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Organization of grant of urgent and urgent medicare is in Ukraine

June 22, 2024

Organization of emergency and urgent care in Ukraine. Initial activities of medical staff of patients emergency condition. Procedure for emergency aid to survivors and patients in the prehospital phase. The primary and secondary examination.

Order of grant of the first medical aid injured and patient with the prehospital stage. Primary and secondary inspection.

Entry

Service of urgent(ambulance) medicare of Ukraine is a structure, that provides the population of the state the first and urgent prehospital aid at various situations that can threaten to health or to life of man. Urgent medicare(UM) is one of links of primary medico–sanitary help. Depending on the amount of population that is served, the stations(centers) of UM are divided into 5 categories:

a 5th category is the stations that serve territory with the quantity of population to 50 000;

a 4th category – from 51 000 to 200 000 habitants;

a 3d category – from 201 000 to 500 000 habitants;

a 2nd category is from 501 000 to 1 million habitants;

a 1st centers of categories, that serve from 1 to 2 million habitants.

The receipt of appeals after UM comes true after a telephone number 103. For a receipt and treatment of calls controller’s separation(point) functions in the structure of the station(separation). Basic mobile functionally-structural unit of the station(separation) of UM is a medical brigade that heads for a call for a grant in place of necessary medical help and realization of reanimation measures, and also urgent hospitalization of patients and victims at presence of corresponding shows. Such medicare is named urgent.

Urgent medicare on the greatest standards must be accessible for everybody after a necessity somewhere and some time. It requires the corresponding system of measures on medicare for all people, whose life suddenly found oneself under threat, conceptions of grant of prehospital, hospital and interhospital urgent medicare. In time and the well organized help reduces lethality, duration and weight of sudden diseases and traumas, diminishes suffering of patients – so one of base positions of the Manifest of European Association of Urgent medicare sounds. In fact in actual fact the characteristic feature of our present time is an incessant increase of amount of accidents, catastrophes, elemental and ecological troubles, acute diseases that is accompanied by various pathological by the states. During the last decades as a result of strengthening of the psychico emotional loading, increase of rate and rhythm of modern life, the amount of cases of the so-called extreme pathology(to the heart attack of myocardium, violations of rhythm and conductivity, disorders of the respiratory system) increased. There is not a doubt, that the end-point of treatment of patients with such diseases or damages largely depends on a timeliness and adequacy of grant of premedical, urgent medical premedical and skilled medical prehospital and early hospital help.

Levels of medicare

Premedical a help is a complex of urgent simple medical measures, that get to the victim or person that became ill suddenly, in place of event and on the period of his transporting to medical establishment. Persons that are under an obligation to render a premeical help to the man in the urgent state are: rescuers of emergency – rescue services, workers of state fire prevention, workers of organs and subdivisions of militia, pharmaceutical workers, explorers of passenger carriages, air stewards and other persons that does not have medical education, but after the official duties must own practical skills from saving and maintenance of life of man that is in urgent state.

The range of operating under the grant of premedical help subordinates in itself three basic groups of measures:

1. Immediate stopping of action of external harmful factors with the observance of the personal safety(electric current, high and subzero temperatures, clench injured heavy objects) and evacuation of victims from the above-stated unfavorable terms, in what of them got(from the damaged transport means, from water, from an apartment that burns or toxic gases accumulated in that);

2. A grant of the first medical aid to the victims is depending on character and type of trauma, accident or disease that arose up suddenly(stop of bleeding, artificial respiration, indirect compression of thorax, imposition of bandages on a wound, and others like that);

3. Organization of the rapid transporting sick or injured to curative establishment.

Premedical (prehospital) medicare – comes true by forces of medical assistant’s brigades of UM. Typical composition of medical assistant’s brigade: medical assistant, medical sister, driver.

General view of coach of UM

Modern equipment of ambulance

In the last decades in foreign countries this help is rendered mainly paraphysicians are persons with medical education (answers 1-2 levels of accreditation) or without her, that operate concordantly the accepted algorithms at implementation of medicare. Paramedicine is extraordinarily widespread practically in every country of the world.

At the same time, it is known that be what medical worker must count life and health of patient higher the personal interests. In bases of legislation of Ukraine rights for are clearly set forth duties of medical worker, where in the articles 136. 139 the Criminal code it is writtenin, that be what medical worker of obliged after the first appeal to come to help to the victim: outside, in transit, public places, at home, and able correctly to render the first medical aid at accidents and sudden diseases.

Addition And (obligatory)

Productive functions, typical tasks of activity and ability, that the graduating student of higher medical establishment must own on speciality

“Curative business” 7.110101

*Table of contents of productive function*	*Name of typical task of activity*	*Code of typical task of activity*	*Table of contents of ability*
1	2	3	4
	*Diagnosticating of the urgent states*	*1.ПФ.Е.02*	Under any circumstances, in the conditions of lack of information and limit time, using standard methodologies of review and data of possible anamnesis, knowledge about a man, his organs and systems, adhering to the corresponding ethic and legal norms, by the acceptance of reasonable decision and estimation of the state of man to diagnose(on a list 3).
	*Determination of tactics of grant of urgent medicare*	*3.ПФ.С.09*	Under any circumstances, using knowledge about a man, his organs and systems, adhering to the corresponding ethic and legal norms, by the acceptance of reasonable decision, on the basis of diagnosis of the urgent state(on a list 3) in the conditions of a limit time by means of standard charts to define tactics of grant of urgent medicare.
	*Grant of urgent medicare*	*3.ПФ.С.10*	Under any circumstances, using knowledge about a man, his organs and systems, adhering to the corresponding ethic and legal norms, by the acceptance of reasonable decision, on the basis of diagnosis of the urgent state(on a list 3) in the conditions of a limit time according to certain tactics, using standard charts, to render urgent medicare.

Ungrant without good reasons of help to the patient by a medical worker, what have to do, according to the set rules, to render such help, if to him scienter it is known that it can have heavy consequences for a patient, punished to fifty of untaxable minimums of profits of citizens with privation of right to hold certain positions or carry on certain activity within three years, or correctional works within three years.

The same act, if it entailed death of patient, or other heavy consequences, is punished by limitation of will within four years or imprisonment within three years, with privation of right to hold certain positions or carry on certain activity within three years or without such (century 139 the Criminal code of Ukraine).

Medical (prehospital) medicare – given by medical brigades, that have in the order a necessary apparatus, tool, medications, and others like that, and provided with theoretical knowledge and practical skills from the grant of skilled urgent prehospital of medicare. Typical composition of medical brigade: doctor, medical assistant, medical sister, driver.

Early hospital the skilled is specialized specialized medicare – urgent measures, to the victims(to the patients), delivered by the coach of UM, that is conducted in the separations of the urgent states by forces of her workers.

At the same time, there is international classification in obedience to that urgent medicare is divided into next groups:

BLS( Basic of life support) is base support of vital functions, namely grant of urgent medicare on the prehospital stage by not physicians(by volunteers, policemen, firemen, rescuers), or the same physicians that by chance appeared in place of event;

ILS (Immidiate of life support) is urgent support of vital functions, that can come true in a policlinic, permanent establishment, in a private cabinet, and others like that, by medical workers to arrival of the specialized rescue medical brigade);

ALS (Advance of life support) – the extended is skilled medical including reanimation help, that is given by physicians and paraphysicians with bringing in of corresponding apparatus, medications, tool on prehospital and to the early hospital the stages;

ATLS (Advance of trauma life support) is a professional grant of the first medical aid at various traumas both on preclinic and on early hospital periods(mainly executed by doctors, rarer by medical sisters, paraphysicians);

ACLS (Advance of cardiac life support) is a grant of professional urgent medicare at cardiovascular pathology(conducted by doctors, medical sisters, paraphysicians);

PALS (Pediatric of advance life support) is a grant of professional urgent medicare for children(comes true by doctors, medical sisters, paraphysicians).

Organization of grant of urgent and urgent medicare is in Ukraine.

Activity of medical first-aid of Ukraine during all, especially last years of independence, regulated by the row of normative state acts, namely: by resolution of Cabinet of Ministers of Ukraine № 1290 from 5.11.2007 “About claim of the Government programs of creation of the single system of grant of urgent medicine help on a period 2010 to by an order №24 Ministries of Guard of health of Ukraine from 17.01.2005 “About claim of protocols from the grant of medicare after speciality “Medicine of the urgent states”, by an order №120 МОЗ of Ukraine from 18.03.2005 “About organization of studies of medical and unmedical workers from the grant of medicare in urgent situations”, order № 132 МОЗ of Ukraine from 2.03.2009 “About organization of studies of separate categories of unmedical workers to skills of grant of the first urgent medical aid”, by an order №283 МОЗ of Ukraine from 28.04.2009 “About the improvement of preparation and in-plant training of medical workers from the grant of urgent and urgent medicare”, by an order №370 МОЗ of Ukraine from 01.06.2009 “About the single system of grant of urgent medicare”.

In July, 2012 was passed an act, that entered into operating under 01.01.2013 On urgent medicare.

After an entry in an action of this Law service of UM of Ukraine tested native, it is possible bravely to say, revolutionary changes. The main task of this reorganization is approaching of the quality first and urgent medical aid to the population and also rapid доїзду to the patients (victims). For today in obedience to the substantive provisions of this law it is regulated доїзд to the patient within the limits of city to 10 minutes, in the settlements of rural locality – to 20 minutes.

There were the created Centers of urgent medicare and medicine of catastrophes in all areas. On Ternopil Region in force of different reasons such Center was organized on the walks of life of Ukraine one of the last. In obedience to an organizational structure, all district stations, substations of UM, and also analogical structures of Ternopil, are inferior him.

In accordance with separate this law, financing of this service provisions will come true from regional and partly state budgets, in fact not secret, that municipal and district budgets are for today able to close the separate most protected articles only, namely salary, fuel, medications.

Activity of Center is envisage the coordinated actions of rescue services 101, 102 and 103 with creation of the system of call after an only number 112. of Cognation of their work important at liquidation of emergencies of natural and technogenic character with plenty of victim.

Especially it topically during liquidation of road and transportation adventures and another cases that take place on the limits of territories of districts, when finding out, from which one district the brigades of UM must drive out results in the loss of precious time. In obedience to the separate this Law provisions from the submission of central district hospitals the separations of UM hatch with creation on their base of the independent stations and substations of UM. Guidance depends all subdivisions of service upon the Territorial center of urgent medicare and medicine of catastrophes of area.

In a law clear differentiation is envisaged between urgent on by the first medical aid. Yes, all accidents, traumas, acute diseases that result in the sudden worsening of general of patient fall into the category of urgent cases and provided by the grant of medicare by the workers of UM and МC. In the sphere of activity of this service realization of departures of leading specialists-physicians enters also within the limits of area for realization of highly skilled consultative and operative help to the patients. At the same time to the patients with chronic pathology of prehospital medicare will be given by district and domestic doctors and she will be named urgent. Arrival to such category of patients can be carried out on the draught of hour.

Yet for a year to the acceptance of this law there is a working group that was headed by the chancellor of the Ternopil state medical university the name of І.Y. Gorbachevskyi, corresponding member of National Academy of Medical Sciences of Ukraine, presiding of regional soviet commissioner from a health protection maternity and childhood professor L.Y.Kovalchuk together with the leading specialists of this industry and scientists hang thoroughly learned and analysed organization and activity of service of UM of Ukraine and Ternopil, separating the row of foreground jobs that have for an object maximally to approach a “ambulance” to the patient here. Gratifying, that a few suggestions from conception of recommended by a commission, found the place in this Law. At the same time, in detail becoming familiar with the map of Ternopil Region, an initiative group were certain regions with a large remoteness from the stations(separations) of UM and made decision about opening 18 points of the temporal basing in the districts of area and 2 substations in Ternopil.\

Creation of twenty-four-hour posts of controllers is pre-arranged with accepting challenge in a number of districts, where they are absent with their further transmission in an only dispatching office at the Territorial center. For the grant of adequate medicare to the population on the prehospital stage at every station of UM in districts a presence will be provided not less than one twenty-four-hour departure medical brigade, here completing positions of medical assistants of brigades of UM to the їз taking into account of two twenty-four-hour posts on every UM in all substations and points. Considerable attention is also spared to the material and technical rigging of coaches of UM. It is known that not having regard to the role of the so-called human factor(professional preparation of physicians), it is difficult to count patients on successful treatment, in particular, on the prehospital stage without the proper apparatus, tool, medications. In obedience to the order of Ministry of health of Ukraine № 500 from 29.08.2008р. the brought list over of property and medications necessary in the robot of brigade UM.

Educational model for working off practical skills by the workers of UM

A shield is for transporting of victims

Leg aspirator

Sack of Аmbou

Pulsoxymetr

Neck collar

Foil for support of temperature condition of victim

A box with the set of tool and medications of brigade of UM

A modern set for implementation of conicopuncture

A bag with vacuum tires

Methodology of application of vacuum tires

A portable respiratory vehicle is with an oxygen bulb for UM

It is ratified

order of Ministry of health of Ukraine

from 29.08.2008 № 500

The Exemplary list of rigging of brigade to the point (separation) of the first medical aid for children population

1. Immobilization of equipment and equipment for transporting
1.1. Loads – arm-chair for transference of patients in position “sitting”	1
1.2. Tires transport vacuum	1
1.3. Loads are soft with pens for transporting	1
2. Respiratory and anesthesia equipment.
2.1. A vehicle for artificial ventilation of lungs is hand(respiratory sack).	1
2.2. Vehicle for the dosed inhalation of oxygen with a device for moistening	1
2.3. Portable mechanical aspirator	1
2.4. Oxygen bulb (2 l)	4
2.5. Oxygen mask	2
2.6. A vehicle transports for brief artificial ventilation of lungs	1
2.7. Laryngeal mask	4
2.7.1. Gag	1
2.7.2. Glossotilt	1
2.7.3. Sterile airexplorers	3
3. An equipment is for diagnostics and reanimation.
3.1. Portable automatic defibrillator is with the observability of electrocardiography and record of data	1
3.2. Electrocardiograph is with possibility of telemetric transmission electrocardiography– signal	1
3.3. Pulseoxymetr	1
3.4. Glyukometr and expense/pl materials is to him	1
3.5. Set for a conicotomy:	2
3.5.1. Napkins 5х5	2
3.5.2. Scalpel	1
3.5.3. Tube of intubation » 10х4 см	1
3.5.4. Sterile surgical gloves	2
3.6. A sphygmomanometer(for adults and children) is hand	1
3.7. A hammer is neurological	1
3.8. Portable stand for fixing of capacities with solutions for infusion(registers to the loads, extensible)	1
4. Bandaging material.
4.1. Bandage 7х14 см	2
4.2. Bandage 5х10 см	2
4.3. The bandage of tubular is elastic(set of different sizes)	1
4.4. Sparadrap	1
4.5. Napkins are sterile 15х15 см	2
4.6. Napkins are sterile 5х5 см	6
5. Medical instruments and articles of the medical setting.
5.1. A hot-water bottle is chemical non-expendable	1
5.2. An element is for the local cooling	1
5.3. Pears are rubber	1
5.4. A plait is styptic	4
5.5. A clamp is styptic	4
5.6. A probe is a stomach for children	2
5.7. A probe is a stomach for adults	2
5.8. Metallic probe of chamfery	1
5.9. Catheters are for the peripheral veins of different sizes	5
5.10. Device for inflowing in small veins as a “butterfly”	3
5.11. A catheter is urology elastic	3
5.12. Packer	1
5.13. Measuring glass measures	1
5.14. Metallic nozzle	1
5.15. Scissors are direct surgical	1
5.16. Scissors are for the scission of clothing	1
5.17. Protective glasses	3
5.18. Surgical pincers	1
5.19. A device is for infusing into solutions for influsion and blood substitutes(system)	3
5.20. Respirators wadding – gauze	3
5.21. Sterile surgical gloves	5
5.22. Gloves are a survey non-sterile non-permanent (latex or neoprene)	100
5.23. A thermometer is medical	1
5.24. Binaural stethoscope	1
5.25. Syringe 20,0	6
5.26. Syringe 10,0	5
5.27. Syringe 5,0	5
5.28. Syringe 2,0	2
5.29. Syringe 1,0	2
6. Medical complete sets.
6.1. Small epidemiology complete set:
6.1.1. Antibiotics of wide spectrum of action (for an urgent heterospecific prophylaxis)	2
6.1.2. Respirators wadding – gauze	4
6.1.3. Rubber Gloves to the way (for wastes) of life	4
6.1.4. Facilities are for current disinfection	1
6.1.5. Protective glasses	4
6.1.6. Alcohol of the 70 rinsing of cavity of mouth at suspicion on a plague), in small bottle (100 mls)	1
6.1.7. Sterile packages are for the selection of material	5
6.1.8. Streptomycin for burying of eyes and nose at suspicion on a plague	1
6.2. A complete set is maternity:
6.2.1. A clamp is non-permanent for an umbilical cord 6.2.2. A pear is rubber 6.2.3. Scissors 6.2.4. Diapers 6.2.5. Pincers	2 1 1 2 1
6.2.6. Sheet	1
6.2.7. Napkins 33х45, 14х16	4
6.2.8. Erythromycini 1% ointment (for the prophylaxis of blennorrhea)	1
6.2.9. Sterile surgical gloves	2
6.2.10. Protective clothing of an increase level of defence	3
6.2.11. Towels are a paper	1
7. Internal rigging of car of the first medical aid. Coverage of salon must be adjusted for a sanitization and disinfection, and sex – not slippery. On ceiling an emergency hatch must be envisaged a salon with a transparent lid, as an additional source of light. In a salon there must be not less than two places for a medical personnel (an easy folding chair is with an underhead, back that deviates and by a seatbelt). In the center of salon there must be the mounted platform for Troll that is fixed. Troll is with supports that is folded must be made from easy alloys and adjusted for transportation of patient by mass not less than 150 kg the Main and tender ends of Troll must rise. Troll must be adjusted for realization of indirect massage of heart, equipped by the straps of fixing of patient. Illumination in a salon must be general and local: powerful source of light above a patient with possibility to direct a ray.
7.1. An internal communicatioetwork is between a driver and salon with a patient.		1
7.2. The system of electroproviding of medical salon must include: an independent accumulator, connecting system to outsourcing of energy, transformer of current from 12V on 220V, wall outlets of 12V/ “source of electro feed” and 220V. The location of wall outlets must answer the assembling places of medical equipment.		1
7.3. Fire-extinguisher		1
7.4. Loud speaker		1
7.5. GPS – navigator (or map of roads and streets)		1
7.6. A complete set of furnitures is with possibility of fixing of standard equipment and mounted capacity for garbage. There must be an isothermal box with heating to 37˚С for infusion solutions and low temperature box for preparations that is kept at the temperature of 40˚С		1
7.7. The system of support of temperature in the salon of car must be more not subzero after 20˚С in winter and not higher after 27˚С in summer (the system must include the standing heater of salon and engine from outsourcing of electric power, heater from the heat of engine, independent heater, conditioner of air, drawing ventilation.		1
7.8. Handie-talkie		1
7.9.Portable emergency system (can be included in a handie-talkie)		1
7.10. Motor-car wireless station		1
7.11. Searchlight		1
7.12. Lantern		1
8. Medications
8.1. Adrenomymethics:
8.1.1. Sol. Dopamini 4,0% 5 ml in amp.		3 amp.
8.2.2. Sol.Phenylephrini hydrochloridi (Mezathoni) 1% 1 ml in amp.		1 amp.
8.2.3. Sol. Epinephrini (Adrenalini) 0,1% in amp. (1 ml).		5 amp.
8.2. Antiangynal:
8.2.1.Isosorbidi mononitratis ore Isosorbidi dinitratis (Iso–micci, Isoketi) spray is dosed under a tongue.		1
8.2.2. Sol. Glyceryli trinitrati (Nitroglycerini) 1% 2 ml in amp.		5 amp.
8.2.3. Glyceryli trinitrati (Nitroglycerini) 0,0005 in tab. (bottles) ore spray is dosed under a tongue.		1 bottle
8.3. Antiunrhythmical preparations:
8.3.1. Sol. Adenosini (Acidi Adenosintriphosphorici) 1% 1 ml in amp.		6 amp.
8.3.2. Sol. Amiodaroni (Cordaroni) 150 mg 3 ml in amp.		4 amp.
8.3.3. Sol. Verapamili (Finoptini) 0,25% 2 ml		2 amp.
8.3.4. Sol. Lidokaini 2%2 ml in amp.		5 amp.
8.3.5. Sol. Procainamidi (Novocainamidi) 10% 5 ml in amp.		4 amp.
8.4. Antibiotics:
8.4.1. Chloramphenicoli (Laevomycetini succinati) 0,5 g in bottles		3 bottles
8.5. Antihistaminic preparations:
8.5.1. Sol. Diphenhydramine (Dimedroli) 1% 1 ml in amp.		2 amp.
8.5.2. Sol. Clemastine (Tavegyli) 1 ml in amp.		3 amp.
8.5.3. Sol. Chloropyramine (Suprastini) 2% 1 ml in amp.		3 amp.
8.6. Antidotes:
8.6.1. Sol. Acidi Tioctici 0,5% 2 ml in amp.		3 amp.
8.6.2. Sol. Methylthionini chloridi 1% 10 ml in amp.		3 amp.
8.6.3. Sol. Sodii Thiosulfati 30% 5 ml in amp.		3 amp.
8.6.4. Sol. Naloxoni (Nalorfini) 0,5% 1 ml in amp.		3 amp.
8.6.5. Sol. Neostigmini (Proserini) 0,05% 1 ml in amp.		3 amp.
8.6.6. Unithioli 5% 5 ml in amp.		4 amp.
8.7. Antiseptics:
8.7.1. Sol. Iodi 5% 10 ml in bottles		1 bottle
8.7.2.Sol. Hydrogeni peroxidi 3% 40 ml in bottle		1 bottle
8.7.3. Sol. Viride nitens 1% 20 ml in bottle		1 bottle
8.8.Antiblood clotics facilities:
8.8.1. Acetylsalicylati lysini (Acelysini) 1g pulv. For injections. in bottle		2 bottles
8.8.2. Heparini 5 ml (5000 IU in 1 ml)		3 bottles
8.9. Anticholinergic facilities:
8.9.1. Sol. Atropini sulfatis 0,1% 1 ml in amp.		10 amp.
8.10.β-Adrenoblockers:
8.10.1. Sol. Metoprololi (Betaloci) 0,1% 5 ml in amp.		2 amp.
8.10.2. Sol. Propranololi hydrochloridi 0,1% 5 ml in amp.		3 amp.
8.11. Broncholytics:
8.11.1. Salbutamoli (Ventolini) aerosol for inhalations in a small bottle		1 bottle
8.11.2. Fenoteroli (Berodual, Beroteci) aerosol in a small bottle		1 bottle
8.12. Vitamins:
8.12.1. Sol. Acidi Ascorbinici (vit C)5% 1 ml in amp.		6 amp.
8.12.2. Sol. Pyridoxine (vit В6) 5% 1 ml in amp.		2 amp.
8.12.3. Sol. Thiamini chloridi (vit В1) 5% 1 ml amp.		6 amp.
8.13. Ganglioblockers:
8.13.1. Sol. Hexamethoni benzosulfonathi (benzohexoni) 2,5% 1 ml in amp.		3 amp.
8.14. Hemostatics:
8.14.1. Sol. Acidi aminocapronici 5% 100ml in a small bottle		2 bottle
8.14.2. Sol. Etamsylati (Dicinoni) 12,5% 2 ml in amp.		3 amp.
8.15. Hypotension:
8.15.1. Sol. Clonidini (Clophelini, Hemithoni) 0,01% 1 ml in amp.		3 amp.
8.15.2. Sol. Labetaloli (Lacardii) 5 mg/ml in a small bottle 4 ml		1 bottle
8.15.3. Sol. Nifedipini (Farmadipini) drops 2% 25 ml in a small bottle		1 bottle
8.16. Hormonal facilities:
8.16.1. Sol. Dexamethasoni 0,4% ml in amp.		10 amp.
8.16.2. Sol. Prednisoloni 30 мг 1 ml in amp.		5 amp.
8.17. Diuretics:
8.17.1. Sol .Mannitoli hexanitrati (Manniti) 15% 200ml for infusion in a small bottle		2 bottles
8.17.2. Sol. Furosemidi (Lasixi) 1% 2 ml in amp.		5 amp.
8.18. Entherosorbents:
8.18.1. Medicinal charcoal		3
8.18.2. Polymethylsyloxani hydrogeli (Enterosgeli) 45 in a small bottle		2 bottles
8.19. Facilities are for anesthesia:
8.19.1. Nitrous oxide 1 l gas force-feed 50 atmospheres		1 bulb
8.19.2. Thiopentali natrii 1g. in a small bottle		1 bottles
8.20 Blood substitutes and perfunic solutions:
8.20.1.Hydroxyethylstarchi (Refortani) 6% 250 ml in a small bottle		3 bottles
8.20.2. Sol. Dextrosi (Glucosi) 5% 200 ml in a small bottle		2 bottles
8.20.3. Electrolyte «Acesoli» 200 ml in a small bottle		2 bottles
8.20.4. Rheosorbilacti 200 ml in a small bottle		1 bottle
8.20.5. Electrolyte «Trisoli» 200 ml in a small bottle		2 bottles
8.20.6.Natrii chloridi 0,9% 200 ml in a small bottle		4 bottles
8.20.7.Natrii hydrocarbonati 4% 100 ml in a small bottle		2 bottles
8.22. Local anestetics:
8.22.1. Proxymetacaini (Alkaini) 0,5% 15 ml eye drops in bottle.		1 bottle
8.23. Narcotic analgetics:
8.23.1. Sol. Morphini hydrochloridi 1% 1 ml in amp.		3 amp.
8.23.2. Sol. Omnoponi 2% 1 ml in amp.		1 amp.
8.24. Unnarcotic analgetics:
8.24.1. Acidi Acetylsalicylici (Aspirini) 325 mg (ore 500mg) in tabl.		1
8.24.2. Sol. Diclofenaci 2,5% 3,0 ml in amp.		3 amp.
8.24.3. Sol. (Ketanovi) 3% 1 ml in amp.		3 amp.
8.24.4. Sol. Metamizoli natrii (Analgini) 50% 2 ml in amp.		6 amp.
8.24.5. Sol. Metamizoli natrii+Pitophenoni+Fenpiverini bromidi (Baralgetasi, Renalgani) 5 ml in amp.		5 amp.
8.25. Neuroleptics:
8.25.1. Sol. Chlorpromazine (Aminazini) 2,5% 2 ml in amp.		3 amp.
8.26. Psychicostimulant and ноотропні facilities:
8.26.1. Acidi Gamma-Aminobutyric (Natrii oxybutyras) 20% 10ml		3 amp.
8.26.2. Caffeine and sodium benzoate 20% 2 ml in amp.		3 amp.
8.26.3. Piracetami 20% 5 ml in amp.		3 amp.
8.27. Sedative facilities:
8.27.1. Tincture Valerianae 30 ml		1 bottle
8.27.2. Aetheri Aethylici α-bromi acidi isovalerici+Phenobarbitali+ Olei menthe piperite (Corvaloli, Corvaldini, Barbovali) 25 ml drops are for peroral application		1 bottle
8.28. Cardiac glycosides:
8.28.1.Sol. Digoxini 0,025% 1 ml in amp.		5 amp.
8.28.2.Sol. 0,025% 1 ml in amp.		3 amp.
8.29. Spasmolysants:
8.29.1. Sol. Theophylline (Eufilini) 2% 5 ml in amp.		2 amp.
8.29.2.Sol. Drotaverini (No-H-Spani, No-Spani) – 2 ml in amp.		3 amp.
8.29.3.Мagnii Sulfatis 25% 10 ml in amp.		5 amp.
8.29.4.Papaverini hydrochloridi 2% 2 ml in amp.		3 amp.
8.29.5. Platyphyllini hydrotartrati 0,2% 1 ml in amp.		3 amp.
8.30. Alcohols:
8.30.1. Sol. Ammonii 10% 40 ml for external applicationу in a small bottle		1 bottle
8.30.2. Ethanoli (Spiriti Aethylici) 70% 30 ml in a small bottle		1 bottle
8.31. Stimulators of peristalsis:
8.31.1. Sol.Metoclopramidi (Cerucali) 0,5% 2 ml in amp.		3 amp.
8.32. Preparations of potassium:
8.32.1. Sol.Potassii and magnesii aspartati (Asparcami) 5 ml in amp.		3 amp.
8.33. Preparations of calcium:
8.33.1. Sol. Calcii gluconati 10% 10 ml in amp.		3 amp.
8.34. Tranquilizers:
8.34.1. Sol. Diazepami (Sibasoni, Relaniumi, Reliumi) 0,5% 2 ml in amp.		2 amp.
8.35. Other facilities:
8.35.1. Aqua pro injectioni 10 ml in amp.		20 amp.
8.35.2. Sol. Natrii chloridi 0,9% 10 ml in amp.		10 amp.
8.35.3. Sol. Dextrosi (Glucosi) 40% 20 ml in amp.		10 amp.
8.35.4. Sol. Sulfocamphocaini 10% 2 ml in amp.		3 amp.
8.35.5.Olei Vaselini 30 ml in a bottle		1 bottle
8.35.6. Dexpanthenoli (Aerosoli Panthenoli) 200 ml in a bottle		1 bottle
8.35.7. Norfloxacini 0,3% 10 ml eye/ear drops		1
8.35.8. Sulfacetamidi (Sulfacyli natrii) eye drops 30% 10 ml in a bottle		1 bottle
8.35.9. Rapid tests are for determination of cardiomarkers (Troponin І and Troponin І, CK-MB, Mioglobin)		3
8.35.10. Diagnostic strakes of tests are for determination of ketones in urine		40
9. List of additional medications
9.1. Antibacterial:
9.1.1. Tab. Nifuroxazidi 0,1 tab. №10		1шт.
9.2. Antidiarrhea preparations:
9.2.1.Tab. Loperamidi 0,1 №10		1 шт.
9.3. Antiseptics:
9.3.1. Tab. Decamethoxini (Septefrili)		1
9.4. β-Adrenoblockers:
9.4.1. Tab. Propranolol (Anaprilini) 0,04 tab.in a bottle		1
9.5. Hypotension:
9.5.1. Tab. Captoprili + Hypochlorothiazidi (Captopresi)		1
9.5.2. Tab. Enalaprili 0,1		1
9.5.3. Tab. Nifedipini (Fenigidini,Corinfari) 0,01		1
9.5.4. Nifedipini (Farmadipini) drops are for peroral application 2% 25 ml in a bottle		1 bottle
9.6. Diuretics:
9.6.1.Tab. Furosemidi 0,04		1
9.7. Spasmolytics:
9.7.1. Tab. Drotaverini (No-H-Spani, No-Spani) 0,04 у фл.		1 bottle
9.8. Spasmolytic and Anticholinergic in combination:
9.8.1.Tab. Extr. Belladonnae+ Phenyliisalicylati (“Besaloli”)		1
9.9. Unnarcotic analgetics:
9.9.1. Tab. Acidi Acetylsalicylici (Aspirini) 325 mg		1
9.9.2. Tab. Acidi Acetylsalicylici+Phenacetini+Coffeini+Acidi limonici («Cytramoni»)		1
9.9.3. Tab.Metamizoli natrii (Analgini) 0,5g		1
9.9.4. Paracetamoli 325 mg in caps.		1
9.10. Stimulators of peristalsis:
9.10.1. Tab.Metoclopramidi (Cerucali) 0,01g		1 bottle
9.11. Other facilities:
9.11.2. Salt mixtures are for peroral rehydration (Rehydroni, Gastroliti, Normohydroni)		3
9.11.3. Mentholi Aetheri Methylici acidi isovalerici (Validoli) subtongue		1

Note: The same set of medications must be on the point(separation) of the first medical aid for child’s and adult population.

Guidance of curative establishment can additionally, taking into account local terms and financing, to complement the types of diagnostic and curative apparatus, substitute by analogues or extend an assortment and amount of medications, bandaging material, tool and wares of the medical setting, that is registered and settled to application in Ukraine.

Director of Department

organizations of medicare М.P.Zhdanova

It is also planned to equip all ambulances a radio contact and systems of GPS- of navigation that will give an opportunity of permanent contact of controller with a brigade and monitoring of movement of ambulance. The coordinating actions of only controller’s service will give an opportunity at the necessity to lead from one district brigade to the patient that is in other district, the so-called territorial principle of medical service of population of area is thus leveled.

Cardinal changes are tested by professional preparation of physicians and drivers of “ambulance”, in fact topically creation Educational-training Center of in-plant training of medical personnel of service of UM of area, in that the envisaged studies of drivers, medical assistants and doctors with their obligatory certification. Presence of certificate of preparation in a center it must the states by a dominant factor at a reception on work. In particular, it touches drivers, most that, unfortunately, reluctantly take part in the grant of urgent medicare. Studies will come true by forces of workers of departments of the first and urgent medical aid and department of medicine of catastrophes and military medicine of Ternopil medical university the name of І. Y. Gorbachevskiy. Except that, in this center the categories of unmedical workers, that mostly contact with plenty of people, will study also, namely: workers of traphic police, government service of emergencies, carriage explorers and others like that.

Realization of substantive provisions of Law on the single system of grant of urgent medicare in our area on condition of rational organization, management and financing of network of the stations, substations and points of the temporal basing of ambulances it is in end-point able to promote the level of readiness of this important link in the system of health protection population and will assist the timely and more quality grant of urgent medicare on the prehospital stage.

LAW O F UKRAINE

About urgent medicare

{With the changes brought in according to Code № 5403 – VI from 2.10.2012

By a law № 333 – VII from 18.06.2013}

This Law determines organizationally – legal principles of providing of citizens of Ukraine and other persons, that are on her territory, by urgent medicare, including during the origin of emergencies and liquidation of their consequences, and principles of creation, functioning and development of the system of urgent medicare.

LAW OF UKRAINE

About urgent medicare

Article 1. Definitions

1. In this Law terms are stated below used in such value:

1) brigade of urgent(ambulance) medicare – morphon of the station of urgent(ambulance) medicare or center of urgent medicare and medicine of catastrophes, the task of that is a grant of urgent medicare to the man in the urgent state directly in place of event and during transportation of such man to establishment of health protection under the Law;

2) calls of urgent medicare are a report about the urgent state of man and place of event та/або appeal about the necessity of grant of urgent medicare after the only telephone number of urgent medicare 103 or after the only number of the system of urgent help to the population 112;

3) separations of urgent(urgent) medicare – structural subdivision of multi-field hospital, in that the grant of urgent medicare is provided in the twenty-four-hour mode;

4) premedical help is urgent actions and organizational measures sent to the rescue and maintenance of life of man in the urgent state and minimization of consequences of influence of such state on her health, that come true in place of event by persons that does not have medical education, but after the official duties must own basic practical skills from saving and maintenance of life of man that is in the urgent state, and under the law be under an obligation to carry out such actions and measures;

5) urgent medicare is medicare, that consists in realization of the system of urgent medicare workers under this Law of the urgent organizational, diagnostic and curative measures sent to the rescue and maintenance of life of man in the urgent state and minimization of consequences of influence of such state on her health;

6) place of event is territory, apartment or any other location of man in the urgent state in the moment of realization of call of urgent medicare;

7) the urgent state of man is the sudden worsening of physical or psychical health, that presents a line and inevitable threat to life and health of man or surrounding her people and it arises up as a result of illness, trauma, poisoning or other internal or external reasons;

8) point of the permanent basing of brigade of urgent(ambulance) medicare is a place of location of brigade of urgent(ambulance) medicare but the specialized sanitary transport, adjusted and it is equipped for her work in the twenty-four-hour mode;

9) point of the temporal basing of brigade of urgent(ambulance) medicare is a place of sojourn of brigade of urgent(ambulance) medicare for providing of timely grant of urgent medicare, including during realization of mass measures and measures with participation of persons, in relation to that a state guard comes true;

10) system of urgent medicare is totality of certain by this Law establishments of health protection and them morphons that provide organization and grant of urgent medicare, including during the origin of emergencies and liquidation of their consequences;

11) a sanitary transport is specialized – the transport vehicle intended for transportation of man in the urgent state and equipped for the grant of urgent medicare in accordance with national standards in relation to such type of transport is equipped by the special light and voice alarm devices.

2. Other concepts and terms are used in this Law in values, that certain in Bases legislations of Ukraine about a health protection and other legislative acts of Ukraine.

Article 2. A legislation of Ukraine is in the field of the grant of urgent medicare

1. The legislation of Ukraine in the field of the grant of urgent medicare is based on Constitution of Ukraine and consists of Bases of legislation of Ukraine about a health protection, other legislative acts, that regulate relations on questions, related to the health protection, this Law and other normatively-legal acts accepted in accordance with them.

2. If by an international agreement, a consent to obligatoryness of that is given by Verkhovna Rada of Ukraine, other rules are set, than those that is envisaged by the legislation of Ukraine in the field of the grant of urgent medicare, the rules of international agreement are used.

Article 3. A right is on urgent medicare and general principles of her grant

1. On territory of Ukraine every citizen of Ukraine and any other person have a right on free of charge, accessible, timely and quality urgent medicare that is given under this Law.

Foreigners and persons without citizenship, that temporally are on territory of Ukraine, and also physical persons that is kept in custody or awarded punishment that in the type of imprisonment are provided by urgent medicare in the order certain Cabinet of Ministers of Ukraine.

2. On territory of Ukraine every citizen of Ukraine and any other person have a right:

to carry out the call of urgent medicare;

to appeal after the receipt of urgent medicare to the nearest separation of urgent(urgent) medicare or other establishment of health protection, that can provide the grant of such help; to report to the treating doctor or workers of the nearest establishment of health protection regardless of pattern of ownership and submission about the urgent state or about the urgent state of other man.

3. In case of exposure of man in the urgent state, that caot personally appeal after the grant of urgent medicare, and in default of medical workers in place of event citizen of Ukraine or any other person, that educed such man, obliged:

immediately to carry out the call of urgent medicare or report about the educed man in the urgent state and about the place of event of workers of the nearest establishment of health protection or any person that is under an obligation to render a premedical help and is near-by the place of event;

for possibilities to give to the educed man in the urgent state necessary help, including by transportation of such man to the nearest to the place of event separation of urgent(urgent) medicare or other establishment of health protection, the grant of necessary medicare can be provided in that.

4. Every citizen of Ukraine or other person, that educed a man in the urgent state, have a right to appeal to the enterprises, establishments and organizations with a request to give a transport vehicle for transportation of such man to the nearest to the place of event separation of urgent(urgent) medicare or other establishment of health protection, the grant of necessary medicare can be provided in that.

Enterprises, establishments, organizations regardless of pattern of ownership and submission, physical persons are businessmen, and also drivers are under an obligation to provide free of charge transportation the present in their order transport of man that is in the urgent state, to the nearest to the place of event separation of urgent(urgent) medicare or other establishment of health protection, the grant of necessary medicare can be provided in that.

5. If during transportation of urgent(ambulance) medicare of patient that is in the urgent state a brigade, in his state there were sudden complications that caot be removed by the medical workers of this brigade, such patient is delivered to the nearest establishment of health protection regardless of pattern of ownership and submission, where to him necessary medicare can be rendered in accordance with his state.

A refuse in the grant of medicare to such patient or creation of obstacles in her grant is shut out and pulls for persons that it admits her or carried out without good reasons, responsibility certain a law.

6. Medical workers of separation of urgent(urgent) medicare are under an obligation to render urgent medicare to the patient that needs her, from the moment of arrival of such patient to this separation regardless of or his brigade of urgent(ambulance) medicare or other persons accompanies. Refuse in the acceptance of patient that needs urgent medicare, or ill-timed grant of urgent medicare to the patient that her needs, shut out and pulls for persons that it admits her or carried out without good reasons, responsibility certain a law.

7. A grant of urgent medicare to the man is in the urgent state in place of event, during transportation and in establishment of health protection comes true in accordance with medical testimonies on the basis of clinical protocols and standards of urgent medicare, that become firmly established a central executive that provides forming and will realize a public policy in the field of a health protection body.

Article 4. Call of urgent medicare

1. The call of urgent medicare comes true after the only telephone number of call of urgent medicare 103 or after the only telephone number of call of urgent help 112.

2. The call of urgent medicare comes true gratuitously.

3. A refuse in possibility of realization of transmission and accepting challenge of urgent medicare is forbidden and heaves up for persons that it admits her or carried out, responsibility certain a law.

4. The order of transmission of calls of urgent medicare is determined by a central executive that provides forming and will realize a public policy in the field of connection body, after the giving of central executive that provides forming and will realize a public policy in the field of a health protection body.

5. Accepting challenge and grant of urgent medicare of urgent medicare provided by the system of urgent medicare, that is created and functions under this Law.

Article 5. Basic principles of organization and functioning of the system of urgent medicare

The system of urgent medicare is in Autonomous Republic of Crimea, areas, cities Kyiv and Sevastopol consists of centers of urgent medicare and medicine of catastrophes, stations of urgent(ambulance) medicare, brigades of urgent(ambulance) medicare, separations of urgent(urgent) medicare.

2. The basic tasks of the system of urgent medicare are organization and providing :

grant of accessible, free of charge, timely and quality urgent medicare under this Law, including during the origin of emergencies and liquidation of their consequences;

medicine– sanitary accompaniment of mass measures and measures with participation of persons, in relation to that a state guard comes true;

co-operating is with accident – rescue subdivisions of ministries, other central and local executive bodies during the origin of emergencies and liquidation of their consequences.

3. Organization and providing of functioning of the system of urgent medicare in the order and within the limits of plenary powers that is certain a law, come true by Cabinet of Ministers of Ukraine, central organ of executive power that provides forming and will realize a public policy in the field of a health protection, by Council of ministers of Autonomous Republic of Crimea, regional, by Kyiv and Sevastopol municipal state administrations, regional soviets, other organs of local self-government.

4. Basic principles of functioning of the system of urgent medicare are:

permanent readiness is to the grant of urgent medicare;

the operative and twenty-four-hour reacting is on the calls of urgent medicare;

availability and free of charge of urgent medicare, her timeliness, quality and priority

sequence and continuity of grant of urgent medicare and her accordance to the only requirements;

regional exterritoriality.

Article 6. Plenary powers of executive, Council of ministers of Autonomous Republic of Crimea and organs of local self-government bodies are in relation to providing of functioning of the system of urgent medicare

1. Cabinet of Ministers of Ukraine :

provides realization of public policy in the field of the grant of urgent medicare, organization and functioning of the system of urgent medicare;

coordinates work of ministries, other central executive bodies in relation to functioning of the system of urgent medicare;

provides development and implementation of the government having a special purpose programs sent to strengthening of material and technical base of the system of urgent medicare;

provides financing of charges on development of network and maintenance of highways, streets and railway moves;

the norm of arrival of brigade of urgent(ambulance) medicare determines to the place of event, accepts statutory measures from his inhibition;

asserts the volumes of preparation, retraining and in-plant training after the government order of medical workers for the necessities of the system of urgent medicare;

takes measure in relation to providing of the system of urgent medicare telecommunication resources;

asserts an order:

providing urgent medicare of foreigners and persons without citizenship, that temporally are on territories of Ukraine, and also physical persons that is kept in custody or awarded punishment that in the type of imprisonment;

application of the aviation, water, motor-car special sanitary transport vehicles;

co-operations of establishments of health protection, that included in the system of urgent medicare, with under abnormal condition – rescue services and subdivisions of central and other executive, government of Autonomous Republic of Crimea, organs of local self-government bodies bodies during the origin of emergencies and liquidation of their consequences;

carries out other functions and plenary powers certain this Law and other acts of legislation.

2. Central executive that provides forming and will realize a public policy in the field of a health protection body:

provides forming and realization of public policy in the field of the grant of urgent medicare;

determines priority directions of development of the system of urgent medicare;

provides the normatively-legal adjusting of activity of the system of urgent medicare and grant of urgent medicare under this Law;

summarizes practice of application of legislation in the field of the grant of urgent medicare, develops suggestions in relation to his perfection and bringing in accordance with established procedure of projects of corresponding normatively-legal acts;

co-ordinates the annual regional plans of functioning and development of the system of urgent medicare in Autonomous Republic of Crimea, areas, cities Kyiv and Sevastopol;

determines only requirements and criteria to establishments of health protection system of urgent medicare and them morphons, and also to establishments of health protection, that can be brought over to the grant of urgent medicare in case of origin of emergencies and liquidation of their consequences, carries out control after their inhibition;

asserts exemplary manning tables and tables of rigging of establishments of health protection system of urgent medicare and them morphons;

determines only qualifying requirements to the medical and other workers of establishments of health protection system of urgent medicare and them morphons;

forms and places the government order on preparation, retraining and in-plant training of medical workers for the necessities of the system of urgent medicare;

asserts exemplary manning tables and tables of rigging of establishments of guard organizes the scientific providing of functioning of the system of urgent medicare;

asserts clinical protocols and standards of urgent medicare, carries out control after their inhibition;

puts right international cooperation and studies world experience in relation to organization and grant of urgent medicare;

carries out other functions and plenary powers certain this Law and other acts of legislation.

3. Council of ministers of Autonomous Republic of Crimea, regional, Kyiv and Sevastopol municipal state administrations:

introduce Verkhovna Rada of Autonomous Republic of Crimea, regional, Kyiv and Sevastopol town councils and other organs of local self-government of suggestion in relation to creation, organization and functioning of the system of urgent medicare on territory of corresponding administrative-territorial units;

develop and assert on a concordance with a central executive that provides forming and will realize a public policy in the field of a health protection body, annual regional plans of functioning and development of the system of urgent medicare, provide their implementation;

determine on a concordance with a central executive that provides forming and will realize a public policy in the field of a health protection body, list of establishments of health protection, that fold the system of urgent medicare of corresponding administrative-territorial unit, carry out a management these establishments;

provide financing of the charges, sent to organization and functioning of the system of urgent medicare on territory of corresponding administrative-territorial unit, providing of her by necessary material and technical resources;

give in accordance with established procedure to the central executive, that provides forming and will realize a public policy in the field of a health protection, suggestion in relation to determination of government order volumes on preparation, retraining and in-plant training of medical workers of the system of urgent medicare, body;

provide building, reconstruction, repair of streets and roads on territory of corresponding administrative-territorial unit and their maintenance in the state that does possible implementation of the norm of arrival of brigade of urgent(ambulance) medicare set under this Law to the place of event, and also provide creation of other terms for the observance of this norm;

determine the list of establishments of health protection, that provide the grant of medicare on territory of corresponding administrative-territorial units in case of origin of emergencies and liquidation of their consequences;

form the network of points of the permanent and temporal basing of brigades of urgent(ambulance) medicare;

provide the system of urgent medicare material and technical resources necessary for her functioning and timely and quality grant of urgent medicare;

provide the observance of clinical protocols and standards of medicare medical workers;

carry out other functions and plenary powers certain a legislation.

4. Government of Autonomous Republic of Crimea bodies regional, Kyiv and Sevastopol town councils, other organs of local self-government in the order and within the limits of plenary powers that is certain a law, make decision on questions, related to creation, functioning and development of the system urgent

medicare in Autonomous Republic of Crimea, areas, cities Kyiv and Sevastopol, taking into account the this Law provisions.

Article 7. Center of urgent medicare and medicine of catastrophes

1. A center of urgent medicare and medicine of catastrophes is establishment of health protection, a basic task of that is providing of organization and grant of urgent medicare on territory of corresponding administrative-territorial unit under this Law.

2. A center of urgent medicare and medicine of catastrophes is a legal entity, has independent balance, corresponding accounts in the organs of treasury and banks, printing and form with the name.

3. Typical position about the center of urgent medicare and medicine of catastrophes becomes firmly established Cabinet of Ministers of Ukraine.

4. The center of urgent medicare and medicine of catastrophes provides:

accepting challenge of urgent medicare;

forming, treatment and information transfer about the calls of urgent medicare;

co-ordination of actions of brigades of urgent(ambulance) medicare and establishments of health protection in relation to the grant of urgent medicare;

co-operate with executive bodies, organs of local self-government, establishments, enterprises, establishments and organizations;

grant of departure consultative medicare;

conduct of statistical account and accounting;

calculation of necessary amount and planning of location of points of the permanent and temporal basing of brigades of urgent(ambulance) medicare for a timely grant to the population of urgent medicare under the Law, introducing organ, authorized agent to manage the center of urgent medicare and medicine of catastrophes, suggestions;

bringing in in case of necessity of establishments of health protection, that is not included in the system of urgent medicare, and their workers and technical resources to the grant of medicare in case of origin of emergencies and liquidation of their consequences.

5. The material and technical base of center of urgent medicare and medicine of catastrophes includes building, building, medical equipment, wares of the medical setting, communication means, transport vehicles and other material values passed to him on balance by organs, by the authorized agents to manage general property of territorial communities, in the order certain a law.

6. Property of center of urgent medicare and medicine of catastrophes is fastened after him on a right for an operative management and used exceptionally for implementation of the tasks envisaged by this Law.

7. The management of urgent medicare and medicine of catastrophes of corresponding administrative-territorial unit a center comes true in the order and within the limits of plenary powers, that is certain to these and by other laws, Council of ministers of Autonomous Republic of Crimea, regional, by Kyiv and Sevastopol municipal state administrations.

The article 8. is Operatively-controller’s service of center of urgent medicare and medicine of catastrophes

1. Operatively-controller’s service of center of urgent medicare and medicine of catastrophes is structural subdivision of center of urgent medicare and medicine of catastrophes, that with the use of telecommunicatioetworks, programmatic, technical and other equipments provides in the twenty-four-hour mode:

acceptance, forming and information transfer about the calls of urgent medicare;

informative support and co-ordination of actions of brigades of urgent(ambulance) medicare and establishments of health protection in relation to the grant of urgent medicare.

2. Operatively-controller’s service of center of urgent medicare and medicine of catastrophes is under an obligation :

to accept challenge urgent medicare, provide his treatment and operative reacting on such call;

during treatment of call of urgent medicare to form information about the place of event, character and features of the urgent state of man, type of help, necessary for the removal of negative consequences of such state for the health of man, and to report about it to the subscriber that carried out the call of urgent medical

to pass to the station of urgent(ambulance) medicare and corresponding brigade of urgent(ambulance) medicare information about the call of urgent medicare, character and features of the urgent state of man;

to define establishment of health protection, to that the brigade of urgent(ambulance) medicare will carry out transportation of patient in the urgent state, pass to this information the brigade of urgent(ambulance) medicare and such establishment;

to carry out informative accompaniment of grant of urgent medicare and accept information about the result of her grant in place of event, during transportation and arrival of patient to establishment of health protection;

to carry out first-line informatively-consultative support of appeals of population after medicare;

operatively to provide departure consultative medicare after the appeals of establishments of health protection.

3. The use, collection, treatment, accumulation, storage, transmission, distribution, elimination, grant to access, to information about the calls of urgent medicare come true in the order set by a law.

4. Information about the call of urgent medicare, subscriber that carried out him, and audio recording of such call and reacting on him subject operatively-controller’s service to storage during three years. Elimination of such information comes true under the law.

5. Routing of calls of urgent medicare comes true in the order set by a central executive that provides body forming and will realize a public policy in the field of connection, after the giving of central executive that provides forming and will realize a public policy in the field of a health protection body.

6. Norms of loading and qualifying requirements to the controllers of operatively-controller’s service of center of urgent medicare and medicine of catastrophes, and also the tables of rigging of operatively-controller’s service of center of urgent medicare and medicine of catastrophes become firmly established a central executive that provides forming and will realize a public policy in the field of a health protection body.

7. Order of informing of brigades of urgent(ambulance) medicare about the call of urgent medicare and order of their direction into place of event determined by Cabinet of Ministers of Ukraine taking into account the requirements of law on the protection of the personal data.

Article 9. Station of urgent(ambulance) medicare

1. The station of urgent(ambulance) medicare is establishment of health protection, a basic task of that is providing of permanent readiness of brigades of urgent(ambulance) medicare to the grant of urgent medicare in accordance with the this Law provisions in the twenty-four-hour mode and co-ordination of their activity with operatively-controller’s service of center of urgent medicare and medicine of catastrophes on territory of corresponding administrative unit.

2. The station of urgent(ambulance) medicare can have status of legal entity or separated subdivision of center of urgent medicare and medicine of catastrophes.

3. Typical position about the station of urgent(ambulance) medicare and brigade of urgent(ambulance) medicare becomes firmly established Cabinet of Ministers of Ukraine.

4. About formation and stopping of the station of urgent(ambulance) medicare made decision in the order and within the limits of plenary powers that is certain a law, by the organs of local self-government taking into account the this Law provisions.

5. The material and technical base of the station of urgent(ambulance) medicare includes building, building, medical equipment, wares of the medical setting, communication means, transport vehicles and other material values passed by organs, by the authorized agents to manage general property of territorial communities of corresponding administrative-territorial unit, in the order certain a law.

6. Property of the station of urgent(ambulance) medicare, that is a legal entity, is fastened after her on a right for an operative management and used exceptionally for implementation of the tasks envisaged by this Law.

Article 10. Separation of urgent(urgent) medicare

1. A separation of urgent(urgent) medicare is structural subdivision of multi-field hospital, in that the grant of urgent medicare to the patients delivered is provided in the twenty-four-hour mode by the brigades of urgent(ambulance) medicare or other persons, and to the patients that appealed after the grant of such help or other first medical aid personally.

2. About organization of separation of urgent(urgent) medicare and his functioning made decision government of Autonomous Republic of Crimea bodies regional, by Kyiv and Sevastopol town councils, by other organs of local self-government in the order and within the limits of plenary powers that is certain a law.

3. Only requirements to the material and technical rigging of separations of urgent(urgent) medicare and qualification of their workers are determined by a central executive that provides forming and will realize a public policy in the field of a health protection body, in accordance with the requirements of this Law.

4. Typical position about the separation of urgent(urgent) medicare becomes firmly established a central executive that provides forming and will realize a public policy in the field of a health protection body.

Article 11. Workers of the system of urgent medicare

1. The workers of the system of urgent medicare under this Law are:

medical workers of centers of urgent medicare and medicine of catastrophes, stations of urgent(ambulance) medicare, brigades of urgent(ambulance) medicare, separations of urgent(urgent) medicare, that directly render urgent medicare та/або provide her grant by law by it;

unmedical workers of centers of urgent medicare and medicine of catastrophes, stations of urgent(ambulance) medicare, brigades of urgent(ambulance) medicare, separations of urgent(urgent) medicare, that carry out the organizationally – technological providing of grant of urgent medicare the medical workers of the system of urgent medicare.

2. Qualifying and other requirements to the medical and other workers of the system of urgent medicare are determined by a central executive that provides forming and will realize a public policy in the field of a health protection body.

3. Preparation, retraining and in-plant training of medical workers, after a government order for the necessities of the system of urgent medicare is provided under the law by a central executive that provides forming and will realize a public policy in the field of a health protection body, jointly with a central executive that provides forming and will realize a public policy in the field of education and science body

4. The medical workers of the system of urgent medicare have a right on:

increase post salaries, raises for the special character of labour, for the special terms of labour, additional charge for a scientific degree, for the honoured ranks, and also for a time-in-service depending on experience of work in state and communal establishments health protection, other raises and additional charges, bonuses and rewards, size and order of establishment of that, are determined by Cabinet of Ministers of Ukraine;

material help for making healthy during the grant of annual vacation in size of one post salary and material help for the decision of socially – domestic questions in size of one post salary, that is set in the order certain Cabinet of Ministers of Ukraine;

social privileges and guarantees envisaged by a legislation about under abnormal condition – rescue services, in cases, Ministers of Ukraine set by Cabinet;

obligatory insurance, that is provided in the order certain a law;

the free of charge providing of only standard a working wear is in the order certain a central executive that provides forming and will realize a public policy in the field of a health protection body.

5. Worker of the system of urgent medicare, that enters in the complement of brigade of urgent(ambulance) medicare, during implementation of official duties has a right of defence from the untillegal trenching upon the life and health, that is provided in accordance with a legislation.

Article 12. Persons that are under an obligation to render a premedical help

1. Persons that are under an obligation to render a premedical help to the man in the urgent state are: rescuers of under abnormal condition – rescue services, workers of state fire prevention, workers of organs and subdivisions of militia, pharmaceutical workers, explorers of passenger carriages, air stewards and other persons that does not have medical education, but after the official duties must own practical skills of grant of premedical help.

2. The order of preparation and in-plant training from the grant of premedical help of persons that are under an obligation to give her is determined by Cabinet of Ministers of Ukraine.

Article 13. Scientific providing of activity of the system of urgent medicare

1. Central executive that provides forming and will realize a public policy in the field of a health protection body, jointly with a central executive that provides forming and will realize a public policy in the field of education and science body, assist to development of scientific researches after directions “Medicine of the urgent states” and “Medicine of catastrophes”, including by ordering of concrete fundamental and/ore applied scientific researches from the aim of introduction of their results in activity of the system of urgent medicare.

2. Researches, that is conducted by scientific establishments, educational establishments, are financed in the order set by a legislation.

Article 14. Financial and material and technical providing of the system of urgent medicare

1. The financial providing of the system of urgent medicare due to budgetary facilities comes true in accordance with a budgetary legislation.

2. For development and improvement of material and technical base of the system of urgent medicare it can be attracted facilities of enterprises, establishments and organizations regardless of pattern of ownership and menage, and also voluntarily offering of physical and legal persons, eleemosynary organizations and associations of citizens, other sources not forbidden by a legislation.

{Text of the article 14 in the release of Law № 333 – VII from 18.06.2013}

Article 15. Responsibility is for violation of legislation in the field of the grant of urgent medicare

1. Persons guilty in violation of the this Law provisions in the order set by a law bear the disciplinary, administrative, criminal or civil legal responsibility after:

ungrant without good reasons in place of event of premedical help or groundless refuse in her grant;

ungrant without good reasons in place of event of necessary medicare or groundless refuse in her grant;

an ungrant is without good reasons of present transport vehicle for free of charge transportation of man that is in the urgent state, to the nearest to the place of event separation of urgent(urgent) medicare or groundless refuse in realization of such transportation;

an ill-timed grant of urgent medicare or creation of obstacles is in her grant;

non-fulfillment is without good reasons of orders of operatively-controller’s service of center of urgent medicare and medicine of catastrophes or brigade of urgent(ambulance) medicare in relation to the grant of the necessary first medical aid to the patient, that is in the urgent state that threatens to life of such patient;

groundless refuse in a transmission and accepting challenge of urgent medicare.

2. Compensation of moral and material harm, corresponding help or improper implementation of the professional duties caused as a result of ungrant by medical workers or other persons, in the cases envisaged by this Law, comes true under the law.

Article 16. Final positions

1. This Law enter into force from January, 1, 2013, except a point 4 the real article, that is entered into by a day, following by a day publication of this Law.

2. Laws and other normatively-legal acts to bringing to conformity with this Law are used in part, that does not conflict with this Law.

3. To make alteration to such legislative acts of Ukraine :

1) in the Budgetary code of Ukraine (Lists of Verkhovna Rada of Ukraine, in 2010, № 50-51, century 572) :

а) in the subitem of “а” point to eliminate 3 parts of the first article of a 89 word of the “station of ambulance and first medical aid”;

b) subitem of “а” point to complement 3 parts of the first article 90 words “centers of urgent medicare and medicine of catastrophes, station of urgent(ambulance) medicare”;

2) points 24 parts of the first article of a 10 Law of Ukraine “About a militia” (Lists of Verkhovna Rada of UKRAINE, in 1991, № 4, century 20) to expound in such release:

“24) to give within the limits of present possibilities to the persons that suffered from offences and accidents or are in helpless or dangerous for life and health the state, including minor that remained without guardianship, premedical help and other help, and also in case of necessity to use envisaged Law of Ukraine “On urgent medicare” of measures for providing of grant to the marked persons of urgent medicare”;

3) in Bases of legislation of Ukraine about a health protection (Lists of Verkhovna Rada of Ukraine, in 1993, № 4, century 19 with next changes) :

а) in part to the first article 3 :

after an indention sixth to complement two new indentions of such maintenance :

the “urgent state of man is the sudden worsening of physical or psychical health, that presents a line and inevitable threat to life and health of man or surrounding her people and it arises up as a result of illness, trauma, poisoning or other internal or external reasons;

a health protection is the system of measures that come true by public authorities and organs of local self-government, them by public servants, establishments of health protection, medical and pharmaceutical workers and citizens with the aim of maintenance and proceeding in physiology and psychological functions, optimal capacity and social activity of man at maximal biologically possible individual duration of her life”.

In this connection an indention is seventh to consider an indentiointh;

to complement an indention tenth of such maintenance :

b) premedical help is urgent actions and organizational measures sent to the rescue and maintenance of life of man in the urgent state and minimization of consequences of influence of such state on her health, that come true in place of event by persons that does not have medical education, but after the official duties must own basic practical skills from saving and maintenance of life of man that is in the urgent state, and under the law be under an obligation to carry out such actions and measures”;

to expound the б) point of the “в” article 10 in such release:

“в) to use envisaged Law of Ukraine “On urgent medicare” of measures for providing of grant of urgent medicare to other persons that are in the urgent state”;

c) in the article 33 :

to expound part first in such release:

“Medicare is given in accordance with medical testimonies by the professionally prepared medical workers that are in labour relationships with establishments of health protection, that provide the grant of medical

help according to the license, and physical persons – businessmen that is registered and got a corresponding license in the order set by a law and can be with these establishments in civil legal relations”, got under the law;

to complement part third words “if other is not statutory”;

d) part first to the article 35 to expound in such release:

“Urgent medicare is medicare, that consists in realization medical workers under the law of the urgent organizational, diagnostic and curative measures sent to the rescue and maintenance of life of man in the urgent state and minimization of consequences of influence of such state on her health”;

to expound г) text of the article 37 in such release:

“Medical workers are under an obligation without delay to render necessary medicare in case of origin of the urgent state of man.

Organization and providing of grant of urgent medicare to the citizens and other persons come true under the Law of Ukraine “On urgent medicare”.

Citizens that during an urgent or extreme situation participated in saving of people and assisted the grant of medicare, avouched for in case of necessity in the order set by a legislation, free of charge treatment and compensation of the moral and property harm caused to their health and property.

For the ill-timed and off-grade providing necessary medicare, that resulted in heavy consequences, winy persons bear the responsibility under the law”;

e) part second to the article 43 to expound in such release:

“Consent of patient or him legal representative on medical interference not need only in case of presence of signs of direct threat to life of patient on condition of impossibility of receipt on objective reasons of consent to such interference from a patient or him legal representatives”;

f) in the point of “н” part of the first article of a 77 word “doctors(head physicians) and middle medical personnel of departure brigades of the stations and separations of ambulance and first medical aid, stations of sanitary aviation and separations of planility and urgent consultative help” to replace words “medical workers of brigades of urgent(ambulance) medicare of centers of urgent medicare and medicine of catastrophes, medical workers of brigades of urgent(ambulance) medicare of the stations of urgent(ambulance) medicare, medical workers of operatively-controller’s services of centers of urgent medicare and medicine of catastrophes, medical workers of separations of urgent(urgent) medicare”;

g) in the point of “б” part of the first article to replace a 78 word “first” a word “corresponding”;

4) in Law of Ukraine “On travelling motion“ (Lists of Verkhovna Rada of Ukraine, in 1993, № 31, century 338; in 1999, № 19, century 173; in 2003, № 29, century 233; in 2005, № 5, ст.116; in 2009, № 10-11, century 137) :

а) indention is tenth to the article 5 to replace two indentions of such maintenance :

“organization and realization of measures for the timely providing of victims as a result of road and transportation adventures urgent medicare directly in place of event and their transporting for the grant of further medicare to corresponding establishments of health protection;

conditioning for implementation of urgent(ambulance) medicare brigades set by Cabinet of Ministers of Ukraine of norm of arrival of brigades of urgent(ambulance) medicare to the patient”.

In this connection indentions eleventh – fifteenth to consider accordingly indentions twelfth – sixteenth;

b) in an indention sixteenth of the article of a 9 word of “ambulance of medical” to replace the words of “urgent medicare”;

c) in the article 14 :

part third after an indention third to complement the new indention of such maintenance :

“timely providing urgent medicare”.

In this connection an indention is fourth to consider an indention fifth;

to complement part fifth indentions fifth and sixth such maintenance:

not to “create obstacles for passage of the specialized sanitary transport of brigades of urgent(ambulance) medicare, that moves with included a gleam lighthouse and special acoustical signal;

in cases certain Law of Ukraine “On urgent medicare”, to render a necessary premedical help and accept all possible measures for providing of grant of urgent medicare, including to the victims as a result of road and transportation adventures”;

part sixth after the words of “travelling-operating services” to complement words “and brigades of urgent(ambulance) medicare”;

d) to complement the second sentence of part of the fifth article 15 the words of “central executive that provides forming and will realize a public policy in the field of a health protection” body;

e) part fifth to the article 24 after a word “adventure” to complement words “or ill-timed providing urgent medicare of man, that is in the urgent state”;

f) in the second sentence of part of the first article of a 25 word “for the call of services of medical first-aid” to replace words “for the call of urgent medicare”;

g) in part to replace the fourth article of a 26-1 word of “medical first-aid” the words of the “specialized ambulances of brigades of urgent(ambulance) medicare”;

to expound the h) article 47 in such release:

Article 47. Organization of the medical providing of safety of travelling motion

Organization of providing of victims during road and transportation adventures urgent medicare comes true under the Law of Ukraine “About urgent medicare” and plans that is annually developed but become firmly established regional state administrations on a concordance with a central executive that provides forming and will realize a public policy in the field of a health protection body, and corresponding subdivisions of trafic police of Ministry of internal affairs of Ukraine.

Providing of victims as a result of road and transportation adventures and other participants of travelling motion by urgent medicare and other medicare comes true by establishments of health protection, that in accordance with the ratified plans is envisaged after the concrete links of highways, streets, railway moves and have the opportunity for the grant of such help in the twenty-four-hour mode.

On the areas of roads, streets and on railway moves corresponding sign-boards are set with information about the nearest establishment of health protection, that can provide grant of urgent medicare or other medicare, direction of motion and distance to him, and also information about the telephone numbers of call of urgent medicare 103 and urgent call 112.

Other establishments of health protection, that are in a direct closeness from highways, streets and railway moves, must be provided with a necessary medical equipment according to a list, ratified central executive that provides forming and will realize a public policy in the field of a health protection body, and mark a sign-board “Point of medicare”.

Establishments of health protection are marked must be equipped by communication means. On main highways establishments of health protection and the station of urgent(ambulance) medicare are envisaged provided also by an alarm-defiant communicatioetwork”;

j) in the article 48 :

in a partial word first by “practical skills of presentation of the first medical aid” to replace words by “practical skills from the grant of premedical help”;

in a partial of “presentation of the first medical aid” word third to replace words the “grant of premedical help”;

{A subitem of a 5 point is 3 articles 16 lost an action on the basis of Code № 5403 – VI from 02.10.2012}

6) in the article of 2 Laws of Ukraine “About privatizing of small state enterprises(small privatizing) ” (Lists of Verkhovna Rada of Ukraine, in 1996, № 34, century 160; in 2011, № 44, century 463) :

an indention is second part third to complement words “establishments of health protection system of urgent medicare”;

part fifth after words not “subject to privatizing” to complement words “establishments of health protection system of urgent medicare”;

a 7) indention is second to the point of “а” part of the second article of a 5 Law of Ukraine “About privatizing of state property” (of List of Verkhovna Rada of Ukraine, in 1997, № 17, century 122; with the changes, brought in by Law of Ukraine from January, 13, 2012 №4336 – VI) to complement words “property of establishments of health protection system of urgent medicare”;

{A subitem of a 8 point is 3 articles 16 lost an action on the basis of Code № 5403 – VI from 02.10.2012}

{A subitem of a 9 point is 3 articles 16 lost an action on the basis of Code № 5403 – VI from 02.10.2012}

10) part second to the article of a 5 Law of Ukraine “About the radio frequency resource of Ukraine”(Lists of Verkhovna Rada of Ukraine, in 2004, № 48, century 526; in 2006, № 14, century 116, № 26, century 215, № 30, century 258; in 2009, № 24, century 299) to complement words the “systems of urgent medicare”;

11) in Law of Ukraine “On a motor transport “(Lists of Verkhovna Rada of Ukraine, in 2006, № 32, century 273; in 2009, № 10-11, century 137; in 2012, № 5, century 34; with the changes, brought in by Law of Ukraine from March, 22, 2012 № 4621, – VI) :

а) in an indention sixty second to the article 1 and in part to the fourth article of a 19 word “medical first-aid” to replace words the ambulance of urgent medicare” is “specialized;

б) in an indention sixth of part of the first article to replace 34 words of the “first medical aid” the words of “premedical help”;

12) point is 3 parts of the second article of a 39 Law of Ukraine “About realization of the public purchasing”(Lists of Verkhovna Rada of Ukraine, in 2010, № 33, century 471; in 2012, № 18, century 156) after a word “constrained” to complement words “with providing of the oil processing foods liquid the specialized sanitary transport of brigades of urgent(ambulance) medicare”;

a 13) text of the article of a 6 Law of Ukraine is “About the order of realization of reformation of the system of health protection in Vinnytsya, Dnepropetrovsk, Donetsk areas and city Kyiv” (Lists of Verkhovna Rada of Ukraine, in 2012, №12-13, ст.81) to expound in such releases:

“1. Urgent medicare is medicare, that consists in realization medical workers under the law of the urgent organizational, diagnostic and curative measures sent to the rescue and maintenance of life of man in the urgent state and minimization of consequences of influence of such state on her health.

2. Organization of grant of urgent medicare in pilot regions comes true by creation in every region of the system of urgent medicare, that consists of center of urgent medicare and medicine of catastrophes, stations of urgent(ambulance) medicare, brigades of urgent(ambulance) medicare and separations of urgent(urgent) medicare.

3. The system of urgent medicare is created taking into account the necessity of providing of implementation the brigades of urgent(ambulance) medicare of norm of arriving on the place of event, that is determined by Cabinet of Ministers of Ukraine, and their co-operating with establishments of health protection”;

14) in the point of a 5 part of the first article of a 1 Law of Ukraine “About the system of urgent help to the population after an only telephone number 112″ words

to replace “services of medical first-aid” the words of “other establishments of health protection system of urgent medicare”.

4. To the cabinet of Ministers of Ukraine in three months term from a day, following by a day publication of this Law :

to give for consideration of Verkhovna Rada of Ukraine of suggestion in relation to bringing of laws of Ukraine to conformity with this Law;

to bring the normatively-legal acts to conformity with this Law;

to provide bringing of executive power of the normatively-legal acts corresponding central organs to conformity with this Law.

A president of Ukraine V.YANUKOVYCH

Kyiv

on July, 5, 2012 № 5081 – VI

Documentation that is conducted in the robot of brigade UM

By a main registration document that regulates there is a map of departure to the robot of brigade UM. An address, master passport data of patient and his complaints, temporal scopes of activity of brigade of UM, is represented in her, namely: time of receipt of call, time of departure and arrival to the patient, time of stay in place of event, time of delivery sick in permanent establishment(if herein there was a necessity), time of return on a base. Farther like registration of hospital of in-patient chart circumstances, anamnesis, data of objective inspection, are laconically described. A previous diagnosis darts out and specified algorithm of treatment with clear description of medications, technical manipulations, procedures, and others like that. The important legal constituent of this document is the so-called abandonment from hospitalization. Quite often patients renounce hospitalization categorically. In case of grave condition that can result in fatal consequences(even deaths), medical brigade of obliged to involve auxiliary rescue services(more often workers of militia) for the immediate transporting of patient(victim) in permanent establishment. In other situations less threatening for life and health of patient, a brigade is fill abandonment from hospitalization after a corresponding form and messaged in a policlinic district(to the domestic doctor) for realization to them of the further watching a patient.

To the patient(to the victim) that was in the state of clinical death and a pneumocardial reanimation was conducted that forces of brigade of UM in detail are describe all their actions of accordingly to parts of protocol of stop of cardiac activity. During establishment of biological death in a time of arrival of coach of UM or after uneffective reanimation measures the workers of service are caused 102 with filling of corresponding columns in the map of departure.

Another element of connect between UM and policlinic is registration of the so-called alarm sheet. He is sent in this curative establishment in case of frequent, sometimes groundless calls to one patient(every day and that a few one time per days). An alarm sheet (urgent report) is also sent in sanitary station, when suspicion is in relation to the exposure of infectious disease.

On a patient that is delivered in permanent establishment, an accompanying sheet part of that is sewn underneath to the hospital chart is recorded, other is added by the brigade of UM to the map of departure. Psychotropic, narcotic and drastic preparations are in magazines after corresponding forms.

An algorithm of initial actions of brigade of UM is in place of event at the exposure of victims that need urgent medicare.

Stage of actions of brigade of UM and her job performance in parallel instances are based on the so-called principles of “platinum half a hour” and “gold hour”. Conditionally “platinum half hours” are divided into three 10 minutes:

10 minutes – arrival to the place of event;

10 minutes is an estimation of place of event including realization of the medical sorting, diagnostic measures and grants of the first aid in place;

10 minutes – transporting suffering in permanent establishment with continuation(after shows) of realization of untilshock measures and permanent monitoring of vitally -impotent organs and systems in the coach of UM.

The “Gold hour” includes for itself next 30 minutes, where to the victim in permanent establishment the various, including highly specialized methods of inspection are conducted in the urgent order, as then computer thomography, МRТ and others like that, up to beginning of operative intervention.

At the same time, there is another conception of “gold hour”, that interpritation weight of the state of trauma victims is with simultaneous realization of the primary medical sorting. In obedience to her all damages are divided into three categories:

1. Irreversible at that even immediate adequate interferences do not bring to the positive result (more often a trauma over, what not consonant with life (in the medical sorting are ” black victims”)

2. Damages at that consequences of trauma (death or disability) depend on timely and quality medical interference are “red victims“. Help they get near-term with further hospitalization for the grant of the specialized treatment in. possible operative intervention during 1 hour(!) from the moment of the got trauma.

3. Damages at that the grant of the specialized medicare can be deferred during 1 hour without an obvious risk for life and health of trauma are “yellow victims”.

Going is near a victim

At going near a victim it follows to find out for casual witnesses, rescuers or militiamen that happened, or safe is a place of adventure, how many are injured.

If place of event, from your point of view related to the criminal actions, then at once cause a police, if requires intervention from rescuers – report rescue service. In all cases, if a crime happened, or violence is applied, law enforcement authorities must preliminary provide safety for medical rescuers.

If no information is, it costs to operate independently, paying attention to first of all everything, that can threaten to the personal safety of members of brigade : a place it follows fully to examine. If there is the least threat(containers marking the special signs, spilled liquid, smoke, fog, fire, natural and other gas, send-offs of electric current, explosive objects, objects that can fall down from above and others like that)it follows to be determined, or there is the real possibility independently without an own risk to remove her, if no, it is necessary to stop motion to the victim, causing rescuers. In this situation it follows to support a verbal contact with a victim, to find out that disturbs him and to give to him recommendations in relation to само– and mutual help.

If it make decision to get around a victim, for a step it is needed to find out for itself, that happened, to envisage the mechanism of trauma and tune in to technology of grant of medicare. One of medical worker or a driver must examine all nooks of place of adventure, to educe other people. When they are, at a necessity the leader of brigade will force to inspect them and also render necessary medicare.

It costs to pay attention to all details of place of adventure, constantly controlling the place of adventure, as in a dynamics there can be additional dangers that will compel physicians to rescue not only life injured but also personal.Without alternatively, priority is remained by own life, farther life of patient, and also all surrounding.

Is it necessary to find out, or necessary additional help or additional funds? In case of her necessity messaged to the controller, where information is laconically given about the locations of victims, their amount, general and character of damages with further determination of quantitative and quality type of auxiliary brigades of UM.

Technology of primary inspection

To victim at possibility it follows to befit from chairmen side. At first by sight the state of patient is estimated on the whole(age, sex, morphology of body, language, color of the cutaneous covering, pose, presence of motions(thorax, extremities), mimicry, state of eyes, visible defeats by an injuring factor), a primary conclusion is done about his weight and further algorithm of help.

The state of consciousness turns out after the algorithm of AVPU :

A – Alert(at consciousness, gives adequate answers for a question, can produce the realized actions – on the request of medical rescuer);

V – Responds of to of Verbal of stimuli – reacts on voice, more precisely on a loud sound about both ears;

P – Responds of to of Pain – reacts on pain(nip for a skin in the area of projection of trapezo visible мяза, left pectoral muscle with a turn on 180о);

U – Unresponsive – insensible.

Estimation of external signs of vital functions by one rescuer

If there is suspicion on the simulation of fainting fit expose 2 and by 5 fingers of eyelid. A patient that is at consciousness necessarily will strain muscles never and they will yield with tension.

Next to it to the patients(to the patients) that are in the comatose state for valuable diagnostics her degrees it follows to apply scale of commas of Glasgow.

Monitoring of general of victim (estimation of притомності, breathing and cardiac activity) by the brigade of UM

SCALE OF COMMAS OF GLASGOW

Clinical signs

Points

Opening of eyes

Arbitrary

On a language appeal

On pain irritations

It is not

Motive reaction

Executes commands

Purposeful on a pain irritation

Unpurposeful on a pain irritation

The tonic bending is on a pain irritation

The tonic unbending is on a pain irritation

It is not

Language

The oriented is full

Entangled

Incomprehensible words

Illegible sounds

It is not

After a scale Glasgow clinical signs are differentiated after the degree of their expressed, that it is represented in points. For the receipt of information about the degree of change of consciousness points summarize. That anymore is a sum of points, then less degree of oppression of functions of brain and vice versa. If sum of points :

– 15 – a comma is not;

– 14-13 is stunning;

– 12 – 10 is sopor;

– 9 -8 is an easy comma(comma of І);

– 7-6 is a middle comma(comma of ІІ);

– 5-4 is a deep comma(comma of ІІІ);

– 3 is an out-of-limit, terminal comma(death of brain(comma of IV)).

Classification of disorders of consciousness

Clear consciousness – Complete maintenance of consciousness, adequate perception itself and environment.

Stunning is Partial oppression of consciousness, as a result mionectic capacity for active attention, language contact stored, but answers are slow, monosyllabic. Hearing a language, opens eyes, executes commands correctly, but something is slow. Increase fatigueability, languor, some impoverishment of mimicry, sleepiness. Control after the functions of pelvic organs is stored. Oriented incomplete in time and space.

Sopor. A patient is indifferent, eyes closed, language contact impossible, a command does not execute. Immobile or executes the automated allokinesiss. At causing of pain irritations the irritations directed to the hearth appear protective motions by a hand. Pupillary, corneal, tendon and periosteal reflexes as a rule are stored. Oculocefalic reflex is negative. Control after the functions of pelvic organs is broken. Congratulatory functions are stored.

Easy comma. Consciousness and wilful motions are not, patients do not answer a question, protective reactions adequate, corneal and tendinous reflexes and reaction of pupils on light are stored, but can be mionectic, breathing and circulation of blood of brain is not broken.

Moderate comma. Absent reactions are on any external irritants. Unbendy or bending motions of extremities appear in reply to very strong pain irritations, tonic cramps with a tendency to generalization or gormetomia. Protective motive reactions uncoordinated, psychomotor excitation, automated gesticulations, is possible. One-sided violation of myotonus and reflexes is often determined in the paralysed extremities. Abdominal reflexes are low-spirited. Tendon reflexes increase more often. The symptoms of secondary barrel syndrome appear. Iris contraction reflexes can be stored, swallowing is sharply laboured, there are positive reflexes of oral automatism, bilateral unbend pyramid reflexes. Control after the functions of pelvic organs is broken. Violation of visceral functions(increase of arteriotony, tachycardia, violation of breathing, fervescence) is marked.

Deep comma. Any reactions are absent on any irritants.Complete absence of spontaneous motions, various changes of myotonus as gormetomia, muscular dystonia, diffuse decline of myotonus and reflexes. There is a presence of bilateral pathological reflexes, protective reflexes, fall of corneal reflexes, narrowing of pupils, absence of their photoharmose. Deep disorder of vegetative reactions, violation of breathing, decline of arteriotony, violation of rhythm of cardiac activity is marked.

Out-of-limit comma. Bilateral midriasis develops, eyeballs immobile. Observed total unreflexia, diffuse muscular atony, rough disorders of functions vitally important organs(disorder of rhythm and frequency of breathing or apnea, sharp tachycardia).

After the estimation of the state of consciousness it follows to define frequency of breathing and pulse, preliminary providing communicating of standard(principle of АВС). Providing of communicating of standard(air vay open) comes true by means of triple reception of P.Saphara, namely: to pelt chairmen(reception № 1), pulling out of lower jaw down and forward(reception № 2), opening of oral cavity with her further revision(reception № 3).

Implementation of reception of Saphara

At the same time, it follows памятати about the category of trauma there is large probability of receipt of CCT in that, that is why to them, as a rule, position №1(pelting of chairman) not executed. Will consider a priori, that a craniocerebral trauma arises up at transport accidents, sporting traumas, falling from a height, traumas on water, and also at traumas for children. An exception is made by victims, that are in the state of clinical death that induces to immediate realization of pneumocardial reanimation . Providing of communicating of standard with the previous rejection of chairman for implementation of AVL is priority before a credible additional damage at the trauma neck department of backbone

The further actions of brigade must be clearly delimited on her participants.

Fixing the neck department of backbone in position, in that found a victim (medical assistant 1), hands.

If position does not assist providing of breathing, neatly return a victim on a back, or in position that approaches stable (on a side) (a medical assistant is a 1 medical assistant 2).

Begin a primary review on methodology And, In, С(optimal term of implementation – 10 sec) (doctor).

STEP A

Provide communicating of standard (medical assistant 1):

Estimate, or it is needed to audit oral cavity. At present excretions (blood, the vomitive masses, extraneous objects ( depending on the mechanism of defeat), it follows to expose an oral cavity (between cheek-teeth it costs to put crack for warning of casual clench of fingers), to take out extraneous bodies a clamp with a tampon or відсмоктувачем to provide the rest room of oral cavity and pharynx, release them from excretions(if there are a few staggered, then priority is a location of them after a hypsography by a chairman downward); bespatter a chairman and heave up a chin; at suspicion on a craniocerebral trauma, pelting a chairman is forbidden, it follows to heave up a chin.

Provide communicating of standard!

Find out vital sparks.

To confirm, or deny the stop of circulation

of blood – Reaction of patient

is Providing of communicating of standard

– Estimation of breathing and pulse(not more than 10 seconds)

Backer-ups of communicating of standard

Nasal and oral air-channels

are Backer-ups of artificial ventilation of lungs

Artificial ventilation of lungs is by means of sack of Аmbou

Laryngeal mask and laryngeal tube

Primary inspection

STEP of В.

Estimation of breathing suffering. A count of breathing frequency is for 10 p.s

Shows to realization of intubation of trachea:

· it is apnea;

· it is a risk of aspiration;

· it is a threat or presence of violation of breathing(damage of standard, jaw is a facial trauma);

· a craniocerebral trauma is closed;

· it is hypoxemia, in spite of realization of oxygen therapy;

· it is breathing frequency less than 10, or more than 30 for 1 minute(for adults);

· it is a threat of stop of breathing and cardiac activity(sepsis, heavy burns).

If breathing is pathological, but not agonical(deep and noisy), and also superficial – oxygen therapy(10-15 л/of хв) is shown a victim.

By an objective test given пульсоксиметрії: satiation < 92 shows are to the oxygen therapy; satiation <90 shows are to the intubation.

Implementation of intubation of trachea by doctor UM

Simultaneously with the decision of question about the necessity of artificial ventilation of lungs and serve of oxygen lay on a neck collar(A doctor and medical assistant lay on 2 or driver) and continue a primary review.

STEP of С.

In parallel find out the presence of pulse on a carotid(during 10 seс), if a patient is without consciousness(doctor).

At absent of pulsation – proceed to the compression of thorax(doctor, while medical assistant 2 prepares cardioscreen and defibrillator) with frequency not less than 100 times after 1 min are 30 pressures on a thorax and 2 insufflations of air(medical assistant 1).

СLМR by two rescuers

At the same time connect the electrodes of cardioscreen, to known type of stop of circulation(medical assistant 2) of blood.

An ambulance of ECG is diagnostics

Cardioscreen (ECG with defibrillator)

By means of electrodes of defibrillator

By means of autoglue electrodes

Examine, or there is not the external bleeding (doctor). At her presence stop bleeding by push inn of wound the hand through a sterile napkin. If bleeding ceases – lay on a clamp, pressing bandage or provide pressure on a vessel in the distance.

If a brigade educed a patient with the traumatically amputated extremity – in parallel with the estimation of the state of breathing and pulse lay on an arterial plait, clearly adhering to the technical and sentinel requirements.

Pay attention to temperature of skin(by the rear of brush), color of skin, time of return of color after pressure on a nail bed, humidity of skin (doctor). These data will specify on development of shock. Pallor, humidity of skin, her drop in temperature by touch, and also the increases of time of proceeding in the color of nail bed after the clench of over 2 с specify on shock of heavy degree. At the signs of development of shock, external bleeding, on the internal bleeding transfusion of blood substitutes is put right suspicion through a catheter in a peripheral vein (medical assistant 2).

Set a presence on the body of patient of bangles, counters on chainlets are medical markers, that can inform of the state a patient, allergy, requirement in concrete medications,(for example, at diabetes, epilepsies and others like that) especially, when a patient is without consciousness (medical assistant 2).

At a review give priority:

– to the dangerous mechanism of the impression;

– to the decline of level of consciousness;

– to respiratory insufficiency;

– by violation at a primary review;

– by a considerable rejection at a general review(at once it is possible to draw conclusion about weight of patient, his viability, tactics of inspection and treatment);

PROTOCOL № 1

ORDER OF GRANT OF MEDICARE

Such measures must be done every patient and such information is collected:

А. to Make sure out of harm’s way for you and Your patient.

B. the Primary review.

Communicating of standard with immobilization of neck department of backbone(after shows), breathing, circulation of blood, control of the profuse bleeding, inhalation of oxygen.

C. the Secondary review.

1. Vital signs, review of patient “from top to toe”.

2. Anamnesis:

а) sex, age, approximate weight;

б) complaints, including time of disease or accident;

в) damage factors;

г) important information from anamnesis of illness;

д) allergy;

е) medications, that accepted a patient;

ж) last name of domestic doctor;

з) last name, name, patronymic patient.

D. Put right connection with a base, to report about a clinical situation.

E. to Provide in/access with introduction of isotonic solution of NaCI, it is possible to do not more than two attempts of venepuncture, except the situation of storage of life suffering. Adjusting in/at access it must not detain transporting.

A contact with a duty doctor must be carried out as quick as possible.

F. to Add a electrocardiography-screen, define a cardiac rhythm and at presence of arrhythmia to conduct treatment of her, in accordance with protocol.

G. of Statute injured must be a comfort, a situation allows as far as.

H. to Quiet a victim. To release from a clothing that mixes.

I. to Transport a victim as quick as possible in the nearest hospital.

PROTOCOL

An algorithm of grant of help and elements of local primary inspection of patient

are PRIMARY REVIEW INJURED(ABC)

not yes

Diagnostics of frequency, character of breathing and circulation of blood is conducted during 8-10 seconds(such short space is especially actual for victims that are in a deep lump or terminal state) and can come true on a background the visual impression from the general of victim as element of primary inspection : to the presence of concomitant damages, change of colouring of skin canopies temperature, humidity, credible lag of part of thorax in the act of breathing, pneumoderma, open penetrating wounds, and others like that. By the elements of primary local inspection, say, for victims with suspicion on a tense pneumo-(hemo) thorax it follows to count the estimation of neck veins(fall down or swelling), position of trachea(displacement is in a healthy side). It an inspection, as a rule, is preceded to imposition of neck collar, after the exception of objective tests what will require realization of intubation of trachea, when a collar is laid on after implementation of this manipulation. At the same time, in a number of cases an early intubation is not priority, taking into account the state of victim : presence of mechanical damages of overhead standard, estimation of degree of respiratory insufficiency, indexes of hemodynamics, in particular shock index of Aldhover, oxigenating of blood, capnograpy. In such cases it is possible to conduct inhalation of 100% oxygen to insetting of patient on a shield. Correct transporting and insetting suffering on a shield – also one of important elements of command work of brigade, first of all with the aim of protection from the additional injuring of victim.

Category of “Load of and of Go”(“load and drive””) after a primary review:

To her take patients in that:

– it is a too serious mechanism of defeat(falling from a height, heavy sporting trauma, motor-car trauma et cetera) or negative impression about a patient at a primary general review(amputation of part of body, heavy defects and others like that).

– at a primary review the decline of level of consciousness is educed.

– it is violation of communicating of standard or respiratory insufficiency.

– it is violation of cardiovascular activity(shock or out-of-control bleeding).

– are children and expectant mothers that were exposed to the striking factor.

A secondary inspection to such victims is conducted during motion in the salon of car. It is executed on principle “rapid inspection of “from head till hills”, where, in particular, on the basis of review, palpation, percusion, the auscultations of corresponding areas of body appear the additional littlevisible, hidden damages, other pathological changes of organs and systems of victim. As soon as their treatment and correction are maybe conducted.

The brigade of UM prepares a trauma victim to transporting in a coach

Also the elements of secondary inspection in the chart of ABCDE for this category of patients are an estimation of violation of consciousness(Disability) and display of patient(Exposure)

D is violation of the state of consciousness (Disability)

A heavy hypoxia, hypercapnia, ischemia of brain or application of sedative medications or analgetics, belong to frequent reasons of violations of the state of consciousness.

It costs to conduct an estimation and treatment of these rejections on the chart of АВС, here it follows to eliminate(to correct) the hypoxia’s state and credible hypotension. At possibility the map of medications of patient is checked up, with the aim of exception of the curable reasons, caused by medications that depressed influence on activity of CNS. If there are shows, then it follows to apply antidotes preparations(for example Naloxonum in case of overdose of opioids).

The estimation of pupils(diameter, symmetry and photoharmose), quackly determination of the state of alive of patient is conducted in the scale of AVPU.

The level of глікемії is determined by means of glucometr; if he below 3 mmol/l. it is needed in/introduction 50-60 mls. solution glucose.

Patient that is in the comatose state with violation of breathing(fill in tongue) translated in stable position.

E is a display of patient (Exposure)

For the all-round inspection of patient necessary review of all parts of his body. It follows with kind regards to behave here to his rights and detail, here trying minimize defervescence.

Additional information

1. it is necessary to take the detailed history from a patient, in case of the comatose state – in his native, friends or surrounding.

2. at possibility to become familiar with documentation of patient, namely: what medications were prescribed to the patient, when and as well as how many he accepted them.

3. verification of values of vital parameters of patient, and also their time-histories, is conducted.

4. the results of laboratory and other inspections are estimated

5. a question decides about the place of stay of patient in a stationary separation(common separation, intensive therapy and others like that).

6. in current documentation(to the map of departure) the doctor of brigade must clearly specify the results of own inspection and treatment is applied here with the obligatory mark of reaction of patient with his realization.

Modern going near introduction of medications by the brigade of UM.

It is known that in most cases at an exposure the brigade of UM of patient, too that is in a grave condition, timely and skilled medicamental support can play a dominant role at next improvement him general, and quite often, has a determining value. During many years and until now by the most widespread way of receipt of medications intravenous. Ability of medical assistant, especially in extreme terms, to conduct the cannulation of peripheral vein is one of decorations of set of him technical skills. Certainly, by such lines a doctor must be allotted, including by theoretical preparation and practical experience of realization of cannulation of central veins : subclavicular, jugular, femoral.

At the same time, for today there are a few alternative methods of introduction of medications to the patients(to the victims), that especially topically during implementation of СLМR.

1. Insidebones introduction purchased wide uset at the beginning XXI of century. More often used in pediatric practice, especially for new-born children and children of infancy, and also in default of the expressed peripheral venous net.Technically simple and high-efficiency means delivery of medications to the organism of patient comes true by means of ” bone injector”. The medications entered in a bone-cerebral channel arrive at a necessary concentration in plasma, that and at their inside viens injections. The lack of this methodology is insufficient in is of necessary influsion therapy. Except that, this methodology allows aspirate bones brain for research of gasometry of venous blood, determination of level of glucose, electrolytes and concentration of haemoglobin. For adults optimal localization is for access to the bone-cerebral channel is a proximal end of big ankle bone(2sm below from grassers on a front-middle surface) and distal end of perone(2sm higher from an internal stone). Unfortunately, on Ukraine this method is used rarely, as ” bone injector” is non-permanent and consequently something by value means.

” bone injector” (blue colouring – adult

red colouring – child)

2. A Intratrachealis method is divided into two methods. The first is accessible enough and comes true on methodology of conicopunction. Second – technically more difficult, as arrived at by the receipt of medications through a intubation tube. A Intratrachealis way has his row of features and warning. The therapeutic dose of preparation(for an example, solution of adrenalin) must be megascopic in 5-7 times. These medications are entered on the distilled water(or to water for injection), taking into account higher from him osmolarity plasma, this solution is quicker sucked in through teethridges, getting to the coronal vessels, creating here a concentration in blood identical, that and at intravenous introduction(in 30-40 seconds.). The lacks of this methodology is a presence in standard of liquid as an irritant also according to the row of researches here is destruction of sulfaktant.

Intratrachealis introduction of medications is on methodology of conicotomy

3. Endarterial method. Also is effective enough methodology, especially on the stage of realization of SLR, however requires clear knowledge of topographical anatomy.

For today methodology of insideheart introduction of medications in force of frequent technical faults during her implementation and presence of the above-mentioned alternative methods is not almost used.

Sources of information:

1. American Heart Association in collaboration with the International Liaison Committee on Resuscitation (ILCOR)/ International Guidelines 2000 for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. A Consensus on Science // Resuscitation. – 2000. – 46. – P. 103 – 252.

2. European Resuscitation Council. Immediate life support. 1- st Edition. Published by European Resuscitation Council Secretariat VZW, 2006.

3. Lattore F., Nolan J., Robertson C. et al. The ALS working group of the European Resuscitation Council. The European Resuscitation Council Guidelines 2000 for Adult Advanced Life Support Resuscitation. 2000. – 48. – P. 211 – 212.

4. Safar P, Bircher NG. Cardiopulmonary and cerebral resuscitation. 3rd ed. London: WB Saunders, 1988.

5. John Campbell. International Trauma Life Support. USA. New Jersey 2008. P. 289.

7. www.erc.edu

8. www.resus.org.uk

9. www.c2005.org

10. www.americanheart.org

11. www.bcs.com

12. www.escardio.org

13. www.ics.ac.uk

14. www.aagbi.org

15. www.bestbets.org

16. www.euroanesthesia.org