Совершенствование системы экстренной медицинской помощи при чрезвычайных

Динамикада со??ы 10 жылда (1998-2007 жж.) ТЖ бол?ан ?лімні? ?ар?ынды ??рсеткіштері ай?ын т?ра?ты ?деме тренд (r=+0,86) ар?ылы ерекшеленді. Техногендік ТЖ ?аза бол?андарды? саны ед?уір басым болып, т?тенше о?и?аларды? саны айтарлы?тай артты (r=+0,91, p< 0,001), керісінше таби?и катаклизмдегі орны толмас шы?ын саны (r=-0,94, p< 0,001) кеміді. Орта есеппен жылды? ?лім коэффиценті А?мола, Алматы ж?не Жамбыл облыстарында елдегіден е? жо?ары (p< 0,01), ал ?ызылорда, ?останай, Батыс ?аза?стан облыстарында ж?не Алматы ?аласында ана??рлым т?мен. Т?тенше жа?дайлар ж?не о?и?аларда орын ал?ан ?лім к?рсеткіші елдегі жедел медициналы? ?ызметті? маркері болып табылатыны д?лелденді. Жалпы Республика бойынша зардап шеккендерді? шамамен 1/6-1/5 о?и?а орнында к?з ж?м?ан, со??ы ?ш жылда б?л к?рсеткіш айтарлы?тай артты (p< 0,001). Республиканы? жеке айма?тарында ТЖ ж?не о?и?аларда ?аза бол?андар ?лесі 8,7%-дан (Алматы) 40,3% -?а (Ма??ыстау облысы) дейін ?згеріп отырды.

?р т?рлі т?р?ындар тобыны? (мектеп о?ушылары, студенттер, ?ызметкерлер, ?нерк?сіпті к?сіпорындарды? ж?мыскерлері ж?не зейнеткерлер) ж?не ?р т?рлі ?ызмет саласыны? ?ызметкерлеріні? (?ртке ?арсы ?ызмет, жол ?ауіпсіздігі, д?рігерлер, ??т?арушылар, ТЖ ?ызметіні? жетекшілері ж?не бас?алар) т?тенше жа?дай айма?ында?ы ал?аш?ы к?мекте жедел медициналы? ж?рдем к?рсету бойынша дайынды? д?режесі жеткіліксіздігі ай?ындалды. Б?л еліміздегі т?р?ындар ж?не ??т?ару ?ызметіні? мамандары ?шін жедел медициналы? ?ызмет к?рсетуді? о?ыту ж?йесін енгізуге, апатты?-??т?ару ?ызметіні? ?ызметкерлерін жо?ары біліктілік категория?а аттестациялау?а cебеп болады.

??делген методология ж?не ?алыпты о?ыту ба?дарламасы ?р т?рлі т?р?ындар тобын ж?не ??т?арушыларды зардап шеккендерге медициналы? к?мек к?рсету бойынша біры??ай ?рекет алгоритмін о?ытуда, ТЖ кезінде ?зін-?зі ?ор?ау ж?не ?зара ж?рдем беруде ТЖ медико-санитарлы? салдарларын, ?леуметтік залалды азайтады.

SUMMARY

Slessarev Vladimir Georgiyevich

IMPROVEMENT OF EMERGENCY MEDICAL AID SERVICE IN EMERGENCY SITUATIONS IN THE REPUBLIC OF KAZAKHSTAN

14.00.33 - public health and health care

Abstract of medical science doctor's dissertation

In accordance with goals and objectives of the investigation, it has been determined that the priority components of improvement of the emergency medical aid service in Kazakhstan are as follows: an optimal structural and functional model of the service, model to operate the system with an improved information content to ensure intra-departmental and interdepartmental interaction in different operation modes (routine, increased readiness or emergency mode); regulatory and legal framework brought in line with the model; an adequate material and technical basis set up subject to results of estimation of an emergency's medical and sanitary implications for some regions of the country; changes to approaches to forming behavioral skills of self-defense and mutual assistance of citizens, emergency and rescue service subjects' in emergency situations in order to improve their initial readiness for emergencies. It has been proved that conceptual fundamentals of the Kazakhstani quality management systems and the emergency medical aid service model developed subject to the international experience, socioeconomic, climatic and geographical peculiarities, priorities of the national policy and public health services development, results of the retrospective analysis (1998-2007), forecast of the emergency degree, medical and sanitary implications are optimal for the Republic of Kazakhstan.

Time and spatial laws of emergency development in the Republic of Kazakhstan have been revealed. They are multifold excess of technogenic catastrophes over non-technogenic ones; a moderate growth in the level of technogenic accidents (r=+0,63, p<0,05), stabilization of natural emergencies (r=+0,30, р>0,05) and a moderate decrease in the number of sociobiological ones (r=-0,61, p<0,05); non-uniform distribution of emergencies throughout the country (they are most common in Eastern Kazakhstan, Karagandy, and Southern Kazakhstan oblasts, but are relatively rare in Atyrau and Mangystau oblasts). It has been found out that some medical and sanitary implications of some kinds of emergency situations are equivocal. Of the total number of the affected, 68,8% suffered from road accidents, 7,6% in accidents associated with water surface, 6,2% - in industrial and domestic fires and explosions, and 14.5% suffered from dangerous infectious diseases and intoxications. The share of other kinds of emergency situations (industrial accidents, accidents associated with highly toxic substances and radionuclide emissions, accidents associated with life support systems, etc.) was equal to fractions of percent. The casualties due to technogenic emergencies are high. The relevant annual indicators' fluctuations were as follows: in industrial and domestic fires and explosions 42,2 persons or 60,9% were killed; 25,7 ones or 65,7% died in industrial accidents; 17,0 ones or 23,0% were killed due to road accidents. The casualties caused by dangerous infectious diseases and intoxications were equal to some tenths of percent.

The last decade's dynamics (from 1998 to 2007) showed that some intensive mortality values associated with emergency situations were noted for a well-pronounced steady upward trend (r=+0,86). Those who died in technogenic emergencies prevailed substantially. The number of such instances was rising clearly (r=+0,91, p< 0,001), whereas the irreplaceable losses due to natural disasters decreased abruptly (r=-0,94, p< 0,001). The average annual intensive death rates were reliably (p<0,01) higher in Akmola, Almaty and Zhambyl oblasts than the total rate for the country, and are substantially lower (p<0,01) in Kyzylorda, Kostanai, Western Kazakhstan oblasts and in Almaty City. It has been proved that the death-rate associated with emergency situations and accidents may be viewed as the indicator of the emergency medical aid service' state. Approximately 1/6 to 1/5 of all affected in the country died in the scenes of accidents. During the last three years this percentage reliably grew (p< 0,001). The share of those killed in emergency situations and accidents varied in separate regions between 8,7% (Almaty City) and 40,3% (Mangystau oblast).

It has been found out that the degree of readiness for rendering emergency medical treatment by different groups of population (middle- and high-school children, employees of industrial companies, and pensioners) and the personnel of different services (fire and road inspection services, doctors, rescuers, heads of emergency services, and others) who are the first who arrive to a site of occurrence, is quite insufficient. This necessitates introduction of a training system for population and rescue teams to teach them medical aid skills, and there upon to attest emergency and rescue services' personnel by qualification categories. The developed methodology and training programs elaborated for different strata of population and rescuers as per single algorithms of actions aimed at rendering medical aid to the affected, self- and mutual aid in emergency situations will minimize medical and sanitary implications thereof, and social damage caused by the same.

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