happened on January, 2 1958 during operations with an experimental flask containing uranium nitrate solution at the Mayak PA. During accident four workers were exposed to short-term gamma-neutron radiation and subsequently suffered from acute radiation syndrome of different severity degree.

Results and discussion.  Symptoms of the initial response, development of disorders in various organs and systems and the course of the acute radiation syndrome in exposed individuals are described.

Conclusion. Multiple organs or tissues are involved in severe acute radiation syndrome at an early period after acute exposure, at that cardiovascular collapse is the most critical physiological state. Multiple organs or tissues failure in the longtrem period after acute exposure is a secondary manifestation both of the primary nonspecific response to radiation and specific radiation-induced direct damage of highly sensitive cells

Relevance. Professional firefighters are exposed to high levels of physical and emotional stress which impacts their functional reserves and makes the susceptible to erroneous actions and occupational traumas. The objective is to assess the decade-long (2012 to 2021) risk of occupational injuries and to establish its correlation with nosologies of external causes under Chapter XIX of the International Classification of Diseases and Related Health Problems, 10th Revision (ICD-10).
Methods. We analyzed occupational injuries across different categories among Federal Fire Service (FFS) officers of the EMERCOM of Russia (emergency response squads, prevention, technical and administrative workforce), their causes (technical, organizational, psychophysiological and hazardous fire-related factors), and performed occupational activities (firefighting, training, sport or daily activities). Based on the ICD-10, injury risks and exposure of particular body areas to external factors were calculated per 10,000 people according (×10–4).
Results and Discussion. Over a 10 year’s timespan, 1,769 occupational injuries have been registered among Federal Fire Service officers EMERCOM of Russia. The occupational injury rate for firefighters was (9.19 ± 0.54)•10–4 injuries/(person•year), which was statistically significantly lower (p < 0.001) than for male workforce employed in Russian economy sectors – (16.50 ± 1.09)•10–4. The overall average diagnose per injury rate was 1.5, including 1.7 in firefighting and other emergency response activities, 1.4 in combat training activities, and 1.5 in routine activities. The weighted average risk of body injuries was (11.96 ± 0.89)•10–4 injuries/(person•year); in particular, cumulative injury risk rate was (10.01 ± 0.83)•10–4 responsible for 83.6% of the total value, with burns (1.39 ± 0.23)•10–4 (equal to 11.6%), poisoning by combustion products (0.39 ± 0.09)•10–4 (equal to 3.3%), heat fainting (0.18 ± 0.04)•10–4 (equal to 1.5%) respectively. The congruent risk trends for occupational injuries, industrial head and body injuries, including burns, are positive and statistically significant, which suggests the trends are driven by identical (unidirectional) parameters. For determination coefficients of different significance, the polynomial trend of body injuries risk shows a downward trend of data reduction; the risk of burns resembles an inverted U-curve; while the risk of poisoning by combustion products demonstrates an increase in indicator values. Risks of injuries to the head (S00–S09 in ICD-10) showed rank 1 of significance among occupational body lesions in the entire cohort of firefighters, reaching the level of (2,49 ± 0,32)•10–4 injuries/(person•year) equal to 20.8 % of all occupational injuries; knee and shin injuries were assigned rank 2 (S80-S89) – (1.87 ± 0.24)•10–4 equal to 15.6 %; ankle and foot area were assigned rank 3 (S90–S99) – (1.11 ± 0.15)•10–4 equal to 9,3 %; rank 4 injuries were injuries of the thorax (S20–S29) – (0.91 ± 0.13)•10–4 equal to 7.6 %; wrist and hand injuries were assigned rank 5 (S40–S49) – (0.88 ± 0.07)•10–4 equal to 7.4 % respectively. Overall, these body traumas amounted to 60.7 % of all occupational injuries of external causes. In the genesis of damages of body areas of firefighters during occupational injury, the leading place is given to head injuries, which contribute to loss of balance and create conditions for falling, as a result of which other areas of the body are injured. The analysis of occupational injuries and nosologies across different workforce categories was effectively performed taking account of injury causes and types of activity.
Conclusion. The analysis of cause-and-effect relations of all injuries among heads of subdivisions, occupational safety officers, fire engineers, firefighters and doctors allows to improve prevention of occupational injuries among officers of the Federal Fire Service of EMERCOM of Russia.

Relevance. Limb injuries occupy the first place in the structure of modern combat injuries and are one of the main reasons for the decline in fitness for military service and disability. In the conditions of conducting largescale hostilities, the role of the advanced stages of medical evacuation, where surgical care is provided according to the principles of damage control, increases. Features of the tactics of damage control in combat injuries of the extremities determine the need for special training of military surgeons.

The objective is to consider the features and effectiveness of the provision of surgical care according to the principles of damage control in combat injuries of the extremities at the advanced stages of medical evacuation in armed conflicts of the last two decades (in the countries of the Middle East and Africa, Afghanistan, Ukraine).

Methodology. A search was made for scientific articles in the PubMed database and the Scientific Electronic Library (eLIBRARY.ru), published from 2013 to 2023.

Results and Discussion. Modern combat trauma of the extremities is characterized by a high frequency of vascular damage, extensive destruction of soft tissues and bones from the impact of damaging factors of explosive ammunition. Surgical interventions for combat injuries of the extremities (external fixation of bone fractures with rod devices, ligation or temporary vascular shunt of damaged vessels, fasciotomy, amputation) were the most frequent of all operations performed at the advanced stages of medical evacuation during modern military conflicts. The volume of surgical interventions corresponded to the first stage of orthopedics and vascular control of injuries and was determined by the severity of the condition of the wounded, the degree of ischemia and severity of limb injuries, and the medical and tactical situation.

Conclusion. Assistance at the advanced stages of medical evacuation according to the principles of orthopedics and vascular damage control can significantly reduce the frequency of amputations and improve the functional results of treatment for combat injuries of the extremities.

Relevance. The timely use of extracorporeal membrane oxygenation within resuscitation measures for patients with refractory circulatory arrest is becoming a routine rescue practice in the world, making it possible to increase the efficiency of resuscitation measures up to 30 %; however, this technology is not widespread in Russia, despite the fact that without extracorporeal mechanical support, the effectiveness of cardiopulmonary resuscitation is no more than 9 %.
Objective. Analysis of the experience of using transport venoarterial extracorporeal membrane oxygenation (ECMO) within extended cardiopulmonary resuscitation in case of out-of-hospital circulatory arrest in inpatient emergency department.
Methods. Analysis of the experience of using transport ECMO within extended cardiopulmonary resuscitation in case of out-of-hospital circulatory arrest in inpatient emergency department.
Results and Discussion. Of the 16 cases of extracorporeal cardiopulmonary resuscitation, effective circulation was restored in 37.5 % (6 out of 16) of cases. In these cases, the duration of extended cardiopulmonary resuscitation outside the medical organization was significantly lower, (50.8 ± 4.2) minutes versus (65.6 ± 4.6) minutes. In the group of patients with ineffective extended cardiopulmonary resuscitation, there was a significant increase in troponin (1820 ± 164) versus (473 ± 180) ng/l and D-dimer (17 566 ± 429) versus (13 122 ± 628) µg/l (FEU).
Conclusion. Transport ECMO technology, which is used for extracorporeal cardiopulmonary resuscitation in patients with out-of-hospital refractory circulatory arrest, allows the use of a wide range of diagnostic and therapeutic procedures, including percutaneous coronary interventions. The analysis revealed the need to reduce the duration of resuscitation by ambulance teams on the spot in favor of extended CPR in motion using an electromechanical device for chest compressions.

Introduction. Stress reaction in deadly scenarios is a systemic response of human body to the impact of extreme and acute psychotraumatic factors. The condition is associated with complete or partial loss of ability to perform tasks and can lead to the development of post-traumatic stress disorder. Therefore, new effective means and methods of stress correction in lethal force scenarios is a most urgent challenge for catastrophe medicine.
The objective is to estimate the therapeutic efficacy of xenon gas mixtures in the treatment of different categories of employees exposed to occupational hazards, including acute stress.
Methodology. A randomized controlled experimental study was conducted, involving 48 employees of law enforcement bodies and rescue operations professionals. Acute stress disorders were treated using a course of oxygen-xenon gas mixture inhalations (oxygen – 75 %, xenon – 25 %). Comprehensive medical and psychological examination allowed to monitor treatment efficiency.
Results and discussion. Oxygen-xenon gas mixture inhalations contributed to normalization of systemic hemodynamics, improved parasympathetic activity and reduced sympathetic nervous system activity, leading to a significant reduction in the level of anxiety and improvement of psychopathological symptoms.
Conclusion. The obtained findings provide extra evidence showing that xenon-based gas mixtures are a promise as a stress correction tool in patients exposed to lethal force scenarios and acute occupational hazard.

Relevance. The prevalence of post-traumatic stress disorder ranges from 1 to 12 % among the general population and reaches 30 % among the population affected by various emergencies, which makes the PTSD problem ever more relevant considering the special military operation in Ukraine.
Objectives. The aim is to study and describe the main clinical approaches to the treatment of PTSD.
Methods. The clinical and bibliographic method were used to perform a comparative analysis of academic research papers published in 2008 to 2022.
Results and discussion. Treatment of PTSD requires an interdisciplinary approach with a particular focus on individually specific psychotherapeutic methods, as well as administration of selective serotonin reuptake inhibitors (SSRIs) as antidepressants. We analyzed clinical and diagnostic aspects of combat PTSDs, their pathology, origin, treatment options and challenges for discussion. Currently, combat PTSDs are acquiring extra relevance.
Conclusion. While trying to investigate the development of clinical PTSD manifestations, the focus is shifted from syndrome-associated parameters towards understanding PTSD as an integral disorder of psychogenic origin with polysyndromic and multisystemic characteristics.

Relevance. The existing traditional tools (scales) to assess severity of the patient’s condition and death probability do not take into account a set of crucial parameters for the upcoming medical evacuation.
The objective is to develop the Transportability Assessment Scale (TAS) and transportability-associated mortality (TAS-mortality) tool to evaluate critical patients and patients injured in emergency situations (ES) of all age groups at different stages of medical evacuation using all types of transportation, followed by inpatient treatment.
Methods. In total, we analyzed N=217 clinical cases of medical evacuation using different types of transportation in combination with either traditional intensive care (n=149, control group) or ECMO (n=68, trial group) due to refractory respiratory and/or circulatory insufficiency in all age groups. Once the patients embarked on medical evacuation, they were immediately split in groups to assess their condition while transportation and within the next 72 hours (associated period). A new scale (formula) to assess patient’s transportability and probability of mortality, including in the ECMO setting, was formulated based on the following statistical techniques: one-factor forecasting, risk classes of disorder development and logistic regression modeling applied to such target indicators as “death”, “transportation negative impact on patient’s condition” and other factors. Most significant factors were further embedded in the new transportability and probability of death assessment scale (formula).
Results and discussion. The Transportability Assessment Scale (TAS) was developed using logistic regression model measuring the impact of transportation on the patient’s condition: y = exp(37∙ x₁ + 6∙ x₂ + 20∙ x₃ +16∙ x₄ + 21∙ x₅ + 27∙ x₆ – 27∙ x₇) / 1+ exp(37∙ x₁ + 6∙ x₂ + 20∙ x₃ +16∙ x₄ + 21∙ x₅ + 27∙ x₆ – 27∙ x₇), where: у – transportability assessment of patient; x1 (PaO₂/FiO₂ ≤ 110); x₂ (Age ≥ 65 years); x₃ (VIS ≥ 4 points); x₄ (PaCO₂ ≥ 55 mm Hg); x₅ (SvO₂ ≤ 60 %); x₆ (HR∙ ≥ 127 beats per minute); x₇ (ECMO application). Depending on the evacuation conditions, correction factors were as follows: x₁ – 0.75 if the patient is to be transported by plane, x₆ – 0.65 if the patient’s body weight is less than 10 kg. The results were translated into a 100-point scoring system: patients scoring up to 30 points were available for evacuation; 30 to 70 indicated evacuation to be performed in ongoing intensive care setting; over 70 indicated impossibility of evacuation until the patient is stabilized and subcompensated. We also developed the new TAS-mortality 100-point scale: y = exp(29∙ x₁ + 16∙ x₂ + 11∙ x₃ + 10∙ x₄ + 9∙ x₅ + 7∙ x₆ + 7∙ x₇ + 6∙ x₈ + 4∙ x₉ + 1∙ x₁₀,) / 1+ exp(29∙ x₁ + 16∙ x₂ + 11∙ x₃ + 10∙ x₄ + 9∙ x₅ + 7∙ x₆ + 7∙ x₇ + 6∙ x₈ + 4∙ x₉ + 1∙ x₁₀), where: y – probability of outcome – death; x₁ (lactate ≥ 8 mmol/L), x₂ (age ≥ 65 лет), x₃ (creatinine ≥ 300 µmol/L), x₄ (duration of mechanical ventilation ≥ 7 days), x₅ (bilirubin ≥ 102 µmol/L), x₆ (PaO₂/FiO₂ ≤ 110), x₇ (CPR), F₈ (VIS ≥ 4 points), x₉ (PaCO2 ≥ 70 mm Hg), x₁₀ (SvO₂ ≤ 50 %). TAS-mortality scale complemented by the ROC analysis program (AuROC = 0.83; p < 0.001), showed higher sensitivity, specificity and efficacy in comparison with traditional scales APACHE-IV & Mortality Rate, SOFA & Mortality Rate, Scale of Assessment of Vital System (ShOVS).
Conclusion. The proposed Transportability Assessment Scale (TAS) and transportation associated mortality (TAS-Mortality) scale have better sensitivity, efficiency and ROC-curve than traditional scales, and therefore could be actively recommended to describe the state of emergency victims or critical patients of all age categories, as well as to make decisions regarding medical evacuation, including ECMO and medical jets.

Relevance. The history of armed attacks on educational institutions originated in the United States, but in recent decades this social phenomenon has spread widely to other countries, including Russia. Mass social tragedies associated with deaths of the youth cause great concern among all groups of population and require comprehensive prevention measures.
The objective of the study is to identify social environmental factors that shape school shooter mentality, as well as to explore various strategies to prevent attacks in educational institutions of different levels (kindergartens, schools, universities).
Methods. Armed attacks in educational institutions are the focus of our research. The material includes published research data (articles, dissertations and monographs) in English and Russian. The set of methods included generalizing conclusions published by peer investigators regarding the considered matter. Bibliographic databases (i.e. Federal State Institution “Russian State Library”, library platforms of Lomonosov Moscow State University and Peoples’ Friendship University of Russia) and scientific networks (ResearchGate, Web of Knowledge, Scopus, Google Scholar, Academia.edu, Mendeley) were used to explore research data. The findings present over 127 thousand publications regarding meta-analysis of armed attacks and mass shooting that occurred in educational institutions, as well as their social, psychological, cultural, and informational implications.
Results and Discussion. The analysis of data regarding armed attacks in educational institutions demonstrates a very specific phenomenon that belongs to a specific type of crimes. Findings show that mass shootings of schoolchildren and students occur annually in the United States, apparently due to the free circulation of firearms and the cult of the guns. From 1974 to 1921 the US witnesses over 50 major armed attacks causing over a hundred deaths. In China, this problem is also substantial due to the country’s rapid and profound social changes (reforms, gender imbalance and demographic policy). Cold arms (knives, hammers) is the major weapon of assault in China, which caused deaths of at least a hundred children. In Europe, school shooting is not a critical problem, with only few cases reported by a few countries (Germany, Denmark and Finland). Russia shows no increase in the number of armed attacks using firearms or cold arms. In general, such incidents occur annually (1 to 4 violence cases) and are associated with slumped standards of living, increased aggression, social and psychological maladaptation among the population. To solve this problem, an integrated approach is needed, which could bring together technical and social aspects. The technical aspects imply broader use of video surveillance security systems and barriers, as well as regular profound inspections of school grounds (the venue and inside the school building). However, preventive measures should effectively provide for the social aspect to ensure expanded and deeper social and communicative relations within the student – administration / school teacher – parents paradigm. Taken together, these measures are bound o mitigate many factors of antisocial, aggressive, and violent behaviors in schools.
Conclusion. A comprehensive analysis of Russian and foreign literature regarding armed attacks in educational institutions suggests that this is an independent psychosocial phenomenon. A system approach of the study allowed to establish a school shooter’s presumable portrait, as well as to identify typical social and personal characteristics of a shooter’s personality (i.e. social isolation; lack of individual ability to cope with life difficulties, such as study failures, conflicts at school or in the family; weak social integration at school and in other communities; decreased self-esteem and identity-related problems, in particular gender-related issues). 

Relevance. Improving mental health of professionals working in extreme environments are an urgent step towards improved health of the urban population.
Objective. The aim is to evaluate the long–term efficiency of hypoxic training wearing a filter gas mask in terms of mental health.
Methods. Mental health assessment was carried out using Spielberger–Khanin questionnaire and the Lusher test. The correlation between the indicators showing changes in the level of anxiety, vital lung capacity and the number of trunk lifts were calculated for the two groups of students, each including 50 participants. Group 1 used a filter gas mask while doing physical exercises within their hypoxic training, whereas Group 2 performed similar amount of exercises without wearing a gas mask.
Results and discussion. Group 1 showed a significant decrease in the level of anxiety and a trend towards having less students with future pursuits and hopes for the best. By the end of the study, moderate negative correlations of reactive anxiety with an increase in the vital lung capacity (r = –0.43; p < 0.05) and the number of trunk lifts in supine position (r= –0.37; p < 0.05) was found in Group 1. Factor analysis in both groups revealed restructured functional body reserves during physical training.
Conclusion. Hypoxic training in students throughout the academic year allowed to significantly increase the vital lung capacity, physical resilience, satisfaction, pursuits and positive perception of the future, while reducing the level of anxiety.

Relevance. Artificial intelligence is one of the fastest growing and promising technologies for processing and classifying natural text.The objective is to conduct a semantic analysis of domestic publications on emergency-related medical, biological and psychological problems, that are registered in the Russian Science Citation Index within 2005–2021 and where authors implement artificial intelligence methods and special software.Method. The object of the study is to analyze emergency-related medical, biological and psychological problems, published within 2005–2021 and registered in the Russian Science Citation Index. The analysis was carried out using VOSviewer program, as well as a neural network using the Python programming language.Results and discussion. For the purpose of semantic analysis, numerous scientific articles were imported from the Russian Science Citation Index into the VOSviewer program. Bibliometric visualization and clustering of key terms was conducted, to provide an insight into the publications and affiliations of main authors. In addition, cluster analysis and the ‘elbow’ method allowed to build a neural network in an automated mode to provide for more effective clustering; these data enabled us to identify 19 thematic clusters of scientific publications.Conclusion. In their publications investigators should be aware that the language of abstracts and keywords shall be inconformity with thesauruses, such as Medical Subject Headings (MeSH). These clarifications contribute to a more correct correlation between publications and existing headings. Further increase in the level of digitalization, including artificial intelligence methods, will allow to conduct more accurate research