Medical-biological and social-psychological issues of safety in emergency situations

The study objective is to analyze the morbidity medical indicators and statistics among operational personnel of the Federal Firefighting Service (FFS) of the EMERCOM of Russia from 2020 to 2024, with a focus on disease prevention measures.

Methods. Periodic medical examinations were conducted in a total of 3,037 operational personnel holding special military ranks in the FFS of the EMERCOM of Russia and serving in fire and rescue units across St. Petersburg and the Leningrad Region. The firefighters’ age ranged from 19 to 54 years (mean age of 34.3 ± 0.14 years), with their professional experience spanning from 6 months to 36 years (mean age of 10.5 ± 0.13 years). The subjects were split into categories by age (19–34 years vs. ≥ 35 years) and l professional experience (0–5 years; 6–14; ≥ 15 years). Morbidity rates were obtained from Form No. 025/u (Outpatient Medical Record) and the qMS ‘SPARM’ medical electronic system, used at the Nikiforov Russian Centre for Emergency and Radiation Medicine, the EMERCOM of Russia. Medical and statistical indicators were classified according to the International Statistical Classification of Diseases and Related Health Problems, 10th Revision (ICD-10). Morbidity rates were calculated per 1,000 firefighters (‰). Statistical analysis was performed using Microsoft Excel 2007 and Statistica 12.0 software. Long-term average rates were calculated as the sum of absolute indicators over 5 years of observation. Average annual rates were calculated as arithmetic mean values and standard errors (M ± m) derived from annual rates.

Results and discussion. Based on the health examination results, 36.6 % of firefighters were classified as Health Group I; 29.5 % as Health Group II; and 33.9 % as Health Group III. The long-term average morbidity rate was 2718.8 ‰, with an average of 2.7 somatic disease diagnoses per firefighter. A decrease in overall morbidity and somatic burden was observed over time. The most prevalent morbidity causes included: diseases of the digestive system (ICD-10 Chapter XI), musculoskeletal system and connective tissue (Chapter XIII), eye and adnexa (Chapter VIII), endocrine system, nutritional and metabolic diseases (Chapter IV), and circulatory system (Chapter IX). Diseases representing the five chapters cumulatively accounted for 77.6% of the total morbidity rate. While most diseases showed a declining trend, an ongoing rise in diseases musculoskeletal system and connective tissue (Chapter XIII) was noteworthy. The group ranking of the most prevalent disease chapters consistently mirrored the overall cohort across all age and work experience groups. However, the older age group and subjects with ³6 year’s work experience showed higher rates for the most prevalent disease chapters, suggesting a significant strain on health functional reserves. For instance, diseases of the circulatory system (Chapter IX) were among the most prevalent in these cohorts. The younger age group and those with 0–5 years of professional experience revealed statistically significantly lower morbidity rates across most disease chapters, including the most prevalent ones, when compared to the older age group and those with ≥15 years of professional experience. Disease prevention and clinical monitoring in operational personnel of the FFS of the EMERCOM of Russia contributed to a morbidity reduction across 9 disease chapters, accounting for 77.4 % of the total morbidity structure over 5 years. Conversely, a rising trend was observed for 6 disease chapters, accounting for 22.6 % of the overall morbidity rate. Notably, diseases of the musculoskeletal system and connective tissue (Chapter XIII) accounted for 17.5 % of the overall morbidity rate, demonstrating an upward trend.

Conclusion. Our findings showed that changes in firefighter morbidity rates depended on the subject’s age, professional experience, and occupational hazards. The observed morbidity trends and rates observed for specific disease chapters could be extrapolated to all operational personnel of the FFS of the EMERCOM of Russia. However, to obtain more objective data, long-term studies on firefighter morbidity rates required.

Relevance. In the Russian Federation, road accidents are still among the top major causes of emergencies. Shock- associated injuries are of special consideration due to their health consequences. The type and scope of injury-associated shock depends on the cause of the accident, time of year, injury type and severity, thus determining the approaches and strategy in emergency medical care of victims at the pre-hospital and subsequent stages of treatment.

The objective is to analyze the shock injuries resulting from road accidents occurring on the M-8 Kholmogory federal highway in the Arkhangelsk region in order to analyze the causes, severity and type of trauma injuries and eventually improve the emergency medical care provided to the injured at the pre-hospital stage.

Methodology. The study analyzed medical records from 49 patients presented with a shock injury following an accident on the M-8 Kholmogory highway and admitted to the Arkhangelsk Regional Clinical Hospital – a first-tier multidisciplinary hospital and trauma center. The classification by A.V. Kaplan et al. was applied to identify the injury type; the injury severity was evaluated using the ISS score; the criteria suggested by E.K. Gumanenko et al. were applied to split combined injuries into severe combined injuries, polytrauma and extremely severe polytrauma. The STATA ver. 12 program was used for statistical analysis of the data obtained.

Results and discussion. The causes of shock injuries in the victims of road accidents on the M-8 Kholmogory highway include vehicle collisions (63.2%), pedestrian injuries (20.5 %) and vehicle rollover (16.3 %). Notably, over 50 % of all shock injury-associated accidents in winter. The patients presented with combined injuries (90 %), including the utmostly severe injuries – polytrauma (55.1%) and extremely severe polytrauma (12.2 %).

Conclusion. Considering that most severe shock injuries caused by road accidents occurred during the winter season, ambulances require specific personal heating equipment to warm the injured – hypothermia evacuation bags with an independent electric heating system and thermal blankets order to mitigate convective heat loss from patients. In addition, an independent blood and IV fluid warmers should be integrated into the ambulance vehicles, in particular type C mobile ICU ambulances. To optimize the evacuation procedure and minimize the transportation time to specialized emergency centers provided the injured multidisciplinary surgical care, it is essential to set up a network of mobile checkpoints throughout the federal highway.

Relevance. Imaging techniques allow to optimize inpatient medical triage in emergency medical care and enhance treatment outcomes. Today, such techniques as automated ECG interpretation (AIECG) and focused ultrasound (FUS) are highly relevant. However, the optimization efficiency in Russia is yet pending a thorough study.

Objective. The objective is to assess the efficiency of a three-level medical triage system, evaluating the contribution AIECG and FUS examination.

Methods. The study is a retrospective analysis of 1,000 patient cases of emergency medical care, provided by the inpatient emergency department at the Academician I.P. Pavlov First St. Petersburg State Medical University. Medical triage was based on the procedure developed at the Saint-Petersburg I.I. Dzhanelidze Research Institute of Emergency Medicine. All cases were split into categories based on the patient’s outcome (discharge or readmission), days of stay in the department, medical triage score. The collected data underwent statistical analysis.

Results and discussion. The median duration of stay per patient in the inpatient emergency department was 229 ± 12 minutes for green, 398.5 ± 19 minutes for yellow flow, and 233 ± 16 minutes for red, with an asymptotic significance p < 0.05. AUC-ROC analysis demonstrated statistically significant improvement in the triage sorting performance once AIECG and FUS were integrated. The area under the curve (AUC) increased to 0.752 compared to 0.581 in triage without imaging (p < 0.005).

Conclusion. The study shows that automated ECG interpretation and focused ultrasound allow to optimize medical triage, eventually rendering the three-tier medical triage procedure more efficient.

Objective. The study objective is to analyze the anatomy of third-order vessels and surrounding tissues in each phalange of the three-joint fingers of the hand with the aim to assess prospects, as well as functional and aesthetic outcomes of soft tissue flap reconstruction of distal phalanx defects.

Methods. The study considered anthropometric and experimental modeling of various axial flap techniques for finger defect reconstruction. Cadaveric studies on the right and left middle and ring fingers from male and female cadavers were done. Measurements included finger length, phalangeal lengths, and finger circumference. Additionally, the vascular structures, paratenon, tendons and ligaments, including triangular ligaments were examined. The following types of soft tissue reconstruction of distal phalanx defects were used: 1) axial flap harvested from the lateral finger surface; 2) cross finger axial flap of the adjacent finger; 3) modified cross finger axial flap from the adjacent finger.

Results and discussion. Our cadaveric study provided new insights into finger tissue morphology, including blood supply of the skin and subcutaneous tissues. The findings revealed that the terminal branches of third-order vessels form a horizontal vascular network responsible for blood supply to the skin and therefore critical for axial flap survival in finger stump defect reconstruction. The obtained cadaveric findings on finger anatomy and blood supply parameters enabled the development of multiple options for autologous axial flap surgery in finder defect reconstruction. These techniques ensure successful surgery outcomes in patients with distal phalanx covering tissue defects of the three-joint fingers. The procedures allowed to achieve good aesthetics of phalanx elongation at the treatment final stage.

Conclusion. The cadaveric modeling allowed to elaborate practical recommendations on flap harvesting in order to ensure sustainable blood supply. Various flap transfer and fixation techniques were refined to maximize treatment efficiency in terms of finger anatomy and aesthetic appearance.

Relevance. The workforce policy of the Federal Fire Service (FFS) of the EMERCOM of Russia is aimed at establishing the relevant workforce potential to satisfy the FFS ultimate professional goals.

The objective is to analyze professional profiles of fire and rescue units in order to identify most relevant factors that may affect the HR policy implementation by the FFS of the EMERCOM of Russia.

Methods. The body of statistical data was analyzed to assess the occupational injury rates from 2012 to 2023 among the FFS workforce of the EMERCOM of Russia. The workforce professional profiles underwent dynamic assessment. For every Russian constituent, the workforce average age, years of service, turnover and shortage rates, as well as the percentage of workers with higher or vocational fire technology degree was analyzed, and data regarding other workforce characteristics were obtained.

Results and analysis. A factor analysis was performed using a matrix of synthetic indicators to reveal eight significant factors that together explain 60.1 % of the total variance. Influence processes were identified for each factor. According to the factor analysis results, the federal constituents of the Russian Federation were divided into five groups depending on the professional profile dynamics among the FFS workforce of the EMERCOM of Russia. The professional profile analysis allowed to outline the following factors that impact the workforce indicator dynamics: dismissal rate from FFS units among the workforce without higher or vocational fire technology degree unwilling to complete professional retraining, whereas those are replaced by professionals with higher or vocational fire technology degree (mostly in task-force units); the replacement rate is insufficient for the observed retirement rate among the FFS workforce, resulting in workforce shortage in task-force units; ongoing retirement of professional workforce, being replacement by civilians; the ongoing aging across FFS divisions; and ultimately the specific characteristics of the dismissal procedure for heads of the FFS guard units are described. Financial and other types of motivation shall be reconsidered for the employees of this category.

Conclusion. The developed program makes it possible to evaluate the implementation of workforce policy across organizations, constituents, and federal regions of Russia by splitting them into 5 groups, ranging from very high to low efficiency levels.

Objective. The study is a VOSviewer-based content analysis of international publications regarding the implementation of information systems in intensive care units (ICUs) published in 2015–2024.

Methodology. Publications were obtained from the international PubMed database using the terms “‘Informatics AND ‘Intensive Care Units’” in the Medical Subject Headings (MeSH). The study identified 1508 apapers published over the past decade (2015–2024). The titles underwent a systematic review to generate a .txt dataset; once saved, the dataset was fed into VOSviewer 1.6.20. In total, the dataset yielded 3977 keywords. Considering 8 term iterations and cluster merging for word combinations, the outcoming dataset comprised 258 keywords.

Results and discussion. The VOSviewer was used to split the keywords into 7 clusters to represent specific topics covered by the text data regarding international ICU informatization research – general informatization and patient safety (30.1 % of papers with 26.8 % of total link strength), information and analytical support, Risk Assessment (15.9 % of papers with 17.9 % link strength), retrospective studies and databases (12.6 % of papers with 14 % link strength), application of artificial intelligence (10.6 % of papers with 11.5 % link strength); the last three clusters included improving outcomes for critically ill patients (cluster 5, neonatal care (cluster 6) and infection management (cluster 7), constituting a total 29.8 % of papers (29.8 % total link strength).

Conclusion. The VOSviewer-based content analysis and clustering of international research papers provided insights into the key research dimensions regarding ICU informatization. The obtained results can improve the information support in emergency medical care research. The international PubMed database provides investigators with vast informational opportunities, with 65 % of full-text papers available for free.