The Russian Way

A different structure of prehospital care & disaster response


 
 

Rick Patrick, MS, EMT-PJeffrey Lindsey, PhD, EMT-P | | Saturday, July 26, 2008


Zdrastvuyte! (Hello)

In October 2005, an EMS and Disaster Relief Professional Delegation of 24 emergency response personnel departed forRussia as part of a People to People Ambassador program. Our mission was to learn more about the Russian culture and their response to emergency medical and disaster incidents.

The Russian culture had a definite mystique when we arrived inMoscow on Oct. 19, 2005, and were greeted by our national guide, Arkady Semyonov. After a two-hour ride from the airport to the hotel, we noticed the traffic inMoscow was much worse than rush-hour traffic inWashington,D.C.,New York orLos Angeles. In fact, traffic inLos Angeles was ˙country roadÓ driving compared toMoscow, minus the car horns. With the addition of 500 licensed vehicles a day, rush hour inMoscow never ends.

The country transitioned from communism to democracy less than two decades ago, so it's still in its infancy stage. Yet the population ofMoscow currently exceeds 10-million residents in a 380-square-mile area. The suburbs add an additional 5 to 7 million residents. It's a city vibrant with activity, with new construction abound.

City Rescue Service

The first portion of the trip was toMoscow with the city's disaster response personnel. The delegation met with the Moscow City Rescue Services, which functions as a rescue service across all disciplines of emergency services. Director Andrey Kravtsev provided a comprehensive overview of the city's rescue services.

There are more than 200,000 injuries and approximately 30,000 deaths inMoscow every year from motor vehicle collisions. The leading cause of death is vascular disease followed by cancer. Trauma is the number one cause of death among the young and third in overall deaths. Seatbelt use is rare, and drinking and driving is a major concern.

The Moscow City Rescue Service provides many services similar toU.S. emergency-dispatch protocols, including a 0-911 service, where 60 dispatchers handle 25,000EMS and rescue calls per day. The rescue personnel provideEMS and stabilize the patient(s) until the ambulance arrives. The rescue service has more than 800 crews that work 24-hour shifts. In 2004, they responded to 8,000 fire calls, 25,000EMS calls and 33,000 police calls. In their 10-year existence, they've handled 55 million calls.

The Moscow Rescue Service begins recruiting efforts as young as adolescents. Much like an explorer program in theU.S., the Rescue Service has a program for 14Ï18 year olds. Those enrolled in the program do community services, such as cleaning houses for residents or taking patients to doctors' appointments. The explorer-type program feeds the Rescue Service with providers.

The city also emphasizes prevention. As a result of their active risk and safety programs, they've only had one line-of-duty death in 10 years. The team concept is strong, and retention and provider tenure is evident. The service's executive director stresses the importance ˙to not fire anyone.Ó Top supervisors are held accountable to instill and maintain a positive and a safe culture.

Personnel are required to go through rigorous testing prior to joining the team and must be retested every six months to stay on the team. As part of their testing, they go through physical and psychological screenings and must meet certain education requirements. The service looks for a personnel with a variety of expertiseƒdoctors, nurses and firefightersƒwho must become experts in mountain climbing and rescue diving. Additionally, they videotape each response, which enables them to review all calls and make improvements.

Another beneficial technique is a weekly meeting with all response services to coordinate mutual efforts. This approach has also been applied to unified response training. The Rescue Service has been the leader in this coordination effort, which has proven effective during major events with multiple services responding.

Funding for the Rescue Service is unique; it receives funds only from an information service it provides. Individuals can call the information line for almost anything required, whether it's reservations for dinner at a certain restaurant or a dentist appointment. A fee is charged for this service, and the money collected is used to fund the Rescue Service.

When asked about basic challenges they've experienced during mass casualty and disaster events, the initial response was, ˙same as theU.S.Ó They pointed out three additional concerns: batteries not being charged, not having gas in generators, or not having a back-up plan.

All-RussianCenter

TheAll-RussianCenter for Disaster Medicine is also located inMoscow and is the headquarters for all disaster response in the country. Professor Sergey Goncharov and the center director lead a team of experts in discussions about various functions and services that are provided throughoutRussia. Their main purpose is to respond to disaster events and establish field hospitals. They provide all logistical support for the field hospitals once established.

The center is also the focal point for research studies in various medical aspects. In addition to providing response to their home country, the center sends teams of personnel to other countries. During our visit, they had deployed a team to assist victims of an earthquake inPakistan that provided assistance to more than 400,000 people. They've also sent teams toTurkey,Afghanistan,Sri Lanka,Iran andColumbia.

Their response teams are similar to the Disaster Medical Assistance Teams (DMAT) in theU.S. and efficient in their deployment. Crews on the rapid reaction brigade are on duty and ready to respond 24 hours a day. Once activated, their response times are typically within 10Ï15 minutes. On arrival to the scene, field hospitals are deployed, and they're ready to receive patients within 20 minutes. The remainder of staff and equipment are typically deployed within two hours of receiving the call.

The field hospitals have necessary equipment to function as a hospital, and all units are self-sustaining. They've also had a high level of success in preventing infections from surgeries. During their response inChechnya, they conducted more than 8,000 pediatric surgeries and had no resulting infections. The center also has telemedicine units equipped for videoconference in disaster areas, which provides better communication and additional resources to field personnel.

As part of the research efforts during their time at the center, responders focus on topics ranging from space exploration to diving and firefighting, with an emphasis on the human factors and the psyche of individuals. It was apparent during our time with our Russian colleagues that the mental health of their personnel was prioritized, conducting a lot of research in this area, including utilizing a biorhythm magnetic device to assist personnel in relieving the stress. This treatment was found to be successful 80% of the time. The center also publishes the Journal for Disaster Response Medicine.

In addition, the center runs the air medical program for the country in a total of 85 units with 70 branches in remote areas. The program employs more than 2,000 personnel, has a 24-hour dispatch service and employs six resuscitation vehicles. These vehicles can be loaded into an aircraft and deployed in many areas in the country. In addition, the patient receives continuous care during the flight to the hospital.

St. Petersburg

We arrived in the city ofSt. Petersburg after a two-hour bus ride. The 60-km city has a population of more than 4.5 million residents. Known as the ˙Venice of Russia,ÓSt. Petersburg comprises 41 islands, with a number of rivers and canals. It has 447 bridges (some of which are drawbridges) that create a hindrance for emergency responders. The hustle and bustle of downtownSt. Petersburg is reminiscent of a busy American city. There's a definite Western feeling about it.

The delegation's second portion of professional development began at the St. Petersburg Ambulance Service, which was established in March 1899, which originally had two horse-drawn carriages and two sanitary workers on duty at each station. Over time, the organization progressed to its current state of 24 substations, with 180 teams of personnel who work 24-hour shifts. Staffing is the envy of any EMS agency in theU.S. because they respond with three to four personnel per unit, depending on the incident type.

The unit is composed of any combination of doctors, nurses and felcures (physician assistants), with ambulance drivers selected from an agency that trains them as professional drivers. They have a variety of specialty units who respond depending on the type of call, including an obstetric, surgical and intensive care, cardiac intensive care, neurological intensive care, pediatrics, and neonatal care. Most of their ambulances are Ford, although some are Russian domestic vehicles.

The ambulance service also has a disaster response team that consists of six medical management and information personnel, five managers of disaster relief and 11 operations personnel. In a disaster, the first arriving team conducts an initial size-up and provides a report to headquarters, where the decision is made to deploy additional resources. They operate on the outer parameters of an incident scene. Two of these disaster teams can be fully deployed within one hour. The service is funded by the City ofSt. Petersburg.

The everyday ambulance call inRussia has both similarities and differences from theU.S. Most of the treatment is done in the patient's home with an average 30% transport rate to one of eight ambulance hospitals that are located throughout the city. The services dispatcher decides where the patient should be transported on the basis of the patient's condition, as well as the availability and capability of the hospital. The average transport time is usually in excess of one hour (traffic inSt. Petersburg was no different thanMoscow).

The ambulance service is fully supported by the city's budget, and we're told volunteers aren't common inSt. Petersburg. Unlike the Moscow Rescue Service, St. Petersburg Ambulance doesn't crosstrain with fire and police personnel. Last year, it responded to more than 450,000EMS calls.

ElizavetinskyHospital

On the last day of our professional meetings, we had the opportunity to meet with the staff and to tour theSt. PetersburgElizavetinskyHospital, one of eight ambulance hospitals in the city. Staffed with 340 physicians and 650 nurses, it has two cardiac units, a neurological department, three surgery departments, two trauma departments, a gynecology and urology department, a therapy department, a GI department, an ENT department, and an ultrasonic and X-ray department. Dr. Boris Tayiz, chief physician and chief executive officer, led the tour, which was proceeded by a question and answer session. The hospital is one of eight ambulance hospitals located in the city.

Dr. Tayiz stated that the emergency department (ED) generates about 90% of the hospital's patients and sees around 200 patients per day. In the winter, they see anywhere between 250 and 280 patients per day; in the summer, they see fewer patients. Regardless, the busiest time of day is typically between 4 and 11 p.m.

The hospital has 1,200 beds but is capable of deploying 3,000 beds during a disaster. The hospital personnel receive specialized training to prepare for disasters and war. The hospital has implemented a triage system that has anElizabeth monitor, which tracks every patient in the ED by updating the status of each patient in the main terminal every 30 minutes. The information on the monitor displays the time, patient's name and where the patient is located. If the patient is in the ED for longer than two hours (the maximum time the patient should wait before being either admitted or discharged), a doctor assigned to this function begins to question why the patient is still there. At this point, the hospital's philosophy is that the patient should either be admitted or discharged home.

Our national guide pointed out that much of the health care inRussia is dependent on the ability to pay for services, so the more money you have, the greater services you receive. This was particularly referenced in how nursing homes operate and was evident by the variety of facility decor during the hospital tour.

Summary

We observed several similarities and differences between emergency and disaster response inRussia and theU.S. The core concepts of planning, preparation, response and recovery (PPRR) were valued by our Russian colleagues. The Russian view, structure and response to EMS and disaster incidents have certain differences from theU.S., which can offer assistance in developing a more efficient and effective response operation.

The experience we gained from being part of the People to People Ambassador program was invaluable. The professional meetings allowed us to learn about the Russian culture, administration and response, such as how they handle emergency calls, transport patients in heavy traffic with few line-of-duty deaths and triage patients in the event of a disaster or war. As tourists, we gained insight into the rich history ofRussia and the formerSoviet Union, where only 15 years ago we may not have had the same opportunity.


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