An emergency physician is a representative of the only profession in medicine whose task is to provide urgent (emergency) medical care on call.

An ambulance doctor goes to the scene of an accident, disaster, accident or home, carries out emergency measures, saves the patient’s life and transports him to the hospital. The emergency doctor’s task is to gain time to relieve the severity of the problem and connect a doctor to treatment in an operating room or intensive care ward. And during mass disasters, doctors must triage the victims, help security forces and rescuers.

Emergency care is provided at any time of the day, in any weather, under any conditions. The work schedule includes daily duty (24 hours), during which a maximum of 15 calls are made. The medical care team consists of a general practitioner or paramedic, a nurse and a professional driver.

Ambulance teams can be linear and advisory (specialized).

• Linear performs the entire scope of emergency care, regardless of the specialty.
• Advisory deals only with highly specialized care: cardiological, psychiatric, gynecological, obstetric, neurological, traumatological, pediatric, neonatological.

An emergency doctor does not treat patients, he provides first aid (resuscitation) for burns, shock, poisoning, angina attacks, renal and hepatic colic, conditions requiring surgical intervention, bleeding, asphyxia, hyperthermia, pre-stroke, pre-infarction, suicide attempt, accident case of drowning.

The meaning of emergency measures is the immediate arrival of emergency doctors after the call. However, the radius of its provision can be so large that it is not possible to arrive to the patient in a timely manner. In this case, doctors have to declare death. The fatal outcome is confirmed by emergency doctors even in the case when the arrival turns out to be impeccable in terms of timing, but the patient dies regardless of this due to the severity of the condition.

The doctor’s task is to gain time to relieve the patient’s dangerous condition.

Differences between an EMS doctor and a paramedic

The difference between a doctor and a paramedic is their qualifications.

Places of work

The position of an emergency medical doctor (EMS) is available in any EMS station or substation, in clinics and hospital inpatient units. In addition, doctors work as part of the air ambulance and the Ministry of Emergency Situations.

History of the profession

For the first time, attempts to organize an ambulance in Rus' were made by F. Rtishchev, who during the war with the Poles collected the wounded on the battlefield and delivered them to nearby cities for care. Subsequently, the functions of emergency medical care were delegated to firefighters and police officers for a long time.

They tried to open the first official emergency hospital in 1818, but it did not receive government approval. Only ten years later, a service for providing emergency care to patients was organized in St. Petersburg. However, it was financed on a residual basis and eked out a miserable existence. With the development of industrial production in cities, the pace of life has noticeably accelerated. Transport appeared, manufactories, plants, and factories opened. They were equipped with advanced technology that created a risk of injury. Life itself dictated the conditions for the emergence of emergency services.

The reason for its final formation was the stampede on Khodynka. More than 2,000 died, many because there was no one to provide emergency assistance. The first ambulance station opened in Russian Warsaw (1897), and then, a year later, in Moscow. But the date of birth of the ambulance is considered to be 1927, when a whole fleet of ambulances was organized. In Moscow, the position of a shift doctor, a dispatch center, and a cover sheet were approved, and in 1957 the first ambulance appeared in Leningrad. A year later, a team appeared to provide assistance for heart attacks and strokes.

Emergency care is provided around the clock and under any conditions.

Responsibilities of an emergency physician

The main responsibilities of an emergency physician are as follows:

• Monitoring the health of the team, its equipment with tools and medicines.
• Receiving a call from the dispatcher and sending it on a route within a minute (the age, address, and complaints of the patient are specified in advance).
• Providing emergency medical care, diagnosing the problem, making decisions on further management of the patient.
• Transporting the patient to a specialized hospital with intensive care if necessary. If the patient refuses hospitalization, it is obligatory to note this on the appointment sheet, indicating the reason and the measures taken.
• Providing assistance in case of an accident on the street, outside of a call, if one is encountered along the route. Mandatory notification to the dispatcher in order to transfer the call to another team.
• Consultation of patients and relatives orally without issuing prescriptions or certificates.
• Ascertainment of death.
• Maintaining a cover sheet indicating the time the call was accepted, the mileage of the trip, the time of arrival at the place, the manipulations performed, the diagnosis and recommendations, or the point of transportation.

Requirements for an emergency physician

Basic requirements for an emergency physician include:

• Higher medical education, current accreditation certificate for emergency medical care.
• Knowledge of medical ethics when communicating with patients and their relatives.
• Resuscitation skills: closed cardiac massage, mouth-to-mouth breathing, tracheotomy, administering medications in various ways.
• Proficient in medical equipment for ECG, ultrasound, and cardiac pacing.

The specialist does not treat patients, but provides first aid or resuscitation.

How to become an emergency doctor

To become an emergency physician, you must:

• Graduate from a university or medical school with a degree in General Medicine or Pediatrics.
• Receive an accreditation sheet. To do this, you need to pass an exam and successfully pass an interview with an expert commission.
• After this, you can work with patients on an outpatient basis (for example, a therapist or pediatrician).
• To obtain a narrow specialization, you can enroll in a residency (2 years of study) in the specialty “Emergency Medical Care”. Paid is easier, because The competition is small and for admission you only need 50 certification points. For free You can get into residency in two ways: through a competition on a general basis or through a targeted referral from the chief physician of a medical organization in which the specialist is already working.

Every year, doctors are required to score 50 certification points. To do this, you can take advanced training courses (36 points), attend scientific and practical conferences (the number of points depends on the event, but usually about 10 points), publish scientific papers, write books, defend dissertations. If you have collected enough points, you can continue working. If the points are not scored, then you will have to either stop practicing medicine or solve this problem in “non-standard” ways.

The experience, skill and quality of the doctor’s work are usually assessed qualification categories, which can be obtained by defending a research paper. During the defense, the commission evaluates the doctor’s skills in the field of diagnosis, treatment, prevention, as well as the relevance of his knowledge.

What are the qualification categories:

• second – over 3 years of experience;
• first – more than 7 years of experience;
• Higher - more than 10 years of experience.

The qualification category allows you to occupy high positions in medical institutions, gives the right to a salary increase, gives status in the professional environment and high trust from patients. Even more respect can be achieved by speaking at conferences, symposiums and writing scientific articles and papers.

A doctor has the right not to qualify, but this will hinder his career and professional growth.

Emergency doctor salary

The general income range is as follows: emergency doctors earn from 26,500 to 150,000 rubles per month. Ambulance doctors are most in demand in the Moscow, Leningrad, Novosibirsk regions and Krasnodar Territory. We found the minimum salary from a doctor in the city of Bataysk (Rostov region): 26,297 rubles per month, the maximum in one of the St. Petersburg enterprises: 150,000 rubles per month.

The average salary of an emergency doctor is 31,000 rubles per month.

Where to get training

In addition to higher education, there are a number of short-term training on the market, usually lasting from a week to a year.

The Medical University of Innovation and Development invites you to take distance courses in retraining or advanced training in the direction of "" to receive a diploma or state certificate. Training lasts from 16 to 2700 hours, depending on the program and your level of preparation.

A paramedic is a medical worker with secondary specialized education. Despite the fact that he is not a doctor, in some cases it is the paramedic who provides medical assistance to the population. First of all, this applies to working in an ambulance.

What are the responsibilities of a paramedic working as part of an ambulance team?

It depends on who is part of the ambulance team.

A paramedic assists a doctor if the ambulance team includes both a doctor and a paramedic. However, such cases are quite rare. More often there are situations when a paramedic works alone on the road and is forced to perform the functions of an emergency doctor. In this case, full responsibility for the treatment of the patient rests only with the paramedic.

Ambulance Paramedic Skills

The functionality of an ambulance paramedic (According to Order of the Ministry of Health of the Russian Federation dated July 23, 2010 No. 541n) is very diverse.

The list of basic skills that an emergency medical technician must have includes:

mastery of injection techniques (all types), the ability to install a “dropper” in a high-quality manner;

taking an electrocardiogram;

measurement of blood pressure, pulse, respiratory rate;

assistance during childbirth; necessary manipulations with the newborn;

treatment of wounds and injuries;

resuscitation procedures;

organization of patient transportation;

organization of anti-epidemic measures, etc.

A paramedic working independently in an ambulance must prove himself as a universal specialist. In different situations, he performs the functions of a surgeon, a traumatologist, and a therapist; he must also be familiar with the basics of toxicology, pediatrics and obstetrics, be able to assess the neurological and mental state of the patient, conduct the necessary research and draw conclusions from the data obtained.

In the case of an ambulance, the personal characteristics of the health worker also matter.

A paramedic working in an ambulance must make quick and responsible decisions, often under time pressure, in extreme conditions, and in the absence of the necessary equipment.

Therefore, it is good if he:

has a stable psyche;

confident in himself and his knowledge and capabilities;

diversified;

knows how to think logically;

friendly, welcoming and attentive.

The last point may seem insignificant, but it is not. Establishing contact with the patient is extremely important not only to facilitate communication, but also to establish a more complete picture of the disease. In addition, it is important to reassure the patient in a timely manner, to give him the opportunity to feel that there is a highly qualified specialist next to him who can help him.

Paramedic training

Working in an ambulance is different from working in any other medical institution - it requires special knowledge. Therefore, in addition to the requirements mandatory for any paramedic, such as secondary specialized education in the specialty "General Medicine", an ambulance paramedic must have a certificate as a specialist in "Ambulance and emergency care"

Emergency Medical Assistant Certificate

A document confirming completion of training in the specialization “Ambulance and emergency care” - a certificate - can be obtained after retraining. Currently, various options for taking courses are being implemented: full-time, part-time and distance learning.

After completing the course. You can work in an ambulance. only if you have this document.

Demand for the profession of emergency medical assistant

Ambulance paramedic is a very popular profession, but, unfortunately, not very prestigious.

The need for specialists is felt almost everywhere.

However, recently the specialty of an ambulance worker has become not only responsible and difficult, but also dangerous. Increasingly, there is information about an attack on an ambulance employee by inappropriate patients and their relatives. This cannot but lead to an outflow of employees.

Currently, there is an active discussion of legislative measures aimed at protecting doctors during execution. As one of the measures, the possibility of legally equating doctors with police officers is being discussed - with all the ensuing consequences for attackers. But this is in the future.

Average salary for emergency medical assistants

Salaries for ambulance paramedics vary in different regions. In Moscow, the average figure is about 45 thousand rubles, in the regions - less, about 20-25 thousand

Benefits for ambulance paramedics

Ambulance paramedics have a number of additional payments and benefits that other categories of health workers do not have:

additional payment (currently – 3500 per month);

additional payments for an understaffed team (not paid in all regions and in different amounts);

shortened working day of 6.5 hours (38.5 hours per week);

additional leave for those who have worked for more than 3 years – 3 additional calendar days;

right to early retirement.

Why do specialists go to work in Ambulance?

The job of an ambulance paramedic is not easy and not very lucrative. Therefore, turnover in this area is very significant.

Therefore, one of the important problems for the entire ambulance service is the insufficient staffing of mobile teams. Increasingly, only one physician works in a field team - usually a paramedic.

But the health workers themselves admit that salary is not the main thing for them. Here are the answers of several ER employees when asked why they work there:

A person does not go into medicine for money. And to provide assistance, to save people’s lives. It's adrenaline when you save a person... Everyone who is not suitable for this job leaves after a year. And whoever remains will never leave. It’s such a thrill to understand that you are needed... At work, every challenge is a surprise, an adventure, a feeling of being needed when you manage to help people... Thanks to this work, I realize my place in life. I don’t want to say pompous words about saving lives and the nobility of the profession, but knowing that your work brings not just joy, but the opportunity to live on is worth a lot...

Pros and cons of being an emergency medical technician

the opportunity to provide real help to a person, even saving a life;

shorter training period compared to a doctor;

high demand;

stable schedule;

benefits and social guarantees

high responsibility;

heavy work schedule;

work in stressful situations;

low salary.

Photo: Press service of the Mayor and Government of Moscow. Denis Grishkin

Today, Moscow's emergency medical service is one of the best in the world.

The Moscow ambulance service is 100 years old. Sergei Sobyanin visited the A.S. Ambulance and Emergency Medical Care Station. Puchkov, got acquainted with the work of the unified city dispatch center and the medical evacuation department. He also inspected the equipment installed in the resuscitation vehicle. In particular, the Mayor of Moscow was shown an automatic cardiopulmonary resuscitation system.

“Moscow ambulance is something to be proud of. Indeed, Muscovites are proud: 95 percent of residents believe that the ambulance service in the city works well. And this is perhaps the most important record for ambulance services, which beat the indicators of all other services in terms of the positive attitude of Muscovites. Congratulations. Thank you to the ambulance workers for their amazing selfless work for the benefit of Muscovites,” said Sergei Sobyanin.

More than 15 thousand calls per day

A unified city dispatch center for ambulance and emergency medical care appeared in the structure of the station in 2017. Its employees receive and process calls to numbers 103 and 112 around the clock, and supervise mobile ambulance and emergency medical care teams. Their responsibilities also include sorting calls by reason, urgency and profile of the teams. They are also responsible for transmitting calls for execution, conducting remote (telephone) consultations with medical specialists, and interacting with emergency services (including in the event of an emergency).

“A few years ago there were several centers in Moscow. These are emergency care, which was scattered across several clinics, and an ambulance. We decided to merge, to create a single dispatch center, which now determines when to send an ambulance and when to send an emergency. And the efficiency of doctors’ work has increased significantly – by one and a half times. At the same time, informatization and modernization of the service was carried out - new equipment and new technology were purchased. And, of course, today a fairly effective chain has been built - from receiving a call from a patient, preliminary diagnosis, sending an emergency room or ambulance, delivery to the hospital to providing assistance to the patient. Today, ambulance service is one of the best in the world, not only in terms of speed, but also the efficiency of decisions made,” said Sergei Sobyanin.

The dispatch center receives more than 15 thousand calls every day. Process calls and manage field teams using automated information systems and GLONASS satellite navigation. All teams have tablet computers connected to the EMIAS system. This allows the doctor to see the patient’s electronic card data on the way to him.

Resuscitator at the A.S. Ambulance and Emergency Medical Care Station. Puchkova Evgeniy Danilov said that the tablet computer displays all stages of the call. It also allows you to view the electronic patient record, estimated time of arrival to the patient, distance to the patient and other information on the call.

“On the way to the patient, we can look at the card; it displays nosological units and diagnoses that the patient has, which were entered by the clinic doctor. There is a list of doctors to whom the patient contacted,” said Evgeny Danilov. “I’m going on a call and can already imagine what I’ll encounter, what diagnoses and what kind of patient, what I can expect on the call,” he noted.

Sergei Sobyanin noted that the electronic card will continue to be filled with laboratory tests, CT and MRI images and other information.

“It is very important that we have such a connection between the patient, the hospital, the ambulance, and the dispatcher. This greatly improves efficiency. Whether the ambulance arrived quickly or slowly is very important, of course, but it is also important that the work be effective at all stages: preparation for departure, receiving a signal, doctor’s request, ambulance team, departure time, arrival time and, in the end, if If a person has some kind of problem, the time it takes for him to be on the operating table is the most important indicator,” the Moscow Mayor emphasized.

In addition, an information monitor has been installed in the unified city dispatch center, on which you can see in real time how often people are currently seeking emergency medical care.

About 200 people work at the center per shift, 70 of them are dispatchers who receive calls on phone 103. One dispatcher receives an average of 350 calls per day. All of them have secondary medical education. 30 senior doctors consult patients remotely. Among them are pediatricians, psychiatrists and obstetricians-gynecologists. 27 dispatchers are responsible for transferring calls to field teams.

The average age of dispatch center employees is 48 years. The youngest specialist is 21 years old, the most experienced is 74.

The medical evacuation department is responsible for transporting sick and injured people to hospitals in the city. The automated “Hospital” system is used, which helps to choose a hospital taking into account the disease and location of the patient, as well as based on the number of available beds in a particular medical institution. For example, if a person is diagnosed with vascular pathology, then, if possible, he will be sent to one of the specialized vascular centers.

The medical evacuation department also monitors the workload of hospital departments, as well as the performance of field teams. Department employees transfer sick and injured people from one medical organization to another, organize the evacuation of victims in mass disasters and emergency situations. They register and transmit information about cases of mass diseases of infectious diseases, and help determine the route for patients with chronic renal failure to undergo outpatient hemodialysis. It is this department that receives requests from medical organizations to send specialized emergency advisory mobile teams. In addition, daily reports on the “Stationary” information interaction program are sent here.

Places for medical evacuation of patients are provided by 28 dispatchers and three doctors. They also accept applications related to the delivery of patients for outpatient hemodialysis.

In the dispatch center and in the medical evacuation department there are rooms for psychological relief and rest, as well as canteens.

Moscow ambulance: equipped, fast, efficient

This year, the international consulting company PwC studied the work of ambulance services in 15 major cities around the world: Moscow, Paris, Shanghai, Delhi, Mexico City, London, Berlin, Singapore, Seoul, Sao Paulo, Rome, Hong Kong, Tokyo, New York and Johannesburg. Experts assessed the speed of work of mobile teams, the availability of emergency medical care, and patient satisfaction.

Thus, the Moscow ambulance service ranks second in efficiency among similar services in megacities around the world, second only to Berlin. New York is in third place, followed by Paris and Singapore. In addition, the capital's ambulance is in the top 3 in terms of equipment. The Berlin service is in first place, the Johannesburg service is in second place, and the New York and Paris services are in fourth and fifth place, respectively.

Every ambulance in Moscow has devices for monitoring heart rate and other vital signs, artificial ventilation devices, restraints, electrocardiographs, defibrillators, 90 types of medications, 30 types of standard medical equipment.

“For example, we have a high-quality artificial lung ventilation device with the ability to ventilate children weighing up to ten kilograms, various fusomators and perfusors for high-precision dosing of drugs during their intravenous administration, various equipment for the treatment of complex cardiac arrhythmias with the possibility of electrical cardiac stimulation. And we have a modern device for providing artificial blood circulation during cardiac arrest - the so-called AutoPulse system,” noted Evgeniy Danilov.

If previously a transported patient experienced clinical death, the ambulance had to stop so that doctors could perform cardiopulmonary resuscitation. Now this can be done while the ambulance is moving, which allows you to quickly deliver the patient to the hospital.

“I think the equipment we have is decent. And in practical terms, it is excellent, because at the pre-hospital stage we can apply those procedures, those manipulations that some of our colleagues can only dream of,” added Evgeniy Danilov.

The capital's ambulance service turned out to be the second in the number of teams per 100 thousand people (8.2 teams). London's ambulance service is in first place (38.1 brigades), followed by Hong Kong (5.2) in third place, followed by Shanghai (3.3) and Tokyo (1.8).

The average response time of a Moscow ambulance operator is only four seconds. This is the best indicator among similar services in megacities around the world. In second and third place are the ambulance services of Berlin and Rome, where the average response time is nine seconds. Next are the London ambulance (20 seconds) and the New York ambulance (one minute 10 seconds).

The average time for registering a call to a Moscow ambulance was one minute 42 seconds. This is the second most efficient indicator. The Berlin ambulance is in first place (one minute), the New York ambulance is in third (one minute 52 seconds), then the Singapore and Paris ambulances (two minutes 21 seconds).

In Moscow, from the registration of an appeal to the departure of the team, two minutes and 30 seconds pass, in New York - five minutes, in London - seven minutes and 24 seconds.

The Moscow ambulance is also the fastest to respond to a call. From the moment the brigade is called until its arrival, an average of 14 minutes and 34 seconds pass. In London - 17 minutes 13 seconds, in New York - 17 minutes 55 seconds, in Berlin - 21 minutes 9 seconds.

The ambulance satisfaction index in Moscow was 95 percent, in Paris - 96 percent, New York - 94 percent, Singapore - 93 percent, Berlin - 90 percent.

Four million trips a year

The first centralized city ambulance station opened in Moscow on October 15, 1919. The first to arrive to the patient - a man with a broken leg - was doctor Leonid Ovosapov.

At that time, the ambulance service was located in three rooms of the former Sheremetevskaya hospital on Bolshaya Sukharevskaya Square. A little later, in 1923, the Institute of Emergency Care was created on the basis of the hospital. Since 1929, it has been named N.V. Sklifosovsky.

In 1923, the ambulance station was headed by Alexander Puchkov (1887-1952). The medical institution was named after him in 1995. It was under him that the position of senior doctor on duty was introduced here.

Alexander Puchkov developed the basic principles of organizing emergency medical care, which were introduced not only in Moscow, but also in many other cities and are still used today. For example, he created an accounting and reporting system, a silent call system, introduced indicators of free teams, and team priority numbers. He led the station until his death.

Today the Ambulance and Emergency Aid Station named after A.S. Puchkova is the largest medical organization in Moscow. It includes 60 substations and 107 posts. 30 of them are located on major highways (including 10 on the Moscow Ring Road), 77 are open at hospitals and clinics.

Specialists provide emergency and emergency care for diseases, accidents, injuries, poisoning and other conditions requiring urgent medical intervention for both adults and children.

The station employs 11.4 thousand people, of which 2.5 thousand are doctors and 8.4 thousand are paramedical personnel. 1040 mobile teams have been formed, of which:

— 913 general-purpose teams;

— 108 specialized teams, including 26 anesthesiology and intensive care teams (four pediatric), 62 pediatric and 20 psychiatric teams;

— 19 specialized emergency advisory teams, including two each of cardiology, neurology, infectious diseases, obstetrics and gynecology, neurosurgical, urology, four teams of anesthesiology and neonatal resuscitation, one cardiology (pediatric), vascular surgery and ophthalmology. There are 186 emergency medical teams (98 for adults and 88 for children).

Medical teams make 12 thousand visits per day. That's four million trips a year.

The average time of arrival to a call (excluding time to register a call) is 12.7 minutes. The team gets to emergency calls faster - in 9.4 minutes, and to road accidents - in 7.7 minutes.

On average, 50 minutes pass from the arrival of the team to the patient to his delivery to the hospital. During this time, the patient is examined, given pre-hospital care, a hospital is selected and brought there. One team travels up to 15 times a day and travels 70 kilometers daily.

Among the station’s employees are three doctors and 70 candidates of medical sciences. About half of the specialists have the first or higher qualification category. 75 employees received the status of “Moscow doctor”. 220 people have been working at the station for more than 40 years, 200 of them are women.

In 2011-2019, five substations were put into operation, including in Troitsk and Nekrasovka. By the end of the year they plan to complete the construction of a substation on Letchika Babushkina Street. Plans for the coming years include five more new substations.

At the Puchkov station and 54 substations, major or current repairs were carried out. In 2019-2021, work will be carried out at almost 20 more sites.

Hi all! I haven’t written for a long time, I had problems and things to do! I will slowly catch up. So, time passes. Everything is falling into place, so let’s continue with the doctor’s notes.

Many people ask me, what is unusual in your work? What are the disadvantages of this profession? I often clarify what people are interested in, so today I will publish the disadvantages of our work, and why you shouldn’t work for an ambulance. Everything written will be purely my personal opinion and the opinion of my colleagues, so let’s go!

Why you shouldn't work in an ambulance.

1. RESPONSIBILITY

Too superficial an examination of the patient, inattention, incomplete clarification of the history of the disease (i.e. anamnesis), a couple of incorrect instructions - and the person may become worse, not better. For example, the administration of narcotic analgesics for cardiac asthma alleviates the patient’s condition, but for bronchial asthma it can quickly kill him.
Each team is given several ampoules of narcotic and psychotropic drugs, which are subject to strict accounting. Empty ampoules are handed over. Losing or accidentally breaking ampoules (even empty ones) is an emergency. At best, you will be left without a bonus. At worst, a criminal case will be opened against you for drug trafficking with all the ensuing consequences, up to and including time in prison.

2.PARONAIDAL PEDANTRY

It is necessary to fill out medical documentation very clearly and carefully. Unfortunately, all people are mortal and will die sooner or later. But relatives sometimes believe that doctors are to blame for everything, and not the patient himself, who spent most of his adult life drinking, smoking or lying on the sofa watching TV. They can write a complaint against a health worker to high authorities and file a lawsuit, and the call card will be read more than once by “interested parties.” In any case, you will spend a lot of nerves, even if the court acquits you. All documents must be written as if the prosecutor will read them tomorrow.
And if you are lucky and no one has filed a complaint against you, you should not relax: medical documentation is routinely read by higher officials and inspectors. In an ambulance, on almost every shift you have to communicate with the police, the Ministry of Emergency Situations and periodically give evidence.

I remembered a joke: to participate in May Day demonstrations before 1917 you had to have courage, after 1917 you had to have cowardice.

3. EXTREME OPERATING MODE.

You don't know where you will be in 5 minutes. Your work shift may start a few minutes earlier than expected (emergency call during rush hour) and end much later. Office workers, bored by monotonous activities, in order to somehow distract themselves, jump with a parachute, play paintball, dig and dive. (Although I have many hobbies))) As far as I know, ambulance workers do not suffer from this. Maybe I'm wrong?
But that's not all. In an ambulance, you have a chance to get dirty not only with blood, but also with vomit and other physiological secretions (I won’t list them). You try, of course, to do everything extremely carefully, but only those who do nothing make no mistakes. I will modestly keep silent about the smells.

It was in the ambulance that I was able to get up close and personal with lice and bedbugs for the first time and saw unafraid cockroaches. Senior colleagues say that they have also seen live maggots in old wounds. It’s okay, this is how wounds were treated during the Great Patriotic War: maggots ate dead tissue and thereby cleaned the wound.
What do you want?
Emergency doctors are on-call attendants. Attitudes towards health workers have now changed significantly. Whereas before it was a more respected profession, now we can get hit and beaten, especially when dealing with drunk people. They even planned to buy special personal protective equipment (shock guns, gas canisters) for the ambulance, but they didn’t buy it. Is it possible to use a stun gun on a client who is always right?

4. WORK ON HOLIDAYS AND WEEKENDS.

“We work where everyone relaxes.” This is the motto of not only gynecologists, but also ambulances. There are no days off in the ambulance. On New Year's Day you usually have to work either December 31st or January 1st. How could it be otherwise if these two days contain four 12-hour shifts?
In addition, during public events (City Day, Victory Day, etc.) additional ambulance teams are on duty. And not always for double payment. And sometimes there are also explosions.

5. STUPID CHARGES

It happens that we are accused of stealing personal belongings. Most often, lonely grannies are guilty of this. The most anecdotal incident in my memory was when my grandmother accused the ambulance crew of stealing a washcloth. Granny later found a washcloth, but she probably still had an unpleasant aftertaste.

6.CARRYING PATIENTS AND MEDICAL EQUIPMENT

If the patient cannot walk on his own or for medical reasons he cannot walk, we ask relatives to help or find stronger neighbors. But there are situations when there is no one to ask (lonely people in a private house, late at night, etc.). Therefore, you have to pull the stretcher mainly on yourself. The main scourge is the LAST floors!! I don’t know why, but basically all sick people live on the top floors!!
The driver also usually helps, but our patients often weigh 100 kg, and it is very difficult to take them down the narrow stairs in the Khrushchev building, where there is not even an elevator. You can’t turn around with a hard stretcher, but soft ones cut your hands. The patient usually has to be dragged in an uncomfortable and unphysiological position.

There are more and more cars on the streets. We risk getting into an accident, especially when driving with flashing lights (the speeds are high, but we may not give way). It is not yet customary for us to insure medical workers at the expense of the employer.
The quality of roads is a separate matter. Due to the constant shaking on the Gazelles, my back often hurts.
Constantly moving along busy streets forces you to breathe in exhaust fumes. We have a mountainous area, so there are problems getting to the place of call.

8. SEASONS

This is work in the hot summer at +35°C in the shade, when the car probably heats up to +50° (air conditioners appeared only recently, but not everywhere). And working in cold weather at −28°, when you have to get into a completely frozen car in the dead of night. Going on call in heavy rain and thunderstorms, when there is a danger of being struck by lightning (to be honest, it was scary a couple of times).

9. DISTURBED DAY ROUTINE

The generally accepted mode of work in an ambulance (every two or three days, or a day, a night, 2 days off) is flawed in itself. At night you really want to sleep, even if you sleep during the day. To be fully functional, night shifts must be consistent. From physiology I remember that the body adapts to the change of day and night during the week. Thus, night work in an ambulance is violence against the body.

10. INTERACTION WITH HOSPITALS.

In the emergency department of hospitals they look at the ambulance in much the same way as Bin Laden looks at America. Some people probably still believe that ambulances look for patients around the city on their own, out of nothing to do. Hospitals, as a rule, are packed to capacity, so there is nowhere to put patients, and it is dangerous to send them home. The emergency department shows miracles of resourcefulness, sending the patient to another hospital. You have to stand your ground, bang your fist on the table and slyly slip in a referral for hospitalization: “Of course, we will go there right away, but you must write your refusal here.” Half the time the last phrase has an effect

There are probably other disadvantages to the work... But what am I talking about! I chose this kind of work myself. So it’s more like just whining! But we are people too, so I want to talk about it. Well, that’s all for now. If you have any questions, please leave a comment!

Important to know! How does emergency medical care work?

Specialists of the Emergency Medical Aid Station named after. A.S. Puchkova is always ready to help in word and deed. However, it is important to know in which cases it is right to call an ambulance, and in which situations you can handle it yourself.

The most common situations when an ambulance is called are related to high fever during colds and flu. It should be noted that the temperature varies. So, everything that is not higher than 39-40 degrees, can often be cured on your own and, in general, is a normal protective reaction of the body to the presence of viruses in it and passes in 2-3 days. This is the case when the local doctor of your clinic will always help, and before his visit you can use a fairly simple and well-known therapy at home. The rest (higher temperature and a longer period of exacerbation) is a good reason to call a team of doctors (paramedic) to your home.

If we are talking about an acute pathology, a sudden illness, a sharp deterioration in the condition of a chronic patient, or a serious injury, of course, you need to call immediately 103. If help is required for a patient suffering from one or another chronic disease without an exacerbation, No the need to contact emergency medicine specialists, since this is not their prerogative.

The fact is that ambulance teams do not have the right to prescribe systemic treatment and medications for regular use (for example, for hypertension, etc.), leave any certificates or write prescriptions. In case of chronic diseases, it is important to constantly monitor patients, to be able to assess their condition over time, and, if necessary, to adjust therapy (replacing the drug or its dosage). If there are no indications for inpatient treatment, then the patient needs to be observed by a local doctor or specialist doctors at a district clinic. An ambulance can only provide one-time (emergency) assistance. This is not always right for the patient. Therefore, there is no need to unnecessarily expose your body to potent drugs. As a rule, they are what emergency workers use, since they are not faced with the task of long-term systemic treatment.

Often, after completing a call, ambulance workers leave a so-called “asset to the clinic,” that is, they call the local or on-duty doctor from the district clinic to the patient. But you can do this yourself, without forcing the team to travel to the patient only to then call and get a local police officer for him. A doctor from the clinic will come on weekends and holidays. It should be noted that a doctor from a clinic comes to the patient’s actual location, regardless of where he is registered and which clinic he is attached to, whether the patient has an insurance policy or not - the doctor will come to the house in any case.

In case of a minor injury that is not life-threatening, you should go to the emergency room at your place of residence - they will provide full assistance and prescribe further treatment. If the emergency room doctor deems it necessary to carry out further treatment in a hospital, he will write a referral and call a team to transport the patient to the hospital.

At the Station there is 24-hour emergency departments for children and adults to provide assistance to the population in connection with diseases that do not require emergency hospitalization (for example, fever, cough, runny nose, headache, etc.). A qualified doctor (pediatrician or therapist) responds to the call and can provide emergency medical care at home and give recommendations. In cases where the doctor suspects a disease requiring hospital treatment, he will give a referral or call an ambulance for medical evacuation of the patient.