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Chapter 1 Independent work of a paramedic in an ambulance and as part of a paramedic and medical team Organization of the work of an ambulance The ambulance service is one of the most important links in the healthcare system in our country. Volume

CHAPTER 9 BASIC PRODUCTION INFRASTRUCTURE In examining American post-war investment in basic production infrastructure, a group led by Uwe Parpart-Henke found that the strongest correlations in the economy are between

1. General Provisions

1. This job description defines the job duties, rights and responsibilities of the head of the feldsher-obstetric station (hereinafter - FAP).

2. A person with a secondary medical education in the specialty "Medicine" or "Obstetrics" is appointed to the position of head of the FAP.

3. The head of the FAP must know the basics of the legislation of the Russian Federation on health care; legal documents regulating the activities of healthcare institutions; the basics of organizing medical and preventive care in hospitals and outpatient clinics, emergency and emergency medical care, disaster medicine services, sanitary and epidemiological services, drug supply to the population and health care facilities; theoretical foundations, principles and methods of clinical examination; organizational and economic foundations for the activities of health care institutions and medical workers in the context of budgetary insurance medicine; fundamentals of social hygiene, organization and economics of healthcare, medical ethics and deontology; legal aspects medical activities; general principles and basic methods of clinical, instrumental and laboratory diagnostics of the functional state of organs and systems of the human body; etiology, pathogenesis, clinical symptoms, course features, principles of complex treatment of major diseases; rules for the provision of emergency medical care; bases of examination of temporary incapacity for work and medico-social examination; fundamentals of health education; internal rules work schedule; rules and norms of labor protection, safety measures, industrial sanitation and fire protection.

4. The head of the FAP is appointed to the position and dismissed by the order of the head of the healthcare institution in accordance with the current legislation of the Russian Federation.

5. The head of the FAP is directly subordinate to the head of the governing body or healthcare institution or his deputy.

2. Job responsibilities

3. Rights

The head of the FAP has the right to:

1. make proposals to the management of the institution to improve the work of the FAP, the treatment and diagnostic process, incl. on the organization and conditions of their labor activity;

2. supervise the work of middle and junior medical staff give them orders within their official duties and demand their precise execution, make proposals to the management of the institution on their encouragement or imposition of penalties;

3. request, receive and use information materials and legal documents necessary for the performance of their official duties;

4. take part in scientific and practical conferences and meetings dealing with issues related to its work;

5. pass in in due course certification with the right to receive the appropriate qualification category;

6. to improve their qualifications at refresher courses at least once every 5 years.

The head of the FAP uses all labor rights in accordance with the Labor Code of the Russian Federation.

4. Responsibility

The head of the FAP is responsible for:

1. timely and high-quality implementation of the duties assigned to him;

2. organization of their work, timely and qualified execution of orders, instructions and instructions of the management, regulatory legal acts on their activities;

3. compliance with internal regulations, fire safety and safety;

4. timely and high-quality execution of medical and other service documentation provided for by the current legal documents;

5. providing, in accordance with the established procedure, statistical and other information on their activities;

6. Ensuring compliance with executive discipline and performance of their duties by subordinate employees (if any);

7. prompt action, including timely informing management, to eliminate safety violations, fire and sanitary regulations that pose a threat to the activities of the healthcare institution, its employees, patients and visitors.

For violation of labor discipline, legislative and regulatory legal acts, the head of the FAP can be brought in accordance with the current legislation, depending on the severity of the misconduct, to disciplinary, material, administrative and criminal liability.

1. General Provisions

1. This job description defines the job duties, rights and responsibilities of the head of the feldsher-obstetric station (hereinafter - FAP).
2. A person with a secondary medical education in the specialty "Medicine" or "Obstetrics" is appointed to the position of head of the FAP.
3. The head of the FAP must know the basics of the legislation of the Russian Federation on health care; legal documents regulating the activities of healthcare institutions; the basics of organizing medical and preventive care in hospitals and outpatient clinics, emergency and emergency medical care, disaster medicine services, sanitary and epidemiological services, drug supply to the population and health care facilities; theoretical foundations, principles and methods of clinical examination; organizational and economic foundations for the activities of health care institutions and medical workers in the context of budgetary insurance medicine; fundamentals of social hygiene, organization and economics of healthcare, medical ethics and deontology; legal aspects of medical activity; general principles and basic methods of clinical, instrumental and laboratory diagnostics of the functional state of organs and systems of the human body; etiology, pathogenesis, clinical symptoms, course features, principles of complex treatment of major diseases; rules for the provision of emergency medical care; bases of examination of temporary incapacity for work and medico-social examination; fundamentals of health education; internal labor regulations; rules and norms of labor protection, safety measures, industrial sanitation and fire protection.
4. The head of the FAP is appointed to the position and dismissed by the order of the head of the healthcare institution in accordance with the current legislation of the Russian Federation.
5. The head of the FAP is directly subordinate to the head of the governing body or healthcare institution or his deputy.

2. Job responsibilities

The head of the FAP has the right to:
1. make proposals to the management of the institution to improve the work of the FAP, the treatment and diagnostic process, incl. on the organization and conditions of their labor activity;
2. control the work of middle and junior medical personnel, give them orders within the framework of their official duties and demand their precise execution, make proposals to the management of the institution for their encouragement or imposition of penalties;
3. request, receive and use information materials and legal documents necessary for the performance of their duties;
4. to take part in scientific and practical conferences and meetings, which discuss issues related to his work;
5. pass certification in accordance with the established procedure with the right to obtain the appropriate qualification category;
6. to improve their qualifications at refresher courses at least once every 5 years.
The head of the FAP enjoys all labor rights in accordance with the Labor Code of the Russian Federation.

4. Responsibility

The head of the FAP is responsible for:
1. timely and high-quality implementation of the duties assigned to him;
2. organization of their work, timely and qualified execution of orders, instructions and instructions of the management, regulatory legal acts on their activities;
3. compliance with internal regulations, fire safety and safety;
4. timely and high-quality execution of medical and other service documentation provided for by the current legal documents;
5. providing, in accordance with the established procedure, statistical and other information on their activities;
6. Ensuring compliance with executive discipline and performance of their duties by subordinate employees (if any);
7. prompt action, including timely informing the management, to eliminate violations of safety, fire and sanitary rules that pose a threat to the activities of the healthcare institution, its employees, patients and visitors.
For violation of labor discipline, legislative and regulatory legal acts, the head of the FAP can be brought in accordance with the current legislation, depending on the severity of the misconduct, to disciplinary, material, administrative and criminal liability.

An important section of the activity of paramedics is the provision of medical care to patients at home. The order of treatment of patients at home is determined by the doctors of the district hospital or the central district hospital (CRH) and only in some cases by the paramedic himself. Patients left at home should be monitored continuously until they recover. This is especially true for children. It is expedient to hospitalize patients from settlements remote from FAP; when leaving the patient at home, the paramedic informs the doctor of the rural medical district about this and monitors the patient.

In outpatient care for tuberculosis patients, the paramedic, being the direct executor of medical prescriptions, conducts immunochemoprophylaxis, medical examination, anti-epidemic measures in the foci of tuberculosis infection, work on hygiene education, etc.

A paramedic working at a FAP must master the simplest resuscitation techniques at the prehospital stage, especially in case of sudden cardiac or respiratory arrest, the causes of which can be severe injuries, blood loss, acute myocardial infarction, poisoning, drowning, electrical injury. Paramedics and obstetricians working independently are also entrusted with the provision of emergency medical care in case of acute illnesses and accidents. In case of an urgent call, the paramedic must have a suitcase with him, complete with medical instruments and medicines according to the packing list.

Paramedics play an important role in medical examination of the rural population. Its main goal is to implement a set of measures aimed at forming, maintaining and strengthening the health of the population, preventing the development of diseases, reducing morbidity, and increasing active creative longevity.

To conduct a general medical examination, a personal registration of the entire population living in the service area of ​​the polyclinic, outpatient clinic and FAP is carried out in accordance with the “Instruction on the procedure for accounting for the annual medical examination of the entire population”. In rural areas, the lists of residents are average medical workers of the FAP.

For the personal registration of each resident, paramedical workers fill out the “Medical examination record card” (educational form No. 131 / y - 86) and number it in accordance with the number of the outpatient medical card ( accounting form No. 025/y). After clarifying the composition of the population, all "Medical examination records" are transferred to the file cabinet.

The paramedic or midwife makes sure that patients who need seasonal (autumn, spring) anti-relapse treatment receive it in a timely manner in a hospital or on an outpatient basis. The proper organization of the examination of temporary disability for FAP is important for reducing the incidence.

In accordance with the "Regulations on the head of the feldsher-obstetric station", the head of the FOP, the paramedic may have the right to issue sick leaves, certificates and other medical documents in the manner established by the Ministry of Health of the Russian Federation.

The basis for granting the right to issue sick leave to the paramedic is the petition of the chief physician of the district, which must indicate:

The remoteness of the FAP from the hospital (outpatient clinic) to which he is assigned;

The number of serviced settlements of the state farm and the number of employees in them;

Status of communication routes;

The experience of the paramedic and the level of his qualifications;

Knowledge and observance by the paramedic of the basics of examinations of temporary disability and the “Instructions on the procedure for issuing sick leave”. The paramedic keeps records of the issued sick leave in the “Book of Registration of Disability Leaves” (form No. 036 / y) with the obligatory completion of all its columns.

Therapeutic and preventive care for women and children. At each FLP, the paramedic (midwife) maintains a file of personal records of women starting from the age of 18, where they enter passport data, past illnesses, information about all pregnancies (years in which each pregnancy ended, complications). The medical assistant (midwife) begins the examination of each pregnant woman at the first visit with a general examination, measures the length and weight of the body, blood pressure on the common arms, determines the condition of the heart, lungs and other organs within her competence, examines the urine for protein. When monitoring pregnant women, the paramedic (midwife) of the FAP is obliged to show each of them to the doctor; in cases where a woman has the slightest deviation from the normal development of pregnancy, she should be immediately referred to a doctor.

One of the important sections of the activity of FAP paramedics is to carry out primary anti-epidemic measures in the event of outbreaks of infectious diseases, the timeliness and quality of which determine the effectiveness of preventing the spread of infection outside the outbreak. In this regard, the organization of the activities of FLP employees, aimed at identifying infectious diseases among the population, is of great importance.

When diagnosing an infectious disease (or suspecting it), the paramedical staff of the FAP should:

Carry out primary anti-epidemic measures in the outbreak;

Isolate the patient at home and organize ongoing disinfection before hospitalization of the patient;

Identify all persons who have been in contact with the patient, take them into account and establish medical supervision over them;

Carry out (together with the doctor) quarantine measures in relation to persons who have been in contact with sick people, attending preschool institutions, schools or working at epidemically important facilities;

Inform at the place of work, study, preschool institutions, at the place of residence about the sick person and the persons who had contact with him;

At the direction of a pediatrician or epidemiologist, conduct gamma globulin prophylaxis for those who have been in contact with a patient with viral hepatitis A.

An infectious patient is hospitalized during the first day of the disease in a special transport. In its absence, the patient can be transported by any means of transport with subsequent disinfection. In the future, the medical worker of the FAP follows the instructions of the epidemiologist (assistant epidemiologist) and carries out:

Collection of material from persons who have been in contact with patients for laboratory research in order to identify bacteria carriers;

Vaccinations according to epidemiological indications and chemoprophylaxis;

Dynamic monitoring of persons who have been in contact with patients during the period incubation period of this infectious disease.

Paramedics and midwives of the FAP play an important role in health-improving activities, hygienic education of the rural population and propaganda healthy lifestyle life. In order to correctly assess the level of well-being of the object, paramedics are trained in the simplest laboratory tests, express methods and are provided with field express laboratories. With the help of such a laboratory, it is possible to determine residual amounts of chlorine in disinfectant solutions, on objects and surfaces (starch iodine method), residual amounts of detergents on tableware (phenolphthalein test).

The FAP paramedic often has to take part in the analysis of occupational injuries and the development of measures to reduce it, so he must be familiar with the main causes of injuries: technical, organizational and sanitary and hygienic. More than half of all victims turn to FAP, so the nursing staff is required to constantly improve their knowledge, in particular, in first aid for injuries. In addition to providing first aid to the victim, FAP paramedics register and record injuries; identify, study and analyze their causes depending on various factors; together with doctors, develop specific measures to eliminate the identified causes; monitor compliance with safety regulations; train workers Agriculture first aid practices.

When working as part of a medical team, the paramedic is completely subordinate to the doctor during the call. His task is to fulfill all assignments accurately and quickly. Responsibility for decisions made lies with the doctor. The paramedic must be proficient in the technique of subcutaneous, intramuscular and intravenous injections and ECG recording, be able to quickly set up a drip system, measure blood pressure, count the pulse and number of respiratory movements, insert an airway, perform cardiopulmonary resuscitation, etc. He must also be able to apply a splint and a bandage, stop bleeding, know the rules for transporting patients.

In the case of independent work, the ambulance paramedic is fully responsible for everything, so he must be fully proficient in diagnostic methods at the pre-hospital stage. He needs knowledge in emergency therapy, surgery, traumatology, gynecology, pediatrics. He must know the basics of toxicology, be able to take birth on his own, assess the neurological and mental state of the patient, not only register, but also tentatively evaluate the ECG.

Appendix No. 10 to the order of the Ministry of Health of the Russian Federation No. 100 dated 03.26.99

"Regulations on the paramedic of the mobile ambulance brigade"

I. General provisions

1.1. A specialist with a secondary medical education in the specialty "General Medicine", who has a diploma and an appropriate certificate, is appointed to the position of paramedic of the "Ambulance" brigade.

1.2. When fulfilling the duties of providing emergency medical care as part of the paramedic team, the paramedic is the responsible executor of all work, and as part of the medical team acts under the guidance of a doctor.

1.3. The paramedic of the ambulance mobile team is guided in his work by the legislation of the Russian Federation, regulatory and methodological documents of the Ministry of Health of the Russian Federation, the Charter of the ambulance station, orders and orders of the administration of the station (substation, department), these Regulations.

1.4. The paramedic of the ambulance mobile brigade is appointed to the position and dismissed in accordance with the procedure established by law.

II. Responsibilities

The paramedic of the mobile brigade "Ambulance" is obliged:

2.1. Ensure the immediate departure of the brigade after receiving a call and its arrival at the scene within the established time limit in the given territory.

2.2. Provide emergency medical care to the sick and injured at the scene and during transportation to hospitals.

2.3. Administer medications to sick and injured medical indications, to stop bleeding, to carry out resuscitation in accordance with approved industry norms, rules and standards for paramedical personnel in the provision of emergency medical care.

2.4. Be able to use the available medical equipment, master the technique of applying transport splints, dressings and methods of conducting basic cardiopulmonary resuscitation.

2.5. Master the technique of taking electrocardiograms.

2.6. Know the location of medical institutions and the service areas of the station.

2.7. Ensure the transfer of the patient on a stretcher, if necessary, take part in it (in the conditions of the work of the brigade, the transfer of the patient on a stretcher is regarded as a type of medical care). When transporting the patient, be next to him, providing the necessary medical care.

2.8. If it is necessary to transport a patient in an unconscious state or in a state of alcoholic intoxication, inspect for documents, valuables, money indicated in the Call Card, hand them over to the admission department of the hospital with a mark in the direction against the signature of the staff on duty.

2.9. When providing medical care in emergency situations, in cases of violent damage, act in accordance with the procedure established by law (report to the internal affairs authorities).

2.10. Ensure infectious safety (observe the rules of the sanitary-hygienic and anti-epidemic regime). If a quarantine infection is detected in a patient, provide him with the necessary medical care, observing precautionary measures, and inform the senior shift doctor about the patient's clinical, epidemiological and passport data.

2.11. Ensure proper storage, accounting and write-off of medicines.

2.12. At the end of the duty, check the condition of medical equipment, transport tires, replenish those used during work medicines, oxygen, nitrous oxide.

2.13. Inform the administration of the ambulance station about all emergencies that occurred during the call.

2.14. At the request of internal affairs officers, stop to provide emergency medical care, regardless of the location of the patient (injured).

2.15. Maintain approved accounting and reporting documentation.

2.16. In accordance with the established procedure, improve your professional level, improve practical skills.

III. Rights

The paramedic of the ambulance team has the right to:

3.1. If necessary, call the medical team "Ambulance" for help.

3.2. Make proposals to improve the organization and provision of emergency medical care, improve the working conditions of medical personnel.

3.3. Improve your qualifications in your specialty at least once every five years. Pass certification and re-certification in the prescribed manner.

3.4. To take part in the work of medical conferences, meetings, seminars held by the administration of the institution.

IV. A responsibility

The paramedic of the ambulance team is responsible in accordance with the procedure established by law:

4.1. For ongoing professional activity in accordance with the approved industry norms, rules and standards for paramedical personnel of the "Ambulance".

4.2. For illegal actions or omissions that caused damage to the health of the patient or his death.

In accordance with the order of the Ministry of Health of the Russian Federation No. 100, field teams are divided into feldsher and medical teams. The paramedical brigade includes two paramedics, an orderly and a driver. The medical team includes a doctor, two paramedics (or a paramedic and a nurse anesthesiologist), an orderly and a driver.

The tactics of the behavior of the ambulance paramedic during the call. Ambulance personnel, including paramedics, work in very difficult conditions. During the call, the paramedic may encounter any, the most unexpected pathology. He needs to have a broad outlook, have knowledge from various fields of medicine, be able to quickly navigate in a difficult situation, keep calm, and make the right decision in a short time. For this, only special training is not enough; certain moral qualities, good health and life experience are also required.

One of the main difficulties is that at the moment of leaving for a challenge, you never know exactly what lies ahead. A "heart attack" can turn into anything - from hysteria to poisoning with pills, and when leaving due to a hand injury, a patient with a gunshot wound, massive blood loss and shock can turn out to be on the spot. Therefore, the paramedic must be constantly prepared for any situation. But you should not keep yourself in a state of nervous tension for a long time - you need to be able to quickly orient yourself and mobilize when you arrive at the place.

Already approaching the place of the call, it is necessary to begin to observe and draw conclusions. Whether they meet you or not; how the greeters look - worried, crying, alarmed, or indifferently leisurely; whether they are in a state of alcoholic intoxication, whether they look strange for the circumstances. There are no general laws, but, as a rule, when something really serious happens, the ambulance is met on the street. Unusual behavior may suggest the insincerity of the callers. In the case of departure on a deliberately criminal occasion (fights, riots, etc.), you must request police escort.

The person meeting should be let forward, let him show the way. On the way, you should start questioning to clarify what happened.

Arriving at the patient, it is necessary to quickly assess the situation. The collection of anamnesis in an ambulance has its own characteristics. It should be carried out purposefully. You should not at the very beginning allow lengthy stories about the history of life, marriage and many chronic ailments. You should find out what happened right now, everything else - later and if necessary. Often chronic patients who abuse the "Ambulance" without sufficient reason, this is perplexing. At the same time, a really seriously ill person may become confused, frightened, unable to immediately find words. This one needs help. One should not only follow the patient's lead, but also suppress him, adjust his complaints to his own (possibly incorrect) idea of ​​the nature of the disease. You should definitely ask what the patient himself connects his condition with, but evaluate his answer critically.

After clarifying the picture of what happened, you need to find out whether this condition arose for the first time or something similar has already happened, what helped then, what diagnosis was made, what other diseases the patient suffers from, are there any medical documents(outpatient card, extracts from hospitals, examination results).

Simultaneously with the collection of anamnesis, it is necessary to begin an examination (count the pulse, measure blood pressure, palpate the abdomen, etc.).

If a small child is sleeping, it is better to first gently palpate the abdomen, and only then wake him up and conduct further examination. Examining the pharynx in restless children should be the last thing, since this unpleasant procedure can make contact with the child difficult for a long time.

In case of injuries, you should first examine the site of injury, while assessing the general condition of the patient, and then proceed to the examination of organs and systems.

The collection of anamnesis and examination in an ambulance is given 5-10 minutes. But sometimes they don't! After that, it is necessary to draw conclusions, make a preliminary diagnosis and make a decision regarding the provision of assistance.

At the bedside of the patient, one should behave benevolently, correctly, but businesslike and firmly. One should not allow familiarity or condescending attitude on the part of relatives or the patient towards oneself, especially rudeness. All actions at the same time should be clear, confident, it is necessary to inspire calmness to the patient with all his appearance.

Before injecting or giving pills, it is necessary to find out if the patient is allergic to these drugs.

Particularly difficult in moral terms are calls to the street or to another public place about car accidents, falls from a height or sudden serious illness, when an excited crowd gathers around, usually negatively or even aggressively disposed towards the ambulance staff. People in such a situation inadequately assess what is happening. Other ambulance personnel may also be at the scene. Listen to their advice and accept help. During transport to the hospital, you should not take more than one escort into the car. If you have to hospitalize a drunk or aggressive patient, he should be laid or planted so that he could not suddenly and quickly reach the paramedic. If the ambulance was stopped on the way to a call to help another patient and he really needs it, you should inform the dispatcher so that the first call is transferred to another team for execution.

After medical assistance has already been provided, it is necessary to explain to the patient what happened to him, how to behave in a similar case next time, and give general recommendations for the treatment and prevention of this disease. If necessary, an active call should be transferred to the local doctor (when the patient is not hospitalized for any reason, but requires dynamic observation) or the medical team (when the patient is in serious condition requires specialized care or the picture of the disease is not completely clear, and you are not sure of the diagnosis ).

The principle of operation of the paramedic (and the doctor) of the ambulance is overdiagnosis. The severity of the patient's condition is better to overestimate than to underestimate.

Methods and means of sanitary and educational work of a paramedic

In organizing his health education work, the paramedic, along with traditional methods of educating the population on health issues (such as interviews, group discussions, lectures, theme evenings, question and answer evenings, round tables, oral journals, health schools, publications in press, conferences) also widely uses the methods of visual agitation: wall newspapers; health bulletins; exhibitions and corners of health; book fairs.

A health bulletin is an illustrated health education newspaper that focuses on one topic only. Topics should be relevant and chosen taking into account the challenges facing modern healthcare, as well as the seasonality and epidemiological situation in the region. The title is in large print. The name should be interesting, intriguing, it is desirable not to mention the word "disease" and "prevention".

The SanBulletin consists of two parts - textual and illustrated. The text is placed on a standard sheet of drawing paper in the form of columns, 13-15 cm wide, typed on a typewriter or computer. It is allowed to write the text in calligraphic handwriting in black or purple ink. It is necessary to highlight the editorial or introduction, the rest of the text should be divided into subsections (headings) with subheadings, which state the essence of the issues and give practical advice. Noteworthy is the presentation of the material in the form of questions and answers. The text should be written in a language that is intelligible to the general public without medical terminology, with the obligatory use of local material, examples of proper hygienic behavior in relation to one's health, cases from medical practice. Artistic design: drawings, photographs, applications should illustrate the material, but not duplicate it. The drawing can be one or more, but one of them - the main one - should carry the main semantic load and attract attention. Text and decoration should not be bulky. The health bulletin ends with a slogan or appeal.

It is necessary to ensure the issuance of a sanitary bulletin at least 1-2 times a quarter.

Health corner. The organization of the corner should be preceded by certain preparatory work: coordination with the leadership of this institution; determination of the list of works and necessary building materials(stands, slats, buttons, glue, fabric, etc.); choosing a place - one where there are constantly or often a lot of people; a selection of relevant illustrated material (posters, photo and literary exhibitions, transparencies, photographs, memos, leaflets, clippings from newspapers and magazines, drawings).

The leading theme of the health corner is various aspects of a healthy lifestyle. In the event of any infection or its threat in the area, appropriate prevention material should be placed in the corner. This may be a health bulletin, a leaflet prepared by the local sanitary and epidemiological surveillance authority, a brief memo, a clipping from a medical newspaper, etc. The health corner should have a question and answer board. Answers to questions should always be timely, efficient and useful.

oral journals. In oral journals, in addition to health workers, traffic police officers, juvenile inspectors, and lawyers should participate. In their reports, they address issues not only of a medical nature, but also affecting legal, social and moral problems. Therefore, in oral journals, several topics can be considered at once.

Disputes and conferences. Debate is a method of polemical discussion of any topical, moral or educational problem, a way of collective search, discussion and resolution of issues of concern to the population. A dispute is possible when it is well prepared, when not only specialists, but also (for example, at school) students and teachers participate in it. Collisions, conflict of opinions are associated with differences in the views of people, life experience, in requests, tastes, knowledge, in the ability to approach the analysis of phenomena. The purpose of the dispute is to support progressive opinion and convince everyone of the rightness.

A form of propaganda close to a dispute is a conference with a pre-designed program and fixed speeches by both specialists and the population itself.

Oral forms of health education propaganda also include themed evenings, round-table discussions, and question-and-answer evenings. Theater and entertainment events, mass sports events can play an important role in promoting a healthy lifestyle. The content of the work in carrying out various forms and methods of hygienic education of the population and promoting a healthy lifestyle at the FAP should be aimed at highlighting the basics of personal and public hygiene, hygiene of the village, town, housing, landscaping and gardening, maintenance of personal plots; to fight pollution environment; prevention of diseases caused by exposure to unfavorable meteorological conditions (high humidity, high and low temperatures, etc.); for implementation physical education in the life of every person. The range of topics of this activity also includes labor and professional orientation: the creation of healthy household and working conditions, the formation of a healthy lifestyle. Much attention should be paid to the prevention of infectious diseases, improvement of water supply and water use. One of the important tasks is to promote occupational health measures in agricultural work, prevent agricultural injuries and poisoning with pesticides, explain hygiene requirements to the delivery, purification and storage of water in the field. A significant place should be occupied by anti-alcohol propaganda, an explanation of the dangers of smoking. Smoking is one of the most common types of addiction. The work of a paramedic in anti-alcohol propaganda should be based on a certain system, including legal, biomedical and moral aspects.

Depending on gender and age, topics can be selected for better perception by listeners.

Sample lecture plans

1. For men: the effect of alcohol on all organs and systems of the body; alcohol and trauma; alcohol and sexually transmitted diseases; alcohol and mortality; alcohol and work capacity; alcohol and family; alcohol and heredity; economic damage caused to the state by persons who abuse alcohol.

2. For women: the effect of alcohol on a woman's body; the effect of alcohol on pregnancy; alcohol and children; the role of women in strengthening the family and overcoming drunkenness of men.

3. For teenagers: anatomical and physiological features of the teenager's body; the effect of alcohol on the body of a teenager; the effect of alcohol on a teenager's abilities; the effect of alcohol on offspring; alcohol and disorderly conduct; how to maintain mental health.

large section preventive work on the education of a healthy lifestyle should be highlighted in pediatrics. Hygienic education and upbringing begins from early childhood, with antenatal protection of future offspring.

Education of a healthy lifestyle and prevention of various diseases should be carried out with pregnant women at prenatal care and group sessions in the form of individual conversations (for example, in the "School of Pregnant Women"). It is desirable to conduct conversations about the hygiene of a pregnant woman and the peculiarities of the newborn period ™ not only among women themselves, but also among their family members, especially husbands in the “School of Young Fathers”.

The need for extensive preventive measures in relation to the child population and youth, including primarily educational and sanitary-educational measures, is also increasing due to the fact that at this age basic behavioral attitudes, attitudes, skills, habits, etc. are formed, i.e. everything that further determines the way of life of a person. During this period, it is possible to prevent the occurrence bad habits, emotional incontinence, passive rest and poor nutrition, which in the future can become a risk factor for many diseases. It is relatively easy for children to cultivate the habit of physical activity, physical education and sports, a varied and moderate diet, and a rational regimen.

Sanitary and educational work at the FAP should be carried out according to a predetermined plan. Drawing up a plan for sanitary and educational work is carried out for the entire current year and for a month. The annual plan provides for the main tasks of protecting health and promoting a healthy lifestyle, and for each month they draw up a specific plan with the names of topics and methods for covering them. At the end of the month and at the end of the reporting year, the medical worker is obliged to report on the sanitary and educational work done.

Hygienic education of the population and promotion of a healthy lifestyle should contribute to early seeking medical care, improving obstetric care, reducing infant mortality, morbidity with temporary disability and injuries, timely hospitalization of patients, attracting the population to preventive examinations, increasing the level of sanitary culture of the population, improving conditions their work and life, the activation of the creative initiative of people in matters of preserving and strengthening health, increasing efficiency and creative longevity.

Fundamentals of the organization and structure of paramedical work. For high-quality medical care, it is necessary to ensure the continuity of the diagnostic and treatment process at all stages of treatment. Here, a clear division of functions at each stage of medical care becomes important. The paramedic is the direct executor of medical prescriptions, must master the simplest resuscitation techniques at the prehospital stage, provide emergency medical care in case of acute illnesses and accidents. Paramedics work in the ambulance service, in clinical diagnostic laboratories and in the feldsher-obstetric station (FAP), where they provide medical care to the rural population.

Paramedics can work both in the lesions and beyond. In some cities, under the leadership of the Center for Disaster Medicine, tactical exercises are conducted for personnel on medical care and interaction with other medical and non-medical formations. Paramedics must be able to work with the equipment that is on the equipment of the ambulance station (electrocardiographs, pneumocomplexes).

Feldsher-obstetric station (FAP) is a primary pre-medical medical institution providing medical and sanitary assistance to the rural population. The medical staff of the FAP carries out a complex of treatment-and-prophylactic and sanitary-anti-epidemic measures on the territory assigned to it, provides the patient with first aid at an outpatient appointment and at home. Medical assistance to patients is provided within the competence and rights of the paramedic and midwife under the guidance of the district doctor.

Main functional responsibilities paramedics. An important section of the activity of paramedics is the provision of medical care to patients at home. The order of treatment of patients at home is determined by the doctors of the district hospital or the central district hospital (CRH) and only in some cases by the paramedic himself. Patients left at home should be monitored continuously until they recover. This is especially true for children. Patients and settlements remote from FAP should be hospitalized; when leaving the patient at home, the paramedic informs the doctor of the rural medical district about this and monitors the patient.

In outpatient care for tuberculosis patients, the paramedic, being the direct executor of medical prescriptions, conducts immunochemoprophylaxis, clinical examination, anti-epidemic measures in the foci of tuberculosis infection, and work on hygiene education. A paramedic working at a FAP must master the simplest resuscitation techniques at the prehospital stage, especially in case of sudden cardiac or respiratory arrest, the causes of which can be severe injuries, blood loss, acute myocardial infarction, poisoning, drowning, electrical injury. The loss of time or the inept actions of the paramedic can lead to sad consequences.

Paramedics and obstetricians working independently are also entrusted with the provision of emergency medical care in case of acute illnesses and accidents. In case of an urgent call, the paramedic must have a suitcase with him, complete with medical equipment and medicines according to the packing list. Paramedics play an important role in medical examination of the rural population. Its main goal is to implement a set of measures aimed at forming, maintaining and strengthening the health of the population, preventing the development of diseases, reducing morbidity, and increasing active creative longevity.

To conduct a general medical examination, a personal registration of the entire population living in the service area of ​​the polyclinic, outpatient clinic and FAP is carried out in accordance with the “Instruction on the procedure for accounting for the annual medical examination of the entire population”. In rural areas, police lists of residents are average medical workers of the FAP. For the personal registration of each resident, paramedical workers fill out a “Medical examination record card” (educational form No. 131 / y-86) and number it in accordance with the number of the outpatient medical card (registration form No. 025 / y). After clarifying the composition of the population, all "Medical examination records" are transferred to the file cabinet.

If persons under dispensary supervision do not come to the doctor, then the paramedic or midwife visits them at home or at work, explaining the need for a medical examination. The paramedic or midwife makes sure that patients who need seasonal (autumn, spring) anti-relapse treatment receive it in a timely manner in a hospital or on an outpatient basis. The quality of the work of paramedics and midwives for medical examination is determined by the timeliness of the appearance of the medical examination and the implementation of medical and recreational activities prescribed by the doctor, as well as the correctness of filling out the control card for dispensary observation (form No.

The proper organization of the examination of temporary disability for FAP is important for reducing the incidence. In accordance with the "Regulations on the head of the feldsher-obstetric station", the head of the FAP - the paramedic may have the right to issue sick leaves, certificates and other medical documents in the manner established by the USSR Ministry of Health. The basis for granting the right to issue sick leave to a paramedic is the petition of the chief physician of the district, which must indicate:
the remoteness of the FAP from the hospital (outpatient clinic) to which he is assigned;
the number of serviced settlements of the state farm and the number of workers in them;
state of communication routes;
the experience of the paramedic and the level of his qualifications;
knowledge and observance by the paramedic of the basics of examinations of temporary disability and the "Instruction on the procedure for issuing sick leaves".

The paramedic keeps records of the issued sick leave in the “Book of Registration of Disability Leaves” (form No. 036 / y) with the obligatory filling in of all its columns. When the doctor closes the sick leave, the patient is on the FAP. The paramedic must fill in the remaining columns of the book; final diagnosis, surname of the doctor who closed the sick leave, for what date the patient is released from work, total number calendar days release from work. Paramedics need to pay special attention correct design, storage and accounting of sick leave, which should be stored in the safe of the FAP, and in its absence, be deposited at the end of the working day in the safe of the state farm.

Therapeutic and preventive care for women and children. At each FAP, the midwife maintains a file of police records of a woman, starting from the age of 18, where they enter passport data, past diseases, information about all pregnancies (years in which each pregnancy ended, complications). The medical assistant (midwife) begins the examination of each pregnant woman at the first visit with a general examination, measures the length and weight of the body, blood pressure on the common arms, determines the condition of the heart, lungs and other organs within her competence, examines the urine for protein. When monitoring pregnant women, the paramedic (midwife) of the FAP is obliged to show each of them to the doctor; in cases where a woman has the slightest deviation from the normal development of pregnancy, she should be immediately referred to a doctor.

An important section of the paramedic's activity is the protection of children's health. Patronage occupies a significant place in this work. According to the current situation, the paramedic (midwife) visits the newborn in the first 3 days after discharge from the maternity hospital; if the first child was born in the family, then he is visited on the very first day after discharge, and in the future - after 2-3 days during the first week and weekly during the first month of life. During the examination, attention is paid to the general condition of the child, as well as to the condition of various organs and systems, especially the nervous system, skin, umbilical ring, and the presence of developmental anomalies.

From sensitive and qualified observation of a child under the age of 1 month. The prevention of septic diseases, the successful treatment of congenital diseases, and, consequently, the health of the child in the future, largely depend. The paramedic (midwife) should see the child during the first year of life 12 times at preventive appointments and 20 times at home patronage. During the second year of a child's life, the paramedic gives a detailed conclusion about his state of health, evaluates his physical and neuropsychic development. This conclusion must be brought to the attention of parents, focusing on the shortcomings, and give recommendations for the further upbringing and improvement of the child.

Paramedic and midwife when serving schoolchildren (where there is no school nurse), must:
take part in medical examinations of schoolchildren conducted by a pediatrician, prepare medical records and fill out their general part; write down an anamnesis, complaints, information about past diseases, vaccinations; carry out anthropometric measurements, determine visual acuity and hearing; send, at the direction of the doctor, to medical institutions for additional laboratory tests, consultations with specialist doctors;
bring to the attention of school teachers the results of medical examinations with the recommendations of medical specialists;
control the organization of a rational regime of the day and nutrition, hygienic education of students, organization of labor education;
exercise control over the observance of the sanitary and anti-epidemic regime, the implementation sanitary requirements to the technology of cooking, washing dishes, as well as compliance with the deadlines for the sale of products and prepared food;
carry out work on the prevention of childhood injuries (including sports), record and analyze (together with the doctor) all cases of injuries;
carry out, after examination by a doctor and under his supervision, preventive vaccinations for students, notifying parents in advance, keep records of them and isolate sick schoolchildren; examinations, thermometry and other measures in relation to children who have been in contact with infectious patients, inform the doctor of the rural medical district, the director of the school in the SES about each case of an infectious disease;
examine students for helminths and, under the guidance of a pediatrician and an epidemiologist, conduct deworming.

One of the important sections of the activity of FAP paramedics is the implementation of primary anti-epidemic measures in the event of outbreaks of infectious diseases, the timeliness and quality of which determine the effectiveness of preventing the spread of infection outside the outbreak. In this regard, the organization of the activities of FAP workers aimed at identifying infectious diseases among the population is of great importance. When establishing the diagnosis of an infectious disease (or suspecting it), the paramedical personnel of the FAP should carry out primary anti-epidemic measures in the outbreak:
isolate the patient at home and organize ongoing disinfection before hospitalization of the patient;
identify all persons who have been in contact with the patient, take them into account and establish medical supervision over them;
to carry out (together with the doctor) quarantine measures in relation to persons who have been in contact with sick people, attending preschool institutions, schools or working at epidemically important facilities;
report at the place of work, study, preschool institutions, at the place of residence about the sick person and the persons who have been in contact with him;
at the direction of a pediatrician or epidemiologist, conduct gamma globulin prophylaxis for those who have been in contact with a patient with viral hepatitis A.

An infectious patient is hospitalized during the first day of the disease on a special transport. In its absence, the patient can be transported by any means of transport with subsequent disinfection. In the future, the medical worker of the FAP follows the instructions of the epidemiologist (assistant epidemiologist) and carries out:
taking material from persons who have been in contact with patients for laboratory research in order to identify bacteria carriers;
vaccinations according to epidemiological indications and chemoprophylaxis.
dynamic monitoring of persons who have been in contact with patients during the incubation period of this infectious disease.

Paramedics and midwives of the FAP play an important role in health-improving activities, hygienic education of the rural population and promotion of a healthy lifestyle. Every year, the district SES draws up a work plan to involve paramedical personnel in the current sanitary supervision, which is approved by the chief physician of the FAP and brought to the attention of all FAPs. In order to correctly assess the level of well-being of the object, paramedics are trained in the simplest laboratory tests, express methods and are provided with field express laboratories. An ordinary automobile first-aid kit can be adapted for a traveling express laboratory, equipped with chemical reagents, indicator paper, cotton wool, tweezers, and instructions. With the help of such a laboratory, it is possible to determine residual amounts of chlorine in disinfectant solutions, on objects and surfaces (starch iodine method), residual amounts of detergents on tableware (phenolphthalein test).

The involvement of FAP paramedics in the current sugar supervision has a positive effect on the quality of sanitary and recreational activities, and contributes to the improvement of the sanitary condition of facilities. The next important section of the work of FAP paramedics is the organization and implementation of antihelminthic measures, the task of which is to identify and timely treat patients, as well as the implementation of a set of measures aimed at improving the focus (settlement) and microfocal of helminthiasis (households, estates, children's institutions). To carry out this work, it is necessary to know the species composition of helminths in a particular area.

Microfoci of helminthiases (ascariasis and trichuriasis) can be detected by examining the soil by sampling from the most fecally contaminated places in household plots. This work should be carried out in conjunction with the SES, but the paramedic organizes the collection of material for laboratory research. In case of mass deworming of the population, the medical staff of the FAP engages a public sanitary asset in its work.

All identified patients with helminthiases in the shortest time subjected to sanitation and report them to the rural medical site. For patients who have undergone treatment, a dispensary observation is established until complete recovery and elimination of the microfocal. The FAP paramedic often has to take part in the analysis of industrial injuries and the development of measures to reduce it. Therefore, he should be well acquainted with the main causes of injuries: technical, organizational and sanitary-hygienic.

More than half of all victims turn to FAP, so the nursing staff is required to constantly improve their knowledge, in particular, in first aid for injuries. Such training of paramedics should be conducted in the surgical room or trauma center of the Central District Hospital. Chief Physician the district hospital (outpatient clinic) and the district surgeon supervise and direct the work of paramedics in providing first aid for injuries.

In addition to providing first aid to the victim, FAP paramedics register and record injuries; identify, study and analyze their causes depending on various factors; together with doctors, develop specific measures to eliminate the identified causes; monitor compliance with safety regulations; train agricultural workers, receiving and providing self-help and mutual assistance. In advanced training of medical personnel of FAP important role plays organizational, methodological and medical advisory assistance provided by their physicians-specialists of the Central District Hospital, rural medical districts during scheduled visits. After an in-depth study of the activities of the FAP, specialists conduct classes with paramedics, at which they analyze in detail the shortcomings in the treatment and prevention work and outline measures to improve it.

One of the effective methods for improving the skills of paramedical workers is the exchange of experience, which provides for a detailed study of the work of an advanced FAP on the spot within 3–5 days. Certification is of great importance for the correct placement of paramedical workers and the improvement of their qualifications. It is an important incentive to improve performance, retain staff in rural areas and necessary condition to determine the compliance of paramedical workers with their position, assess the prospects for their use, as well as to develop new criteria for training and creative initiative.

Laboratory Technician:
Performs laboratory tests in accordance with established load standards and qualification requirements.
Prepares reagents, chemical glassware, equipment, disinfectant solutions for work.
Registers biological material entering the laboratory for research, including using a personal computer, processes the material and prepares for research.
Takes blood from a finger.
Sterilizes laboratory instruments in accordance with current regulations.
Leads necessary documentation(registration, entries in journals, forms of analysis results).
Fulfills the instructions of the head of the CDL for the material and technical support of the laboratory.
Takes part in classes for employees with secondary medical education.
Complies with the rules of safety and industrial sanitation, in accordance with the requirements of the sanitary and epidemiological regime.
Raises professional qualification according to established order.

The medical laboratory technician has the right to:
Make proposals to higher officials on improving the organization and working conditions.
Periodically, in accordance with the established procedure, pass certification for the assignment of a qualification category.
A medical laboratory technician is responsible for failure to fulfill his duties under this regulation and the internal labor regulations.

Equipment. In accordance with the requirements of the Order of the Ministry of Health of the Russian Federation No. 100 of March 26, 1999.
Medical box-laying basic.
Additional medical box to accommodate the birth package, resuscitation kit, infusion solutions.
The electrocardiograph is portable single-channel.
Portable defibrillator with electrocardioscope.
Ventilator type "Pneumocomp" or (and) KI-5.
Apparatus for inhalation anesthesia type AN-9.
Ventilator manual portable type ADR-1200.
Portable glucometer or glucotests.
Tonometer and phonendoscope.
A set of pneumatic and (or) vacuum immobilization tires.
A set of immobilization head holders such as Shants collars.
Vacuum mattress.
Folding stretcher.
Stretcher-cloth type "drag".
Folding wheelchair.
Receiving device with a stretcher.
Support for infusions.
Cylinder oxygen with a reducer of 10 l.
Aspirator portable mechanical or electric.
Furniture for placement of medical equipment and accessories.
Directional lamp in the cabin.
Communication means (radio station or radiotelephone).

Medicines:
Adrenomimetics: dopamine, mezaton.
Adrenergic drugs: isoprenaline (izadrin).
Adsorbents: activated carbon in the table. By 0.5 No. 50.
Analeptics: nikethamide (cordiamin), 2 ml No. 2.
Antianginal agents: nitroglycerin tab. 0.0005 No. 40, isosorbide dinitrate (isoket, nisopercutene), aerosol - 1 vial.
Antiarrhythmic drugs: novocainamide, finoptin.
Antibiotics: chloramphenicol, streptomycin.
Antihistamines: diphenhydramine, calcium chloride 10%, tavegil, pipolfen, suprastin.
Antiseptics: iodine 5% alcohol solution, potassium permanganate, hydrogen peroxide 3% - 30 ml, brilliant green solution - 10 ml.
Anticholinergics: atropine 0.1% - 1 ml No. 10.
Bronchodilators: berotek (aerosol), 1 vial.
Vitamins: ascorbic acid 5% - 1 ml No. 10, pyridoxine, thiamine chloride, cyanocobalamin.
Ganglioblockers: Pentamine 5% - 1 ml No. 4.
Hypotensive: clonidine (clophelin, hemiton) 0.01% - 1 ml No. 2.
Hormonal agents: hydrocortisone, 0.025 (0.05) with a solvent - 1 amp., Insulin 400 units. - 10 ml., norepinephrine, oxytocin, prednisolone - 30 mg No. 10, adrenaline 0.1% - 1 ml No. 10.
Infusion agents: sodium chloride 0.9% - 500 ml No. 2, glucose 5% - I - 500 ml No. 2, polyglucin - 500 ml, reopoliglyukin 500 ml, hemodez - 400 ml, gelatinol, disol, etc.
Local anesthetics: novocaine, trimecaine, lidocaine, chloroethyl.
Muscle relaxants: muscle relaxin (listenone) 2% - 5 ml No. 1.
Diuretics: furosemide (lasix) 1% - 2 ml No. 2.
Narcotic analgesics: morphine - 2 amps, omnopon - 2 amps, promedol - 2 amps, fentanyl - 2 amps.
Non-narcotic analgesics: analgin - 4 amps, tramal - 2 amps.
Antipsychotics: chlorpromazine - 3 amps, droperidol 0.25% - 10 ml - 1 amp No. 1.
Antidotes: unithiol - 1 amp., Naloxone - 1 amp.
Antimalarials: Chloroquine (Delagil, Chingamine).
Sedatives: tincture of valerian or valocordin.
Cardiac glycosides: strophanthin-K - 4 amps, corglicon - 4 amps, digoxin - 2 amps.
Antispasmodics: eufillin 2.4% - 10 ml - 2 amps, dibazol - 5 amps, no-shpa - 3 amps, magnesium sulfate 25% - 5 amps, baralgin - 2 amps, papaverine hydrochloride (or platifillin) - 5 amp.
Alcohols: ammonia 10 ml, ethyl alcohol 96% 30 ml, ethyl alcohol 70% 30 ml.
Means that affect blood coagulation: aminocaproic acid - 100 ml, vikasol, heparin - 5000 IU per 1 ml, dicynone.
Means for anesthesia: nitrous oxide 5 l, ketamine (calypsol, ketalar) 10 ml, sodium oxybutyrate 20% - 10 ml.
Central nervous system stimulants: caffeine 20% - 1 ml No. 2.
Tranquilizers: diazepam (relanium, seduxen, sibazon), 3 amp.
Thrombolytic agents: streptokinase 250,000 units.
Cholinolytics: scopolamine 0.05% - 1 ml 2 amp.
Aerosol anti-burn "Panthenol" or analogues - 1 vial.
Vaseline oil, 30.0.
Dressings: sterile bandages of various sizes - 6 pcs., adhesive plaster, sterile wipes of various sizes - 20 pcs., hemostatic wipes (or sponges) - 2 pcs.

Instrumentation and patient care items: scissors, tweezers - 2 pcs., hemostatic clamps - 2 pcs., mouth expander, tongue holder, scalpel - 2 pcs., a set of air ducts and endotracheal tubes, a rechargeable laryngoscope with removable blades, a probe for gastric lavage with a funnel (adult and child), rubber urinary catheters.
Mechanical hemostatic tourniquet with dosed compression.
Venous tourniquet for intravenous injections.
Pipette, plastic beaker, thermometer in a case, disposable spatulas - 10 pcs., disposable sterile syringes with needles of various capacities - 10 pcs., a device for opening ampoules.
Systems for transfusion of blood substitutes disposable sterile - 2 pcs.
Disposable sterile rubber gloves - 2 pairs, disposable sterile catheters for peripheral veins - 2 pcs., disposable apron.
A container with a disinfectant solution for used needles, a bag for used syringes.
Epidemiological layout (formed in accordance with the action plan when a patient with AIO is detected, see above - scheme No. 2 in the section "Basic orders regulating work".
Sterile generic package: Kocher clamp - 2 pcs., scissors - 1 pc., umbilical cords - 5 pcs., napkins - 5 pcs., ligature - 1 pc., diaper - 1 pc., rubber pear - 1 pc.
Resuscitation package (box): sets of endotracheal tubes and air ducts, a device for conducting closed heart massage of the “Cardiopamp” type, a device for ventilation of the type of bag “Ambu” (for adults and children), a set for vascular catheterization, a set for conicotomy, disposable syringes of various capacities - 5 pcs., systems for transfusion of blood substitutes - 2 pcs., infusion solutions of 500 ml - 3 pcs., portable aspirator, mouth expander, tongue holder.
Inventory: pillow, blanket, set of linen (preferably disposable), towel, soap.
Note: these medicines can be replaced with analogues or supplemented with new ones. medicines, registered and permitted for use in the Russian Federation.