Twenty (20) new emergency medical services standards.

Development 

In accordance with Article 37 of the Federal Law of November 21, 2011 No. 323-FZ “On the fundamentals of protecting the health of citizens in the Russian Federation” (Collected Legislation of the Russian Federation, 2011, No. 48, Art. 6724; 2015, No. 10, Art. 1425 ) I order:

1. Approve the standard of emergency medical care for hypertension in accordance with.

IN AND. Skvortsova
Standard

Hypertensive encephalopathy

2. Medical services for the treatment of disease, condition and treatment monitoring

3. List of medicinal products for medical use registered on the territory of the Russian Federation, indicating average daily and course doses

*(1) - International statistical classification of diseases and related health problems, X revision

*(2) - The probability of providing medical services or prescribing drugs for medical use (medical products) included in the standard of care, which can take values ​​from 0 to 1, where 1 means that this activity is carried out by 100% of patients corresponding to this model, and numbers less than 1 indicate the percentage of patients with appropriate medical indications specified in the standard of medical care.

*(3) - international nonproprietary or chemical name of the medicinal product, and in cases of their absence - trade name of the medicinal product

*(4) - average daily dose

*(5) - average course dose

Notes:

1. Medicines for medical use registered on the territory of the Russian Federation are prescribed in accordance with the instructions for use of the medicinal product for medical use and the pharmacotherapeutic group according to the anatomical-therapeutic-chemical classification recommended by the World Health Organization, as well as taking into account the method of administration and use medicinal product.

2. The prescription and use of drugs for medical use, medical devices and specialized medical nutrition products that are not included in the standard of medical care are allowed in the case of medical indications (individual intolerance, for health reasons) by decision of the medical commission (part 5 of article 37 of the Federal Law of November 21, 2011 No. 323-FZ “On the fundamentals of protecting the health of citizens in the Russian Federation” (Collected Legislation of the Russian Federation, 2011, No. 48, Art. 6724; 2015, No. 10, Art. 1425)).

Document overview

A new standard of medical care has been approved, defining the basic requirements for the diagnosis and treatment of patients with hypertension. The standard is recommended for use in emergency medical care (including specialized care).

The standard of emergency medical care for diseases characterized by high blood pressure is no longer valid.

Dear colleagues!

In accordance with the Federal Law of December 25, 2018 No. 489-FZ “On Amendments to Article 40 of the Federal Law “On Compulsory Health Insurance in the Russian Federation” and the Federal Law “On the Fundamentals of Protecting the Health of Citizens in the Russian Federation” on clinical recommendations » clinical guidelines are now defined as a document containing structured information based on scientific evidence on issues of prevention, diagnosis, treatment and rehabilitation.

This Federal Law defines a transition period until December 31, 2021, necessary for the revision and approval of clinical recommendations in accordance with the standards introduced by the bill. Approved clinical recommendations will contain parameters reflecting the correct choice of diagnostic and treatment methods based on the principles of evidence-based medicine. The use of clinical recommendations will allow medical professionals to determine the tactics for managing a patient with a specific nosology at all stages of medical care.

Clinical recommendations will be used as the basis for the development of other documents regulating the process of providing medical care, including standards and procedures for providing medical care, as well as criteria for assessing the quality of medical care. Thus, at the end of the transition period, a comprehensive quality management system for medical care will be created, based on clinical recommendations that take into account the best global practices.

The Ministry of Health of the Russian Federation has issued a number of orders regulating the work on the formation of clinical recommendations:

1. Order of the Ministry of Health of Russia dated February 28, 2019 No. 101n “On approval of criteria for the formation of a list of diseases, conditions (groups of diseases, conditions) for which clinical recommendations are developed.” Currently, this list is posted on the website of the Ministry of Health of the Russian Federation https://www.rosminzdrav.ru/poleznye-resursy/nauchno-prakticheskiy-sovet;
2. Order of the Ministry of Health of Russia dated February 28, 2019 No. 102n “On approval of the Regulations on the Scientific and Practical Council of the Ministry of Health of the Russian Federation”;
3. Order of the Ministry of Health of Russia dated February 28, 2019 No. 103n “On approval of the procedure and timing for the development of clinical recommendations, their revision, the standard form of clinical recommendations and the requirements for their structure, composition and scientific validity of information included in clinical recommendations”;
4. Order of the Ministry of Health of Russia dated February 28, 2019 No. 104n “On approval of the procedure and timing for the approval and approval of clinical recommendations, criteria for the scientific and practical council to make a decision on approval, rejection or referral for revision of clinical recommendations or a decision on their revision.”

According to the order of the Ministry of Health of Russia dated February 28, 2019 No. 103n, “Medical professional non-profit organizations develop draft clinical recommendations and organize their public discussion, including with the participation of scientific organizations, educational organizations of higher education, medical organizations, medical professional non-profit organizations, their associations (unions ) specified in Part 5 of Article 76 of Federal Law No. 323-FZ, as well as by posting on the Internet information and telecommunications network.

According to Order of the Ministry of Health of Russia No. 102n dated February 28, 2019, after development, clinical recommendations will be further considered by the Scientific and Practical Council of the Ministry of Health of Russia and approved, rejected or sent for revision in accordance with the deadlines and criteria regulated by Order of the Ministry of Health of Russia 104n.

If the scientific and practical council of the Russian Ministry of Health makes a positive decision, clinical recommendations are approved by professional non-profit organizations.

In connection with the above, we inform you that the medical professional non-profit organization Union of Pediatricians of Russia has begun developing clinical recommendations for diseases, conditions (groups of diseases, conditions) included in the List for which clinical recommendations should be developed/updated. .

We also inform you that the formation of working groups will be carried out in cooperation with medical professional non-profit organizations in the relevant profiles and will include, among other things, specialists providing medical care to patients of the adult age category.

The Union of Pediatricians of Russia widely involves professional communities, as well as scientific, educational organizations and the public in the formation of clinical recommendations.

President of the Union of Pediatricians of Russia,
Chief freelance pediatric specialist in preventive medicine of the Russian Ministry of Health,
acad. RAS L.S. Namazova-Baranova

Honorary President of the Union of Pediatricians of Russia,
Chief freelance specialist pediatrician of the Russian Ministry of Health,
acad. RAS A.A. Baranov

• Vaccinal prevention of hemophilus influenzae type b infection in children
• Vaccinal prevention of diseases caused by human papillomavirus
• Vaccinal prevention of pneumococcal infection in children
• Vaccinal prevention of rotavirus infection in children
• Very long chain fatty acid acyl-CoA dehydrogenase deficiency in children
• Immunoprophylaxis of meningococcal infection in children

Order of the Ministry of Health and Social Development of the Russian Federation dated April 16, 2012 N 366n
"On approval of the Procedure for the provision of pediatric care"

The Procedure for the provision of pediatric care has been approved. It applies to all medical organizations.

Assistance is provided in the form of primary health care, emergency and specialized medical care. In this case, different conditions are possible.

The first is outside the medical organization (at the place where the ambulance is called, as well as in a vehicle during medical evacuation).

The second is outpatient (in conditions that do not provide round-the-clock medical supervision and treatment).

The third is in a day hospital (in conditions that provide observation and treatment during the day, but not around the clock).

The fourth is inpatient (in conditions that provide round-the-clock observation and treatment).

The rules for organizing the activities of a local pediatrician's office, a children's clinic (department), a consultative and diagnostic center for children, and a pediatric department are given. For each of these structures, recommended staffing standards for medical personnel and equipment standards have been determined.

Just a couple of weeks ago, the Faculty of Medical Law introduced readers and subscribers to the list of newly introduced standards of medical care in the article “The Ministry of Health has approved new standards of medical care for the use of psychoactive substances” (publication dated July 13, 2016). And again, the Russian Ministry of Health “released” a whole series of standards of medical care regulating the rules for providing medical care for extremely serious diseases.

Thus, in July 2016, the following 20 new emergency medical care standards were approved. Please note that not all of these standards are the first of their kind. Thus, previously, for some diseases, standards had already been adopted, which became invalid since the adoption of new standards of medical care.

So, in July 2016, the following standards of medical care were adopted, the scope of which had already been regulated:

• Standard for emergency medical care for bradycardia (approved by Order of the Ministry of Health of Russia dated July 5, 2016 No. 453n) - comes into force on August 2, 2016. From this moment on, the Standard for emergency medical care for bradyarrhythmias, approved by Order of the Ministry of Health of Russia dated July 7, 2013 No. 359n, has become invalid.
• Standard of emergency medical care for sudden cardiac death (approved by Order of the Ministry of Health of Russia dated July 5, 2016 No. 454n) - comes into force on July 29, 2016. From this moment on, the Standard of Emergency Medical Care for Sudden Cardiac Death, approved by Order of the Ministry of Health of Russia dated December 20, 2012 No. 1113n, became invalid.
• Standard of emergency medical care for cardiogenic shock (approved by Order of the Ministry of Health of Russia dated July 5, 2016 No. 455n) - comes into force on July 31, 2016. From this moment on, the Standard of Emergency Medical Care for Cardiogenic Shock, approved by Order of the Ministry of Health of Russia dated December 24, 2012 No. 1432n, has become invalid.
• Standard of emergency medical care for acute coronary syndrome without ST segment elevation (approved by Order of the Ministry of Health of Russia dated July 5, 2016 No. 456n) - comes into force on July 30, 2016. From this date, the Standard of emergency medical care for acute coronary syndrome without ST segment elevation, approved by Order of the Ministry of Health of Russia dated December 24, 2012 No. 1387n, became invalid.
• Standard of emergency medical care for acute transmural myocardial infarction (approved by Order of the Ministry of Health of Russia dated July 5, 2016 No. 457n) - comes into force on August 6, 2016. From this moment on, the Standard for emergency medical care for acute coronary syndrome with ST segment elevation, approved by Order of the Ministry of Health of Russia dated December 24, 2012 No. 1383n, has become invalid.
• Standard of emergency medical care for acute respiratory failure (approved by Order of the Ministry of Health of Russia dated July 5, 2016 No. 458n) - comes into force on August 6, 2016. From the same date, the Standard of Emergency Medical Care for Acute Respiratory Failure, approved by Order of the Ministry of Health of Russia dated December 20, 2012 No. 1080n, became invalid.
• Standard for emergency medical care for pneumonia (approved by Order of the Ministry of Health of Russia dated July 5, 2016 No. 459n) - comes into force on July 29, 2016. From this date, the Standard of Emergency Medical Care for Pneumonia, approved by Order of the Ministry of Health of Russia dated December 24, 2012 No. 1437n, became invalid.
• Standard of emergency medical care for heart failure (approved by Order of the Ministry of Health of Russia dated July 5, 2016 No. 460n) - comes into force on July 20, 2016. From this moment on, the Standard of Emergency Medical Care for Heart Failure, approved by Order of the Ministry of Health of Russia dated December 20, 2012 No. 1283n, has become invalid.
• Standard for emergency medical care for fainting (syncope) and collapse (approved by Order of the Ministry of Health of Russia dated July 5, 2016 No. 461n) - comes into force on August 5, 2016. From this date, the Standard for emergency medical care for fainting, approved by Order of the Ministry of Health of Russia dated December 24, 2012 No. 1398n, became invalid.
• Standard of emergency medical care for tachycardias and tachyarrhythmias (approved by Order of the Ministry of Health of Russia dated July 5, 2016 No. 464n) - comes into force on August 5, 2016. From the same date, the Standard for emergency medical care for tachyarrhythmias, approved by Order of the Ministry of Health of Russia dated December 20, 2012 No. 1284n, became invalid.
• Standard of emergency medical care for acute cerebrovascular accident (approved by Order of the Ministry of Health of Russia dated July 5, 2016 No. 466n) - comes into force on July 29, 2016. From this date, the Standard for Emergency Medical Care for Stroke, approved by Order of the Ministry of Health of Russia dated December 20, 2012 No. 1282n, became invalid.
• Standard of emergency medical care for convulsions, epilepsy, status epilepticus (approved by Order of the Ministry of Health of Russia dated July 5, 2016 No. 468n) - comes into force on July 29, 2016. from this date, it lost the Standard of Emergency Medical Care for Convulsions, approved by Order of the Ministry of Health of Russia dated December 20, 2012 No. 1082n.
• Standard of emergency medical care for status asthmaticus (approved by Order of the Ministry of Health of Russia dated July 5, 2016 No. 469n) - comes into force on July 31, 2016. From this moment, the Standard of emergency medical care for status asthmaticus, approved by Order of the Ministry of Health of Russia dated December 20, 2012 No. 1087n, has become invalid .
• Standard for emergency medical care for hypertension (approved by Order of the Ministry of Health of Russia dated July 5, 2016 No. 470n) - comes into force on July 31, 2016. From this date, the Standard for emergency medical care for diseases characterized by high blood pressure, approved by Order of the Ministry of Health of Russia dated December 20, 2012 No. 1513n, became invalid.
• Standard of emergency medical care for doubt, stupor, unspecified coma (approved by Order of the Ministry of Health of Russia dated July 5, 2016 No. 471n) - comes into force on July 29, 2016. From this date, the Standard for emergency medical care for unspecified coma, approved by Order of the Ministry of Health of Russia dated December 20, 2012 No. 1431n, became invalid.

The following standards are fundamentally new:

• Standard of emergency medical care for meningitis (approved by Order of the Ministry of Health of Russia dated July 5, 2016 No. 462n) - comes into force on July 29, 2016.
• Standard of emergency medical care for acute headaches (approved by Order of the Ministry of Health of Russia dated July 5, 2016 No. 463n) - comes into force on July 31, 2016.
• Standard of emergency medical care for myasthenia gravis (approved by Order of the Ministry of Health of Russia dated July 5, 2016 No. 465n) - comes into force on August 5, 2016.
• Standard of emergency medical care for bleeding from the upper respiratory tract (pulmonary hemorrhage) (approved by Order of the Ministry of Health of Russia dated July 5, 2016 No. 467n) - comes into force on July 31, 2016.
• Standard of emergency medical care for inflammatory polyneuropathy (approved by Order of the Ministry of Health of Russia dated July 5, 2016 No. 472n) - comes into force on August 6, 2016.

The Faculty of Medical Law reminds that standards of medical care are developed in accordance with the nomenclature of medical services and includes average indicators of the frequency of provision and frequency of use:

• medical services;
• medicinal products registered on the territory of the Russian Federation (indicating average doses) in accordance with the instructions for use of the medicinal product and the pharmacotherapeutic group according to the anatomical-therapeutic-chemical classification recommended by the World Health Organization;
• medical devices implanted into the human body;
• blood components;
• types of medical nutrition, including specialized medical nutrition products;
• otherwise based on the characteristics of the disease (condition).

At the same time, all standards of medical care differ from each other and reflect the specifics of a particular disease.

More detailed content of the above standards can be found on the website of the Faculty of Medical Law in the “” section.

MINISTRY OF HEALTH OF THE RUSSIAN FEDERATION

ORDER

In accordance with Article 37 of the Federal Law of November 21, 2011 N 323-FZ “On the fundamentals of protecting the health of citizens in the Russian Federation” (Collected Legislation of the Russian Federation, 2011, N 48, Art. 6724; 2015, N 10, Art. 1425)

I order:

1. Approve the standard of emergency medical care for hypertension in accordance with the appendix.

2. Recognize as invalid the order of the Ministry of Health of the Russian Federation of December 24, 2012 N 1513n “On approval of the standard of emergency medical care for diseases characterized by high blood pressure” (registered by the Ministry of Justice of the Russian Federation on February 27, 2013, registration N 27355).

Minister
V.I.Skvortsova

Registered
at the Ministry of Justice
Russian Federation

registration N 42897

Application. Standard for emergency medical care for hypertension

Application
to the order
Ministry of Health
Russian Federation
dated July 5, 2016 N 470n

Floor: any

Phase: acute condition

Stage: any

Complications: regardless of complications

Type of medical care: ambulance, including specialized emergency medical care

Conditions for providing medical care: outside a medical organization

Form of medical care: emergency, emergency

Average treatment time (number of days): 1

Hypertensive encephalopathy

2. Medical services for the treatment of disease, condition and treatment monitoring

3. List of medicinal products for medical use registered on the territory of the Russian Federation, indicating average daily and course doses

Notes:

1. Medicines for medical use registered on the territory of the Russian Federation are prescribed in accordance with the instructions for use of the medicinal product for medical use and the pharmacotherapeutic group according to the anatomical-therapeutic-chemical classification recommended by the World Health Organization, as well as taking into account the method of administration and use medicinal product.

2. The prescription and use of drugs for medical use, medical devices and specialized medical nutrition products that are not included in the standard of medical care are allowed in the case of medical indications (individual intolerance, for health reasons) by decision of the medical commission (part 5 of article 37 of the Federal Law of November 21, 2011 N 323-FZ “On the fundamentals of protecting the health of citizens in the Russian Federation” (Collected Legislation of the Russian Federation, 2011, N 48, Art. 6724; 2015, N 10, Art. 1425)).

Electronic document text
prepared by Kodeks JSC and verified against:
Official Internet portal
legal information
www.pravo.gov.ru, 07.20.2016,
N 0001201607200004