Массовое одновременное поступление пострадавших в чрезвычайных ситуациях в лечебные медицинские организации: организационные проблемы и возможные пути их решения

Abstract

Summary. The aim of the study is to identify problems in the organization of medical triage and medical care in trauma centers of different levels at mass simultaneous admission of victims in emergency situations and to determine possible ways to solve them. Study materials and methods. We analyzed the results of treatment of 136 emergency patients in Saratov and Saratov region trauma centers in 2010-2021. All patients were delivered by emergency medical teams (EMTs). Road traffic accidents (RTA) were the most frequent cause (76.0%) of traumatization of the patients, in the remaining cases (24.0%) carbon monoxide poisoning and burns caused by fires were the most common. The mean age of the victims was (39±7) years, of whom 71 (52.2%) were men, and 65 (47.8%) were women. The study was a total retrospective study, using patient medical histories as primary documentation. Patients older than 18 years were included in the study. Victims, who were delivered to trauma centers in addition to ambulance teams, were excluded from the study. Results of the study and their analysis. The results of the study show that of 136 accident victims delivered to trauma centers in Saratov and Saratov region, 76 cases (55.9%) proved to have errors in the organization of medical triage and medical care to the victims. Most of the errors can be conditionally divided into 2 large groups. The first group included 52 observations (38.2%) related to the organization of the admission of injured persons who arrived from the emergency area. The second group included cases of underestimation of the patient’s condition severity, wrong diagnosis, incompletely performed antishock or infusion therapy. The authors designated these errors as therapeutic — they occurred less frequently and were noted only in 9 cases (6.6%) — all these errors were made only in Level III trauma centers. Analysis of the study results showed that the main problem encountered by the management of trauma centers in Saratov region during mass simultaneous admission of victims in emergencies was the incorrect involvement of medical specialists in medical triage, which led to an increase in the timing of its implementation and in the timing of medical care — for example, the involvement of therapeutic specialists in the medical triage of surgical patients. To solve this problem, the authors propose to reverse the involvement of anesthesiology, surgery, and neurology medical specialists in the emergency departments of medical treatment organizations with their subsequent return to their departments as the workload in the emergency departments decreases.