Vol 39, No 4 (2020)

It is difficult to overestimate the Importance of the quality of first aid in saving the lives of the wounded, improving the outcomes of injuries and improving the effectiveness of the system of medical care in war. According to the literature, in a number of armed conflicts of the late XX – early XXI centuries, the share of first aid measures performed in almost half of cases did not exceed 50 % in the structure of those in need of these measures, and of the dead, more than 30 % had injuries compatible with life.

AIM: To analyze the legal and regulatory aspect of the organization of first aid in civil and military health care. Identify problematic legal issues in the provision of first aid to military personnel in combat conditions and formulate proposals for their solution.

MATERIALS AND METHODS: Data from domestic and foreign literature sources, dissertations and research papers, Internet sources, Federal and departmental regulatory legal acts in the field of first aid organization are analyzed. We used logical and comparative-historical methods, as well as the method of system analysis.

RESULTS: The article analyzes data from the literature, Internet sources, and the legal framework for the organization of first aid in civil and military health care. There are legal problems in expanding the scope of first aid by including medical care measures (pre-medical, primary medical care in emergency form) in combat conditions. Proposals for their solution are formulated.

CONCLUSION: The system of first aid organization for military personnel of law enforcement agencies and departments in combat conditions has a number of problematic issues that require regulatory regulation. It is necessary to develop regulatory legal acts (the Decree of the RF Government, the order of the Minister of Defense of the Russian Federation), regulating first aid in combat conditions to organize in the new Center for tactical medicine training of specialists of divisions and parts of special purpose law-enforcement ministries and departments of the Russian Federation to enter the Russian Ministry of defense Institute Chief off-staff specialist on first aid, to whom to entrust the task of uniting the efforts of specialists Main Military Medical Department of the Ministry of the Russian Defense Ministry and other cooperating ministries and agencies (1 table, bibliography: 20 refs).

The options of formalization of some tasks of medical support are offered: the choice of rational routes of evacuation of the wounded and sick, the choice of rational loading of transporters with the wounded and sick. It is planned to implement them in automated medical service management systems as part of special mathematical support. Special attention is paid to the use of geoinformation technologies. It is assumed that the automated control system will link each helicopter, each combat vehicle and individual soldier into a single system and will allow in the near future to obtain the necessary information about the physical state of the soldier’s body, the presence of injuries and the degree of their severity, and a preliminary forecast of the outcome of the injury. You need to find routes from each source to some destination that have the following properties: the greatest usefulness of visiting the selected nodes; restrictions on the total volume or mass of objects loaded at these nodes; restrictions on the total volume or mass of objects that can accept destinations; the minimum length of each route; mandatory removal of all objects concentrated in nests. In a formalized form, the problem can be represented by several options. Thus, the problem of evacuation of the wounded (affected) is a linear programming problem; it is possible that this is a kind of the well-known “backpack problem”, but in which you can put not one item of each type in the “backpack”, but several (bibliography: 22 refs).

AIM: to determine the principles and assess the possibilities of informatization of medical support of the Armed Forces in military conflicts based on the concept of network-centric control.

MATERIALS AND METHODS: A content analysis of domestic and foreign literary sources has been carried out for the identification and subsequent analysis of the organizational aspects of creating a network-centric model for managing medical support in general and medical personnel in particular, capable of performing the tasks assigned to it in high-tech military conflicts (wars).

RESULTS: The definition of the concept of “network-centric medical support” is formulated as a system of measures aimed at increasing the capabilities of medical units in modern wars and military conflicts in order to reduce sanitary losses and return to service the maximum number of wounded and sick by creating a communication and information space and combining all medical systems. provision in a single network. The principles of using the network-centric approach to the construction of a promising management system for medical services are formulated. The results of approbation of a network-centric approach to solving problems of medical support of troops’ actions are presented. The tools for ensuring the consolidation and optimal use of the organizational potential and information and analytical resources of the medical service management bodies and military medical organizations are characterized.

CONCLUSION: It is shown that the creation of a unified medical information system will significantly increase the efficiency of medical support without a quantitative increase in service. The authors give a report that it is difficult, but quite possible, to catch up with the leading foreign countries in terms of opportunities, availability and quality of medical supplies with network-centric control. For this, it is necessary in parallel to consider, develop and implement a program designed to create a system of network-centric control of military medical organizations and medical support of troops in general, to launch a process of elaborating a theory and testing ideas (bibliography: 20 refs).

Modern level of medical science development provides the attending doctor with thousands of various diagnostic and therapeutic techniques as well as medicines. Practically applicating them, the clinician has to take into account a variety of factors: indications and contraindications of the method or modalities of treatment, characteristics of the patient and the course of the disease, compatibility or strengthening of the influence of certain examination methods, medications on each other, individual drug intolerance and contraindications in the patient. It becomes more difficult to keep all this in memory and make error-free, correct and timely decisions. Moreover, the situation is rapidly aggravated by the fact that the volume of knowledge in medicine is growing incrementally, and the time for a doctor to make an appropriate decision when making a diagnosis does not increase. In this regard, the question of creating a system that will minimize the time for a doctor to make a decision on the presence of a particular disease arises.

AIM: To develop a medical decision-making support system based on Bayesian networks in diagnosing patients.

RESULTS: A variant of the medical decision support system for the diagnosis of cold, flu and coronavirus are considered. A Bayesian network model using the GeNIe Academic software is proposed. The results of the percentages of possible diseases of the patient based on the existing symptoms are obtained.

CONCLUSION: The approach to the decision support system construction considered in the article is intended to assist doctors in making a diagnosis to a patient based on his anamnesis. It should be noted that the constructed Bayesian network can be modified by adding other symptoms with their conditional probabilities and adjusting the existing ones after expert judgment (6 figs, bibliography: 6 refs).

RELEVANCE: The medical personnel of military medical organizations are put under unfavorable working conditions during their professional activity. These conditions increase the risk of developing work-related diseases, lead to deterioration in health and wellness, and decrease efficiency in the workplace. Physical and mental stress increase significantly during the pandemic –especially for health care providers providing treatment for COVID-19.

AIM: To establish the correspondence between real working conditions and the results of the special assessment of working conditions for health care providers providing treatment for the new coronavirus infection.

RESULTS: The biological factor is the main cause of harm for all types of medical personnel, according to the study of the special assessment of working conditions of medical personnel in military-medical organizations cards in 2016–2019. Dealing with patients with the new coronavirus infection is in the 3.3 class of harmfulness, which grants the right to shorter work hours/work days to all medical personnel. However, working hours increase during a pandemic. Factors such as emotional stress and work schedules are not taken into account during the special assessment of working conditions. The negative impact of the use of personal protective equipment (e.g. anti-plague suits) during the entire shift has not been evaluated.

CONCLUSION: The analysis of the special assessment of working conditions of the medical personnel of the military medical organizations shows that the existing system for assessing working conditions does not fully reflect the actual working conditions of workers in present-day conditions, who work with patients who have COVID-19 (1 table, bibliography: 8 refs).

One of the oldest medical universities in Russia, an object of cultural heritage of the peoples of the Russian Federation — the S.M. Kirov Military Medical Academy — over the course of its centuries-old history has repeatedly changed the date of its foundation, and even more often it has been disputed. For the first almost a hundred years after the acquisition of the status of “academy” the first meeting of the conference in 1800 was considered as the starting point of its foundation. Then, a repeated decree from 1798 on the construction of one of the academic buildings was taken as a starting point, although the commemorative plaque and documents indicate the time of construction in 1796–1808. Already in the 1730s. two imperial decrees were issued, which regulated the staff from the standpoint of education and stated the rules relating to training personnel. 12 years before its official foundation, the academy had already acquired the right to award the doctor`s degree of medicine. In 1937, the commission under the leadership of Professor V.N. Shevkunenko decided to consider the foundation date of the academy as 1786. In 1939, the academy celebrated its 140th anniversary, taking as a basis the approved report of Baron A.I. Vasiliev, where the word “academy” was first heard. Researchers of the XX – beginning of the XXI century stop at the dates of 1733 or 1735. In our article, we tried to draw the reader’s attention to inconsistencies in approaches and facts in order to re-initiate a discussion about the currently accepted date of the foundation of the Military Medical Academy. We believe that it is the formation of the personnel training system that should be the fundamental factor in determining the beginning of the academy (3 figs, bibliography: 12 refs).