Vol 342, No 8 (2021)

An analysis of the modern regulatory framework governing the provision of the high - tech assistance to military personnel outside military medical organizations is carried out. Incomplete compliance of bylaws with the current federal legislation was revealed, which in a number of cases may limit the right of military personnel to free medical care, enshrined in the Constitution of the Russian Federation and the Federal Law «On the Status of Military personnel». The ways of bringing the legislation in line with the actual state of the country’s modern health care are proposed: approval of new Rules for reimbursing medical organizations for the costs of providing medical care to military personnel, amendments to the Federal Law of 27.05.1998, No. 76-FZ «On the status of military personnel», which will allow military personnel to in exceptional cases, seek emergency assistance in the organization of a private health care system.

Optimal conditions and the best results of treatment of victims (including military personnel) with polytrauma are achieved in level I trauma centers. The key factor in the success of treatment is the possibility of prompt medical evacuation of victims, even in an extremely serious condition, from trauma centers of levels III-II to central and district clinical hospitals, which are analogs of level I trauma centers. The area of medical responsibility of the chief medical specialists of the Western Military District includes 26 constituent entities of the Russian Federation, and the victims are primarily delivered to the medical organizations of the Ministry of Health. In this regard, the process of making managerial decisions to determine surgical tactics and carry out a medical evacuation of victims to trauma centers of military medical organizations of a higher level is complicated and time - consuming. The analysis of treatment and medical evacuation of 258 victims with severe trauma accompanied by shock and (or) coma in the Western Military District in 2015-2020, including 131 (89.9%) - with polytrauma (ISSі18). Medical evacuation was carried out in 232 cases (89.9%). Digital software solutions have been developed to optimize, accelerate the collection and transmission of objective information about the severity of the injury and the transportability of victims.

In the program for combating cardiovascular diseases in the Armed Forces of the Russian Federation, an important place is given to the prevention of sudden cardiac death. At the same time, the group of maximum risk includes military personnel with combined coronary and non - coronary pathology, in which there are objective difficulties in diagnosis, conservative treatment, and the provision of high - tech medical care. A clinical case of subtotal atherosclerotic heart disease with dissection of the coronary artery proceeding under the mask of chronic exudative pericarditis against the background of acquired heart disease is presented. The tactics of managing such patients are analyzed from the standpoint of evidence - based medicine.

In a unselected single - point indiscriminate study, the features of remodeling of the left ventricular myocardium in hypertension in military personnel with increased body weight were studied. The study involved 82 patients. It was found that with arterial hypertension combined with increased body weight, as well as with arterial hypertension without increased body weight, hypertrophy of the left ventricle of the heart develops, leading to myocardial remodeling. Moreover, the higher the body mass index, the longer the duration of the disease.

The study aims to determine the features of the etiological structure of acute respiratory infections in military groups. The contribution of various pathogens of respiratory infections of a viral and bacterial nature to the structure of infectious pathology of the respiratory tract of personnel of 8 military teams in the territory of the Ural, Volga, and Siberian federal districts during the epidemic season 2019-2020 is shown. The causative agents of respiratory diseases were determined by the polymerase chain reaction method. The leading role in the epidemic process was played by viruses of non - influenza etiology (pathogens of parainfluenza, adenovirus, respiratory syncytial infection), causing mono - and mixed infection of military personnel. The share of causative agents of influenza was 3-20.8%, causative agents of acute respiratory viral infections of non - influenza etiology - up to 62.5%, Chlamydia pneumoniae - up to 29.1%.

Individual and personal characteristics of pilots are considered, linking the uncertainty of the professional situation, firstly, with information; secondly, with knowledge, abilities, skills, experience; thirdly, with a negative emotional state. It is discussed within the framework of the developed concept of «professional - role» trust of a specialist, his idea of actions in a situation of uncertainty and risk. The results of the study showed that pilots who associate uncertainty with the quality of the information received trust not only themselves but are also focused on joint activities and interaction with their colleagues, demonstrate three types of professional strategy - for themselves, for others, and the situation. Pilots who define uncertainty as a lack of knowledge, skills, and abilities, emphasize the importance of knowing the algorithms of activity, assessing the social situation and themselves in it, they are characterized by confident behavior, orientation towards interaction. The leading strategies in professional activity are focusing on oneself and one’s knowledge, on another. For pilots who describe uncertainty as an emotionally significant situation, the leading strategy is to focus on themselves, to assess their ability to cope with the situation.

Institutions of self - regulation and co - regulation in the field of health protection as a form of partnership between the state and business are analyzed. Studied the constitutional and legal problems of self - regulation and co - regulation in health care. Self - regulation as a form of partnership between business and government has drawbacks due to insufficient protection of citizens’ rights. The institute of co - regulation, which is applied in Russia in the medical field, can become a substitute for the institute of self - regulation.

A clinical case description provides an analysis of a complicated and rarely found in medical practice diagnostic situation - the development of heart attack - like changes on the electrocardiogram in a young patient after drinking alcohol without signs of chronic alcohol abuse. With suspicion of myocardial infarction, the patient was sent for examination to a hospital. After additional examination, including coronary angiography, the diagnosis of myocardial infarction was excluded.

The experience of the medical supply of troops (forces) shows that the effectiveness of the functioning of this important component in the structure of military health care largely depends on the level of training of the pharmaceutical personnel. The article describes the historical evolution of the training of pharmaceutical personnel for the army and navy of Russia from the era of Peter I to the present. The contribution of the Military Medical (Medico - Surgical) Academy to the formation and development of domestic pharmaceutical education, education, and training of pharmaceutical specialists was highly appreciated. The article describes the modern multi - level system of training pharmaceutical personnel for the army and navy of Russia, which implements the educational «trajectory» - specialty, residency, magistracy, and postgraduate studies. The prospects for the development and improvement of this system in the interests of preserving and strengthening the health of military personnel are shown.