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For prompt processing of calls, the number of call center operators 122 has been increased by two thirds and, if necessary, will be doubled.

The City Consultative Center for Anesthesiology and Resuscitation, a center for critical conditions, was opened in Moscow. It was created on the basis of the A.S. Puchkov. The Center for Critical Conditions is a unified city dispatching office that coordinates the provision of advisory assistance to specialists from resuscitation and intensive care units of city hospitals and ambulance teams.

“Due to the spread of the omicron strain, the load on all parts of the medical system is growing, especially the load on call centers, the 122 medical referral system, ambulances, and polyclinics. In particular, here, at the ambulance, the workload has increased by about 30 percent this week, ”said

Sergei Sobyaninduring an inspection of the call center of the Ambulance Station named after A.S. Puchkov.

According to him, for prompt processing of calls, the number of operators has grown by two thirds and, if necessary, will be doubled. “The number of operators of the 122 center has been doubled, next week it will be tripled so that Muscovites can call and receive background information or medical support and assistance in time. The number of operational ambulance teams has also been increased,” said the Moscow Mayor.

Chief freelance specialist in emergency medical care and head physician of the Station named after A.S. Puchkov Nikolai Plavunov said that the staff of the institution managed to adapt to such situations during the pandemic. If at the end of last week the increase in calls was 10 percent, then on Monday it was 30 percent. “Of course, we were ready for this, we predicted it. And on Monday, we immediately introduced an additional 40 jobs for dispatchers and medical consultants, which made it possible to cope with the increased workload,” he said.

According to the chief physician, during the pandemic, about 40 ambulance teams were additionally formed, which help ensure that calls are received even during periods of increased workload. “All conditions have been created for us to work in a pandemic. This concerns the renewal of medical equipment and the fleet of ambulances, the introduction of new technologies. Soon, it is planned to update the tablets of all ambulance teams – they will be with new functions, with new services,” Nikolay Plavunov noted.

The Mayor of Moscow added that the contract for the renewal of the ambulance fleet has already been concluded. We are talking about an additional supply of 200 vehicles. Also, 1,700 units of medical equipment for the ambulance service were purchased. According to Nikolai Plavunov, these are ultrasound, ventilator, ECG and other devices.

“I want to thank all the ambulance workers, operators, dispatchers, doctors, medical staff who serve thousands of calls every day. More than a thousand teams in the ambulance system are working, they provide tremendous help, especially during periods of a surge in diseases that we are seeing today. I hope they will adequately do their job and provide Muscovites with the necessary medical care,” said the Mayor of Moscow.

How the critical care center will work

In the new center for critical conditions, Sergei Sobyanin was presented with a unique technology that has no analogues in the world. She has absorbed many medical possibilities.

“The main goal of the center is to provide an opportunity to obtain a second opinion on the treatment of the most severe patients, namely patients who, as they say, are on the verge of life and death. In fact, this center realizes the possibility of mobilizing all the most powerful resuscitation resources of the city, which are truly unlimited now, in order to provide the opportunity to provide assistance to the most difficult patients who find themselves in a very difficult clinical situation, when the bill goes directly to hours, and sometimes even minutes. , – said the Deputy Chief Physician of the Station of Emergency and Emergency Medical Care named after A.S. Puchkova Petr Davydov.

According to him, the Center for Critical Conditions allows coordinating the work of doctors in hospitals. Its consultants are leading experts in their fields, chief physicians of hospitals, chief external specialists – the most qualified and most competent.

Modern technologies make it possible to identify critical conditions, for example, those associated with respiratory failure (to determine its cause), and to choose the tactics of patient management. Sometimes doctors have the opportunity to help even those patients who have experienced circulatory arrest. “We are practically in the ambulance, conducting a sound examination, we can diagnose the reversible cause of the patient’s condition and eliminate it, and the patient in our car comes to life on the way to the hospital,” said Petr Davydov.

Having received information about a critical patient, the specialists of the center involve the most experienced consultants in resuscitation of adults and children’s hospitals, including the main freelance specialists Department of Health of the city of Moscow. Workplaces of doctors are equipped with computers connected to the Unified Medical Information and Analytical System (EMIAS) and the Unified Radiological Information Service (ERIS), as well as special Remote Assistant software. To use it, the doctor, who is next to the patient, puts on a special augmented reality helmet, which creates the effect of presence for the consultant. He sees the patient as if with his own eyes and can remotely provide assistance to colleagues.

If the hospital does not have the technical ability to communicate with consultants of the Critical Conditions Center, an ambulance team equipped with all the necessary equipment, including augmented reality helmets, immediately leaves for it.

In addition to resuscitators, dispatchers of the center can involve narrow specialists in the management of critical patients: hematologists, toxicologists, and others. In fact, a remote medical consultation is being held in the intensive care unit with the participation of the most experienced specialists of the city healthcare system.

In addition, the center’s specialists are involved in triage and routing of patients with life-threatening conditions at the pre-hospital stage.

The list of critical conditions to be monitored by the center includes:

– for adults – a state of persistent shock of III and IV degrees, massive blood loss, to whom the cause is unclear, renal, adrenal and liver failure and a number of other serious conditions;

– for children – acute respiratory failure, life-threatening cardiac arrhythmias, prolonged convulsive syndrome and other conditions.

Plans for the future

Further plans for the development of the Center for Critical Conditions include the introduction of automatic monitoring of the condition of patients in intensive care. Consultants will be able to track the dynamics of critical patients. If an acute situation arises that requires the intervention of more experienced colleagues, the system will automatically send a signal to the dispatcher, who will connect consultants to work.

There will also be an online transmission of information about the patient’s condition (objective status, cardiogram parameters, saturation, and so on) from the ambulance to the critical care center and hospital, which is necessary for greater efficiency and continuity in the provision of care. To do this, defibrillators-monitors of ambulances will be integrated into a single information network.

In case of sudden cardiac arrest and other critical conditions of the patient in the ambulance, the center’s consultants will contact the ambulance team and give advice while the car is moving.

In the future, on the basis of the Center for Critical Conditions, it is planned to deploy a headquarters for managing emergency advisory teams of anesthesiology and resuscitation, equipped with extracorporeal membrane oxygenation devices.

Moscow ambulance: at the forefront of the fight against COVID-19

Due to the pandemic, doctors, nurses, paramedics and ambulance drivers have placed a huge physical and psychological burden on them. Many new tasks were entrusted to them, including transporting patients to outpatient CT centers, providing medicines at home, and others.

In 2021, ambulance teams completed 4,381,990 trips, which is 4.9 percent more than in 2020. Brigades leave 12-12.5 thousand times a day.

334,546 patients diagnosed with pneumonia were hospitalized, up 43.3 percent from a year earlier. Another 381,399 patients were taken to outpatient CT centers for diagnosis and determination of further treatment tactics.

Nevertheless, even with a significant additional load, the average arrival time for calls in 2021 was:

– in emergency form – 10.4 minutes;

– in an accident – 7.7 minutes.

To improve the efficiency of the ambulance during the pandemic, some new solutions have been introduced. For example, an analytical unit has been launched that takes into account contacts and cases in the city. Its employees call citizens, teams are sent to all contacts and sick people to provide medical care, take biomaterial, and draw up documentation to comply with quarantine.

A mobile application was also developed for mobile teams, which allows you to enter primary information about the sick person in order to monitor compliance with quarantine, receive information about confirmed cases of COVID-19, and distribute patients to hospitals.

To improve the efficiency of call processing in a single dispatch center, checklists have been introduced that allow operators to quickly receive calls and assess the preliminary risk of a patient having COVID-19 and possible complications.

In addition, a system was developed to notify the team about a call to a patient with symptoms of COVID-19. If the electronic call card contains information about the disease (complaints of shortness of breath, fever, and so on), a message is displayed on the screen of the team with a warning and an active link to instructions for using protective equipment.

Algorithms were also created to provide additional assistance to those who fell ill with a new coronavirus infection in the form of delivery of the antiviral drug Aleplevir and preemptive anti-inflammatory therapy with Levilimab to patients with viral pneumonia and signs of a cytokine storm.

During the COVID-19 pandemic, the Moscow ambulance service has maintained high efficiency thanks to systemic development and regular equipment upgrades over the course of several years.

The composition of the Station of emergency and emergency medical care named after A.S. Puchkov includes 60 substations, as well as 42 posts: 12 are located on the Moscow Ring Road, seven are on other major transport routes, 11 are in remote areas of the TiNAO, and 12 are in crowded places.

In 2021-2023, the city plans to complete the construction of four emergency substations in the city of Moskovsky, the settlement of Kievsky, the city of Shcherbinka and on Leninskaya Sloboda Street.

1,075 ambulance teams and 150 emergency response teams are sent to patients every day. All of them are equipped with the necessary medical equipment, including portable anesthesia and respiratory equipment, electrocardiographs, heart monitors, defibrillators, and are also provided with medicines and consumables.

There are 1,075 ambulances in the ambulance fleet, 73 percent of which were produced no more than five years ago. At the beginning of 2022, another 200 new cars will be added to the fleet.

In addition to the Critical Conditions Center, the ambulance includes:

– a single city dispatch center (EGDC), which receives all requests from citizens and controls the work of teams;

– the department of medical evacuation, which takes into account and distributes the number of beds in medical institutions, sends teams to transport patients to hospitals;

– Department of emergency advisory ambulance, which organizes the work and coordinates the activities of advisory teams;

– emergency medical departments where citizens can apply for primary health care;

— the department for organizing quality control and safety of medical activities, which monitors the implementation of medical and diagnostic measures;

– educational and organizational department, in which medical staff improve their professional level.

There are 65 dispatchers in the YGDC that receive calls by phone 103 around the clock.

In total, at the A.S. Puchkov employs 11.2 thousand people, including 2370 doctors, 8328 specialists with secondary medical education and 96 employees of junior medical staff. Among the employees there are seven doctors and 78 candidates of medical sciences. Almost half of the employees have the first or highest qualification category, and 132 people have the status of “Moscow Doctor”.

Modern technologies in the ambulance service

The information system of the EHDC is fully integrated with the unified medical information and analytical system (UMIAS), systems 112 and 122 (unified medical reference service).

Reception and processing of calls are automated.

Mobile team specialists use tablets connected to EMIAS, thanks to which, on the way to the patient, they can view the data of his electronic medical record. In addition, tablets allow you to determine the location of each team and transfer calls to the nearest free car.

The automated system “Hospital” helps to keep track of the number of beds, see the workload of hospitals, interact with medical institutions online and choose the optimal place for hospitalization of the patient.

A network of specialized vascular centers has been formed in the city, and patients with acute coronary syndrome and cerebral stroke are referred to these institutions, where it is possible to immediately perform CT, MRI and angiography.

One of the best in the world

In 2019, the consulting company PwC (PricewaterhouseCoopers) conducted an international study “Analysis of the effectiveness of the organization of emergency medical care in megacities of the world.” Experts evaluated ambulance services in 15 metropolitan areas: Moscow, Paris, Shanghai, Delhi, Mexico City, London, Berlin, Singapore, Seoul, Sao Paulo, Rome, Hong Kong, Tokyo, New York and Johannesburg. Among the evaluation criteria were considered the speed of the ambulance, the availability of ambulance, its sufficiency in the city and patient satisfaction.

According to the results of the study, the Station of Emergency and Emergency Medical Care named after A.S. Puchkova Moscow Health Department ranked second in efficiency among similar services in other metropolitan areas. And according to some indicators, the capital of Russia has become a leader. The average response time of a Moscow ambulance operator is three to four seconds, while in Berlin and London this figure is nine seconds, in London – 20 seconds, and in New York – one minute 10 seconds.

EDITOR’S NOTE: This article is a translation. Apologies should the grammar and or sentence structure not be perfect.

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