Medical Emergency Team Research Articles

Features of the Use of Personal Protective Equipment in the Foci of a New Coronavirus Infection

Relevance. In the context of the new SARS-CoV-2 coronavirus pandemic, the range of use of personal protective equipment (hereinafter referred to as PPE) is becoming increasingly broad, from emergency and emergency medical teams that go to patients with suspected COVID-19, to specialized covid hospitals. Aim. Identification of features in the operation of PPE in a strict anti-epidemic regime and development of recommendations on the use of PPE to improve the efficiency of medical professionals. Materials and methods. In the period from April to May 2020 in the field hospital of the Association of Alpine shooters at the exhibition centre, FIERA DI BERGAMO Italian Republic (hereinafter - the hospital), 8 medical and nursing teams, each of them included the doctors-epidemiologist, anesthesiologist-resuscitation, general practitioner, and nurse anesthetist (total number 32 professionals) conducted relevant sanitary-antiepidemic (preventive) and treatment-and-prophylactic interventions among patients with clinical manifestations of COVID-19. Conclusion. As a result of using a whole range of disposable PPE of various modifications, the features and disadvantages of their operation in the field were established. The main recommendations for using PPE when working with patients infected with SARS-CoV-2 are formulated.

Post-crisis debriefing: A tool for improving quality in the medical emergency team system

ObjectivesTo examine clinicians’ perception of quality of technical and non-technical response to emergencies and application of post crisis debriefing. DesignDescriptive, anonymous, self-reporting survey on the needs and perception of a post-crisis debriefing implementation. SettingMulti-specialist medical institute in Italy focused on solid organ transplantation and organ failure support. Main outcomesPerception of application of guidelines and evaluation of debriefing implementation during in-hospital emergencies. ResultsResponse rate to the survey was 25% (148 health care workers). Of all respondents, 86% were employed >10 years, 75% were involved in ≤5 emergencies over the previous year. Resuscitation guidelines were considered fully applied by 55%; 64% of respondents considered the teaching programme as sufficient. Of all participants, 97% were aware of the importance of teamwork dynamics, 79% were aware of the importance of the personal performance, and 52% considered emergencies as valid opportunities for professional growth. Leadership was considered important by 45% of respondents; debriefing implemented by 41%, and considered a potentially useful tool by 85%. ConclusionPost-crisis debriefing is a way to diffuse self-reflective and life-long learning culture; it is perceived as a powerful tool for improving quality of the rapid response system by the vast majority of those surveyed.

ASSESSMENT OF INTERVENTIONS COMPLETED BY THE VOIVODESHIP RESCUE SERVICE IN KATOWICE IN THE SILESIAN VOIVODESHIP IN 2018 DUE TO INJURIES

Aim: To assess the trips made by Emergency Medical Teams due to injuries (ICD-10 code: S) completed by Voivodeship Medical Rescue Teams in Katowice in 2018. Material and methods: Analysis of the characteristics of the trips was done based on information contained on “Emergency ambulance travel cards”. Statistical analysis was carried out using the t-Student, ANOVA variance as well as the Tukey post-hoc tests (p<0.05). Results: The whole number of trips made by the Emergency Medical Teams in the Silesian Voivodeship totalled 211,896, of which due to the reported injury, the total number of trips was 202,946 cases (183,827 calls were in town – 91%; 19,119 calls were out of town – 9%; p<0.05). The most common cause for calls were due to head injuries (S03 – dislocation, sprain and strain of joints and ligaments of the head as well as S04 – cranial nerve injuries). Statistically significant differences in the number of trips depending on cause identification (p<0.05) were determined, as well as in comparison to the number of cases identified as S03 and S04 between the in town and out of town territory (p<0.05). The median arrival time to an in town site was 7 minutes and 42 second, whereas in out of town sites it was 13 minutes and 19 seconds. Conclusion: The characteristics of the trips made by Emergency Medical Teams depends on the time, and what is affected by organizational changes in the emergency medical system.

Advanced do-not-attempt-resuscitation directives and emergency medical services for out-of-hospital cardiopulmonary arrest patients in Japan: a pilot study.

AimsWe investigated how do‐not‐attempt‐resuscitation (DNAR) orders are currently used, and we examined the emergency medical team responses for out‐of‐hospital cardiac arrest (OHCA) cases in Japan.MethodsThe sample for this prospective study comprised all OHCA cases attended to by the Sagamihara Municipal Fire Department emergency medical services between May 30, 2019 and February 15, 2020. Data were recorded by the responding emergency medical team.ResultsThere were 396 OHCA cases. The mean age was 75 ± 18 years, and individuals aged 65 years or older accounted for 80.6%. Approximately 70% of the patients had an underlying disease. A DNAR order was available in only 45 (11.4%) of the cases, of which 12 (26.7%) were written, 27 (60%) were verbally confirmed, and six (13.3%) were confirmed in some other way or both. The home physician was present and able to confirm the patient’s death in only one of the DNAR cases. In 43 (95.6%) of the cases, the emergency medical team carried out cardiopulmonary resuscitation despite a DNAR order; of them, a total of 17 (37.8%) patients were transported to a tertiary emergency hospital.ConclusionsOur analyses indicate the under‐utilization of DNAR advance directives and advance care planning (which are important for better end‐of‐life care) in Japan. Currently, an emergency medical team could be required to attempt resuscitation against an individuals’ clear DNAR order. In the future, legal arrangements regarding the handling of DNAR directives on site may be required to respect patients’ wishes.

Sudden cardiac death in excited delirium, and how to prevent it

The purpose of this study was to review data on restraint related deaths in persons in a state of excited delirium (ExDS) and to propose guidelines for treatment. We analysed three unexpected deaths in persons in a state of ExDS shortly after police restraint. Death which occurs during a police intervention, using physical restraints, may be related to placing the individual in a prone position, the use of neck holds, expert grips, and handcuffs or pepper spray. ExDS results in an altered mental state with agitation, aggression, paranoia, and panic attacks, and is a life-threatening condition. Therefore, before police intervention is initiated, a medical emergency team should be present. In patients with ExDS, physical restraints used by the police should be brief, effective, and include rapid tranquilization (sedation) using benzodiazepines, and antipsychotics.

Rapid Response System for In-Hospital Large Vessel Occlusion: A Case-Control Study.

Acute ischemic stroke due to large vessel occlusion (LVO) in hospitalized patients is relatively rare but important condition. However, unlike community-onset cases, there are only few time-saving protocols for in-hospital LVO. This study aimed to evaluate the time-saving effects of rapid response system (RRS) for the management of in-hospital LVO. We retrospectively evaluated consecutive in-hospital LVO patients who underwent mechanical thrombectomy (MT) between April 2015 and January 2020. In November 2017, we added "acute hemiparesis, eye deviation, and convulsive seizures" to the activation criteria for RRS. In this protocol, the patient is immediately transported from the ward to the emergency room (ER) by Medical Emergency Team (MET). The stroke team can then start assessment in the same manner as for community-onset cases. The time metrics between those with and without RRS intervention were compared. The primary outcome was time from detection to the first assessment by stroke team and to initial CT. To investigate the validity of the revised criteria, we also analyzed all RRS-activated cases. In total, 26 patients (RRS group, 11 patients; non-RRS group, 15 patients) were included. The median time from detection to stroke team assessment (10.0 [interquartile range: IQR, 8-15] minutes vs 65.5 [18-89] minutes) and to CT (22.0 [16-31] minutes vs. 46.5 [35-93] minutes) were significantly shorter in the RRS group. RRS was activated in 34 patients (mean, 1.3/month) according to the added criteria, of whom 20 (58.8%) had cerebral infarction and 9 underwent MT. About two-thirds of the other patients developed neurological emergencies (e.g., epileptic seizure, syncope, or hypoglycemia) that required acute care. RRS has the potential to shorten response time efficiently in the management of in-hospital LVO. Prompt transportation of the patient to the ER by MET enables faster intervention by the stroke team.

Sistemi za spašavanje života

The European Resuscitation Council (ERC) has produced these Systems Saving Lives guidelines, which are based on the 2020 International Consensus on Cardiopulmonary Resuscitation Science with Treatment Recommendations. The topics covered include chain of survival, measuring performance of resuscitation, social media and smartphones apps for engaging community, European Restart a Heart Day, World Restart a Heart, KIDS SAVE LIVES campaign, early warning scores, rapid response systems, and medical emergency team, cardiac arrest centres and role of dispatcher. The Systems Saving Lives chapter describes numerous and important factors that can globally improve the management of cardiac arrest patients not as a single intervention but as a system-level approach. The aim of this paper is to provide evidence-informed best practice guidance, about interventions which can be implemented by healthcare systems to improve outcomes of out-of-hospital and/or in-hospital cardiac arrest (OHCA and IHCA). The intended audience of the paper are governments, managers of health and education systems, healthcare professionals, teachers, students and laypeople.

Anesthetics management strategy for endovascular treatment of acute ischemic stroke. A proposal for anesthetic approach

GEAcute ischemic stroke is one of the leading causes of death and long-term disability for adults. Endovascular therapy is the standard of care for severe acute ischemic stroke, caused by large-vessel occlusion in the anterior circulation; however, the optimal anaesthetic management during the procedure is still a matter of debate. The best anesthetic treatment should mainly be related to patients’ clinical conditions and the site of arterial occlusion. With this article, we share our experience based on the use of ketamine as the choosen hypnotic drug for general anesthesia, in order to avoid a sudden drop in blood pressure. The core of our proposal approach is the general anesthesia management by the medical emergency team with skills on both time-dependent diseases and neurocritical care.

Brugada sindrom detektovan na prehospitalnom nivou

Introduction/Objective Brugada syndrome (BS) is becoming less of a mystery and more of a challenge for early recognition and treatment. We are presenting the case of a patient with Brugada syndrome recognized at the prehospital level. Case report The Emergency Medical Team (EMT) treated a 23-year-old Syrian native, who had fallen ill in a public place. He declared that he had experienced chest pain, 7/10 in strength, and weakness on the left side of his body followed by a short-term collapse some 20 minutes earlier. After that, he felt weak, languid, very tired and had neck pain. As declared by witnesses, he did not lose consciousness, but was confused, pale, covered with sweat and was breathing rapidly. All this happened after a prolonged quick-paced walk in high air humidity conditions. He declared that he hadn't had similar episodes before, nor had he had significant injuries, allergies or chronic diseases. There was no sudden cardiac death history in his family. Upon examination, he was conscious, afebrile, eupnoeic (18 breaths per minute) with normal heart frequency (70 per minute), blood pressure of 120/90 mmHg and blood oxygen saturation level of 100%. His heart and breath sounds were normal. All other physical examination findings were normal as well. ECG: sinus rhythm, 70 beats per minute, saddleback ST-segment elevation > 1mm in V2. An IV line was inserted and an ECG monitor placed. He was transported to the hospital with the diagnosis of having collapsed and a suspected Brugada syndrome. After short observation and a repeated ECG recording, the Brugada syndrome type II diagnosis was confirmed. Conclusion The Emergency Medical Team doctor must recognize the ECG pattern of this disease, apply necessary CPR measures including early defibrillation if needed, and closely monitor the ECG and vital signs of the patient during transport.

Epidemiology of spontaneous nasal, ear and throat bleedings

The purpose of this study was to evaluate spontaneous bleeding epidemiological profile of Moscow city emergency service. Study included statistical reports of Moscow city emergency services medical teams (EMT) were servicing adults. We analyzed total number of calls and number of EMT calls to pa-tients with SB during the period between 2015 and 2019. The excluding criteria was EMT re-calls to patents with SB. In a study, it was found that over five-year period of observation, EMT made 15 709 862 calls, included 215 840 calls (1.37%) to patients with SB. It was found that the most frequency sources of SB were: the gastrointestinal tract (33.18%), the nasal cavity (28.14%) and the vagina with the uterus (23.91%). There is the proportion of patients suffering of SB from ENT organs is 28.52% in structure of Moscow city Emergency Medical Service. There are the proportion of epistaxis 98.65%, ear bleeding - 0.89%, throat bleeding - 0.46% in structure of SB from ENT organs. We analyzed, that spontaneous epistaxis most frequent between October and April. This period characterized with 70.6% EMT calls from the total EMT calls to patients with SE.

Road Accidents Involving Motorcyclists in the Practice of Emergency Medical Teams – Statistical Analysis of the Effects of Motorcycle Accidents on Polish Roads in 2019

Purpose: The aim of the article was to analyze motorcycle accidents in Poland on the basis of statistical data from the Polish Police Headquarters from 2019. The author presents the collected data in the form of charts, broken down by causes, the number of events in individual months, and the age of the perpetrators, injured and victims. The work also deals with the issue of dealing with victims of motorcycle accidents as part of first aid and rescue. Introduction: Every year, the number of casualties on Polish roads is increasing. Accidents affect all forms of transport and communication. Modern technologies used in the production of motor vehicles, a number of forms of improving their skills available to drivers offered by training entities and the improving infrastructure of roads in the country predispose to increased traffic on Polish roads. Drivers often lose control of their vehicles, forgetting about the potential dangers of recklessness and irresponsibility. Various types of traffic incidents involving these vehicles then take place. The chances of motorcyclists during traffic accidents, despite the security measures used in helmets and protective clothing, are small. Methodology: The main research tool used during the work on the article was the analysis of data contained in the documentation. The data presented in this study constitute the material entitled Road accidents in Poland in 2019 provided by the General Police Headquarters (KGP) Road Traffic Office. The author has made a statistical analysis of the above-mentioned data to visualize road accidents involving motorcyclists and their consequences. The events in which a motorcyclist was injured and the most common causes of accidents caused by motorcyclists, the age of the perpetrators of accidents – motorcyclists, as well as fatalities and injuries in these road accidents are presented. Conclusions: In 2019, motorcyclists made up a large group of people who died or were seriously injured in road accidents. The number of traffic accidents and the number of killed motorcyclists is greater than 2018. Data analysis allowed to define the most common causes of accidents involving motorcyclists caused by drivers of other vehicles. These include: failure to give right-of-way and incorrect behavior on the road while driving, such as turning, changing lanes or overtaking. On the other hand, the most common causes of accidents caused by motorcyclists are: excessive speed, incorrect overtaking, no safe distance from other vehicles, failure to give right-of-way. Keywords: motorcycle accidents, emergency medical team, multi-organ trauma Type of article: review article

Implementing the Sphere Project's standards for patient's healthcare rights in the disaster zone: The experience of the Israeli field hospital in post-quake Nepal.

Emergency medical teams (EMTs) encounter chaos upon arriving at the scene of a disaster. Rescue efforts are utilitarian and focus on providing the technical aspects of medical care in order to save the most lives at the expense of the individual. This often neglects the basic healthcare rights of the patient. The Sphere Project was initiated to develop universal humanitarian standards for disaster response. The increase in the number of EMTs led the World Health Organization (WHO) to organize standards for disaster response. In 2016, the WHO certified the Israel Defense Forces Field Hospital (IDF-FH) as the first to be awarded the highest level of accreditation (EMT-3). This paper presents the IDF-FH's efforts to protect the patient's healthcare rights in a disaster zone based on the Sphere Principles. These core Sphere Principles include the right to professional medical treatment; the right to dignity, privacy, and confidentiality; the right for information in an understandable language; the right to informed consent; the obligation to maintain private medical records; the obligation to adhere to universal ethical standards, to respect culture and custom and to care for vulnerable populations; the right to protection from sexual exploitation and violence; and the right to continued treatment.

Pilot Project of Special Emergency Medical Service Team for Anaphylaxis in Gangwon-do, Korea: Results from an Online Questionnaire Survey.

BackgroundEarly recognition and prompt intramuscular epinephrine administration are critical for the treatment of anaphylaxis. The special emergency medical service team (SEMST) is a reorganization plan that incorporates first-level emergency medical technicians (EMTs) and nurses from Korea to give the authority to administer epinephrine. This study evaluates the experience of SEMST and aims to investigate further needs in the pre-hospital management of anaphylaxis.MethodsAn online survey of 29 questions on the Gangwon-do 119 EMST was conducted. IBM SPSS Statistics ver. 20.0 (IBM Co., Armonk, NY, USA) and R ver.4.0.3. were used for statistical analysis.ResultsA total of 428 (44.6%) participants responded to the questionnaire, and 55.6% (238/428) experienced anaphylaxis. The common presumed cause was insect sting/animal bites at 84.5% (201/238), followed by food (7.6%, 18/238), and drugs (6.3%, 15/238). The frequency of occurrence was highest for tourist attractions (58.6%, 167/285), followed by homes (31.9%, 91/285) and workplace (3.5%, 10/285). Among 136 medical personnel (31.8%) who were currently active or had been active as the SEMST, 95 (70.0%) experienced anaphylaxis, and 58 (61.1%) used epinephrine, which was significantly lower in the non-SEMST group (n = 36, 25.2%). The biggest difficulty in pre-hospital treatment was the limitation of drug administration authority (23.4%, 22/95). The lack of experience and tricky treatment are the chief difficulties in pediatric anaphylaxis. The percentage of correct answers regarding anaphylaxis awareness was significantly higher in the educated (n = 374) than in the non-educated group (n = 54), both for diagnosis (24.9% vs. 11.1%) and treatment (73.5% vs. 37.0%).ConclusionProper administration of epinephrine is particularly important for pre-hospital anaphylaxis management in rural areas. Expanding SEMST and conducting periodic education using virtual experiences is necessary.

ANALYSIS OF ORGANIZATIONAL COMPONENTS OF EMERGENCY MEDICAL CARE FOR PATIENTS WITH ACUTE CORONARY SYNDROME IN POLTAVA REGION OF UKRAINE

The aim of our research was to study the structure of patients with acute coronary syndrome and determine the organizational components of medical care for patients with suspected acute coronary syndrome in Poltava region. Material and methods: For our study was on the one hand statistical reports of health care institutions for 2016-2018, and on the other – a survey of doctors and paramedics of emergency medical care teams on tactics management of patients with AMI. The methodological apparatus used to achieve the set goals was based on the determination of relative values and analysis of time series. Results: The number of patients hospitalized with acute coronary syndrome is growing every year: from 82 people in 2012 to 489 in 2018. According to the monitoring conducted in Poltava region, emergency medical care for patients with acute coronary syndrome with ST segment elevation in 2018 in the cities was provided in the amount of 717, while in rural areas – 288. Conclusions: Data from the analysis of emergency medical care for patients with acute coronary syndrome showed that among patients with ST-segment elevation, urban residents predominate; in 90.6% of cases, the time to the patient’s hospitalization was less than 120 minutes.

Severe Tachycardia Associated With Psychotropic Medications in Psychiatric Inpatients: A Study of Hospital Medical Emergency Team Activation

The use of antipsychotic medications is associated with side effects, but the occurrence of severe tachycardia (heart rate ≥130/min) is not well described. The aim of this study was to determine the frequency and strength of the association between antipsychotic use and severe tachycardia in an inpatient population of patients with mental illness, while considering factors which may contribute to tachycardia.

Emergency department care-related causal factors of in-patient deterioration.

Objective The aim of this study was to determine factors related to emergency department (ED) care causing in-patient deterioration. Methods This retrospective cohort study examined in-patient records using the human factors classification framework for patient safety in a regional health service in New South Wales, Australia, between March 2016 and February 2017. Deterioration was defined as either the initiation of a medical emergency team call, cardiac arrest or unplanned admission to the intensive care unit. Results Of the 1074 patients who deteriorated within 72 hours of admission via the ED, the care received in the ED was a contributing factor for 101 patients (9%). The most common human causal factors were poor communication between staff, medical management errors, delayed treatment, medical documentation errors, nursing management errors and unclear policies or guidelines. Communication issues occurred the most when patients had more comorbidities (P = 0.039) and were more likely to occur in the presence of a medical documentation error (odds ratio 4.4; 95% confidence interval 1.7-11.3). Unclear policies or guidelines as a factor was most frequent with a surgical diagnosis (34.5% vs 15.7% for surgical vs medical, respectively; P = 0.038) and in patients ≥80 years of age (30.0% vs 21.8% for age ≥80 vs <80 years, respectively; P = 0.027). Conclusion Quality monitoring and interventions that consider human factors are required to address preventable in-patient deterioration. What is known about the topic? The ED represents the hospital's point of contact for potentially life-threatening conditions. Adverse event rates for emergency admissions are more than double those of non-emergency admissions. Patients are at particular risk of deterioration on discharge from the ED to the ward in the first 72 hours. Predicting which patients will deteriorate following transfer to the ward remains challenging, with care in the ED hypothesised to play a role. What does this paper add? This paper reveals that in-patient deterioration relating to ED care could be reduced through the routine identification of causal factors within a human factors framework in any patient deterioration event and subsequent evidence-informed interventions to address these factors. It is also extrapolated that the implementation of any intervention should be informed by behaviour-change principles. What are the implications for practitioners? It is implied that there is a need for the clarification and revision of policies and guidelines pertaining to the management of elderly patients, education regarding the critical importance of the often clinically masked vital sign deviations in younger patients and improved communication between staff, especially regarding patients with more comorbidities. Reviews of adverse events, such as patient deterioration, should incorporate a human factors analysis. Regular collation of data following adverse events should occur, with interventions considering all aspects of the factors that led to the event.

EMOTIONAL PROBLEMS AND SLEEP DISTURBANCES IN PARAMEDICS IN THE ERA OF THE COVID-19 PANDEMIC

Infectious diseases have accompanied mankind for centuries, and the effects of their dramatic course are felt on many levels of everyday life. The COVID-19 pandemic caused by SARS-CoV-2 virus infection carries a tremendous psychological burden for both those infected and health care workers. Particularly vulnerable to psychological strain are paramedics who have direct contact with and caring for patients infected with coronavirus. From a review of the literature, it is known that Emergency Medical Team members, as a result of the stress experienced during a pandemic, manifest symptoms such as depression, anxiety, and sleep disturbances. In order to limit the adverse impact of the pandemic on the mental condition of this professional group, it is necessary to create appropriate conditions for solitary rest, relaxation and satisfaction of basic needs such as: food, sleep and protective clothing. An important role is also played by unrestricted access to psychological support in the broad sense of the word and often also to psychiatric care.

The Development of WHO Guidelines for Burns Care in Mass Casualty Incidents: WHO Emergency Medical Teams Technical Working Group on Burns

The Development of WHO Guidelines for Burns Care in Mass Casualty Incidents: WHO Emergency Medical Teams Technical Working Group on Burns

Ocena umiejętności praktycznych w zakresie resuscytacji wśród studentów ostatniego roku kierunku lekarskiego Warszawskiego Uniwersytetu Medycznego

Introduction. One of the basic skills acquired during medical studies is the ability to lead and participate in cardiopulmonary resuscitation. Education of sudden states diagnosis and technical activities during resuscitation is based on the Advanced Life Support (ALS) protocol in accordance with the Guidelines of the European Resuscitation Council. The last-year students of medical faculties took part in simulated Medical Emergency Teams (METs) scenario of cardiac arrest. Analysis of audiovisual recordings of activities undertaken during resuscitation was performed to evaluate the practical skills required for resuscitation. Material and methods. The studied group of students took part in a simulated emergency scenario during which there was an irreversible cardiac arrest. The instructor assessed selected parameters of the work of 37 METs. Results. The first element of scenario was to treat bradycardia which occurred at the beginning. 17 METs (less than 49%) took any action to treat it, 12 METs (slightly over 32%) administered atropine. The next step was to diagnoses and treat adequately cardiac arrest. 15 of METs (40.5%) reacted within 10 s, 10 METs (67.5%) in 11–20 s, and 9 METs (13.51%) took any activity during 21–40 s. Among the therapeutic measures required by the ALS protocol, at the moment of cardiac arrest 12 METs — just over 32% checked the presence of the breath, the most METs (100%) gave adrenaline, 29 METs (slightly more than 78%) performed airway, 27 METs (less than 73%) called the resuscitation team. Conclusion. The lack of students‘ skills of the proceedings in accordance with the guidelines of the ALS protocol in terms of treatment of bradycardia and during cardiopulmonary resuscitation suggests to put greater emphasis on teaching both basic and advanced life support activities as general medical skills, gradually throughout the undergraduate training during the whole medical education.

Организационные аспекты оптимизации работы службы скорой медицинской помощи г. Сургута

Aim. To analyze the quantitative and qualitative indicators of the ambulance and emergency medical services in Surgut in the conditions of redirecting calls with urgent conditions to the emergency departments of outpatient clinics. Materials and methods. The study was conducted in the period from 2013 to 2018 on the basis of the Surgut city clinical ambulance station in Surgut. In accordance with the set aim of the research was defined these forms of statistical reporting № 40 “Report of the station (Department), hospital of emergency medical care” (app. by order of the Ministry of health and social development of the Russian Federation from December 2, 2009 № 942 “On approval of statistical tools stations (offices), hospital emergency medical service”). Results. The experience of redirecting calls with urgent conditions to emergency departments of outpatient clinics in Surgut, which began at the end of 2012, showed that during the period from 2013 to 2018, with an increase in the number of calls (by 15.9%) to the ambulance service, there was a decrease (by 6.4%) in the daily load on the team from 15.8 visits in 2013 to 14.8 visits in 2018. At the same time, the share of departures of the ambulance with the arrival time to the patient in less than 20 minutes after the call, the total number of calls, with an increase from 63.9% in 2013 to 78.1% in 2018, mortality before the arrival of the ambulance, with a reduction (36.1%) from 302,0%000 in 2013 to 192,8%000 in 2018, successful resuscitation at the exit from height (22.3%) from 8.5%000 in 2013 to 10.4%000 in 2018. Conclusion. Reducing the number of visits of emergency medical service teams for urgent conditions, by redirecting requests from patients with chronic diseases to the emergency departments of medical organizations of outpatient clinics during the operation of these institutions, reduced mortality at the pre-hospital stage of medical care, and increased the efficiency of the ambulance station when providing emergency medical care. Due to the control of the standard time for making emergency calls by the dispatcher service of the ambulance station, cases of unintentional failure to provide medical care are excluded. All cases of return of forwarded calls to the ambulance service are transferred to the ambulance team for execution, followed by an analysis of the reasons for violation of the quality criteria established by the Territorial program of state guarantees of free medical care to the population of the Khanty-Mansiyskiy Autonomous okrug – Yugra.