General Theoretical issues
Over 5 years (2009–2013) 1855 emergency situations (ES) were registered in Russia, in which 3658 people were killed and 333,200 people were injured. There were 1022 (55.1 %) man-made disasters, 584 (31.5 %) natural ES, 207 (11.1%) biological and social ES, and 42 (2.3 %) terrorist attacks. Among them, 918 ES (49.4%) occurred at the local level, 721 (38.9 %) were municipal, 93 (5.0 %) – intermunicipal, 107 (5.8 %) – regional, 7 (0.4 %) – interregional, and 9 (0.5 %) – federal ones. Most ES occurred in Siberia, Volga and Southern federal districts (FD); most of the deaths were reported in the Central, Volga and Siberian FD, the number of injured was the greatest in the Far East, Volga and Southern FD. The positive relationship was established between the number of man-made disasters and regional gross domestic product as a percentage (r = 0.76; p < 0.05). In Russia, there is a low consistency between the number of emergencies and ES deaths (r = 0.33; p> 0.05), which served as the basis for calculating risk indicators. The risk of being in ES (R1) in Russia amounted to (0.259 ± 0.019) ESs per 100 thousand persons per year, or (0.259 ± 0.019) · 10–5. The risk of death in 1 ES (R2) in Russia was (2.01 ± 0.17) fatalities per year. Individual risk of death in ES (R3) was (0.511 ± 0.031) deaths per 100 thousand of Russian population per year, or (0.511 ± 0.031) · 10–5. R3 parameter has decreased. For example, in the previous five years (2004–2008) it was higher (0.752 ± 0.070) · 10–5, p <0.001. The optimum, acceptable and unacceptable risks for FD and specific regions of Russia were calculated. Favorably risk indicators were established in the Central FD and the relatively favorable ones – in the Northwestern FD of Russia. Risk indicators allow EMERCOM employees to predict and prevent ESs in the regions and disaster medicine specialists – to calculate the forces and means for the elimination of medical consequences.
Medical Issues
The experience of anesthetic and resuscitative care for the wounded in the war in Afghanistan (1979–1989) is provided. Difficulties faced by anaesthetists in the initial period of the war are described: discrepancy between amount of work and the staffing of anesthesiology and intensive care departments; complex combined pathology (injury + overheating + dehydration + infection); difficulty choosing adequate anesthesia techniques; outdated logistics and other factors. Ways to improve this type of aid are outlined which resulted in the increase of anesthetic activity from 34.2 to 64.9 % with decline in mortality from 14.6 to 6.1% in the department of anesthesiology and resuscitation.
Presented is an experience of complex treatment of 15 patients with injuries and extensive traumatic detachment of skin and subcutaneous tissue of the lower extremities, conducted by experts of the Department of Traumatology and Orthopedics, Nikiforov Russian Center of Emergency and Radiation Medicine, EMERCOM of Russia in 2012–2014. In 6 patients the severity of the injury was assessed as Degree II by Tscherne classification and Degree IIIB by Gustilio–Andersen; in 9 patients – III and IIIC, respectively. On admission primary wound debridement was performed, the limb was fixed using external fixation device (ExFixAO or Ilizarov apparatus), a vacuum drainage bandage was put over. In case of total soft tissue defects in the front lower leg, a non-free muscle flap was used on a permanent feeding pedicle from the medial abdominal belly of m. gastrocnaemius. To close tissue defects in the middle and lower third of the tibia, perfused free thoracodorsal flap was used. Tissue defects covered with granulation tissue and prepared for grafting were closed with perforated split skin autograft. Mesh wound cover was applied over the graft, and again on day 3 suction drainage was installed (in constant mode of 80 mm Hg). All patients received a vascular fluid therapy, antibiotics and anticoagulants in the treatment dosages and additionally underwent oxygenbarotherapy (5–15 sessions).
Based on the analysis of the dynamics of physiological, psycho-physiological and biochemical parameters it was assessed the efficacy of enterosorbents as a means of correction the functional status of the sailors in the prolonged (54 days) voyage. The study was carried out with the participation of volunteers – crewmembers of a surface ship of the Navy of Russia (56 sailors, the average age of 19,3 ± 0,12 years). There were formed 3 equal groups in terms of age and professional military activities. In the group 1 (n = 19), the sailors received enterosorbent "Polisorb-MP", in the 2nd group (n = 18) – enterosorbent "Activated carbon". Group 3 (n = 19) was the control (placebo). The drugs were administrated orally in the last 20 days of sailing in a daily dose of 5 g once in the form of an aqueous suspension in 100–120 ml of water. It is shown that on the background of enterosorbents decreased functional stress the cardiovascular system and did not occurred the significant deterioration of sensorimotor coordination and sensorimotor reaction in sailors after voyage. It was observed less than in the control an increase in lactic acid, urea, malonic dialdehyde, medium mass molecules and circulating immune complexes levels in the blood. Positive influence of enterosorbents on the functional status of sailors is regarded as improving the flow of adaptation processes in the organism by reducing the metabolic (toxic) load on the organs of detoxification and excretion.
The organization of rendering the medical care in the modern war and military conflicts is in direct dependence on possibility of use in the advanced area of medical parts and the organizations. Thus development of military medicine goes on the way of integration of new technologies as in rendering medical care, and basic provisions of a control system of a medical support of armies (forces). The integrative way and interrelation of questions of management of the military field mobile organization and treatments of a modern fighting trauma allows to raise a question of development of new postulates of the military-medical doctrine. For this purpose it is necessary to make use of the saved up experience in the organization treatment of casualties (patients), especially near areas of operations.
Biological Issues
An information-analytical review of the open scientific literature devoted to the health and environmental consequences of depleted uranium munitions. We consider the set of possible etiologic factors of Gulf War syndrome, the Balkan syndrome, growth of disorders among residents of affected areas and veterans of these wars. Continuing research into the long-term consequences of the use of munitions containing depleted uranium is required.
Successful treatment of acute radiation syndromes relies on immediate supportive care. In patients with limited hematopoietic recovery potential, hematopoietic stem cell (HSC) transplantation is the only curative treatment option. We propose MSC treatment as an alternative treatment for severely radiation-affected individuals. In vitro differentiation of human MSC (hMSC) into progenitors for hematopoietic and endothelial cells revealed that MSC changed their morphology and gene expression profile, suggesting that investigated cells possess hematapoietic capacity in vitro. Mouse mesenchymal stromal cells (mMSCs) were expanded from bone marrow, retrovirally labeled with eGFP (bulk cultures) and cloned. Lethally irradiated recipients were i.v. transplanted with bulk or clonal mMSCs. We found a long-term survival of recipients with fast hematopoietic recovery after the transplantation of MSCs exclusively without support by HSCs. Quantitative PCR based chimerism analysis detected eGFP-positive donor cells in peripheral blood immediately after injection and in lungs within 24 hours. However, no donor cells in any investigated tissue remained long-term. Despite the rapidly disappearing donor cells, microarray and quantitative RT-PCR gene expression analysis in the bone marrow of MSC-transplanted animals displayed enhanced regenerative features characterized by decreased proinflammatory, ECM formation and adhesion properties and boosted anti-inflammation, detoxification, cell cycle and anti-oxidative stress control as compared to HSC transplanted animals. We could show that injection of MSC-derived microvesicles resulted in a similar protection as MSC transplantation. Our results suggest that MSCs, their release of trophic factors and their HSC-niche modulating activity rescue endogenous hematopoiesis thereby serving as fast and effective first-line treatment to combat radiation-induced hematopoietic failure.
The study included 163 male soldiers, who have contact with organophosphorus weapons. Work experience at the sites averaged 7.7 years. Time in protection equipment was (3.2 ± 0.8) h / day. The control group consisted of 40 "chemically intact" soldiers. During the medical examination and observation of military personnel engaged in destruction of chemical weapons, it was found that they have formed a more significant esophagogastroduodenal pathology in comparison with the control group (frequency of erosive gastritis 25 and 5 %, respectively). Furthermore, this pathology is associated with a few symptoms (pain frequency 2.3 and 63 %, respectively); however, Helicobacter pylori is detected frequently (81.4 and 63 %, respectively). With the help of histological analysis of gastric mucosa, more pronounced inflammatory changes as well as atrophic and fibrotic manifestations and microcirculation disturbances were confirmed. It is suggested that the peculiarities of these pathological disorders are due to exposure to a complex of harmful factors, including possible influence of subliminal toxic components of chemical weapons to be destroyed. Negative impact of shift work and irregular nutrition cannot be excluded. These studies made it necessary to review the principles of military medical examination and develop more effective methods of treatment and prevention.
Combat experience of internal troops over the last decades necessitates constant search for ways to improve the effectiveness of training of officers to participate in the responsible service and combat operations. However, despite the pronounced military-professional orientation of the learning process in high schools of internal troops, specific physical preparation for combat activities, taking into account the characteristics of different climatic regions and combat tasks is not quite adequate. This often leads to low combat effectiveness of internal troops and unjustified losses. All of this suggests that to date, content, organization and methods of physical training sessions with students of universities of Russian Interior Ministry requires further scientific and practical justification in view of the forthcoming implementation of service and combat operations. Experimental work has shown that required fitness for service and combat missions in extreme conditions can be achieved as follows: training complexes of physical exercises specially tailored for the upcoming combat activities; techniques and actions to develop general and speed-strength endurance; the formation of skills in unarmed combat, combined with overcoming mountain obstacle course with shooting from the personal weapons; 3, 5 and 10 km forced marches over rough terrain in combat gear and gear with weapons, with overcoming of water obstacles and forested mountainous terrain.
Effectiveness of agents (polysorb, glycine and sodium dithionite) influencing the main elements of ethanol toxicokinetics was compared in terms of three-day survival, neurological status, and some vital signs in 35 rats with acute ethanol intoxication at extremely heavy dose of 1.5 LD50 (12 g/kg). Ethanol as 40 % solution was administered intragastrically. Polysorb was administered intragastrically at a dose of 2000 mg/kg, glycine – intraperitoneally at a dose of 12 mg/kg, and sodium dithionite – intraperitoneally at a dose of 10 mg/kg. Preparations were administered (15 min after alcohol) separately or in combination. It was established that polysorb and sodium dithionite are the most effective as monotherapy; time to coma onset was twice as much as compared with the control group. Combination therapy with the study drugs reduced the number of animals in the terminal coma by 50 %, increased the time to onset of sopor and superficial coma two-fold, positively influenced respiratory rate of poisoned rats.
To optimize antithrombotic therapy in critical situations, specific and pleiotropic effects of different groups of antiplatelet agents were studied at various stages of fibrinogenesis. It was revealed that in the early stages of blood coagulation (initiation / amplification), expressed specific antiplatelet effects of cyclooxygenase (COX-1) and ADP-receptor inhibitors are associated with increased thrombin activity and the formation of chronometric hypercoagulation. Phosphodiesterase inhibitors have lower specific antiplatelet effects and influence the changes in thrombin activity to a lesser extent, thus facilitating chronometric and structural hypocoagulation in subsequent stages of fibrinogenesis. The differences in pleiotropic effects of antiplatelet agents under study necessitate their careful selection for antithrombotic therapy. Particularly, in cases of increased thrombin activity phosphodiesterase blockers are pathogenetically justified. Given the impact of drugs on all stages of fibrinogenesis in thrombotic and hemorrhagic syndrome, antiplatelet agents should be used based on an individual assessment of hemostasis. To quickly assess hemostatic potential, low-frequency piezoelectric thromboelastography is recommended.
Social and Psychological Issues
Socio-psychological characteristics of 955 combatants of the Ministry of Internal Affairs of Russia, for the ten-year period of service were catamnestically analyzed. The dynamics of personal-typological features and professional adaptation was assessed in 3 groups: 305 police officers (Group 1), with a history of adjustment disorder and post-traumatic stress disorders, who underwent multidiscipline comprehensive medical and psychological rehabilitation between missions; 311 police officers (Group 2) with some neurotic symptoms and negative dynamics of character accentuations after missions, who underwent psychological rehabilitation at the place of service; and 339 police officers (Group 3), without detected abnormal and prepathological conditions, who received no intervention. It is established that an integrated approach to treatment and rehabilitation in police group 1 compared with the 2nd and 3rd groups significantly (p < 0.001) improves adaptation of combatants under peaceful conditions. Lack of timely psychocorrection in mentally healthy combatants leads to personality changes with dominating dysphoria, impulsive behavior and exaltation, which complicates the professional and home adaptation. There has been suggested to create mental health centers within departmental facilities for improving rehabilitation quality and maintaining the functional reliability of the police officers.
Possible ways of reducing the negative impact of human factors in transport emergencies. Importance of proper aircraft staffing and assessment of staff interaction are highlighted. Various evaluation criteria of efficiency of interaction have been studied using survey data from 362 aviation professionals. The main criteria used were prognostic socionic efficiency of interaction, as well as several measures of human behavior style. To assess the adequacy of the results, they were compared with indirect (color) sociometry data. Correlations, factor and multiple regression analyses were used. Linear regression equations relating interaction effectiveness were derived. Directions for further research were determined.
Temperament and its dynamic changes were studied in firefighters during their professional activities. The study included 74 specialists of the Federal Fire Service, EMERCOM of Russia. The mean age of firefighters was (31.8 ± 0.8) years and experience – (9.5 ± 0.8) years. A temperament survey by J. Strelau was used. It was found that firefighters have a balanced mental activity, but with increasing age and length of service in the Emercom of Russia the ability of their nervous system to withstand prolonged and intense exposure to stressful circumstances decreases as well as flexibility of adjustment to extreme situations.
ISSN 2541-7487 (Online)
