No 4 (2023)

Background. Occupational injuries indicate the level of safety at work and are subject to controlled management. Impossible to eliminate entirely, injuries lend to minimization only. Injuries are investigated not only by medical professionals exclusively. At the same time, by knowing the occupational injury dynamics and the types of potential body injuries, we can prospectively assess the required capacities and resources to eliminate the consequences.

The objective is to develop a tool to forecast the scale of occupational body injury in firefighters of the Federal Firefighting Service (FFS) of the EMERCOM of Russia.

Methods. The paper analyses occupational injury reports for 2012–2021 produced by the FFS of the EMERCOM of Russia. Total 1769 injuries were registered and matched to injury groups contained in chapter XIX of the International Classification of Diseases and Behavioral Disorders (ICD-10). Personnel injury risks for different body parts are identified and calculated with adjustments for non-identified (absence of diagnoses in injury records) and poorly identified injuries (generalized diagnoses are given). The body injury risk level among the personnel was (11.96 ± 0.89) ∙ 10–4 injuries/(individual ∙ year), which was greater than the level of injuries – (9.19 ± 0.54) ∙ 10–4, since each case of injury correlated with an average of 1.3 diagnoses, with 1.4 in firefighters, including those involved in elimination of other emergency consequences, conducive of concomitant and combined injuries. The curves show high, positive and statistically significant congruence (r = 0.686; p < 0.05), suggesting the impact of identical (unidirectional) factors as an underlying cause. External impacts include mechanical injuries amounting to 83.6 %, burns – 11.6 %, heat syncope – 1.5 %, poisoning by combustion products – 3.3 %. The average age of the injured FFS personnel of the EMERCOM of Russia was (36.2 ± 0.3) years, including (10.2 ± 0.3) years of work experience, with the overall FFS forces standing at (191.3 ± 3.3) thousand people.

Results and discussion. The predicted number of occupational injuries among the FFS personnel of the EMERCOM of Russia was calculated using the discriminant formula: y = (2.49 ∙ z1 + 0.21 ∙ z2 + 0.91 ∙ z3 + 0.68 ∙ z4 + 0.72 ∙ z5 + 0.71 ∙ z6 + 0.88 ∙ z7 + 0.43 ∙ z8 + 1.87 ∙ z9 + 1.11 ∙ z10  + 1.11 ∙ z11)∙10–4 × (2.54∙10–4 ∙ t2 – 2.98∙10–2∙t + 1.72) × (–2.94∙10–4∙s2 – 1.76∙10–2 ∙ s + 1.24), where y is the number of occupational injuries of the FFS of the EMERCOM of Russia; x is the number of personnel (absolute); t is the average age, years; s is the average professional experience, years; z₁–z₁₁ is the predicted number of body damages (contained in chapter XIX of the ICD-10) derived by multiplying the corresponding coefficient by the number of firefighters per 10 thousand people (10–4): z1 is head (S00–S09), z2 is neck (S10–S19), z3 is chest (S20–S29), z is abdomen, lower back, lumbar spine and pelvis (S30–S39), z₅ is shoulder girdle and shoulder (S40–S49), z₆ is elbow and forearm (S50–S59), z₇ is wrists and carpus (S60–S69), z₈ is hip and thigh areas (S70–S79), z₉ is knee and lower leg (S80–S89), z₁₀ is ankle and feet (S90–S99), z₁₁ is other external impacts, i.e. thermal and chemical burns (T20–T32), combustion by-product poisoning (T58–T59), heat syncope (T67.1). Linear discriminant formulas are provided to calculate body lesions split by categories of personnel (operational, preventive, technical and managerial personnel).

Conclusions. The method allows to predict the total number of occupational injuries among firefighters, including injuries of certain body areas and thereby calculate the resources and efforts required for treatment and rehabilitation.

Relevance. With the army and navy forces understaffed with physically strong and healthy young recruits, the problem is currently being considered at the state level; the lack of military reserve forces is a major problem for the Armed Forces of the Russian Federation.

The objective is to assess the health status, lifestyles, quality of life, ethic and professional aptitudes of potential conscripts in the Orenburg region in the course of preliminary military training.

Methods. Reports and accounts of enlistment commissariats across Orenburg municipalities were studied from 2012 through 2021. The study focused on the Orenburg region residents of conscription age, who underwent an anonymous social and demographic survey. Quality of life indicators were estimated by MOS SF-36, whereas dedicated personality and aptitude testing was used to assess neuropsychic stability and cognitive abilities.

Results and analysis. In 2012 the Orenburg region had 21,600 residents of conscription age, with 65.1% considered healthy and apt for military service. Almost one in three conscripts was unfit for military service due to health issues. Due to demographic challenges in the region, the number of conscripts decreased year to year, resulting in a 30% drop-down by 2021 according to forecasts. This situation undermined military service conscription goals. Therefore, efforts were undertaken to mainstream healthcare and fitness initiatives among the youth, as well as actively promote healthy lifestyles and sports, which eventually allowed to attract more newly drafted conscripts. Thus, in 2021 the rate of conscripts considered healthy and apt for military service stood at was 77.7%.

Conclusion. Analyses of medical, social and psychological characteristics of Russian nationals of conscription age provides evidence for appropriate decision-making to maintaining the combat abilities of the Armed Forces of the Russian Federation.

Relevance. Improving prognostic criteria to assess the severity of combined chest and abdominal trauma is urgently needed to justify the scope of intensive care in victims of road accidents during acute traumatic illness.

Objective. The objective of the study is to improve the results of treatment during acute traumatic illness in combined chest and abdominal trauma after road accidents, as well as to enhance efficiency of prognostic criteria for severity assessment.

Methods. A single-center retrospective and prospective controlled clinical study was conducted in 1400 victims who were treated at the N.S. Karpovich Krasnoyarsk Interdistrict Clinical Hospital of Emergency Care Medicine from 2012 to 2022 and were diagnosed with isolated or combined chest and abdominal trauma. To assess the severity of injury and perform triage, the specific method of severity assessment in combined trauma after road traffic accidents was used, which was developed by the research team of the Prof. V.F. Voino-Yasenetsky Krasnoyarsk State Medical University.

Results and discussion. A detailed analysis of the indicators applied to patients of different severity showed that mild and moderate chest and abdomen injuries led to changes in hemodynamic parameters within the physiological norm. The injury in question did not cause consciousness or respiratory disorders in victims of road traffic accidents. Severe injuries led to the development of shock and respiratory failure, in combination with depression of consciousness. In order to compare across different condition severity degrees evaluated by physiological indicators, respective medians and dispersion measures were analyzed for each group. The analysis allowed to assess exacerbated severity of condition in our patients. This procedure requires further adjustment to pre-hospital emergency medical care.

Conclusion. The performed statistical analysis allowed to assess the efficiency of severity assessment in victims of road accidents in prehospital setting.

Relevance. According to scientific publications, preventive measures undertaken amid the COVID-19 pandemic failed to did reliably protect healthcare workers from the new coronavirus infection. The use of personal protective equipment (PPE) that protected against biological factors failed to protect HCWs from becoming infected and in most cases contributed to the functional disorders and impaired health.

The objective is to provide evidence-based justification of preventive measures aimed at increasing healthcare workers’ (HCW) safety by using PPE during elimination of biological and social emergencies (based on the case of the COVID-19 pandemic).

Methods. The study design included four consecutive stages: occupational morbidity assessment for COVID-19, assessment of HCWs’ working conditions; assessment of HCWs’ safety when using PPE sets in real setting and simulation, and justification of preventive measures to improve safety of HCWs.

Results and discussion. The first year of the COVID-19 pandemic saw the incidence of 30.4 % among all HCWs working at the Military Medical Academy, suggesting a high risk of infection transmission. Morbidity was utmost among HCWs specializing in infections, followed by a significant number of HCWs who do not work in contaminated areas on a daily basis (surgeons, urologists, traumatologists). In addition to high incidence rate, the new coronavirus infection pandemic demanded enforcement of specific measures associated with the use of PPE at increased physical stress, including amid elevated ambient temperature. A sociological survey and experimental data allowed to assess the risk of functional and heat-injury related health disorders, as well as injuries in HCWs using PPEs. In order to reinforce occupational safety and minimize occupational risks of health deterioration in HCWs wearing PPEs at work, the research results allowed to develop a two-stage preventive action plan: stage 1 includes identification of dangerous factors, whereas stage 2 focuses on preventive measures to eliminate negative impact of hazards and associated risks.

Conclusion. A set of preventive measures developed for the COVID-19 pandemic suggests practical tools to reinforce occupational safety for HCWs who use PPEs to deliver biological and social emergency response and elimination.

Relevance. To reduce the consolidated budget burden, public administration both in Russia and abroad is pursuing optimal solutions. In turn, identification of the most effective approaches to eliminating terrorist attack consequences is implemented by all concerned departments, agencies and services, with reimbursement of damages incurred by terrorist attacks among the goals.

By analyzing retrospective data on the reported incurred damage of different scale, medical specialists and health care authorities can justify medical and economic feasibility of efforts to adapt preparedness to the elimination of the medical and sanitary consequences of terrorist attacks.

The objective is to identify in terms of incurred damage the most dangerous methods, strategies, and targets to perform terrorist attacks.

Methods. This study relies on a generalized database of terrorist attack consequences taken place from 1970 through 2020, and reported by various experts. The retrospective analysis included more than 220,000 cases of terrorist actions; the study key parameters were identified to include terrorist attack methods, strategies, and targets.

Results and analysis. The study results show that depending on the scale of damage over years, the share of terrorist attacks associated with fatal outcome is characterized by a general upward trend. Terrorist attacks by explosion remains the most significant in terms of frequency of cases and share among other methods. Individuals are top one target of terrorist attacks by the number of cases. Business community representatives bear the utmost share of major consequences.

Relevance. Combat stress and other forms of stress-associated mental disorders, as well as their consequences currently remain a most urgent issue in military personnel directly or indirectly involved in armed conflicts. Active deployment of weapons for remote destruction of manpower and infrastructure has caused qualitative transformations in the profile of medical casualties, thus becoming a powerful stress factor of intense psychological pressure on personnel. The fundamentally new nature of armed confrontations, which in many ways is incompatible with domestic experience acquired over the recent decades during local hostilities in the "hot zones", is gaining relevance, as well as effective prevention and treatment of health disorders associated with combat mental trauma in the personnel deployed in the special military operation.

The objective is to identify pre-disease characteristics of stress-associated disorders in combatants, depending on their professional activity profile.

Methods. We examined 209 males earlier deployed in combat zones. All the examined combatants were divided in three groups according to professional criteria: group 1 – employees of the Ministry of Internal Affairs of Russia (n = 71); group 2 – soldiers of the National Guard of Russia (the Rosgvardiya) (n = 70); group 3 – employees of the EMERCOM of Russia (n = 68). Clinical and psychopathological examination with prior blood chemistry and toxicological screening were conducted to identify metabolites of psychoactive substances.

Results and discussion. Although the research showed an elevated risk of post-traumatic stress disorder in the combatants across all the three groups, employees of the EMERCOM of Russia and the Ministry of Internal Affairs of Russia demonstrated average stress coping ability, whereas soldiers of the National Guard of Russia showed higher levels of maladaptation and greater susceptibility to subclinical anxiety and depressive disorders. Combatants directly involved in combat operations often resort to alcohol or sedatives.

Conclusion. Programs for medical and psychological rehabilitation implemented as part of psychological and psychiatric prevention efforts shall be adjusted to the combatants’ professional profile with a specific focus on the type of combat service duties.

Relevance. Despite advancements in industrial production technologies, no decrease is observed in global statistics for disasters and emergencies, as well as their identified precursors. Reliable and comprehensive inventory of global and regional disaster databases reinforces the development of effective national emergency prevention policies, improving the resilience of industrial facilities against adverse and thus generating extensive evidence for research.

The objective is to study top global disaster information management databases and their inventory.

Methods. The Internet, state reports, research papers available in the Russian Science Citation Index, Scopus and Web of Science bibliography databases were the major sources of data regarding top global disaster and emergency databases.

Results and discussion. EM-DAT: OFDA/CRED (Emergency Events Database), NatCatSERVICE, SIGMA, GLIDE (Global IDEntifier Number), CatNat Global (The natural disasters database (NATDIS)), DesInventar (Disaster Inventory System) are among the top global databases, having quantitative assessment for disaster risk indexes and consequences. Comparative studies of emergency data entries across databases was performed to allow countries and regions to develop common global assessment tools for emergency consequences.

Conclusion. Consistent terminology and uniformity of data submission procedures across top global international databases allows Russian and international experts to develop the most effective tools to predict and prevent various emergencies and build common consequence assessment strategies for countries and regions of the world.