The relevance of the problem of achieving high-quality hemostasis in patients with spontaneous nosebleeds (NC) in emergency medical care (SMP) is beyond doubt.The purpose of the study. To compare the effectiveness of providing emergency medical care to patients over 18 years of age with anterior NC in the conditions of the NSR using a silicone single-chamber intra-nasal tampon with internal point glues and the classic method of tamponade using gauze turunda.Research objectives. To analyze the prevalence and causes of NC development in the structure of SMP calls in patients over 18 years of age in Moscow; to compare the effectiveness of the developed silicone single-chamber intra-nasal tampon with internal point glues and gauze turunda.Materials and methods. An analysis of the structure of calls to patients with NC and an assessment of the effectiveness of stopping NC using an intra-nasal tampon with internal point glues and a gauze turunda were carried out.Results. In the study groups, NC ranged from 66 % to 68 % in patients with hypertension. It was found that in the first group of observations using a single-chamber intra-nasal tampon with internal point glues, the best characteristics of the effectiveness of stopping NC were revealed: hemostasis was achieved in 94 % of cases, which is 28 % higher than the result of nasal tamponade with gauze turunda (66 % of cases); less time spent on anterior nasal tamponade was 3 times before 1.2 ± 0.3 min. and 3.4 ± 0.4 min. accordingly, the time spent on making a call decreased by 9.4 minutes – from 33.1 ± 1.7 minutes to 23.7 ± 1.2 minutes; pain in patients was less pronounced – 0.31 ± 0.01 and 1.45 ± 0.01 points, respectively; the number of repeated calls with recurrent NC (6 % and 22 % of cases, respectively) and repeated anterior nasal tamponade (2 % and 12 % of cases, respectively).Conclusion. The results are of great scientific and practical importance for SMP specialists and allow us to recommend a promising expansion of the range of medical devices used with an innovative approach to creating high-quality hemostasis in NC at the prehospital stage.

In recent years, the number of diagnosed cases of stroke in children and adolescents has significantly increased. Purpose : to study the prevalence and structure of calls from emergency medical teams (EMS) to children and adolescents with a preliminary diagnosis of stroke, taking into account age, gender and seasonality in Moscow. Objectives : to analyse calls from emergency medical services teams in Moscow to children and adolescents, to study the prevalence of childhood stroke. To establish the structure of childhood strokes and the most common types of stroke. To track the dynamics of average monthly indicators of EMS calls to pediatric patients with a preliminary diagnosis of stroke and to clarify the patterns specific to the prevalence of calls to EMS teams during the year. Materials and methods : there was carried out an analysis of the prevalence and structure of calls from emergency medical teams to patients with a preliminary diagnosis of acute cerebrovascular accident among the child population of Moscow. The distribution of cases of acute cerebrovascular accident was analysed depending on the gender and age of the child, and types of stroke. Results of the study: Age, gender and seasonal characteristics, prevalence and structure of nosological forms and types of stroke were identified. It was found that stroke is more common in children aged 7 to 15 years — 1 453 cases (57%). In 73.5% of cases, the visiting medical staff of the EMS diagnosed a transient ischemic attack, in 19.3% — a stroke not specified as a cerebral hemorrhage or infarction, in 4.4% — a subarachnoid hemorrhage, in 1.7% — a hemorrhagic stroke, and in 1.1% — cerebral infarction. An increase in the number of calls is observed from September to April (77.8% of all calls from emergency medical services teams).

The article is devoted to the activities of Alexander Sergeevich Puchkov as part of the Russian Red Cross Society, which during the First World War was one of the largest public organizations that provided assistance to wounded soldiers and officers in the theater of military operations and in the rear. The Red Cross appointed those responsible for all military sanitary, medical evacuation and organizational measures in this area of military operations: a special officer, a chief officer. The events of the period 1914–1918, which formed the professional qualities of the organizing physician A.S., are described. Puchkova, approaches and principles to providing medical care to the wounded in case of mass injuries and injuries in the performance of official duties of the special representative of the Russian Red Cross Society under the 2nd Army of the Western Front.

The article is devoted to the first documents of the decision of the Board of the medical and sanitary department of the Moscow Council of Workers’ Deputies on the organization of an ambulance station in Moscow. The data of archival materials on the formation of the first team of employees of the Moscow Ambulance Station, the memories of the first doctors about the organization and the first years of the team’s work, the difficulties faced by workers in providing emergency care, household issues are presented. The dynamic growth of the Ambulance Station staff is shown. The peculiarity of the visiting staff’s duties in the first years of work, the role of doctors in providing emergency care, and the formation of the driver’s staff is reflected. Eyewitnesses describe the working atmosphere, discipline, principles and fundamentals in providing emergency medical care to patients and injured, which were formed in the team with the arrival of Alexander Sergeevich Puchkov. The traditions that originated in the early years of the Moscow Ambulance Station are maintained today.

The constant increase in cases of arterial ischemic stroke requires the development of algorithms for the diagnosis and management of stroke patients. Currently, there are no effective methods for diagnosing arterial ischemic stroke (AII) in children at the stage of emergency medical care (SMP). In 2020, the Prehospital Stroke Diagnosis Scale (DDI) was developed, which may be the optimal algorithm for prehospital diagnosis of childhood stroke.The purpose of the study. To determine the optimal algorithm for prehospital diagnosis of arterial ischemic stroke in children. Objectives of the study: To determine the frequency of occurrence of «masks» of stroke and separately migraine in the structure of cases of hospitalization with suspected ONMC. To evaluate cases of hospitalization with confirmed diagnoses of ischemic stroke and migraine on the DDI Scale. To determine the statistical indicators of the effectiveness of the DDI Scale as the optimal algorithm for prehospital diagnosis of stroke in children.Materials and methods. 401 cases of hospitalization of children to the Center via the NSR channel with symptoms of ONMC for the period from June 2023 to June 2024 were analyzed. All patients were evaluated by the staff of the NSR and the doctors of the Center on the DDI scale. Statistical data on the effectiveness of the DDI Scale are determined.The results of the study. «Masks» of stroke in the structure of cases of hospitalization with suspected ONMC are detected in 94.26 %. Migraine is the main «mask» of AII and is detected in 69 % of cases of stroke «masks» and in 65.05 % of cases among all children with suspected ONMC. High indicators of the effectiveness of the DDI Scale in the differential diagnosis of AII and migraine in children have been established: sensitivity 96 % and specificity 95 %.Conclusion. Thus, the DDI scale can be used as an effective algorithm for diagnosing AII in children, used by NSR staff.

The article is devoted to the history of the creation and development of emergency medical care for the population of Moscow. The stages of the activity of the home care centers, the night emergency room at the Ambulance Station and their subsequent organization in the district emergency centers are considered. The main regulatory and legal documentation is indicated, in the development of which the heads of the Station n. a. A. S. Puchkov and A. M. Nechaev took part. The work on the creation of a system of emergency and emergency medical care for adults and children in Moscow, the rules of action of the doctor of the emergency room upon receipt of appeals is shown. The article describes the search for effective ways to solve organizational and material problems in the field of emergency and emergency medical care at different stages of the development of the emergency service. The role of the Moscow Ambulance and Emergency Medical Care Station in the development and implementation of organizational and methodological measures to improve the work of emergency departments in the capital is shown. A description of a major project is given, the purpose of which was the full integration of emergency medical care for adults and children into the structure of the Ambulance and emergency Medical Care Station in Moscow at the present stage, the organization of a Single city dispatch center for emergency and emergency medical care with the formation of a single information space, the previous preparatory work for receiving calls on a single federal number 103 on the base of the Station. During its history, the Moscow emergency medical Service has passed a difficult path. Thanks to the efforts made, the service is now an integral part of the Ambulance n. a. A. S. Puchkov and Emergency Medical Care Station in Moscow.

Objectives . To perform a comparative analysis of symptoms in arterial ischemic stroke (AIS) and stroke-like conditions in children and to develop and analyze the Suspected Stroke Scale in Children for prehospital diagnosis of AIS in children (referred to as the Scale). Materials and methods . Emergency hospitalizations of children at the Stroke Center with suspected cerebrovascular pathology were analyzed. Symptoms detected in patients with suspected AIS were analyzed, referral and final diagnoses were compared, and the main maskers of stroke and their symptomatologies were identified. Data were compared with results obtained at an earlier phase in this research. Results . The study results suggest a predominance of motor and coordination disorders in AIS and cerebral symptoms in stroke-like conditions in children. The most common stroke masker was migraine. The study results led to proposal of the Scale, and preliminary assessment of the effectiveness of the Scale was carried out using examples of confirmed cases of AIS and stroke maskers. Conclusions . Prompt hospitalization of children with AIS can not only reduce mortality, but also allows up-to-date diagnostic and treatment methods to be used to reduce the extent of brain damage and provide the opportunity for complete restoration of motor and cognitive functions. Further analysis of the sensitivity and specificity of the proposed Scale is needed.

Despite the low level of morbidity, the significance of meningococcal infection (MI) persists and is primarily due to the predicted rise in morbidity after a long period of relative well-being (decline), instability of the serogroup landscape, an increase in morbidity caused by previously rare serotypes (meningococcus W), lack of routine vaccination, as well as severe course, the development of formidable complications and high risk of death. The risk of up to 30–60 % disabling complications after generalized forms of meningococcal infection (GFMI), including physical and neuropsychiatric problems, is also important. The reason for the unfavorable prognosis of the disease is the late diagnosis at the pre-hospital stage, hospitalization in non-core hospitals, the severity of the pathological process. With a low incidence, a wide range of antibacterial drugs, the mortality from GFMI is significant, from 6 to 14 %. The main means to significantly reduce the incidence and mortality from GFMI is currently the introduction of mass vaccination of the population against MI.

The article is devoted to the Moscow Ambulance Society, established in 1908 by enthusiastic doctors, mainly surgeons, to provide free medical care to accident victims on the streets, in all public places, factories, railways and others. The article presents the efforts of Moscow doctors in the distant 1907–1917 to create an emergency medical service on a scientific basis, the opening of the station. The basic principles on which emergency medical care should be organized for the population of the city of Moscow and the rationality of the approach in providing assistance are outlined. The approaches and principles developed by the Emergency Medical Care Society in Moscow were not in vain and formed the basic basis of modern emergency medical care.

Nasal bleeding (NB) is a pathological condition that threatens the patient's life. This is a common condition in emergency otorhinolaryngology, occurring in 60% of the population. The simultaneous presence of several diseases in one patient (multimorbidity) becomes crucial to consider in the era of personalized approach in medicine. NB can be addressed not only as an independent condition, but also in combination with concomitant pathology. The study of the NB epidemiology does not lose its relevance, since the revealed patterns allow us to develop measures for effective management of hospitals that provide emergency assistance. Purpose of the study: to establish the long-term epidemiological features of NB in the structure of otorhinolaryngological departments of general hospitals. Material and methods. We studied the annual reports of the heads of ENT departments from 15 hospitals of the Moscow Healthcare Department, which provide assistance to the adult population, for the period from 2003 to 2019 (17 years). We analyzed admissions with NB and their annual dynamics. The following indicators were assessed in the reports: the number of patients treated in the otorhinolaryngology departments; the number of patients treated with a diagnosis of NB; the number of patients with NB who died; ratio and dynamics of these indicators. We performed the cumulative technical analysis of the data obtained with the determination of tendencies from the average values of the indicators, the graphical display of which is the trend line (TL), using Microsoft Office Excel software. The use of TL allowed to predict the future dynamics of the indicators. Each NB-related death was investigated from the deceased patient's brief “information note”. The information on concomitant pathology (clinical diagnosis) in patients who died from NB in a hospital was studied, the multimorbidity index (the number of nosologies in the diagnosis in one patient) and the Charlson comorbidity index were calculated with and without relation to the age of the patients. Results. During the observation period, 563189 patients were treated in the ENT departments of Moscow, 20623 (3.7%) patients were treated with NB. The average length of hospital stay was 1.04 bed-days. The trend values of prevalence and mortality are practically at the same level with the minimum multidirectional linear dynamics – 0.24% and + 0.04%, respectively. We observed an increase in the number of patients treated per year in otorhinolaryngological departments over the past 17 years by 58.5%. The increase in the absolute number of hospitalized patients with NB annually over the same period of time was 51.1%. We have identified 3 periods. From 2003 to 2010, the average growth rate of patients number per year was 3.3% (min 1.3% in 2004 and max 4.5% in 2007). From 2011 to 2015 - 0.5% (min 0.04% – 2013 and max 1.2% – 2011). From 2016 to 2019 - 6.4% (min 2.2% - 2016 and max 11.2% - 2019). The proportion of patients with NB during from the total number of treated patients was practically at the same level during the entire observation period, and on average was 3.7% (min 3.1% in 2016 and max 4% - 2008 and 2012). The mortality rate in the cohort of patients with NB was 0.25% (n = 52, of which 33 were men and 19 were women). The average age of the deceased was 64.7 years. Along with NB and post-hemorrhagic anemia, 17 other diseases / conditions appeared in clinical diagnoses (from 2 to 5 in each patient). The risk of death with NB remained at approximately the same level, with an average annual increase of 0.002% (according to approximation analysis). In patients who died from NB, the multimorbidity coefficient averaged 2.9±0.6 diseases / conditions, the comorbidity index – 5.74±1.12 points on the Charlson scale with considering patients age and 3.27±0.74 points without considering patients age (from 0 to 9 points). Diseases / conditions such as radiation and chemotherapy, pulmonary and cerebral edema, cachexia, coagulopathy, and pulmonary embolism were reported in 40 clinical diagnoses, but were not included in the Charlson score. Conclusion. When studying the prevalence of NB in the structure of ENT hospitals in Moscow, due to a large volume of statistical data, we managed to analyze not only absolute values and relative values, but also to determine trends characteristic of a given epidemiological process, the frequency of deaths, dynamics of death rates and indicators of multi- and comorbidity in this cohort of patients over a 17-year observation period. With the increasing number of patients treated with NB, the mortality rate in hospitals remained stable for 17 years, which is possible due to well-coordinated work and constant improvement of the provision of specialized medical care to these patients. Based on the trend analysis, it is possible to predict a further increase in the absolute number of patients with NB in ENT hospitals in Moscow. The deceased patients with NB belonged to the older age group with severe concomitant pathology and a high level of comorbidity. Perhaps, upon admission to the hospital, patients of the older age group with NB require a more thorough examination. The results of the study are of clinical significance and should be correlated with pathological data and data on the comorbidity of other groups of patients with NB in the future, to assess NB as a risk factor for long-term mortality. Носовое кровотечение (НК) – патологическое состояние, угрожающее жизни больного. НК может рассматриваться не только как самостоятельное заболевание, но и в совокупности с сопутствующей патологией. Изучение эпидемиологии НК не теряет своей актуальности, т.к. выявляемые закономерности позволяет разрабатывать меры эффективного управления стационарами, оказывающими экстренную помощь населению. Цель исследования: установить эпидемиологические особенности НК в структуре оториноларингологических отделений многопрофильных больниц за длительный период времени. Материал и методы. Проведен анализ ежегодных отчетов заведующих ЛОР-отделениями 15 стационаров ДЗМ, оказывающих помощь взрослому населению, за период с 2003 по 2019 г. (17 лет). Были проанализированы госпитализации пациентов с НК и их годовая динамика. По данным отчетов были исследованы следующие показатели: число пациентов, пролеченных в оториноларингологическом отделении; число больных, которые находились на лечении с диагнозом НК; число умерших больных НК; соотношения и динамика указанных показателей. Совокупный технический анализ полученных данных с определением тенденциозных закономерностей средних значений анализируемых показателей, графическим отображением которых является линия тренда (ЛТ), был проведен с помощью программного обеспечения Microsoft Office Excel®. Результаты. За период наблюдения в ЛОР-отделениях г. Москвы были пролечены 563 189 больных, 20 623 (3,7%) пациента находились на лечении с НК. Средняя продолжительность госпитализации составила 1,04 койко-дня. Был отмечен прирост числа пролеченных за год больных в оториноларингологических отделениях за прошедшие 17 лет на 58,5%. Увеличение абсолютного числа ежегодно госпитализируемых пациентов с НК за тот же период времени составило 51,1%. Наряду с НК и постгеморрагической анемией в клинических диагнозах фигурировали еще 17 заболеваний/состояний (от 2 до 5 у каждого пациента). Риск смерти при НК сохранялся приблизительно на одном уровне. У пациентов, погибших от НК, коэффициент полиморбидности составил в среднем 2,9±0,6 заболевания/состояния, индекс коморбидности – 5,74±1,12 баллов по шкале Чарлсон с учетом возраста и 3,27±0,74 балла без учета возраста. Заключение. При изучении распространенности НК в структуре ЛОР-стационаров Москвы, благодаря большому объему статистических данных, удалось провести анализ не только абсолютных значений и относительных величин, но и определить тенденции, характерные для данного эпидемиологического процесса, определить частоту летальных исходов, охарактеризовать ее динамику и установить показатели поли- и коморбидности у данного контингента больных за 17-летний период наблюдения.

The alternative use of local hemostatic agents based on chitosan is the gentlest method of stopping bleeding, with minimal damaging effect on tissues, in comparison with the imposition of a hemostatic tourniquet or a pressure bandage.Goal. To evaluate the effectiveness of temporary stopping of external bleeding with the help of local hemostatic agents based on chitosan in powder and bandage forms and to determine the expediency of their use by visiting ambulance teams.Materials and methods. Specialists of the field teams of Ambulance and Medical Emergency Care Station n. a. A. S. Puchkov (Moscow, Russia) used local hemostatic agents based on chitosan in the form of a powder, a bandage in comparison with traditional hemostatic agents (a hemostatic tourniquet to stop arterial bleeding and a pressure bandage). The criteria for hemostasis were the absence of wetting of the pressure bandage and the absence of the need for a hemostatic tourniquet.Results. 103 patients were included in the main group, and 106 patients with arterial and venous bleeding from wounds of various localization were included in the control group. The age of patients in the compared groups ranged from 18 to 94 years. When using hemostatic powder and bandage, primary hemostasis was achieved in 99 patients in 96.1 % of cases, compared with the control group in 76 patients in 67.9 % of cases.Conclusions. Simplicity and ease of use, the speed of stopping bleeding and achieving results, as well as the absence of the need for special skills among specialists in the use of hemostatic agents, improved the quality of emergency medical care for patients with bleeding and allowed them to be recommended as a dressing for emergency medical care.

Bleeding is a life-threatening condition, requiring an urgent care. The first line of treatment this kind of patients is ambulance doctors (emergency medical team). Spontaneous bleeding (SB), in this case, don't have a traumatic agent (including surgical trauma). STUDY OBJECTIVE The purpose of this study was to evaluate spontaneous bleeding epidemiological profile of Moscow city emergency service. METHODS 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. RESULTS 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.

The effectiveness of the treatment of acute tonsillitis directly depends on the etiological diagnosis and adherence to the principles of rational etiotropic antibiotic therapy. Currently, streptococcal genesis of inflammation is considered as the only indication for the appointment of systemic antibiotic therapy. The article presents the results of clinical and statistical analysis of calls to patients with acute tonsillitis and express diagnostics of streptococcal infection using «Streptatest». For the period from 30.07.2018 until 30.11.2018 Doctors of the emergency department teams for adults and children performed express diagnostics of group A β-hemolytic streptococcus in 252 patients with acute tonsillitis complaining of «sore throat», whose age ranged from 3 to 44 years. This rapid diagnostic system «Streptatest», based on the method of immunochromatographic analysis, made it possible to identify as early as possible in 117 (46.4%) patients β-hemolytic streptococcus group A and promptly prescribe etiotropic antibiotic therapy to them. The second group consisted of 135 (53.6%) patients with a negative result of the «Streptatest» rapid test. In the group with a positive result of the express test, the main part was made up of children of preschool and school age — 92 (78.6%) patients. In 114 (97.5%) patients with diagnosed group A β-hemolytic streptococcus, clinical symptoms according to the McIsaас modified Centor scale were rated from 3 to 5 points. Early etiological verification of acute tonsillitis made it possible to follow the strategy of preventing the sp read of antimicrobial resistance and reducing the resistance of microorganisms to antibacterial drugs.

The article describes statistical data on patients with angioedema (AE) in the structure of ambulance services and four large multidisciplinary hospitals with otorhinolaryngological departments of the city of Moscow for 2017. The ratio of the number of calls to the NSR in Moscow for AE to the total number of calls was analyzed; the ratio of the number of calls to the ambulatory system for AE to the total number of calls to patients with allergic reactions; the ratio of patients with AE among the total number of treated patients in 3 hospitals in Moscow; the ratio of patients with AE of the upper respiratory tract (URT) among the total number of patients with AE; the ratio of patients with AE URT among the total number of patients with ENT pathology. As a result of the study, it was found that the share of AE in the structure of emergency calls of ambulance teams (n=3 070 491) was 0.7% (n=20 040) and 38.4% of the total number of calls for allergic reactions (n=giant urticaria 52 153). Patients with AE make up 0.34% (n=919) of the total number of treated patients in hospitals (n=269 980). The proportion of patients in whom AE was manifested with a lesion of URT among patients with AE is 1 1.5%. The frequency of occurrence of AE URT among patients hospitalized with pathology of ENT organs (n=14 395) is 0.7% (n=106).

Currently, information about the epidemiology, clinical features, prevention and treatment of coronavirus infection affected by SARS-CoV-2 (COVID-19) is constantly updated and updated. The most common clinical manifestations of COVID-19 are fever, symptoms of intoxication, cough, shortness of breath, fatigue, chest congestion, decreased sense of smell and taste, less often — abdominal pain, vomiting, diarrhea, and others. For the current period, there are data from clinical observations describing skin lesions in the new COVID-19 coronavirus infection. One of the first descriptions of skin manifestations in COVID-19 was published by the Italian dermatologist Recalcati S. (2020), who provided data on possible types of skin lesions as a variant of the manifestation of a new COVID-19 coronavirus infection.This paper presents the confirmed cases COVID-19 infection with skin lesions, from the practice of specialists of mobile teams of emergency medical care state budgetary institution «Station of emergency medical care to them. A.S. Puchkov» in Moscow, at survey of the patients at disease onset. In the initial period of the disease, when examining patients, various morphological elements were observed: papulo-vesicular, papulo-squamous, erythematous, urticary, and others, their localization was also different. Whether the described changes on the skin are associated with direct exposure to the pathogen COVID-19 or are a manifestation of secondary pathogenetic factors (infectious-allergic, allergic, toxic, etc.) is not currently known. Further accumulation of clinical observations of skin manifestations in this disease is necessary in order to analyze and evaluate their diagnostic and prognostic value.

OBJECTIVE:The article presents an analysis of pre-hospital diagnosis of stroke in children.MATERIAL AND METHODS:Pediatric Stroke Center of Morozov Children's City Clinical Hospital (Center) for the period from October 2018 to December 2019, 502 cases of hospitalization of children by the First aid Station to the Center with directing diagnoses of ischemic stroke (IS), haemorrhagic stroke (HS), transient ischemic attack (TIA), vertebrobasilar syndrome (VBS) were analysed.RESULTS AND CONCLUSION:TIA was the most prevalent diagnosis made by the First aid station, with the lowest rate of confirmation after further examination in the hospital (7.8%). The higher rates of confirmation were observed for VBS (31.5%), IS (11.2%) and HI (9.1%). The so-called «masks of stroke» were diagnosed in 84.3% cases of hospitalizations that was in line with earlier studies, which reported 50 to 93%. Based on the data on the frequency of symptoms, their combinations and specificity, a screening scale for pre-hospital diagnosis of stroke in children was suggested.