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Kostomarova Ludmila Grigoryevna, Scientific-Research Center for Emergency Medical Services of the Department of Healthcare in Moscow, Professor
Potapov Vladimir Igorevich, Scientific-Research Center for Emergency Medical Services of the Department of Healthcare in Moscow, Doctor of Medical Sciences E-mail: ро[email protected]
Buk Tamara Nikolaevna, Scientific-Research Center for Emergency Medical Services of the Department of Healthcare in Moscow, Candidate of Medical Sciences
The results of the activity of the territorial service of emergency medicine of Moscow
Abstract: The authors present a retrospective statistical analysis of the kinds and scale of emergency and crisis situations on the territory of Moscow for 2011-2015.
Keywords: emergency situations (ES), ES structure, organization of emergency medical service in the ES.
The problem of organization ofrendering of emergency medical service to the injured in emergency and crisis situations remains important according to the publications [1; 2; 3; 4].
Liquidation of medical consequences of emergency situations in Moscow is laid upon the territorial disaster medicine service (TDMS) of the Department of Healthcare and its lead agency Scientific-Research Center for Emergency Medical Services — the territorial disaster medicine center (TDMC).
The DMS currently operating on the territory of the city has a strong disaster medicine service and a full-fledged chain of trauma centers of the 1st and 2nd level. In accordance with the approved plans-tasks on the admission of the mass flow of the injured for adult and children population in respect of certain specializations, the city hospitals can arrange up to 15 thousand beds within a short period of time in case of an ES.
The automated information-analytical system «Disaster Medicine of Moscow» (AIAS «Disaster Medicine of Moscow») established in the TDMC performs the functions of recording, functions related to collection, registration, grouping and generalization of data about ES in Moscow, functions of formation of operative and reporting information, functions of control of the condition of resources as well as planning of resources and regulation of their use.
The following sub-systems function in the AIAS «Disaster Medicine ofMoscow»:
• Management of medical team and equipment of EMS («Team and equipment of EMS»);
• Recording, control and analysis of everyday medical-sanitary situation in the city («Monitoring of medical-sanitary situation in the city »);
• Management of medical support of scheduled city all-city events with large concentration ofpeople («Medical support of public events»);
• «Monitoring of medical-sanitary situation in the ES
zone»;
• Personified recording of the injured in large-scale ES and results of rendered medical aid at all stages of medical-evacuation support («Injured — ES»);
• Formation and keeping of data base of the AIAS «Disaster Medicine of Moscow».
In order to improve the organization of operation of the territorial disaster medicine service of Moscow, a retrospective statistical analysis of emergency and crisis events of different kind and scale on the territory of Moscow during 2011-2015 was conducted.
The following events contained in the data base of the AIAS «Disaster Medicine of Moscow» were selected by us for the purpose of the study:
1. Vehicle accidents:
- Road traffic accidents with the injured more than 3,
- All RTA with public transport,
- Accidents with rail, water and air transport;
2. Fires:
- All fires with the injured,
- All fires with evacuation, failures,
- All fires at institutions, enterprises, medical organizations;
3. Failures not related to fires:
- All events with the cause «Failure»;
4. Technological accidents (including production) with causes:
- «Explosion» of non-criminal character,
- «Emission of high-toxic substances», «Emission of radioactive materials», «Emission of BIO agents»,
- «Life support system accidents», «Spill of fuels»,
- «Detection of aggressive substances», «Gas emission»,
- «Breach of safety guidelines at production facilities»;
5. Biological-social:
- All events with the cause «Infectious diseases»,
- Poisoning with medical and non-medical products;
6. Social:
- All events with the cause: criminal, violent and anti-social activities, including explosion threats, realized explosions, detection of explosive devices, mass disorders, use of guns and offensive weapons,
- Terrorist attacks;
7. Natural:
- Hydro-meteorological (hurricanes, rain showers, landslides, floods).
The structure of crisis and emergency situations as well as their dynamics for 2011-2015 are presented in the table and figures.
The results of the activity of the territorial service of emergency medicine of Moscow
Table 1. - Structure of the causes for crisis and emergency situation calls
Type of crisis and emergency situation Years
2011 2012 2013 2014 2015
Abs. % Abs. % Abs. % Abs. % Abs. %
Technogenic: 1546 56.0 1701 61.7 1662 60.8 1682 63.2 1501 60.6
Fires 770 27.9 792 28.7 768 28.1 854 32.1 732 29.6
Vehicle accidents 708 25.6 808 29.3 785 28.7 725 27.2 649 26.2
Failures not related to fires 13 0.5 11 0.4 20 0.7 20 0.8 14 0.6
Technological accidents 55 2.0 90 3.3 89 3.3 83 3.1 106 4.3
Biological-social 260 9.4 252 9.1 280 10.2 220 8.3 170 6.9
Social 933 33.8 770 27.9 771 28.2 742 27.9 771 31.1
Natural 22 0.8 21 0.8 19 0.7 12 0.4 21 0.8
Other - - 11 0.4 - - 5 0.2 13 0.5
Total 2761 100 2755 100 2732 100 2661 100 2476 100
As it is seen from the data presented in the table, the events of social character (criminal, violent and anti-social activities, including explosion threats, realized explosions, detection of explosive devices, mass disorders, use of guns and offensive weapons), fires and vehicle accidents were the most frequently occurred among all ES in different years. Herewith, during the last three years, there was an obvious tendency for reduction of the total number of crisis and emergency situa-
tions. Thus, compared with 2011, the number ofES in 2015 reduced by 10.4 %. Similar tendency is observed throughout Russia in the whole.
The analysis of the dynamics of events according to years shows that crisis and emergency situations of technogenic character prevail (Fig. 1).
Among technogenic ES, the first place is taken by the fires and vehicle accidents (Fig. 2).
Fig. 1. Dynamics of ES and crisis situations in Moscow
Fig. 2. The structure of ES of man-made character in Moscow for 5 years
In 2015, there structure of crisis and emergency situations underwent some alternations. The first place, just like in 2011, was taken by the ES of social character that accounted for 31.1 %. Fires took second place and accounted for 29.6 %. Starting from 2014, there has been a tendency for reduction of vehicle accidents. Thus, in 2015, vehicle accidents took third place in the structure of crisis and emergency situations and accounted for 26.2 % (Table 1, Fig. 1 and Fig. 2). The reduction by 19.7 % took place compared with 2012.
The assessment of the scale ofevents according to the size of sanitary losses certifies that the structure of events hasn't changed scale-wise for the last 5 years. The biggest number is the events with sanitary
losses from 1 to 5 (68 % at average), events with the injured from 6 to 10 people accounted for 2.5 %, and the events with sanitary losses with over 10 people — 1.2 %. Events without sanitary losses were 28.3 %. However, crisis situations without sanitary losses but being a risk event (failures not related to fires, technological accidents and events of social character) took first place for separate kinds of events.
Figure 3 shows that the number of ES with the injured has a tendency for reduction and the number of events without the injured is increasing starting from 2012.
The dynamics of sanitary losses as a result of emergency and crisis situations for 5 years is presented in Figure 4.
2012 2013 2014
Fig. 3. Scale of events in the dynamics for 5 years
Fig. 4. The dynamics of sanitary losses as a result of emergency and crisis situations for 5 years
Fig. 5. Medical consequences of vehicle ES
Fig. 6. Medical consequence of fires
Fig. 7. Medical consequences of crisis and emergency situations of social character
The presented data certifies that the number of medical losses in ES has a tendency for reduction.
This tendency is especially noticeable in vehicle accidents and ES of social character. Thus, the number of the injured in vehicle accidents in 2015 reduced by 21.6 % compared with 2011, and the number of the injured in ES of social character in 2015 reduced by 44.6 % compared with 2011.
The structure of sanitary losses for the last years remains unchanged.
Among the injured, at average, a significant number (65.2 %) was hospitalized; the share of the deceased at the scene of accident was 6.4 %, and 28.4 % of the injured were provided out-patient help at spot.
Figures 5-7 present the structure of sanitary losses for separate kinds of ES in total for 5 years.
The presented data certifies that despite the most number of the injured in vehicle accidents, deaths at the scene of accident accounted for 5 %. Whereas, deaths during pre-hospital period during fires is 5 times more than the deaths during vehicle accidents and accounted for 25 % at average, which indicates significant sanitary losses and severity of the condition of the injured in the fires.
Thus, the conducted retrospective statistical analysis of crisis and emergency situations in Moscow revealed the tendency for reduction of events starting from 2011.
The size of sanitary losses over the last two years also showed the tendency for reduction, especially in vehicle accidents and ES of social character.
Hemodynamics features investigation in research groups of pregnant women mother-placenta-fetus system
References:
1. Isaev I. V. The role of disaster medicine in case of a threat and occurrence of emergency situations//Kazan Medical Journal. - 2011. -№ 1. - P. 82-85.
2. Levchuk I. P., Kostyuchenko M. V. II All-Russian scientific and research Olympiad of students and young scientists on disaster medi-cine//Journal of disaster medicine. - 2015. - № 3. - P. 57.
3. Popov V. P., Garmash O. A. Stages of interaction of the new technologies of emergency medical service and disaster medicine service in Sverdlovsk region//Journal of disaster medicine. - 2012. - № 3. - P. 48-50.
4. Mass-gathering medical care: retrospective analysis of patient presentations over five years at a multi-day mass gathering/Grant W. D., Nacca N. E., Prince L. A., Scott J. M.//Prehos. Dis. Med. - 2010. - 25, № 2. - P. 183-187.
Radjabova Zulola Abdukhakimovna, Postgraduate student, Department of Obstetrics and Gybecology No. 2, Tashkent Institute of postgraduate medical education E-mail: [email protected]
Karimova Feruza Djavdatovna, DM, Professor, Head of Department of Obstetrics and Gybecology No. 2, Tashkent Institute of postgraduate medical education
Hemodynamics features investigation in research groups of pregnant women mother-placenta-fetus system
Abstract: Currently, herpes virus infection is a serious problem of modern medicine. This is due to the steady increase in the frequency of herpes virus infection, its decisive influence on reproductive health, leading role in the development of intrauterine infection, leading to perinatal and infant morbidity and mortality. Keywords: herpes, pregnancy, fetoplacental insufficiency, fetus, placenta.
The prevalence of genital herpes in Russia are also very high. Its frequency has been growing steadily and is 7.4 per 100 thousand population [2; 7]. The current situation is contagious, according to experts, primarily related to the expansion of diagnostic capabilities as well as an absolute increase in the number ofpatients with genital herpes [3; 5].
In recent years there has been a tendency to a predominantly asymptomatic (latent) flow of herpesvirus diseases. A frequency of recurrent herpes genital infections primarily in young, sexually active people increased twice. This contributes not only to the wide and uncontrolled spread of infection with the herpes simplex virus, but further negative impact on the possibility of a normal pregnancy and birth of a healthy baby [1; 6; 7]. Herpesvirus disease are generally highly contagious, transmission path are very diverse, but the infection often occurs during close physical contact. This is a horizontal transmission path, which is carried out mostly domestic, air-borne and sexually transmitted [4; 5; 8]. Vertical transmission path of infection from mother to fetus is tipical for herpes viruses: prenatal transplacental infection of the fetus and during labor when there is an infection of the child during the passage through the infected birth mother's ways. Intrauterine transplacental infection of the fetus is a cause of antenatal mortality, miscarriage, premature birth, and early disability children (deafness, blindness, epilepsy, microcephaly, heart defects, splenomegaly, and others). Up to 70 % of cases of prenatal herpes infection is associated with the child's mother, having a latent herpes virus infection [1; 7]. Manifestation of herpes infections in newborns frequently observed in the first 2 weeks of life proceeds in the form of disseminated disease with severe skin lesions, mucous membranes, lungs, central nervous system, liver, accompanied by development of thrombus syndrome. Mortality in infants with herpes virus infection as high as 80 %. In this context, alertness obstetricians about testing pregnant women
becoming particularly urgent in order to identify infection by herpes simplex viruses, as well as the development of tactics prenatal conduct and prenatal preparation of infected pregnant women, which will greatly reduce the likelihood of intrapartum injury of the child and thus reduce the risk of severe herpetic disease in neonates.
The aim of our study was evaluation of fetoplacental complex and fetus functional state during recurrent herpes infection.
Research materials and methods
The study involved 144 pregnant women with herpes infection. Clinical observations carried out on the basis of urban maternity hospitals in Tashkent. The control group consisted of 60 healthy women without herpes infection. The investigation of the fetus status was made by using ultrasound dopplerometric methods.
Increased fetal vascular resistance due to their spasm, is one of the compensatory mechanisms — centralization of circulation with the primary blood supply to vital organs with increasing hypoxia and metabolic disorder. With the development of placental insufficiency opposite changes in the blood flow state in comparison to the aorta artery and the umbilical cord occurs in fetal cerebral arteries. The value of diastolic blood flow in the cerebral vessels initially remains unchanged and then increases, resulting in a reduction of the numerical values of the indices of vascular resistance [3; 8].
The increase in fetal hypoxia associated with reduced resistance of cerebral vessels, ensuring its adequate oxygenation. Preferential blood flow of the fetal brain in the condition ofpulsation index (PI) progression has been called «brain-sparing effect» [8].
Doppler study analysis in the I-main group revealed significant differences of hemodynamic parameters in the mother-placenta-fetus as compared with those in the control and comparison group (Table 1).
There was a significant violation of utero-placental blood flow at 46.67 ± 9.11 % of pregnant women in the main group.
