The article is devoted to the analysis of medico-social factors that determine the outlook Image of the system of medical care for victims in emergency situations in the Arctic Zone of the Russian Federation. The social and economic development of the Russian Arctic zone is a strategic priority of the Russian Federation’s state policy in the Arctic. The goals of Russia’s state policy in the Arctic are to expand the resource base of the Arctic zone, to support the necessary combat potential of groups of troops of the Armed forces of the Russian Federation in the region, to preserve the natural environment, to ensure an adequate level of fundamental and applied scientific research, etc. Strategic priorities of the state policy of the Russian Federation in the Arctic are determined to increase the efforts of the Arctic States in creating a unified regional system of search and rescue, as well as prevention of man-made disasters and elimination of their consequences, including coordination of rescue forces; improving the quality of life of indigenous people and social conditions of economic activity in the Arctic. The main areas of development of the Russian Arctic include hydrocarbon production, fisheries, improvement of transport infrastructure and tourism. Three directions of socio-economic transformation of the Arctic zone of Russia, in the near future, can affect the formation of the appearance of the system of medical care for victims of emergencies: spatial expansion and increase of the economic potential of the Arctic zone of Russia; orientation to the concept of Trinity « innovative economy of energy efficiency sustainable development»; implementation of the concept of the formation in the Arctic eight reference zones of socio-economic development, of which the Kola, Nenets and Yamalo-Nenets reference zones are defined as pilot.
The health care of the Russian Federation and its medicine of accidents industry were undergoing systemic changes that required, inter alia, reappraisal of approaches to the work of specialist doctors in federal ministries, agencies and services in the implementation of joint activities during the elimination of medical and sanitary consequences of emergencies of various genesis. It is noted that during interpersonal communication, medical specialists often encounter various understandings and paths of special professional terms, which often leads to a decrease in the quality of organization of interaction and management. A particular feature of the use of military-medical terminology in the Disaster Medicine Service of the Russian Federation was its mixing with the terminological definitions of specialists from other federal ministries, agencies and services, which in some cases significantly complicates management communication. A scientific search has been carried out using content analysis, rank-based dispersion analysis of data, sociological and linguistic analysis to study the most used terms that characterize such concepts as wounded, sick and affected, injured, patient, medical and sanitary care, treatment and evacuation support, medical care, and terms characterizing types of care. The most significant, according to experts, terms that reflect the practical activities of medical specialists and allow them to master at the proper level the training programs for personnel of higher qualifications in the field of disaster medicine were the terms affected in an emergency, patient (3,770,82 points), as well as treatment and evacuation support (4,670,55 points) and medical support (4,21,1 points). Meaningful terminological contradictions that can lead to a violation of organizational integrity are also identified of the system of medical and evacuation support of troops (forces) and the population during the elimination of medical and sanitary consequences of emergency situations by the forces and means of the medical service of the Armed Forces of the Russian Federation as not always reflecting the specific conditions of activity and organization of interaction of medical specialists of federal ministries, agencies and services. All this requires harmonization (bringing to a common understanding) of the relevant terminology for the application of military-medical terminology in the Disaster Medicine Service of the Russian Federation.
Relevance. Arrangement of the medical support for the EMERCOM of Russia specialists and employees needs constant monitoring and analysis of activities of the Nikiforov Russian Center of Emergency and Radiation Medicine, EMERCOM of Russia (NRCERM) as the leading multidisciplinary medical institution of the EMERCOM of Russia.Intention – To analyze NRCERM activities (2012–2017) on specialized primary care, including high-tech care, at outpatient, day-time and inpatient hospitals.Methods. Results of health care and treatment in the NRCERM were assessed (2012–2017): 787,057 out-patient cases, 3,782 day-time cases, and 79,572 inpatient cases.Results and Discussion. In 2017, volumes of specialized primary care in outpatient hospitals was 156.6 % compared to that in 2012. The proportion of this type of health care paid for by the federal budget varied from 44.3 to 57.0 %. The most popular types of specialized primary care were internal medicine, neurology, gastroenterology, otolaryngology, ophthalmology, gynecology, surgery, urology and dentistry. The proportion of individuals who underwent preventive physical examinations in 2012–2017 amounted to 22–23 % among the whole number of outpatient visits, with 95.4 % of them were EMERCOM of Russia employees and 4.6 % – patients who paid themselves or were paid for. NRCERM mobile medical teams performed prevention physical examinations of employees of the EMERCOM of Russia in the Republic of Crimea and the city of Sevastopol: 1431 and 2070 individuals were examined in 2015 and 2016, respectively. The number of patients in the day-time NRCERM hospital increased to 1059 individuals in 2017. In 2017, volumes of specialized primary care increased to 191.9 % compared to 2012, with maximums in 2015 and 2016. Inpatient specialized primary care within the federal budget decreased from 63 % in 2012 to 28 % in 2017. Volume of inpatient care increased progressively due to programs of obligatory and voluntary medical insurance and self-paying. The proportion of surgery patients among all the in-patients increased from 35 % in 2012 to 58.4 % in 2017. In the NRCERM as a whole, the average duration of patient’s stay in a hospital decreased from 9.9 days in 2012 to 8.0 days in 2017, which is considerably less than in the Russian Federation (11.7 days) and Saint Petersburg (11.3 days). The bed turnover in the NRCERM increased owing to both therapy and surgery departments, with maximums in 2015 (29.0) and 2016 (28.8). This parameter increased in 2017 compared to 2012 (27.5 vs 13.9; 197.8 %). In 2017, number of operations increases compared to that in 2012 up to 258.6 %, with related increase in anesthesia procedures up to 274.1 %. High tech surgeries considerably increased (3.5-fold) in 2017 compared to 2012. The proportion of high tech surgeries was 14.2 % in 2012 and 18.7 % in 2017. The NRCERM mortality rates in 2012–2017 were 0.4–0.5 % which is considerably less than in the Russian Federation (1.77 %) and in Saint Petersburg (2.49 %). In cause-of-death structure, the following diseases dominated: circulatory diseases (40.3 %), neoplasms (29.8 %) and, third, traumas (10.4 %) – a total of 80.5 %.Conclusion. Within NRCERM activities, volumes of specialized primary care increased, including high tech care, in outpatient, day-time and inpatient settings. Besides, intensity of medical-diagnostic process increased, with low hospital mortality rate due to optimized organizational structure of medical institution, improved performance of outpatient and inpatient departments, introduction of innovative medical technologies.
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