Should I call an ambulance or a local doctor? Is it always possible to refuse hospitalization recommended by emergency services? Will the hospital accept you if you seek help on your own?
The ambulance doctor, Hierodeacon Theodorit (Senchukov), explains.
When to call an ambulance?
Ambulance (03) is called only in emergency cases when the situation requires or may require prompt intervention.
Unusual abdominal pain. The need for hospitalization is determined depending on the nature of the pain.
Trauma, if the patient is physically unable to get to the emergency room on his own. Whether hospitalization is necessary is decided based on the condition.
According to the order on the procedure for hospitalization, the ambulance does not hospitalize patients with superficial abrasions and bruises in the absence of other injuries.
Pressing chest pain, especially radiating to the arm, back, etc.
Currently, ambulances very rarely hospitalize patients with an attack of atrial fibrillation, unless there are complications, the worst of which is arrhythmogenic shock - the attack is stopped on the spot.
If the attack does not stop, according to Moscow standards, the team leaves the asset after two hours - that is, after two hours the ambulance team will return to this patient to find out about his condition and determine whether he needs hospital care.
Attacks of chronic diseases (epilepsy, bronchial asthma, etc.). As a rule, they are also stopped on the spot.
Sudden headache, accompanied by a sharp change in facial expression, paralysis, etc. Also paralysis without pain syndromes.
Feeling of suffocation.
Poisoning.
Sudden drop in pressure.
And similar cases.
When you don't need to call an ambulance
Stitching and cutting pains in the heart area, if the patient has already been examined, these pains are known to him and are not accompanied by cardiac pathology, do not require an immediate call to the ambulance - you should try to relieve them with home and usual remedies. To prescribe treatment, you need to contact a cardiologist at the clinic. An ambulance should not be called at all to prescribe treatment for a chronic disease.
In the event of a rise in blood pressure or the heart pain described above, it is advisable to call an ambulance (in many cases, calls are transferred to this service even in cases of calls on 03) - it does not arrive so quickly, but it is always a doctor, not a paramedic. This service is not yet available in all areas of Moscow, but is gradually developing.
Acute respiratory infections and ARVI, temperature up to 39.5 and cough are not a reason to call an ambulance, if only because the emergency doctor has different training. The therapist from the clinic will prescribe the best treatment.
Ambulances are not called to issue sick leave certificates, certificates or prescriptions. This is also done by the clinic doctor.
Do children need emergency help?
Children should call an ambulance:
If the temperature approaches 40;
If the child is choking (not choking from a runny nose, but, for example, he begins to have croup);
In case of abdominal pain. An exception is if a child regularly suffers from abdominal pain: then he must be examined, diagnosed and treated not urgently, but as planned.
But most often, children do not need to call an ambulance at all - especially in Moscow. In Moscow there is a children's emergency service, where a pediatrician is guaranteed to work, while a pediatrician very rarely comes by ambulance. There are only about 50 pediatric teams throughout Moscow, and, as a rule, 30-35 work. It is not even a general emergency doctor who can come to the child, but a toxicologist, traumatologist, resuscitator, and so on. If an emergency doctor acquires some skills in pediatrics during his training, then a specialist has knowledge in pediatrics - a short course at the institute.
How to get to the hospital?
When calling an ambulance at home or to a clinic (then a general practitioner or specialist calls), the need for hospitalization is determined upon examination of the patient. Patients with stroke and such cardiac diagnoses as heart attack and unstable angina, diseases requiring emergency surgery, severe injuries, a number of infections, etc. are definitely subject to hospitalization. The diagnosis is made by the emergency physician. The patient or his legal representative has the right to refuse the proposed hospitalization (for children under 15 years of age - parents, for persons over 15 years of age - only a guardian appointed by the court). If a patient is indicated for hospitalization for health reasons, neither the spouse, nor the immediate family, nor those living with him have the right to refuse for him, even if the patient himself is unconscious. If the patient’s surroundings prevent hospitalization, the emergency doctor is obliged to call the police and, with their help, pick up the patient from the place of call.
Determining where to treat the disease is the first steps towards recovery. I would like these steps to be in the right direction.
21.03.2019City hospitals in Moscow, Moscow region, Russia - accept patients with a large number of different pathologies.
Clinics that accept patients through the municipal (city ambulance) channel:
- city (municipal)
Clinics that accept patients through the commercial medical ambulance channel:
- city (municipal)
- departmental clinics (Administration of Presidential Affairs, Federal Medical and Biological Agency, etc.)
- commercial hospitals (with a high level of treatment and diagnostic potential and conditions of stay)
Where does the city ambulance take the patient:
Where does our company’s commercial ambulance take the patient:
- city hospitals at the patient’s location
- city hospitals at the place of registration or registration
- any hospitals in any locality, subject to prior agreement between the patient and the clinic
- any hospitals in any locality, the agreement for hospitalization in which is carried out through our company
In their diversity, however, there are practically no universal clinics that provide treatment for diseases of all profiles. Some clinics have strong neurosurgery, but do not have a purulent department, some clinics have a burn center, but there are no conditions for treating complicated spinal injuries, there are regional clinics with a vascular center for the successful treatment of myocardial infarction, but do not have a “strong laboratory” for the most effective therapy pneumonia and infectious diseases.
A hospital is a concentration of specialists in various fields of medicine, a set of material and technical bases for improving the treatment and diagnostic process.
To carry out hospitalization in a clinic that is most suitable in terms of equipment and medical personnel, citizens call a commercial ambulance.
The difference between the work of a commercial ambulance and a city (municipal) one in the case of hospitalization in a hospital is the absence of territorial restrictions.
A commercial ambulance can travel outside the service area, city and even region. To carry out hospitalization in a target hospital, our company's commercial ambulance service is able to cover long distances without losing the quality of medical service along the way.
The longest medical transportations for hospitalization by ambulance were routes with a length of 1500 -1800 km from the point of receiving the patient to the destination (Krasnodar, Maykop, Chelyabinsk). The longest air ambulance flights were 8 and 10 hour flights from Magadan, Thailand. The most frequent air ambulance routes are flights from and to: Schönefeld (Berlin), Tel Aviv, Simferopol, Anapa.
Patients will be taken to medical institutions, where they will receive comprehensive care, and not to the nearest medical organizations. Such delivery of patients is already practiced in the capital and some regions. However, emergency doctors themselves have ambivalent attitudes towards the new rules.
Changes to the rules for providing emergency care to patients came into force on October 1. Now the ambulance must deliver the patient to a place where he can receive comprehensive specialized care, and not to the nearest medical facility.
The changes are commented by the head of the State Budgetary Institution Research Institute of Healthcare Organization in Moscow, David Melik-Guseinov:
Director of the State Budgetary Institution Research Institute of Healthcare Organization and Medical Management“For a long time, emergency medical care worked on the principle of delivering the patient to the nearest medical organization, and very often a situation occurred when the ambulance delivered the patient, and the person was forced to be transported to another medical organization, wasting precious time. In Moscow and in some other regions of the Russian Federation, they began to test a model where an ambulance takes the patient not to where it is closer, but to where there are technologies, where there are doctors and free places. The condition is preliminarily assessed, for what profile the person needs to be hospitalized, information is requested from the central dispatcher, where there are currently free places, where there is a free X-ray operating room, if we are talking about myocardial infarction, and the ambulance takes the person to this particular medical organization, where assistance will be provided as as quickly as possible, as efficiently and comprehensively as possible.”
However, no actual changes will occur in the work of ambulances: today, ambulances everywhere deliver patients to specialized medical institutions. But if for Moscow this practice is rather a plus, then in the regions the situation is bad: to get to a specialized hospital, you often need to travel hundreds of kilometers, he says ambulance paramedic Dmitry Belyakov:
“It’s not clear what they actually wanted to say by this.” If we take, say, Moscow, then here the team transports the patient strictly according to the profile, and on the periphery they make at least ten orders, but, let’s say, the nearest vascular center to Pereslavl-Zalessky in Yaroslavl is 150 kilometers away, they take you there. What new this order introduced is completely unclear. As I understand it, this is more of an order for the regions. There is a clause, I think, for 24 hours. That is, the patient is simply brought to the hospital, and within 24 hours must be transported to a specialized hospital. But again, all this will fall on the ambulance: first bring him to one hospital, then take him from there within 24 hours to another hospital. Some semblance of work.
- What was more important to do?
— Go back to what it was like under Soviet rule: a multidisciplinary hospital in district departments, salaries for doctors so that they don’t run away, because we may have a department, but we may not have specialized doctors. Even if we take the Moscow region, Sergiev Posad is a fairly large city, but there is no vascular center there, and again the teams go to Krasnogorsk, in a completely different direction.
The functions of emergency physicians at disaster medicine centers have also changed. Now the specialist can arrange a remote consultation with doctors from other medical organizations on issues of diagnosis and treatment, and will also interact with emergency operational services, including firefighters, police and the Anti-Terror service.
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