According to the Federal Law of November 21, 2011 No. 323-FZ “On the fundamentals of protecting the health of citizens in the Russian Federation,” medical care is provided by medical organizations.

Methods of providing medical care:

0 diagnostics using anamnestic, organoleptic, express, laboratory and instrumental research methods;

o correction of the body’s condition through surgical, pharmacological, physiotherapeutic and psychotherapeutic methods of influence;

• 0 creating comfortable conditions through immobilization, protection of the skin, wound and burn surfaces, warming or cooling, pain relief;
• 0 medical care (food, toilet, catheterization).

Medical assistance is provided:

• 0 outside a medical organization;
• 0 outpatient - in conditions that do not provide round-the-clock medical supervision and treatment, including at home when a medical professional is called;
• 0 in a day hospital - in conditions that provide for medical observation and treatment during the day, but do not require round-the-clock medical observation and treatment;
• 0 inpatient - in conditions that provide round-the-clock medical supervision and treatment.

Medical care is provided in the following forms:

• 0 emergency - medical care provided for sudden acute diseases, conditions, exacerbation of chronic diseases that pose a threat to the patient’s life;
• 0 emergency - medical care provided for sudden acute diseases, conditions, exacerbation of chronic diseases without obvious signs of a threat to the patient’s life;
• 0 planned - medical care that is provided during preventive measures, for diseases and conditions that are not accompanied by a threat to the patient’s life, that do not require emergency and emergency medical care, and delaying the provision of which for a certain time will not entail a deterioration in the patient’s condition or a threat to his life and health.

The following types of medical care are distinguished: primary health care, specialized, including high-tech, emergency, including specialized emergency, palliative.

Primary health care is the basis of the medical care system and is provided in outpatient and day hospital settings.

The main sections are prevention, diagnosis, treatment of diseases and conditions, medical rehabilitation, monitoring the course of pregnancy, the formation of a healthy lifestyle, sanitary and hygienic education of the population.

Primary pre-hospital health care is provided by paramedics, midwives and other medical workers with secondary medical education.

Primary medical care is provided by general practitioners, local physicians, pediatricians, local pediatricians and general practitioners (family doctors).

Primary specialized health care is provided by medical specialists, including medical specialists from medical organizations providing specialized medical care, including high-tech care.

is provided by medical specialists in inpatient settings and in a day hospital and includes the prevention, diagnosis and treatment of diseases and conditions (including during pregnancy, childbirth and the postpartum period), requiring the use of special methods and complex medical technologies, and also medical rehabilitation.

Ambulance, including specialized emergency medical care is provided to citizens in case of illnesses, accidents, injuries, poisonings and other conditions requiring urgent medical intervention, in an emergency or emergency form outside a medical organization, as well as in outpatient and inpatient settings.

If, after providing emergency medical care, the victims require further treatment, and therefore evacuation, then they receive an evacuation assignment.

In emergency situations of peacetime and wartime, depending on the conditions, emergency medical care can be provided in full or limited scope.

Depending on the conditions of the situation and the nature of the medical procedures, assistance may be provided: pre-medical, first aid, qualified, specialized.

Pre-medical and first medical aid is provided in medical units and medical organizations that remain near the source of damage (at the first stage of medical care for victims).

First aid- therapeutic and preventive measures performed by doctors (or as directed by a doctor) and aimed at eliminating the consequences of exposure to hazardous factors that directly threaten the life of the victim, preventing the development of complications and preparing the victim, if necessary, for further evacuation. First medical aid can be provided in full or reduced scope.

With a reduced volume, emergency measures are performed, failure of which threatens the victim with death or the occurrence of a serious complication. Activities that can be forced to be postponed (urgent) and activities that can be provided at the next stage are carried out later.

Typical first aid treatment measures include: stopping external bleeding, maintaining the cardiovascular system, resuscitation, tracheostomy or tracheal intubation, applying an airtight bandage for open pneumothorax, drainage of the pleural cavity, immobilization of the head, neck, spine, limbs, infusion therapy, etc. .

Qualified medical care includes treatment and preventive emergency and emergency measures performed by general medical specialists - surgeons and therapists.

At the same time, surgeons, through various surgical interventions, eliminate severe, life-threatening conditions caused by damage, and take measures to prevent subsequent complications and ensure further evacuation. The scope of care and treatment methods depend on the specific medical situation. It is necessary to strive to expand the volume of assistance.

In emergency situations in healthcare, all measures of qualified surgical care are forced to be divided into three groups of surgical interventions - emergency, first-line emergency, second-line emergency.

Emergency surgeries qualified medical care, i.e. interventions used for life-saving indications are:

• 0 final stop of external and internal bleeding;
• 0 complex therapy of acute blood loss, shock and traumatic toxicosis;
• 0 elimination of asphyxia;
• 0 surgical treatment and suturing of wounds for open pneumothorax, thoracentesis for valve pneumothorax;
• 0 laparotomy for wounds and closed abdominal injuries with damage to internal organs;
• 0 operations for damage to the bladder and rectum;
• 0 amputation due to separation and destruction of limbs;
• 0 operations for anaerobic infection;
• 0 decompressive craniotomy for injuries and injuries accompanied by compression of the brain.

Emergency surgical interventions of first-line qualified medical care- operations, the delay of which leads to obviously serious complications:

• 0 imposition of a suprapubic fistula in case of damage to the urethra;
• 0 imposition of an unnatural anus in case of retroperitoneal injury to the rectum;
• 0 amputation for ischemic necrosis of the limb;
• 0 primary surgical treatment of wounds with significant damage to soft tissues.

Emergency surgical interventions of second-line qualified medical care- operations, the delay of which, provided early and systematic use of antibiotics does not necessarily lead to the development of dangerous complications:

• 0 surgical treatment of soft tissue wounds that are not subject to surgical treatment;
• 0 treatment of heavily contaminated burn surfaces;
• 0 suturing for patchwork wounds of the face;
• 0 ligature binding of teeth for fractures of the lower jaw with a defect.

Specialized medical care includes a complex of comprehensive treatment measures performed by medical specialists of various profiles in specialized medical organizations using special equipment.

In accordance with the specialization of doctors, surgical specialized care can be: ophthalmological, neurosurgical, otorhinolaryngological, dental, traumatological, obstetric-gynecological, angiosurgery.

The types of specialized therapeutic care are toxicological, radiological, and neuropsychiatric.

When providing emergency medical care, if necessary, medical evacuation is carried out - transportation of victims (sick) in order to save lives and preserve health, including persons being treated in medical organizations that do not have the ability to provide the necessary medical care for life-threatening conditions, women during pregnancy, childbirth, the postpartum period and newborns, persons affected by emergencies and natural disasters.

Medical evacuation is carried out by mobile emergency medical teams, carrying out medical care during transportation, including the use of medical equipment, and includes:

• 0 sanitary air evacuation carried out by air transport;
• 0 sanitary evacuation carried out by land, water and other modes of transport.

Palliative care is a set of medical interventions aimed at relieving pain and alleviating other severe manifestations of the disease, in order to improve the quality of life of terminally ill citizens and is provided in outpatient and inpatient settings by medical professionals trained to provide such care.

The organization and provision of medical care in emergency situations, including medical evacuation, is carried out by the All-Russian Disaster Medicine Service in the manner established by the authorized federal executive body.

All-Russian Disaster Medicine Service carries out:

О rapid response, mobilization of material and technical means and personnel in emergency situations in order to save the lives and preserve the health of the largest number of people by providing them with all types of medical care in a timely manner and in full;

About the elimination of epidemic foci;

О creation of a reserve of material reserves;

O training in providing medical assistance to citizens, including medical evacuation, in emergency situations.

The organization of medical care for the population is carried out in accordance with the decisions of the heads of civil defense.

CONTROL QUESTIONS

• 1. List the main tasks of the civil defense medical forces.
• 2. What is included in the civil defense medical forces?
• 3. Describe the role of heads of health authorities and medical organizations in the preparation and conduct of civil defense.
• 4. What is medical care for the population? Where is it carried out?
• 5. Expand the participation of medical specialists in civil defense activities.
• 6. What does every medical organization need to have to provide emergency medical care at the scene of illness?
• 7. What should every doctor be able to do when conducting medical triage?
• 8. What types and conditions for the provision of medical care are established by the Federal Law of the Russian Federation of November 21, 2011 No. 323-FZ “On the fundamentals of protecting the health of citizens in the Russian Federation”?
• 9. What forms of medical care are established by this law?
• 10. What functions are assigned to the All-Russian Disaster Medicine Service?

Medical care is provided by medical organizations and is classified according to the types, conditions and form of such care.

Types of medical care include:

• 1) primary health care (Article No. 33);
• 2) specialized, including high-tech, medical care (Article No. 34);
• 3) ambulance, including specialized emergency medical care (Article No. 35);
• 4) palliative medical care (Article No. 36).

Medical assistance can be provided in the following conditions (Article No. 32):

• 1) outside a medical organization (at the place where the ambulance team is called, including specialized emergency medical care, as well as in a vehicle during medical evacuation);
• 2) on an outpatient basis (in conditions that do not provide round-the-clock medical supervision and treatment), including at home when a medical professional is called;
• 3) in a day hospital (in conditions that provide medical supervision and treatment during the day, but do not require round-the-clock medical supervision and treatment);
• 4) inpatient (in conditions that provide round-the-clock medical supervision and treatment).

The forms of medical care are:

• 1) emergency - medical care provided for sudden acute diseases, conditions, exacerbation of chronic diseases that pose a threat to the patient’s life;
• 2) emergency - medical care provided for sudden acute diseases, conditions, exacerbation of chronic diseases without obvious signs of a threat to the patient’s life;
• 3) planned - medical care that is provided during preventive measures, for diseases and conditions that are not accompanied by a threat to the patient’s life, that do not require emergency and urgent medical care, and the delay of which for a certain time will not entail a deterioration in the patient’s condition, a threat to his life and health.

The regulations on the organization of the provision of medical care according to the types, conditions and forms of providing such assistance are established by the authorized federal executive body.

Primary health care.

Primary health care is the main, accessible and free type of medical care for every citizen and includes: treatment of the most common diseases, as well as injuries, poisoning and other emergency conditions; maintaining sanitary and hygienic and anti-epidemic measures, medical prevention of major diseases; sanitary and hygienic education; carrying out measures to protect the family, motherhood, paternity and childhood, and other activities related to the provision of health care to citizens at their place of residence.

Primary health care is provided by institutions of the municipal health care system and the sanitary-epidemiological service. Institutions of public and private health care systems may also participate in the provision of primary health care on the basis of agreements with insurance medical organizations.

The scope of primary health care is established by the local administration in accordance with territorial compulsory health insurance programs.

The procedure for the provision of primary health care is established by the governing bodies of the municipal health care system on the basis of regulations of the Ministry of Health of the Russian Federation, the State Committee for Sanitary and Epidemiological Surveillance of the Russian Federation, the ministries of health of the republics within the Russian Federation, legal acts of the autonomous region, autonomous okrugs, territories, regions , cities of Moscow and St. Petersburg.

Specialized, including high-tech, medical care.

Specialized medical care is provided by medical specialists and includes the prevention, diagnosis and treatment of diseases and conditions (including during pregnancy, childbirth and the postpartum period) requiring the use of special methods and complex medical technologies, as well as medical rehabilitation.

Specialized medical care is provided in inpatient and day hospital settings. High-tech medical care is part of specialized medical care and includes the use of new complex and (or) unique treatment methods, as well as resource-intensive treatment methods with scientifically proven effectiveness, including cellular technologies, robotic technology, information technology and genetic engineering methods developed based on the achievements of medical science and related branches of science and technology. High-tech medical care is provided by medical organizations in accordance with the list of types of high-tech medical care approved by the authorized federal executive body.

Ambulance, including specialized emergency medical care.

Ambulance, including specialized emergency medical care, is provided to citizens in case of illnesses, accidents, injuries, poisoning and other conditions requiring urgent medical intervention. Ambulance, including specialized emergency medical care, is provided to citizens free of charge by medical organizations of the state and municipal healthcare systems.

Ambulance, including specialized emergency medical care, is provided in an emergency or emergency form outside a medical organization, as well as in outpatient and inpatient settings.

On the territory of the Russian Federation, in order to provide emergency medical care, a system of a single number for calling emergency medical care operates in the manner established by the Government of the Russian Federation.

When providing emergency medical care, if necessary, medical evacuation is carried out, which is the transportation of citizens in order to save lives and preserve health (including persons being treated in medical organizations that do not have the ability to provide the necessary medical care for life-threatening conditions, women during pregnancy, childbirth, the postpartum period and newborns, persons affected by emergencies and natural disasters).

Palliative care

Palliative care is a set of medical interventions aimed at relieving pain and alleviating other severe manifestations of the disease, in order to improve the quality of life of terminally ill citizens.

Palliative care can be provided in outpatient or inpatient settings by health care providers trained to provide palliative care.

Medicinal assistance

Many Russian citizens enjoy the right to preferential provision of medicines. When treated in inpatient medical institutions - hospitals, clinics, hospitals, etc. - regardless of the duration of treatment, medications are provided free of charge.

The Decree of the Government of the Russian Federation “On state support for the development of the medical industry and improving the provision of medicines and medical products to the population and healthcare institutions” dated July 30, 1994 stipulates the population groups and categories of diseases for the outpatient treatment of which medicines and medical products are dispensed according to doctor's prescriptions free of charge and with a 50% discount on retail prices.

Thus, the following have the right to free provision of medicines:

• ?participants in the Civil and Great Patriotic Wars;
• participants in combat operations in defense of the USSR and the Russian Federation;
• ?Heroes of the Soviet Union and Russia;
• ?disabled people of the Great Patriotic War and persons equal to them in terms of benefits;
• * parents and wives of military personnel who died as a result of shell shock or injury received while defending the country or while performing other military service duties, or as a result of an illness associated with being at the front;
• * citizens who worked during the blockade in Leningrad;
• * disabled people of group I and non-working disabled people of group II;
• * former minor prisoners of fascist concentration camps;
• * children of the first 3 years of life;
• * children from large families.

• * pensioners receiving a minimum pension;
• * non-working disabled people of group II and disabled people of group III, recognized as unemployed in accordance with the established procedure;
• * persons who are “Honorary Donors of the Russian Federation”;
• * persons who took part in the work to eliminate the consequences of the Chernobyl disaster.

The legislation also establishes a list of diseases for which drug care is provided free of charge: cerebral palsy; HIV infection; oncological diseases; tuberculosis; bronchial asthma; myocardial infarction (first 6 months); diabetes; glaucoma and some others.

The procedure for preferential distribution of medicines and medical products was approved by the Decree of the Government of the Russian Federation “On the procedure and standards for preferential provision of medicines and medical products to war disabled people and other groups of the population” in accordance with the Federal Law “On Veterans” of January 12, 1995.

In accordance with this document, persons entitled to preferential drug coverage can (if desired) be assigned to a pharmacy at their place of residence. If, when contacting the specified institution, it does not have the necessary drug, then it is obliged to keep the prescription and immediately take measures to purchase the drug in other pharmacies.

For certain types of medicines, the price is set by the state (see Decree of the Government of the Russian Federation “On approval of the state register of prices for medicines” dated July 20, 1999).

The opportunity to receive medical care within the framework of the program of state guarantees of free provision of medical care to citizens and territorial programs of state guarantees of free provision of medical care to citizens;

The procedure, volumes and conditions for the provision of medical care in accordance with the program of state guarantees of free provision of medical care to citizens and the territorial program of state guarantees of free provision of medical care to citizens;

Medical care at the Bonum Medical Center is provided as planned. Planned medical care is medical care that is provided during preventive measures, for diseases and conditions that are not accompanied by a threat to the patient’s life, that do not require emergency and urgent medical care, and delaying the provision of which for a certain time will not entail a deterioration in the patient’s condition or a threat to his life and health.
Within the framework of the Territorial State Guarantees Program, the following are provided free of charge:

primary health care, including primary medical care and primary specialized care;

specialized, including high-tech, medical care; Primary health care is the basis of the medical care system and includes activities for the prevention, diagnosis, treatment of diseases and conditions, medical rehabilitation, promotion of a healthy lifestyle and sanitary and hygienic education of the population.

Primary health care is provided in accordance with established procedures for the provision of certain types of medical care. Primary health care is provided free of charge on an outpatient basis in a planned form upon presentation of a compulsory health insurance policy (hereinafter referred to as compulsory medical insurance) and (or) a passport of a citizen of the Russian Federation or a document replacing it;
Primary medical care turns out to be general practitioners and pediatricians.

Primary specialized health care provided by medical specialists, including medical specialists from medical organizations providing specialized, including high-tech, medical care.

Specialized medical care is provided free of charge in inpatient and day hospital settings by medical specialists and includes prevention, diagnosis and treatment of diseases and conditions that require the use of special methods and complex medical technologies, as well as medical rehabilitation. Primary specialized health care (consultative and diagnostic) in outpatient clinics is provided upon the direction of the attending physician or other medical specialist of the medical organization to which the patient is attached to provide primary health care on a territorial-precinct basis, with the obligatory indication of the purpose consultations and if the results of a preliminary examination are available. The waiting period for a consultation appointment should not exceed two weeks.

High-tech medical care is part of specialized medical care and includes the use of new complex and (or) unique treatment methods, as well as resource-intensive treatment methods with scientifically proven effectiveness, robotic technology, and information technology.
High-tech medical care is provided by medical organizations in accordance with the list of types of high-tech medical care approved by the Ministry of Health of the Russian Federation. Specialized, including high-tech, medical care is provided in inpatient and day hospital settings. Hospitalization in a 24-hour hospital is carried out upon the direction of the attending physician or a medical specialist of an outpatient clinic in accordance with medical indications requiring hospital treatment, intensive treatment methods and round-the-clock medical supervision. The provision of planned specialized medical care in a hospital setting to citizens from other municipalities in the Sverdlovsk region is carried out free of charge upon referral from a medical organization from the patient’s place of residence in accordance with the procedures for providing medical care and routing patients according to medical care profiles established by regulatory documents of the Russian Federation and the Sverdlovsk region with taking into account the waiting period established by the Program. In medical organizations providing specialized medical care in inpatient settings, a waiting list for specialized medical care is maintained in a planned form and citizens are informed in an accessible form, including using the Internet information and telecommunications network, about the waiting period for specialized medical care, taking into account requirements of the legislation of the Russian Federation on personal data. The waiting time for planned hospitalization in medical organizations for the provision of specialized medical care, with the exception of high-tech medical care, is allowed within limits not exceeding 30 days from the date the attending physician issues a referral for hospitalization (provided the patient applies for hospitalization within the time frame recommended by the attending physician), and also depending on the patient’s condition and the nature of the disease. The waiting time for planned hospitalization to receive high-tech medical care in various fields is determined based on the needs of citizens for certain types of medical care, the resource capabilities of the medical institution and the availability of a waiting list. Conditions for hospitalization in medical organizations: 1) a mandatory condition is the presence of a referral for planned hospitalization and pre-hospital examination data; 2) patients are accommodated in wards with 2 or more beds in compliance with current sanitary and hygienic requirements and standards; 3) therapeutic and diagnostic procedures begin on the day of hospitalization after examination of the patient by the attending or duty doctor.

Conditions for providing medical care in day hospitals of all types: 1) the indication for sending a patient to a day hospital is the need for active diagnostic, treatment and rehabilitation measures that do not require round-the-clock medical supervision, including after discharge from a round-the-clock hospital stay. The daily duration of the above activities in a day hospital is from 3 to 6 hours; 2) priority for hospitalization in day hospitals is allowed within a period of up to 30 days, depending on the patient’s condition and the nature of the course of the disease; the organization of work in a day hospital can be in one or two shifts; 3) in a day hospital in a medical organization, the patient is provided with: - in a day hospital in an outpatient clinic - a place (bed); - in a day hospital within the structure of a 24-hour hospital - a bed for the period of therapeutic, diagnostic or rehabilitation measures; - daily observation by the attending physician; - diagnosis and treatment of the disease; - drug therapy, including using parenteral routes of administration (intravenous, intramuscular, subcutaneous injections, etc.); - medical manipulations and procedures according to indications.

Active Federal Law of November 21, 2011 No. 323-FZ“On the fundamentals of protecting the health of citizens in the Russian Federation” (hereinafter referred to as the Law on Health Protection), for the first time at the level of law, defines . Which is understood as a set of measures aimed at maintaining and (or) restoring health and including the provision of medical services. Medical care in the Russian Federation is provided by medical organizations and is classified according to the types, conditions and form of such assistance.

Before the adoption by the State Duma of the Russian Federation of the Law on Health Protection, the concept of medical care was contained in the Industry Classifier “Simple Medical Services”. OK PMU 91500.09.0001-2001, approved by Order of the Ministry of Health of the Russian Federation of April 10, 2001 No. 113. In this document, medical care was considered as a set of measures (including medical services, organizational and technical measures, sanitary and anti-epidemic measures, drug provision, etc.) aimed at meeting the needs of the population in maintaining and restoring health.

Types of medical care to the population are named in Art. 32 of the Health Protection Law. These include: ; , including high-tech medical care; , including emergency specialized medical care; . It should be emphasized that the Law on the Protection of Citizens' Health not only names the types of medical care in healthcare, gives their definitions, but also establishes the forms and conditions for the provision of medical care, which, of course, can be attributed to its advantages. The forms and conditions for the provision of medical care are also determined by the Regulations on the organization of the provision of relevant types of medical care.

Conditions for providing medical care

Medical care can be provided in the following conditions:

• Outside a medical organization (at the place where the ambulance team is called, including specialized emergency medical care, as well as in a vehicle during medical evacuation);
• Outpatient (in conditions that do not provide round-the-clock medical supervision and treatment), including at home when a medical professional is called;
• In a day hospital (in conditions that provide medical supervision and treatment during the day, but do not require round-the-clock medical supervision and treatment);
• Inpatient (in conditions that provide round-the-clock medical supervision and treatment).

The forms of medical care are:

• — medical care provided for sudden acute diseases, conditions, exacerbation of chronic diseases that pose a threat to the patient’s life;
• — medical care provided for sudden acute diseases, conditions, exacerbation of chronic diseases without obvious signs of a threat to the patient’s life;
• Planned - medical care that is provided during preventive measures, for diseases and conditions that are not accompanied by a threat to the patient’s life, that do not require emergency and emergency medical care, and delaying the provision of which for a certain time will not entail a deterioration in the patient’s condition, a threat to his life and health.

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Article 11 Federal Law of November 21, 2011 No. 323-FZ“On the basics of protecting the health of citizens in the Russian Federation” (hereinafter referred to as Federal Law No. 323) says that in an emergency, a medical organization and a medical worker provides a citizen immediately and free of charge. Refusal to provide it is not allowed. A similar wording was in the old Fundamentals of Legislation on the Protection of Citizens’ Health in the Russian Federation (approved by the Supreme Court of the Russian Federation on July 22, 1993 N 5487-1, no longer in force on January 1, 2012), although the concept “” appeared in it. What is emergency medical care and what is its difference from the emergency form?

An attempt to isolate emergency medical care from emergency or emergency medical care that is familiar to each of us was previously made by officials of the Ministry of Health and Social Development of Russia (since May 2012 -). Therefore, since approximately 2007, we can talk about the beginning of some separation or differentiation of the concepts of “emergency” and “urgent” assistance at the legislative level.

However, in explanatory dictionaries of the Russian language there are no clear differences between these categories. Urgent - one that cannot be postponed; urgent. Emergency - urgent, extraordinary, urgent. Federal Law No. 323 put an end to this issue by approving three different forms of medical care: emergency, urgent and planned.

Emergency

Medical care provided for sudden acute diseases, conditions, exacerbation of chronic diseases that pose a threat to the patient’s life.

Urgent

Medical care provided for sudden acute diseases, conditions, exacerbation of chronic diseases without obvious signs of a threat to the patient’s life.

Planned

Medical care that is provided during preventive measures, for diseases and conditions that are not accompanied by a threat to the patient’s life, that do not require emergency and emergency medical care, and the delay of which for a certain time will not entail a deterioration in the patient’s condition, a threat to his life and health.

As you can see, emergency and emergency medical care are opposed to each other. At the moment, absolutely any medical organization is obliged to provide only emergency medical care free of charge and without delay. So are there any significant differences between the two concepts under discussion?

The main difference is that EMF occurs in cases of life threatening person, and emergency - without obvious signs of a threat to life. However, the problem is that the legislation does not clearly define which cases and conditions are considered a threat and which are not. Moreover, it is not clear what is considered a clear threat? Diseases, pathological conditions, and signs indicating a threat to life are not described. The mechanism for determining the threat is not specified. Among other things, the condition may not be life-threatening at a particular moment, but failure to provide assistance will subsequently lead to a life-threatening condition.

In view of this, a completely fair question arises: how to distinguish a situation when emergency assistance is needed, how to draw the line between emergency and emergency assistance. An excellent example of the difference between emergency and emergency care is outlined in the article by Professor A.A. Mokhov “Features of legislative regulation of the provision of emergency and emergency care in Russia”:

Sign	Medical assistance form
	Emergency	Urgent
Medical criterion	Threat to life	There is no obvious threat to life
Reason for providing assistance	The patient’s request for help (expression of will; contractual regime); treatment of other persons (lack of expression of will; legal regime)	Request by the patient (his legal representatives) for help (contractual regime)
Terms of service	Outside a medical organization (pre-hospital stage); in a medical organization (hospital stage)	Outpatient (including at home), as part of a day hospital
Person obliged to provide medical care	A doctor or paramedic, any medical professional	Medical specialist (therapist, surgeon, ophthalmologist, etc.)
Time interval	Help must be provided as quickly as possible	Assistance must be provided within a reasonable time

But unfortunately, this is also not enough. In this matter, we definitely cannot do without the participation of our “legislators”. Solving the problem is necessary not only for theory, but also for “practice”. One of the reasons, as mentioned earlier, is the obligation of each medical organization to provide emergency medical care free of charge, while emergency care can be provided on a paid basis.

It is important to note that the “image” of emergency medical care is still “collective”. One of the reasons is territorial programs of state guarantees for the free provision of medical care to citizens (hereinafter referred to as TPGG), which contain (or do not contain) various provisions regarding the procedure and conditions for the provision of EMC, emergency criteria, the procedure for reimbursement of expenses for the provision of EMC, and so on.

For example, the 2018 TPGG of the Sverdlovsk region indicates that a case of emergency medical care must meet the criteria of an emergency: suddenness, acute condition, life-threatening. Some TPGGs mention emergency criteria, referring to Order of the Ministry of Health and Social Development of the Russian Federation dated April 24, 2008 No. 194n “On approval of Medical criteria for determining the severity of harm caused to human health” (hereinafter referred to as Order No. 194n). For example, the 2018 TPGG of the Perm Territory indicates that the criterion for emergency medical care is the presence of life-threatening conditions, defined in:

• clause 6.1 of Order No. 194n (harm to health, dangerous to human life, which by its nature directly poses a threat to life, as well as harm to health that caused the development of a life-threatening condition, namely: head wound; contusion of the cervical spinal cord with disruption of it functions, etc. * );
• clause 6.2 of Order No. 194n (harm to health, dangerous to human life, causing a disorder of the vital functions of the human body, which cannot be compensated by the body on its own and usually ends in death, namely: shock of severe III - IV degree; acute, profuse or massive blood loss, etc.*).

* The full list is defined in Order No. 194n.

According to ministry officials, emergency medical care is provided if the patient’s existing pathological changes are not life-threatening. But from various regulations of the Ministry of Health and Social Development of Russia it follows that there are no significant differences between emergency and emergency medical care.

Some TPGGs indicate that the provision of emergency medical care is carried out in accordance with emergency medical care standards, approved by orders of the Russian Ministry of Health, according to conditions, syndromes, diseases. And, for example, the TPGG 2018 of the Sverdlovsk region means that emergency care is provided in outpatient, inpatient and day hospital settings in the following cases:

• when an emergency condition occurs in a patient on the territory of a medical organization (when the patient seeks medical care in a planned form, for diagnostic tests, consultations);
• when the patient self-refers or is delivered to a medical organization (as the closest one) by relatives or other persons in the event of an emergency;
• if an emergency condition occurs in a patient during treatment in a medical organization, during planned manipulations, operations, or studies.

Among other things, it is important to note that if a citizen’s health condition requires emergency medical care, the citizen’s examination and treatment measures are carried out at the place of his appeal immediately by the medical worker to whom he turned.

Unfortunately, Federal Law No. 323 contains only the analyzed concepts themselves without the criteria that “separate” these concepts. As a result, a number of problems arise, the main one of which is the difficulty of determining in practice the presence of a threat to life. As a result, there is an urgent need for a clear description of diseases and pathological conditions, signs indicating a threat to the patient’s life, with the exception of the most obvious (for example, penetrating wounds of the chest, abdominal cavity). It is unclear what the mechanism for identifying a threat should be.

Order of the Ministry of Health of Russia dated June 20, 2013 No. 388n “On approval of the Procedure for providing emergency, including specialized emergency medical care” allows us to identify some conditions that indicate a threat to life. The order states that the reason for calling an ambulance in emergency form are sudden acute diseases, conditions, exacerbations of chronic diseases that pose a threat to the patient’s life, including:

• disturbances of consciousness;
• breathing problems;
• disorders of the circulatory system;
• mental disorders accompanied by the patient’s actions that pose an immediate danger to him or others;
• pain syndrome;
• injuries of any etiology, poisoning, wounds (accompanied by life-threatening bleeding or damage to internal organs);
• thermal and chemical burns;
• bleeding of any etiology;
• childbirth, threat of miscarriage.

As you can see, this is only an approximate list, but we believe that it can be used by analogy when providing other medical care (not emergency).

However, from the analyzed acts it follows that often the conclusion about the presence of a threat to life is made either by the victim himself or by the ambulance dispatcher, based on the subjective opinion and assessment of what is happening by the person who sought help. In such a situation, both an overestimation of the danger to life and a clear underestimation of the severity of the patient’s condition are possible.

I would like to hope that the most important details will soon be more fully spelled out in the acts. At the moment, medical organizations probably still should not ignore the medical understanding of the urgency of the situation, the presence of a threat to the patient’s life and the urgency of action. In a medical organization, it is mandatory (or rather, highly recommendatory) to develop local instructions for emergency medical care on the territory of the organization, which all medical workers must be familiar with.

Article 20 of Law No. 323-FZ states that a necessary precondition for medical intervention is the giving of informed voluntary consent (hereinafter referred to as IDS) by a citizen or his legal representative for medical intervention on the basis of complete information provided by a medical worker in an accessible form about the goals and methods of providing medical care. , the associated risk, possible options for medical intervention, its consequences, as well as the expected results of medical care.

However, the situation in providing medical care in emergency form(which is also considered a medical intervention) falls within the exception. Namely, medical intervention is allowed without the consent of a person for emergency reasons to eliminate a threat to a person’s life, if the condition does not allow one to express one’s will, or if there are no legal representatives (clause 1 of part 9 of article 20 of Federal Law No. 323). The basis for disclosing medical confidentiality without the patient’s consent is similar (clause 1 of part 4 of article 13 of Federal Law No. 323).

In accordance with clause 10 of Article 83 of Federal Law No. 323, expenses associated with the provision of free emergency medical care to citizens by a medical organization, including a medical organization of the private healthcare system, are subject to reimbursement. Read about reimbursement of expenses for the provision of emergency medicine in our article: Reimbursement of expenses for the provision of free emergency medical care.

After entry into force Order of the Ministry of Health of Russia dated March 11, 2013 No. 121n“On approval of the Requirements for the organization and performance of work (services) in the provision of primary health care, specialized (including high-tech) ...” (hereinafter referred to as Order of the Ministry of Health No. 121n), many citizens have a well-founded misconception that emergency medical care must be included in the medical license. The type of medical service “emergency medical care”, subject to , is also indicated in Decree of the Government of the Russian Federation dated April 16, 2012 No. 291“On licensing of medical activities.”

However, the Ministry of Health of the Russian Federation, in its Letter No. 12-3/10/2-5338 dated July 23, 2013, gave the following explanation on this topic: “As for the work (service) for emergency medical care, this work (service) was introduced for licensing the activities of medical organizations that, in accordance with Part 7 of Article 33 of Federal Law N 323-FZ, have created units within their structure to provide emergency primary health care. In other cases of providing emergency medical care, obtaining a license providing for the performance of emergency medical care work (services) is not required.”

Thus, the type of medical service “emergency medical care” is subject to licensing only by those medical organizations in whose structure, in accordance with Article 33 of Federal Law No. 323, medical care units are created that provide the specified assistance in an emergency form.

The article uses materials from the article by A.A. Mokhov. Features of providing emergency and emergency care in Russia // Legal issues in healthcare. 2011. No. 9.

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