Algorithms for the Provision of Emergency Surgical Care and Improvement of the Organizational and Functional Structure of Sanitary Aviation in the Republic of Sakha (Yakutia)

The dissertation is devoted to the analysis of the activity of sanitary aviation in the Republic of Sakha (Yakutia) and to the development of algorithms for the provision of emergency surgical care under the conditions of a vast territory with low population density, complex climatic and geographic features, and limited transport accessibility. Based on a study of the service's work over the period from 1993 to 2005, the author examines the results of treatment of patients with acute abdominal pathology and victims with abdominal trauma, as well as the role of branches of sanitary aviation, specialized teams and cooperation with the disaster medicine service. The author proposes and introduces into clinical practice algorithms for treatment-and-evacuation measures, standard equipment for teams, and a rational organizational and functional structure of sanitary aviation of the republic. The research results were used in preparing normative acts of the Government of the Republic of Sakha (Yakutia) and in the educational process.

The Republic of Sakha (Yakutia) occupies an area (including the New Siberian and Lyakhovsky Islands) of 3,103.2 thousand square kilometres, which constitutes 18% of the territory of the Russian Federation. More than 40% of the territory of Yakutia lies beyond the Arctic Circle. The distance between north and south is about 2,000 km, and between west and east 2,500 km; within the republic there are three time zones. It consists of 35 administrative-territorial units — districts (raions) or uluses (Fig. 1).

The climatic and geographic features of the territory, the low population density, settlements with a small number of inhabitants and their remoteness from one another, the large number of hunting and fishing grounds and farms, especially in the North, combined with the absence of roads and river transport, create difficult conditions for the provision of emergency medical care (Aleksandrov V.L., 2003). At the same time, in many localities of the Republic of Sakha (Yakutia), the use of sanitary aviation is the only means of providing emergency medical care to patients and victims.

According to the data of Abakumov M.M. and Sulimanov R.A. (2002), despite the development of the basic principles of surgical tactics in abdominal trauma and acute diseases, and the wide range of antibacterial agents, the results of treatment do not always satisfy physicians. In the republic, acute abdominal pathology and abdominal trauma occupy one of the leading places among urgent surgical diseases (Bushkov P.N. et al., 2001; Vinokurov M.M. et al., 2003; Potapov A.F., Ignatiev V.G., 2003).

The special relevance of the research is dictated by the increase in the number of emergencies, the growth of motor vehicle accidents, criminal injuries, the rising requirements for the organization and execution of sanitary tasks, and organizational problems (provision of sanitary transport and aviation fuel, etc.). The demand is growing for the modern equipment of specialized teams and for a unified approach to treatment-and-evacuation measures at the stages of emergency surgical care.

Aim of the Research

The aim of the present work is to seek ways to optimize treatment-and-evacuation measures and to improve the organizational and functional structure of sanitary aviation in the Republic of Sakha (Yakutia) in order to improve the results of treatment of patients with acute abdominal surgical pathology and of victims with abdominal trauma at the stages of medical care.

Research Tasks

1. To study the activity and role of sanitary aviation in the provision of emergency specialized surgical care in the Republic of Sakha (Yakutia) over the period from 1993 to 2005.

2. To analyze the results of treatment of patients with acute abdominal surgical pathology and of victims with abdominal trauma at the stages of emergency medical care.

3. To determine the transport accessibility of therapeutic-and-prophylactic institutions of the republic.

4. To develop and introduce into clinical practice algorithms for treatment-and-evacuation measures in acute surgical pathology and trauma of the abdominal organs.

5. To improve the organizational and functional structure of sanitary aviation of the Republic of Sakha (Yakutia) and to assess its effectiveness in acute surgical diseases and trauma of the abdominal organs.

Scientific Novelty of the Research

The dissertation presents new data on the work of sanitary aviation in the republic. The standard equipment of specialized sanitary aviation teams has been determined and applied in practice. Algorithms for the provision of emergency surgical care to patients and victims at the stages of medical care have been developed and introduced. The most rational organizational and functional structure of sanitary aviation of the Republic of Sakha (Yakutia) has been developed and introduced.

Practical Significance of the Research

The developed algorithms for treatment-and-evacuation measures of sanitary aviation contribute to the improvement of treatment outcomes. The creation of branches of sanitary aviation makes it possible to reduce the time of provision of specialized medical care in road traffic accidents, emergencies and the execution of sanitary calls. The use of the new standard equipment of specialized teams has determined their mobility in providing emergency medical care.

Implementation of Research Results

The obtained research results have been implemented in the daily practice of the Republican Centre for Disaster Medicine of the Ministry of Health of the Republic of Sakha (Yakutia), branches of sanitary aviation, formations of the disaster medicine service of the republic, Republican Hospital No. 1 — the National Centre of Medicine, Republican Hospital No. 2 — the Centre for Emergency Medical Care, and central district hospitals. The main provisions and individual fragments of the dissertation are used in the work of the Ministry of Health of the Republic of Sakha (Yakutia), in the educational process during classes with students at the departments of general, faculty and hospital surgery and at the department of traumatology, orthopaedics and disaster medicine of the Medical Institute of Yakutsk State University, as well as in the work of civil aviation units and the Ministry of the Russian Federation for Civil Defence, Emergencies and Disaster Relief in the Republic of Sakha (Yakutia). The research materials were used in preparing decisions of the collegiums of the Ministry of Health of the Republic of Sakha (Yakutia) on issues of improving the disaster medicine service and sanitary aviation, as well as in compiling methodological recommendations for healthcare institutions. From 2002 to 2005, on the basis of the conducted research, 6 resolutions and orders of the Government of the Republic of Sakha (Yakutia) were prepared and approved, addressing the creation of branches of sanitary aviation with established staffing units, medical-and-sanitary zoning of the territory of the republic, locations of basing and standby duty of civil aviation aircraft, and related matters. The developed algorithms for emergency surgical care are used in the daily practice of rural and urban surgeons.

Approval of the Dissertation

The results of the conducted research and its main provisions were reported and discussed at scientific-practical conferences «Actual Problems of Emergency Medical Care» in December 2000 in the city of Yakutsk; «Actual Issues of Providing Surgical Care to the Rural Population» in March 2003 in the city of Yakutsk; at a scientific-practical conference with international participation in June 2003 in the city of Perm; at an interregional scientific-practical conference «Actual Problems of Emergency Medical Care» in December 2003 in the city of Yakutsk. The dissertation was approved at the joint conference of the surgical departments of the Medical Institute of Yakutsk State University, the staff of the surgical departments of Republican Hospital No. 2 — the Centre for Emergency Medical Care and the Centre for Disaster Medicine on 4 November 2006.

Publications

On the topic of the dissertation, 19 scientific articles have been published, of which 2 are in peer-reviewed journals.

Volume and Structure of the Dissertation: The dissertation is presented on 124 pages of typewritten text and consists of an introduction, 5 chapters, a conclusion, conclusions, practical recommendations and a list of references. The list of references includes 138 domestic and 67 foreign sources. The work is illustrated with 18 tables, 16 figures and 1 questionnaire form.