The territory of Russia exceeds 17 million km2. Rural territories - 23.4% of the entire territory - have powerful natural, demographic, economic, historical and cultural potential, which, if used rationally and effectively, can ensure sustainable diversified development, employment, high level life of the rural population.

The demographic resource of rural areas is 38 million people (27% of the total population), including the labor force - 23.6 million people. The population density is low - 2.3 people per 1 km2. The settlement potential includes 155.3 thousand rural settlements, of which 142.2 thousand have permanent residents. 72% of rural settlements have a population of less than 200 people; villages with a population of over 2 thousand people make up only 2%.

Over the past 10 years, positive trends in the demographic situation in rural areas have been outlined. Natural population decline decreased from 281 thousand people in 2000 (-7.3 per 1000 people) to 82 thousand people at the beginning of 2010 (-2.1). The birth rate of the rural population is higher than the Russian average - 14 per 1000 people (compared to 12.6). This has a positive effect on the overall fertility rate.

However, the high birth rate in rural areas is accompanied by high mortality. In 2010, with infant mortality in Russia 7.5 babies per 1000 births

alive in rural areas and in the city, the indicators were respectively LOS and 6.9 infants per 1000 live births. The overall mortality rate per 1000 rural residents is 16.1, which is 6% lower than in 2000, but 19% higher than the mortality rate of the urban population. All this negatively affects the health indicators of the country's population as a whole.

The life expectancy of citizens in rural areas at the beginning of 2010 increased by 2.7 years compared to 2000 and amounted to 66.7 years versus 69.4 in the city.

Rural areas are characterized by low population density and large distances between small settlements from each other. As a result, the average radius of the service area is 60 km, and often the distance of settlements from the regional center exceeds 100 km. The service range of a local therapist can reach 10 km or more.

The seasonality of work in rural areas creates tension in the spring-summer and autumn periods, when workers are mainly outdoors, which leads to overheating or hypothermia. The diet and quality of nutrition are often not respected. The incidence of injuries, joint diseases, and vibration disease is high. Contact with animals creates a risk of specific diseases.

As a result, rural residents are characterized by a large number of chronic diseases, for which patients practically do not seek medical help, specific diseases associated with the characteristics of agricultural production (injuries, diseases of peripheral nervous system, eye damage, vibration disease).

Medical care for rural residents based on the principles of protecting the health of the country's population. One of the important organizational principles of public health is maintaining unity and continuity medical care population in urban and rural areas.

However, the factors that determine the differences between urban and rural areas influence the organizational forms and methods of operation of rural health care institutions.

The main factors contributing to differences in health care between urban and rural populations are:

Features of the settlement of residents in comparison with the city are low density, scattered and remote settlements;

Features of agricultural labor - seasonality, high specific gravity manual labor, often a significant distance between the place of residence and the place of work;

The outflow of young people and people of working age to the city;

Aging rural population;

Lower living standards in villages;

Poor condition of roads and transport:

Insufficiency or inaccessibility of new information technologies;

Low availability of medical personnel;

Socio-economic and everyday difficulties.

In general, the rural health care system is characterized by limited availability of medical care and low effectiveness of medical, social and preventive measures. The task of bringing together the levels of medical care for urban and rural populations remains relevant.

The frequency of rural residents seeking medical care is significantly lower than that of urban residents. Moreover, the farther a settlement is from a medical institution, the less often residents turn to medical workers. The bulk of medical care is provided by paramedical personnel. A rural resident spends on visiting a medical facility

much more time than city. The equipment of rural medical institutions is much worse than that of urban ones, and the qualifications of personnel are lower than the average in healthcare.

Features of the organization of medical care for rural residents are significant decentralization of outpatient care and pronounced centralization of inpatient care. The main human resource in rural areas is paramedical workers. Medical personnel are largely concentrated in regional hospitals. by receiving the population at the place of their main work and on trips to remote rural settlements as part of special teams according to a specific plan.

In accordance with the Federal Law “On the fundamentals of protecting the health of citizens in Russian Federation» dated November 21, 2011 N-323-FZ (Article 5, paragraph 2). The state provides citizens with health protection regardless of place of residence and any other circumstances. For residents of rural areas, it is also necessary to adhere to the principles of health protection:

Ensuring the rights of citizens to health care and related state guarantees:

Priority of the patient’s interests in the provision of medical care;

Priority of children's health;

Social security in case of loss of ability to work;

Responsibility of public authorities and bodies local government, officials for ensuring the rights of citizens to health care;

Availability and high ILC;

Inadmissibility of refusal to provide medical care;

Priority of prevention and maintaining medical confidentiality.

Organizational basis for providing medical care to rural areaspopulation laid down in the 19th century. zemstvo doctors. The zemstvo medicine system was formed in Russia during the period of zemstvo self-government and operated in 1864-1917. It had new and progressive methods of providing medical care to the population, which have not lost their relevance to this day:

Focus not on the paramedic station, but on the medical level of primary health care;

Local service for the rural population with the organization of several paramedic stations and a pharmacy on the site, in the center of each site there is a hospital with an outpatient clinic;

Maintaining “card” records during outpatient visits to patients, which allows you to collect valuable material for statistical analysis of morbidity;

Combination of medical and sanitary-preventive work;

Active propaganda healthy image life;

Free medical care.

These principles are also implemented in the organization of primary health care for the population in Soviet system health care (1918-1991). By the beginning of the first Soviet five-year plan in Russia (1929-1932), the rural population was served by 4,677 medical stations and 3,413 paramedic stations. There were 18,200 residents per medical area. Over the five-year period, the network of medical stations grew to 7962, i.e. more than 70%; the number of rural hospital beds increased from 43,600 to 82,000. Health care expenditures in the USSR during the first five-year plan increased compared to Russian Empire(1913) almost 4 times. As a consequence of the efforts made. The life expectancy of Soviet people from 1926 to 1972 increased by an average of 26 years. Health care in general in the RSFSR can be judged from the data of the 3rd edition of the Great Soviet Encyclopedia (1969-1978; Table 5.20).

A typical rural medical institution - FAP - is a primary pre-medical structural unit that provides preventive, curative, and health-improving services. sanitary and anti-epidemic, sanitary and educational, hygienic medical and sanitary care.

In subsequent years, the main feature of the organization of medical care to the rural population was the staged nature of its provision. Conventionally, there are 3 stages of providing treatment and preventive care to the population.

The first stage is a rural medical station - a local hospital, a paramedic station and a first aid station, health centers, medical centers of educational institutions. At the first stage, rural residents receive pre-medical, primary and qualified medical care (therapeutic, pediatric, surgical, obstetric, gynecological, dental).

The second stage - healthcare institutions of the municipal district: district and central district hospitals (CRH). which provide basic types of specialized medical care.

The third stage is healthcare institutions of a constituent entity of the Russian Federation. among which the leading place is occupied by regional (regional, republican, district) hospitals. At this stage, specialized, including high-tech, medical care is provided in all major specialties.

IN modern conditions this approach is being revised. During the implementation of the healthcare modernization program, a unified system of providing medical care to both urban and rural populations is being built.

Primary health care for the rural population will consist of three levels. At the 3rd level, all outpatient medical institutions are concentrated: at the 2nd level - intermunicipal centers providing qualified specialized outpatient and inpatient medical care in the most popular profiles in accordance with the procedures for providing specialized medical care: at the 1st level - consultative and diagnostic specialized assistance in regional CDCs.

In rural areas of the Russian Federation there are 1,349 hospital medical institutions, including 727 central district ones. 79 district and 382 district hospitals, with a total number of beds of 153.4 thousand. The provision of hospital beds per 10 thousand rural residents is 40.9, which is 2.7 times less than the provision of hospital beds for the urban population (Table 5.21).

In 2010, in the Russian Federation, 40,650 doctors (7.6% of the total number of doctors) and 207,497 paramedical workers (15.7% of the total number of paramedical personnel) worked in rural medical institutions. The provision of doctors in rural areas in 2010 was 12.2 per 10 thousand population, paramedical personnel - 54.3 per 10 thousand population. In all constituent entities of the Russian Federation in rural areas there was a shortage of doctors and paramedical personnel.

The emerging trend of reducing the number of district and rural district hospitals and increasing the number of central district hospitals is due to the proven economic inexpediency of the existence of hospital medical institutions with low bed capacity. In large medical institutions (central district, regional, regional, republican, district hospitals) they spend less money per bed on economic and technical needs, heating, maintenance service personnel, nutrition. engineering and technical services. In addition, they effectively use diagnostic equipment, qualified medical personnel, introduce modern medical technologies and thereby provide the population with higher quality qualified medical care. In this regard, rural district hospitals in a number of regions of the Russian Federation are being repurposed into medical outpatient clinics, medical clinics.

Often, regions, in order to develop central district hospitals, curtail primary care facilities, leaving the rural population without medical care and drug supply.

District hospitals need to be rebuilt taking into account local conditions: population density, transport accessibility, availability of hospital beds in general, etc.

PHC- the basis of the system of providing medical care to the rural population - includes prevention, diagnosis, treatment of diseases and conditions. medical rehabilitation, monitoring the course of pregnancy, promoting a healthy lifestyle and sanitary and hygienic education of the population.

To get closer to the territory of residence, primary health care is organized according to the territorial-area principle, which provides for the formation of groups of the population served at the place of residence. Primary pre-hospital health care is provided by paramedics, midwives and other paramedics in the FAP.

FAPs are organized in rural areas with a population of 700 people or more and the distance to the nearest medical facility is more than 2 km. If this

the distance exceeds 7 km, then the FAP is organized in a populated area with a population of up to 700 people. Functions of the FAP according to the current regulatory framework:

Providing first aid:

Providing for the population medicines(according to the approved nomenclature);

Timely and full implementation of doctor’s prescriptions;

Patronage of children and pregnant women, dynamic monitoring of the health of certain categories of citizens;

Implementation of measures to reduce child and maternal mortality;

Teaching the population a healthy lifestyle,

FAP also plays a significant role in carrying out preventive vaccinations according to the National Vaccination Calendar, which is compiled taking into account the age and sex composition of the population.

The main task of the FAP in working with children is timely and high-quality patronage. security full complex preventive measures. The procedure for prenatal care and medical examination of children is the same for cities and rural areas.

In addition, the duties of a paramedic include systematic monitoring of the work of children's educational institutions, their sanitary condition, and the conduct of physical education in them; organization of preventive examinations. instilling hygienic skills in children, conducting extensive educational work among parents, children, educators and teachers.

There are 37.8 thousand FAPs in the Russian Federation with a steady trend of network reduction. Compared to 2000, their number was reduced by 12.8%, while a number of GP offices were organized in rural areas. When closing a FAP, it is necessary to first comprehensively assess the availability of medical care, especially in sparsely populated areas where the FAP is the only accessible healthcare unit. This is especially important when the FAP provides the population with medications, monitors the intake of anti-tuberculosis drugs, carries out a set of preventive measures to promote a healthy lifestyle, and patronizes the elderly. Accordingly, the attitude towards a paramedic in rural areas needs to be changed and his working conditions reviewed.

The leading link in the provision of primary health care should be a general (family) practitioner. Its goal is to provide primary health care to the population in a volume that partially replaces the narrow specialists of the clinic, and under the condition of being as close as possible to the place of residence of the assigned citizens.

GPs can work individually or in a group. In individual practice, a doctor works independently, independently of other doctors and specialists, using the assistance of nursing staff working with him. Individual practice is mainly used in rural areas, where

There are only a small number of people living there and the involvement of other doctors is unjustified in terms of the volume of care provided and financial support.

Group practice involves combining the efforts of several doctors to ensure interchangeability, mutual assistance in the provision of medical services to the population and to increase the economic efficiency of the organization of GP offices.

Group practice has a number of advantages:

Possibility of interchangeability during the day and during illness. vacation, training of one of the doctors:

Better equipment of offices, including diagnostic and treatment equipment, creation of a day hospital;

Opportunity for professional communication and consultations;

The possibility of a certain specialization in narrow specialties for each of the doctors (ophthalmology, endocrinology, cardiology);

Reduction of administrative costs;

More efficient use nursing staff.

The location of the GP's office is determined by the size of the locality;!, the ability of the health care facility to provide premises, the CAPABILITIES of the settlement administration to provide premises for the office as close as possible to the place of residence of the attached population (usually on the ground floor of a multi-storey residential building or in a specially constructed building). The location of the GP office in new microdistricts of settlements, where there is usually no developed social infrastructure, is especially convenient. The number of citizens served per GP is established based on the norm of 1,500 people. It has been established in practice; A smaller number of attached residents will not ensure the economic feasibility of the work, and a larger number will not allow the doctor to provide them with a full range of services in a high-quality manner and on time. The specific number of residents is determined for each doctor by the chief physician of the clinic to which the GP belongs, based on the size of the living population and the staffing level of the institution. The service radius can reach 1.5 km in the city, up to 12 km in the countryside,

Attachment to a GP is carried out in the presence of a compulsory medical insurance policy and a document. identification of a citizen. Every citizen has the right to choose a treating physician, including a GP. However, in most cases, a GP serves the population living in close proximity to his site: for example, in a multi-storey multi-entrance building - the residents of this one house. This approach allows for assistance to be provided at home and at night.

The GP’s work schedule is determined by the location of the office, the size and composition of the assigned population, service radius and availability of vehicles. GP tasks:

Outpatient reception of the population, including simple studies (electrocardiography, clinical examination of blood and urine, determination of blood sugar levels, visual acuity, etc.);

Providing emergency assistance;

Providing assistance in a day hospital setting;

Visiting patients at home;

Visiting your patients in hospital:

Consultations of patients with specialists:

Interaction with social protection authorities.

The doctor's workload is 4-5 thousand visits per year. Subspecialists The clinic accepts only on the direction of a GP.

Despite the important place of the FAP in the primary health care system for the rural population, the leading health care facility at the first stage of rural healthcare is the rural district hospital (RPH) or the corresponding unit of the central district hospital. which and

They include a hospital and a medical outpatient clinic. Primary medical care is provided here by general practitioners, local general practitioners, pediatricians, local pediatricians and GPs (family doctors).

The nature and volume of medical care in a rural district hospital are determined by the capacity, equipment, and availability of specialist doctors. Regardless of the capacity of the SUB, it provides outpatient care to therapeutic and infectious diseases patients, assistance during childbirth, and pediatric and preventive care for children. emergency surgical and trauma care. The staff of the SUB includes doctors in the main specialties: therapy, pediatrics, dentistry, obstetrics and gynecology, surgery. Tasks of the SMS:

Providing the population of the assigned territory with qualified medical care (outpatient and inpatient):

Planning and carrying out activities to prevent and reduce morbidity and injury among various groups of the rural population;

Treatment and preventive health care for mothers and children:

Implementation modern methods prevention, diagnosis and treatment, advanced forms and methods of organizing medical care;

Organizational and methodological management and control of the work of the FAP and other medical institutions that are part of the rural medical district.

The organization of outpatient care for the population is the most important section of the work of rural district hospitals. In rural areas there are 2,979 outpatient clinics with 436 thousand visits per shift. These include rural medical outpatient clinics(polyclinics), both included in the structure of other medical organizations and independent. Their main tasks are: carrying out broad preventive measures to prevent and reduce morbidity, early identification of patients, medical examination. provision of qualified medical care to the population, Doctors see adults and children, make house calls and provide emergency medical care. Paramedics can also take part in the reception of patients, but outpatient care in a rural medical outpatient clinic must be provided by doctors.

In addition, the functions of the rural outpatient clinic include:

Bringing outpatient medical care closer to rural residents;

Carrying out a set of sanitary and anti-epidemic measures (preventive vaccinations, ongoing sanitary supervision of institutions and facilities, water supply and cleaning of populated areas);

Scheduled visits of doctors to subordinate FAPs and children's educational institutions to provide practical assistance and monitor their work.

Maternal and child health care plays an important role in the work of a rural medical hospital. Medical care for children at a rural medical site provided by doctors and paramedics under the guidance of the chief physician of the local hospital. If there is a pediatrician at a rural medical site, he is responsible for organizing medical care for children (as a rule, the chief physician). In the absence of a pediatrician, the chief physician of a rural district hospital has the right to assign responsibility for medical care to children to one of the general practitioners, allocating him a certain time to work with children.

The main responsibilities of a doctor responsible for medical care for children at a rural medical site:

Constant preventive monitoring of children in villages assigned to the local hospital;

Periodic medical examination of all children in the area, especially in the 1st year of life;

Active identification of sick and weakened children, taking them to the dispensary for regular observation and recovery:

Timely and complete coverage of children with preventive vaccinations;

Regular supervision of children in organized groups, monitoring the correct neuropsychic and physical development of children. carrying out necessary health measures;

Active identification of sick children, timely provision of qualified medical care and provision of hospitalization if necessary;

Constant study of the conditions and lifestyle of children in the family, identification and assistance in eliminating unfavorable environmental factors;

Monitoring the work of the FAP by regular (according to schedule) field visits, providing them with the necessary organizational and methodological assistance;

Extensive educational work among parents, children, teachers, educators on child health issues.

Doctors from rural outpatient clinics travel according to a certain schedule to the FAN of their site for a consultation. At the same time, they should strive to improve the qualifications of their assistants by transferring knowledge and experience to them. The population is notified of the departure schedule.

Pediatricians from central district hospitals must travel to rural district hospitals on schedule to improve medical care for children in rural areas. The population is notified in advance of the pediatrician's arrival.

Materials from inspections of the work of rural district hospitals and first-aid posts on medical care for children are summarized by district pediatricians and organizational and methodological offices of the Central District Hospital. are periodically heard at district conferences and medical councils. Based on the results of the discussion, appropriate organizational measures are taken.

In accordance with these tasks, the main responsibilities of the doctor (doctors) of the rural medical district are determined;

Outpatient reception of the population;

Inpatient treatment of patients in a rural district hospital:

Providing assistance at home;

Providing medical care in case of acute diseases and accidents;

Referring patients to other health care facilities for medical reasons;

Examination of temporary disability and issuance of certificates of incapacity for work:

Organization and conduct of preventive examinations;

Timely registration of patients for dispensary registration:

Carrying out a complex of medical and health measures, ensuring control of clinical examination;

Active patronage of children and pregnant women;

Carrying out a set of sanitary and anti-epidemic measures;

Sanitary educational work, promotion of a healthy lifestyle;

Scheduled visits to the first aid station.

The structure of a rural medical district is formed depending on the size of the population served, the service radius, the distance to the central district hospital and the condition of the roads. The number of people served in a rural medical district can reach 2.5 thousand people.

Primary specialized health care is provided by medical specialists, including medical specialists from medical institutions providing specialized, including high-tech, medical care. Primary health care is provided on an outpatient basis and in a day hospital setting.

To provide primary health care to citizens in case of acute diseases, conditions, exacerbation of chronic diseases that are not accompanied by a threat to the patient’s life and do not require emergency medical care, medical care units are created within the structure of medical institutions that provide it in an emergency form.

The organization of medical care for residents of rural areas, its volume and quality depend on the distance of medical institutions from the place of residence of patients, the availability of qualified personnel, equipment, the possibility of receiving specialized medical care, and the implementation of medical and social security standards at the regional and federal levels.

Central District Hospital(CRH) is the main medical institution for providing qualified medical care to the rural population. At the same time, the Central District Hospital is a center for organizational and methodological management of healthcare in a municipal district, responsible for organizing medical care for the population, increasing the efficiency, quality and accessibility of this care.

IN different regions countries operate central district hospitals of different capacities, which depend on the population size, provision hospital institutions and other factors. The optimal capacity of the central district hospital is at least 250 beds. The structure of the Central District Hospital includes:

Hospital with departments for main specialties;

Clinic with treatment and diagnostic rooms and laboratory:

Emergency departments:

Pathology Department:

Organizational and methodological office;

Auxiliary structural units (pharmacy, kitchen, medical archive, etc.).

The profile and number of specialized departments of the central district hospital depend on its capacity, but their optimal number should be at least 5: therapeutic, surgical with traumatology, pediatric, infectious diseases, obstetrics and gynecology (if there is no maternity hospital in the area).

The main tasks of the Central District Hospital:

Providing the population of the district and regional center with qualified specialized inpatient and outpatient medical care;

Operational, organizational and methodological assistance to medical organizations in the region;

Organization of material and technical support for the departments of the Central District Hospital:

Development and implementation of measures aimed at increasing the IMP of the population, reducing morbidity, infant and general mortality, improving health;

Arrangement, rational use, advanced training of medical personnel;

Implementation of activities to promote a healthy lifestyle.

The chief physician of the Central District Hospital has deputies in the main areas of activity: medical department, outpatient work, organizational and methodological work (head of the organizational and methodological department), administrative and economic work, security, and in areas with a population of 70 thousand or more - on childhood and obstetrics.

To provide methodological, organizational and advisory assistance to doctors of rural medical districts, the Central District Hospital allocates district specialists who, within the framework of their specialty, organizationally and methodologically manage all medical institutions in the district - often heads of departments of the Central District Hospital or the most experienced doctors. Each of them heads medical work in the region in his specialty, travels for consultations, conducts demonstration operations, examinations and treatment of patients, sends teams of medical specialists to medical institutions of rural medical districts, listens to reports from doctors of local hospitals, heads of first aid stations, analyzes their work, statistical reports, conducts scientific conferences, seminars, advanced training in the workplace.

To bring specialized medical care closer to the rural population, regional centers are creating interdistrict specialized departments(centers, medical districts) equipped modern equipment. The functions of inter-district centers are performed by health care facilities. capable of providing the population with specialized, highly qualified inpatient or outpatient care if the central district hospitals of neighboring areas do not have the ability to provide specialized care or its volume in each health care facility is minimal, and the necessary specialists are not available. Along with performing the functions structural unit Healthcare interdistrict specialized centers (departments) carry out:

Consultative appointments in the clinic for patients referred by doctors from health care facilities in the attached areas;

Hospitalization of patients from assigned areas:

Organizational, methodological and advisory assistance (including examination of work ability) to doctors of health care facilities in the assigned areas, including scheduled visits:

Introduction into the work of healthcare institutions modern means and methods of prevention, diagnosis and treatment of patients in the relevant specialty;

Analyzing the results of providing medical care to residents of the assigned districts, providing information on the work of the interdistrict medical center;

Conducting joint thematic conferences, seminars. Medical institutions in the attached areas transport patients

and pregnant women to the interdistrict center (by agreement), refer patients for consultation only subject to a complete examination in accordance with the standards of medical care, inform the population about the work hours of the center’s specialists. To coordinate the work of inter-district medical centers and assigned districts create inter-district medical councils.

Polyclinic Central District Hospital provides qualified medical care to the rural population in 8-10 medical specialties. The tasks of the clinic include:

Providing qualified outpatient care to the assigned population of the district and regional center;

Organizational and methodological management of outpatient departments of the district;

Planning and implementation of activities aimed at preventing and reducing morbidity and disability;

Introduction into the work of all outpatient clinics in the region of modern methods and means of prevention and treatment of diseases, best practices in providing outpatient care;

Implementation of measures to promote a healthy lifestyle.

Rural residents come to the district clinic following referrals from medical institutions of rural medical districts to receive specialized medical care, functional examination, and consultations with medical specialists.

To bring specialized medical care closer to the place of residence, mobile medical care teams are created from among full-time doctors and nurses at the Central District Hospital.

The organizational and methodological office of the Central District Hospital plays an important role in organizing medical care for the population of rural areas. which is staffed by the most experienced doctors. It has data on the economy and sanitary condition of the region, the network and staffing of medical institutions, and the provision of the population different types medical and social security, etc. The organizational and methodological office is headed by the head, who can simultaneously be the deputy chief physician of the Central District Hospital.

Outpatient and inpatient medical care for children in rural areas they are assigned to children's clinics, children's hospitals and children's departments of the central district hospital.

Children's health care in the district is carried out according to a unified plan approved by the chief physician, who is responsible for the quality of medical care for children. However, he places direct responsibility on his deputy for pediatrics and obstetrics or (in the absence of one) on the district pediatrician who manages medical care for children in the rural area.

The position of a district pediatrician is established on the staff of each district hospital, which includes a children's consultation clinic, in addition to the medical positions provided for by the standard staff of a children's clinic.

The main health care facility providing medical care to children at the subject level RF.- Children's regional (regional, district, republican) hospital. and in its absence - a regional (regional, republican, district) hospital with a children's department and a consultative clinic for children.

In the area, except for the central district hospital. organize specialized dispensaries (anti-tuberculosis, skin and venereology, drug treatment), which operate as inter-district medical institutions, serving the population of nearby areas.

Highly qualified specialized medical care for the rural population in all main specialties is provided by regional (territorial, republican district) medical institutions. The main one is regional (regional, republican, district) hospital, which provides full medical care not only to rural residents, but also to all residents of the constituent entity of the Russian Federation. It is the center of organizational and methodological management of medical institutions located in the region (region, republic, district), a clinical base for specialization and advanced training of doctors and nursing staff.

The capacity and staffing of the hospital are determined by the population of the administrative territory. The optimal capacity of a regional (regional, republican, district) hospital is 700-1000 beds.

Objectives of the regional hospital:

Highly qualified specialized consultative, diagnostic and therapeutic assistance to the population of the administrative territory in outpatient clinics and inpatient conditions using highly effective medical technologies,

Advisory and organizational and methodological assistance to specialists from other medical institutions of the administrative territory;

Qualified emergency and planned advisory medical care using air ambulance and ground transport;

Development and implementation of targeted programs for improving medical care:

Introduction of modern medical technologies into the practice of medical institutions of the administrative territory, effective methods management and principles health insurance:

Participation in training, professional retraining and advanced training of medical workers;

Formation of a healthy lifestyle.

Organizational and methodological department;

Consultative and diagnostic clinic:

Hospital with emergency department;

Department of expert and planned advisory assistance;

Medical Library;

Other structural units necessary for the operation of the hospital (catering department, accounting, medical archive, garage, etc.).

The work of a regional hospital is in many ways similar to the work of a city hospital. but it also has its own characteristics. One of them is the presence within the hospital of a regional consultative and diagnostic clinic.

The main tasks of the consultative and diagnostic clinic: providing patients referred from medical institutions at the local or district level with specialized qualified advisory assistance in diagnosing diseases, recommending the volume and methods of treatment, and, if necessary, inpatient care in the departments of the regional hospital. Consultative and diagnostic clinics not only perform a consultative and therapeutic function, but also evaluate the quality of work of rural doctors, district, city and local hospitals.

Patients are referred to the regional advisory clinic, as a rule, after preliminary consultation and examination by regional medical specialists. To evenly distribute the flow of patients, specialists of the consultative and diagnostic clinic regularly report the availability of free places in hospital departments or appointments for examinations, coordinate the timing of admission of patients from medical institutions in rural areas, organize and conduct on-site consultations with medical specialists, provide a medical report for each patient, which indicates the diagnosis. treatment performed and further recommendations. The clinic systematically conducts quality assessments: significant discrepancies in diagnoses, errors made by doctors in district medical institutions when examining and treating patients locally, etc. are examined.

A special feature of the regional hospital is the presence in its composition departments of emergency and planned advisory assistance, which provides emergency and advisory assistance with travel to a remote locality. The department transports the patient to a medical organization, sends specialists on calls from areas and maintains contact with teams sent to provide medical care. Branch emergency assistance organizes the delivery of patients, accompanied by medical personnel, to specialized institutions outside the region, urgent delivery of medications and supplies necessary to save the lives of patients.

This department usually has a fleet of cars for traveling to rural areas. In addition to the manager, its staff includes doctors, specialists

those involved in providing emergency medical care, paramedics, nurses. All specialists from the regional hospital and other medical institutions can be involved in the work of the department. The department of emergency and planned advisory care in some regions is the basic medical unit of the regional center for disaster medicine. In this case, specialized medical care teams work in almost constant readiness.

To bring medical care closer to village residents, specialists from regional institutions practice scheduled visits by integrated teams to consult with pre-selected patients who need clarification of the diagnosis. correction of prescribed treatment, determination of the need for hospitalization in regional medical institutions. This work is also carried out by specialists from central regional hospitals.

Research work- one of the areas of activity of the regional (regional, republican, district) hospital: conducting scientific research, introduction of the results of new developments and techniques into the practice of medical institutions, organization of scientific conferences and seminars, work scientific societies doctors.

In a regional hospital, unlike a city hospital, the functions organizational and methodological department much wider. In fact, it serves as a scientific and medical basis for the state health management body of the region for introducing advanced technologies into practice. organizational forms and methods of medical care to the population. Its main functions:

Analysis of the activities of medical institutions in the region:

Organizational, methodological and advisory assistance:

Study and analysis of population health indicators:

Organization of staff training;

Work planning.

The organizational and methodological work of medical institutions in the region involves the main staff (chief surgeon, therapist, pediatrician, obstetrician-gynecologist) and freelance (often heads of specialized and highly specialized departments) specialists.

Emergency medical care in rural areas at the level of FAP, SUB. Family medical outpatient clinics are provided by the medical staff of these institutions at any time of the day.

The most important issues in organizing emergency medical care for the rural population:

Schedule and procedure for providing emergency medical care in all rural medical organizations;

Availability of styling, bags and their necessary equipment;

Emergency medical care standards;

Registration of calls received and measures taken;

Continuity (based on the principle feedback) between the ambulance service, outpatient clinic service, dispatch services of farms and enterprises:

Preparing the population to provide self- and mutual assistance, increasing the sanitary literacy of the population;

Development and availability of incentives for participation in this type of assistance for all health workers, including nursing staff, including their training, equipment and financial incentives;

Training of medical personnel to provide ambulance and emergency medical care;

Priority of medicinal and logistical support.

To improve medical care for the rural population great job carried out as part of the implementation of the healthcare modernization program. which provides organization of households, further strengthening of the material and technical base of medical institutions in rural areas, advanced training, training and retraining of personnel.

The modernization program provides for the opening of more than 3,800 households in settlements with a population of less than 100 people.

The concept of housekeeping implies a local resident who has agreed to provide first aid to sick or injured residents of the settlement. To do this, specialists in the field of disaster medicine will teach such a resident the basic skills and techniques of first aid, and local authorities will equip him with a telephone connection for promptly calling a paramedic, a doctor, an emergency medical team and a first aid kit. Such work is already being actively carried out in some regions of the Russian Federation.

It is planned to open 1,093 first aid stations and paramedic stations in rural areas. 226 medical outpatient clinics, 1,381 GP offices.

The situation with medical personnel, working in rural areas, in last years getting worse. In 2005-2010 the number of doctors in rural areas decreased by 1,653 people (from 42.2 thousand to 40.6 thousand doctors), the coefficient of part-time doctors increased by 6.7%.

From January 1, 2012, by Decree of the Government of the Russian Federation of October 17, 2011 No. 39, medical and pharmaceutical workers living and working in employment contract in rural settlements, workers' settlements (urban-type settlements), who are on staff at the main place of work in federal government institutions, subordinate to the federal executive authorities, as a measure of social support, a monthly cash payment has been established to compensate for the costs of paying for living quarters, heating and lighting in the amount of 1,200 rubles.

To reduce the shortage of medical personnel in rural areas, it was proposed to create additional incentives for doctors who transfer to work in rural areas, in the form of one-time payments in the amount of 1 million rubles for arrangement, solution of housing and other everyday problems.

It is planned to make one-time compensation payments to medical workers under the age of 35. arrived in 2011-2012. after graduating from a higher educational institution, to work in a rural locality or by moving from another locality.

The condition for receiving these payments is the conclusion between the doctor and the authorized executive body of the constituent entity of the Russian Federation of an agreement on moving to work in a rural locality for a period of at least 5 years.

The executive authorities of a constituent entity of the Russian Federation have the right to provide for payments to the average medical personnel at the expense of the constituent entities of the Russian Federation.

Federal target program “Social development of rural areas until 2013” (as amended by Decrees of the Government of the Russian Federation dated April 29, 2005 No. 271 and April 28, 2011 No. 336) provides for the implementation of additional measures for the development of a network of primary health care institutions:

Strengthening the material and technical base of healthcare facilities in rural areas, taking into account the creation of mobile units, centers, and departments of general medical (family) practice;

Improving primary health care for the rural population by introducing general medical (family) practice;

Providing the rural population with emergency medical care by improving regulatory, logistical and personnel support;

Improving consultative, diagnostic and therapeutic assistance by introducing on-site forms of medical care;

Staffing healthcare institutions primarily with specialists from general medical (family) practice:

Development of the Institute of GP (family doctor).

As a result of the implementation of measures, the rural population's access to the services of medical institutions and their departments will be expanded.

To increase the efficiency of implementation of the Concept demographic policy of the Russian Federation for the period until 2025, approved by Decree of the President of the Russian Federation of October 9, 2007 No. 1351. in relation to rural areas, additional measures are required in order to:

Reducing the mortality rate, especially in working age:

Reducing infant mortality rates;

Preserving and strengthening the health of the rural population: increasing life expectancy;

Creating conditions for a healthy lifestyle;

Reducing the incidence of socially significant diseases,

Reducing the migration flow of the rural population. In this regard, in the regions it is necessary to provide:

Strengthening primary health care in rural areas:

Increasing the availability of medicines for rural residents;

Forming motivation for a healthy lifestyle, including programs to reduce the consumption of alcohol and tobacco products, non-medical use of narcotic drugs and psychotropic substances, prevention of alcoholism, drug addiction, cardiovascular and other diseases;

Ensuring the operation of health centers in rural areas.

In the field of medical care, it is planned to expand the access of the rural population to qualified primary health care. emergency and specialized medical care based on strengthening the FAP network. district hospitals, the creation of general medical practice outpatient clinics, taking into account territorial characteristics. strengthening the material and technical base of district, central district hospitals and inter-district centers using telemedicine, ensuring transport accessibility for the rural population of inter-district centers, regional, republican and federal medical institutions. It is planned to expand the emergency medical services service, the pharmacy network, on-site forms of specialized medical care and the use of remote forms of diagnostics in rural areas. The entire rural population should be covered by dispensary observation.

To popularize a healthy lifestyle and attract rural residents to exercise physical culture and sports, it is planned to expand the network of sports facilities and grounds.

All activities proposed and carried out by the Government and local health authorities should really change the existing rural health care system and bring it to a new, higher quality level that meets modern medical requirements.

Dear Vladimir Volfovich! Medical care in rural areas is of particular importance. Every year, villages and the people living in them are aging more and more. And with age, sadly, comes health problems. Where to go? Who to contact?

Fast and qualified assistance you can get it on the spot - at a rural paramedic-obstetric station (FAP). And it’s easier to get to it, and a well-known paramedic will meet you here, and there is enough medicine here. FAP is a very important part of rural infrastructure. This is the place where you can not only get first aid, recommendations for the treatment of colds and viral diseases, get advice, get a referral for a medical appointment at the Central District Hospital, get an injection, prescribe or buy medications, but also meet and chat with friends. Indeed, in some places, even bread is delivered to the first aid station, so that people can receive here not only medical care, but also moral and spiritual support. Now in some settlements, all socially significant objects for villagers are located in one place: savings budget funds forced to unite the first aid station, library, post office, village club, and school under one roof.

And this is very important for an elderly person who finds it difficult to walk far. The economic crisis continues; in connection with this, is the question of closing FAPs being raised in our area?

— Neither the administration of the municipal district, nor the administration of the Central District Hospital, and especially the administration rural settlements this question is not raised. On the contrary, everyone understands that FAP is necessary in rural areas. There is no one to replace him. Despite economic difficulties, the district administration allocates funds for the maintenance of first aid stations, and this is a rather large expense item: heating, lighting, medicines, equipment, etc. Reading these lines, tears involuntarily well up.

This all applies to the Kirov region. We are residents of the Kursk region, Sovetsky district. Our situation with FAPs is completely opposite. FAPs are closed even when local residents still need them. Our administration does not want to pay for light and heating, calling these costs not the intended use of budget funds. Paramedics are licensed in neighboring villages and forced to go there to work, but the assigned areas remain the same.

But which of our elders is able to travel vast distances when there is no regular transport service? It seems that local officials do not understand the essence of the work of a paramedic. Come to the office in the morning, get the necessary injections and vaccinations and go to the site to see those who are completely unable to walk, provide patronage for children, and gather people for a routine examination. It turns out that people are forced to go to the paramedic’s house and wait for him there. But there is no equipped office there, quartz lamp for disinfection. The paramedic will not agree to give injections at home, and has every right to do so.

Where to store the vaccine for vaccinations, in the refrigerator with food or something? This is how our administration makes healers out of paramedics, and this is a gross violation of all laws and rules. We, residents of the village of Mikhailoannenka, Sovetsky district, Kursk region, ask you to take all measures to return the FAP to the people. It was closed in 2009, but the local administration found funds for lighting and partial heating, which made it possible to continue to receive the necessary medical care. Instead of the FAP there was an office for a paramedic. After some time, the library and village council were moved to the same building, which is what they do in those regions where they are trying to save on heating and lighting.

But the head of the village council changed and decided to move closer to her home and returned the village council to its original place. She was asked to at least leave the light on, but she said that this was not a targeted use of budget funds. She did not turn any of her convolutions towards people. Pursuing her interests, she found funds to repair the old village council. Maybe our entire administration lives in a completely different country? After all, the president himself spoke about priorities in healthcare and the availability of medical care.

The former building of the FAP is a building from the late sixties, made of brick and has a service life of 150 years - in excellent condition. Repairs were made there when the village council was transferred, and now it is facing gradual destruction. There's nowhere to even vote. They always find money for themselves, but don’t want to think about people. We have many other problems. There is no road to the first aid station, and during snowfalls people leave their cars on the highway, or at home for the whole winter, with no chance of leaving.

For several years now, the entire village has been adorned with a new water tower, which was never put into operation, the water pumps do not work, and the water from the old water tower is not suitable for cooking. And all these difficulties accompany the villagers throughout their lives. With every elected official, people hope for changes for the better, but it only gets worse, and the administration is not even going to solve these problems, and those who should take care of people are killing with their indifference. Maybe you can make the authorities work? 22.08.

2016 Residents of the village of Mikhailoannenka.

Maxim DENISOV

What money is spent on must work effectively

The title of the article may lead a regular reader of the NSG to some bewilderment - once they wrote and wrote that FAPs will not be repaired in any way, and now they suddenly ask why they are needed at all. How come? In fact, there is no contradiction here.

Of course, people living in rural areas should have access to medical services, and feldsher-midwife stations are designed to bring these services closer to them geographically. However, the whole question is what kind of services are these? Sometimes, a health worker in such a medical center can only give an injection and bandage, which, in principle, every citizen should be taught in elementary school in high school.

But we will return to this point. In the meantime, let's pay attention to the official message published on the website of the Government of the Penza Region. “The Governor of the Penza Region Vasily Bochkarev instructed the heads of administrations of city districts and municipal districts to create special commissions that should monitor the logistics of healthcare institutions. The corresponding instruction was given during a meeting that was held via videoconference on Monday, November 10, 2014.”

“Local managers must know the state of the medical institution and have information about activities aimed at developing the healthcare industry. Head or his deputy social issues Once a week they must go to sites and personally get acquainted with the situation - check the conditions in which patients are, the availability of medications and the quality of food. Representatives of political parties in the person of deputies, public organizations and the health insurance fund need to be involved in this work,” emphasized Vasily Bochkarev.

The governor also pointed out that it is unacceptable to lag behind the schedule for the repair of medical and midwifery stations. According to the Ministry of Health of the Penza Region, 81% of FAPs have been repaired. In this regard, Vasily Bochkarev drew the attention of the meeting members to strict adherence to work schedules.

It is curious that when the NSG drew the attention of the same thing a month ago (“Unfulfilled order”, NSG No. 38 (135) of October 9, 2014), the Ministry accused us of publishing “unreliable facts” and “incorrectly” posing the issue. And we, rubbing our hands, waited for the punishment from the Penza Ministry of Health to the governor. Now they will give him the first number - he will know how to be incorrect with unreliable facts! But for some reason they didn’t wait...

But the most interesting thing in the message is not this, but the following information: “Within the framework of the subprogram “Prevention of diseases and the formation of a healthy lifestyle. Development of primary health care" of the state program "Health Development of the Penza Region for 2014–2020" 70.9 million rubles were allocated for the overhaul of regional medical and obstetric centers and 99.1 million for the purchase medical equipment. A list of 163 FAPs in need of repair has been compiled, as well as a list of 5.5 thousand pieces of equipment to be brought into compliance with the equipment standard.”

Once again we emphasize “equipment to comply with the equipment standard”! Meanwhile, they only report to us about repairs. There is silence about the quality of subsequent medical care. Meanwhile, this is precisely what the governor previously emphasized. At the session of the Legislative Assembly on April 22, one of the deputies, addressing the governor, said that residents of the Penza region often ask questions about the work of FAPs regarding improving the quality of medical care in rural areas. “When checking the work of FAPs, we are faced with the fact that often no more than six people a month come there for appointments.

Deputy Chairman Vladimir Maltsev is now traveling to the districts to inspect paramedic and obstetric centers, but he does not notify either the Minister of Health or the head of the district administration about his visits. There are cases that the first aid stations are either closed for half a day, or there is no doctor there, so the population immediately goes to the hospital. Why then maintain this FAP? If we invest a resource, then it must work and be attractive to the population,” the governor responded (quoted by Penza-Press news agency). And at a meeting with the regional Minister of Health, he clarified: “all residents of the Penza region should receive timely, high-quality and qualified medical care, and also have the opportunity to undergo examination using modern primary diagnostic methods in the territory of all municipalities...

Improving the quality of primary health care is a priority task that we have set for ourselves and are obliged to solve. It is necessary to install the required medical equipment in the first aid stations, which will be used to the maximum extent possible, and the staff will be able to work on it.”

How did it happen that the governor’s order suddenly disappeared from its main component – ​​the quality of medical care? Officials from the Ministry of Health concentrated their efforts on repairing the premises of the FAP and reported on their planned equipment in accordance with the current federal standard. But, alas! With such equipment at FAPs, village residents will still be forced to travel to regional centers every day, even for banal, but often quite effective, physical procedures. So, “thoroughly” renovated health centers run the risk of remaining “empty” premises.

In this regard, we note that according to the information available to the editorial office, the list of 5.5 thousand units of medical equipment, for which nearly one hundred million has been allocated, has not yet been approved. And we again take this opportunity to attract the attention of the regional Ministry of Health and the Government body supervising it to a unique Penza development - the AIST-3 device, modernized with an EHF therapy adder. The device was not only developed and constructed by Penza specialists, but is also produced by the Penza enterprise PO Start.

Equipping Penza FAPs with this device, which has a huge range of applications in therapy and rehabilitation activities, will make it possible to turn them into actually working medical institutions that perform their medical and rehabilitation functions. Well, in addition, it will allow us to preserve and develop truly innovative production in Penza, the need for which our governor also never tires of talking about.

It's a small matter. The Penza Ministry of Health needs to develop and approve its own standard for equipping FAPs in our region, because active Federal standard contradicts itself, prescribing the implementation of medical rehabilitation measures in the absence of appropriate material equipment in the proposed standard.

The law allows this. All you need is desire and will. This is precisely what the bureaucracy, as we know, lacks. It is much more convenient to formally report, igniting only from criticism in the media, and even then it is unproductive. Alas, real action begins only with pressure from above.

According to the information available to the NSG, S.V. Kozlov showed interest in this issue. – deputy of Maltsev V.A. (Deputy Chairman of the Government of the Penza Region, in charge of healthcare). Which gives some hope that Penza FAPs will not remain an entourage of Potemkin villages.

“New Social Newspaper”, No. 43, November 20, 2014
The publication was published with the permission of the NSG editors.
Address of the editorial office of Novaya Social Gazeta:
Penza, st. K. Marx, 16. Tel./fax: 56-24-91, 56-42-02, 56-42-04.

Rural paramedic... On the shoulders of these people lies concern for the health of a quarter of the Russian population living in rural areas. They have always enjoyed great respect, because almost every villager owes their health, and sometimes their life, to this specialist. There are 26 medical and midwifery stations and 5 outpatient clinics in the district.

It's no secret that working as a paramedic in the countryside is much more difficult than in the city. The city doctor has workplace and limited working hours. A rural paramedic, as a rule, is one for several villages. He rushes to help the patient at any time of the day or night, in any weather. A paramedic is required to combine many medical specialties: treat colds, provide assistance for injuries. In addition to receiving appointments, going on calls, and preventive visits, he carries out vaccination activities. It happens, and he treats animals. A paramedic needs to be prepared for anything: sometimes even to deliver a baby. And yet, for most rural doctors, their work and profession seems to be the best in the world. They are attached not only to people, but also to their mother village, without whom they cannot imagine their existence.

Over the course of two weeks, a Selskaya Pravda correspondent visited several medical and obstetric stations in the Gryazovets district. The time was not wasted: firstly, we met and talked with wonderful people, professionals in their field; secondly, we saw with our own eyes what life is like in a rural first-aid post; thirdly, medical workers identified the most actual problems their FAPs.

In addition to communicating with paramedics, a survey of rural residents was conducted. In general, villagers are grateful to their doctors and are satisfied with their work. But as they say, as many people as there are, so many opinions. Here are just a few quotes.

People says

“I rarely turn to a paramedic for help over the phone; more often I come myself or my wife. If we call a paramedic, she always comes. In general, this person needs to erect a monument during his lifetime. She rushes to help people at any time of the day or night, regardless of time.”

“Our paramedic will always come to the rescue. I can only say good things."

“Our paramedic is a reliable person. My father was dying, so she went not only to give injections, but also put in IVs.”

“I can’t say anything bad. We really like our doctors. We went on foot to see my grandson, son, and daughter (we live in a remote village). I am very grateful to them."

“Very kind, affectionate, one can only be proud of such a paramedic.”

“Our paramedic is a sensitive, friendly person, responsive to the pain of others. People feel this and are drawn to her with all their hearts. And since the paramedic’s wards are mainly elderly people who need participation and care, they all look forward to her every visit.”

Among the reviews there are complaints that the paramedic does not always arrive on time when called, sometimes being delayed for several hours. People also complained about how much they sometimes have to listen to from their doctor when he visits a patient on call.

Villagers are also concerned that the paramedic may answer that “he has a day off...” or simply not answer if they call him on his mobile or home phone.

One good thing is that there are very few such cases when citizens expressed their complaints about the work of a paramedic. Of course, this topic is very sensitive. We cannot discount the fact that a paramedic’s salary is small, but the responsibility is enormous. And no one has canceled the human factor. But... our citizens are still inclined to the opinion that “that’s why they chose this kind of work for themselves, so that one day, having taken the Hippocratic oath, they would be devoted to their profession and people.” This is above all, the rest does not count. That’s why a rural paramedic has no right to say that he has a day off if someone is waiting for his help somewhere...

Analyzing the opinions of rural residents about the availability and quality of medical care in rural areas, it can be unequivocally stated that the majority of rural paramedics work by calling, are proud of their profession and the path chosen in their youth. Most of these fragile women, despite everything, are still strong in spirit and are not indifferent to other people’s grief and pain. And as people say, a real doctor will not go to bed while the light is on in someone's house waiting for the doctor.

So, meet rural paramedics.

Our paramedic

In Yurov, the residents are the luckiest: their outpatient clinic employs two experienced doctors - Tatyana Aleksandrovna Mayorova and Marina Fedorovna Isakovskaya. In addition, both live on the central estate. In addition, in 2012 alone, under the Healthcare Modernization Program, 2.5 million rubles were allocated for the overhaul of the outpatient clinic.

Tatyana Aleksandrovna Mayorova: “Our outpatient clinic serves 1,200 people, so there are calls at any time of the day. We never refuse and always rise to the challenge. Of course, if they find us, because situations are different. We can, for example, go to the city. In this case, the call is handled by an ambulance. The ambulance workers know our mobile phones. the main problem Our first aid station, probably like everyone else, is transport. We get to the call by hitchhiking or on a work bus, and sometimes on foot. For example, in the village of Stepurino, which is 5 kilometers from Yurov, it is more advisable to call an ambulance, unless, of course, it is an emergency call. Help will be provided much faster, therefore, I believe that servicing urgent calls in remote settlements should fall on the ambulance service.

Paramedic at Minkinsky outpatient clinic Ekaterina Vladimirovna Domashina- the youngest paramedic in our area - lives in Yurov. She loves her job, despite the fact that it is several kilometers away. In 2010, after graduating from college, the girl returned to her home village. During this time, she gave birth to a child and has been standing guard over the health of the villagers for six months now. Ekaterina gets to work by personal vehicle: her husband drops her off at work on the way to Vologda and drops off her child at kindergarten. The paramedic returns to Yurovo every day by school bus. Almost the entire population of the service area (700 people, including 90 schoolchildren) is concentrated in Minkino.

Ekaterina Vladimirovna Domashina: “Our first aid station is open from 8 a.m. to 2 p.m. If I’m already in Yurov, and I receive a call, then I have to get there either by personal transport, or arrange for them to come pick me up in their car. The ambulance was informed that I do not live in the serviced area, so they always go to my patients without any problems. If the case is not severe and not urgent, I consult some patients by telephone. Sometimes villagers are helped out by Valentina Ivanovna Parfenova, who lives in Minkino and works as a paramedic in Panfilov. My home and mobile phone patients and ambulances know. I can never refuse and not come to a challenge if I have the opportunity. It probably comes from within..."

Made at Minkinsky FAP redecorating. The young paramedic has a great desire to help people, but is not satisfied with the salary, which differs from the salary of a nurse by only a thousand. The FAP, according to the paramedic, at the moment, in addition to repairing the building, is in great need of a phonendoscope and a tonometer, for which an application was submitted to the chief physician.

Paramedic of Sidorovsky FAP Anna Nikolaevna Perevozchikova originally from Gryazovets, he has been working at the local first-aid post for 24 years. About 200 people live in the serviced area, which is quite a few 10 villages. The FAP is located 25 kilometers from the city, so people most often turn to a local doctor for help. And Anna Nikolaevna never refuses, because helping people is her calling. We met Anna Nikolaevna in Rostilov: she was replacing a Rostilov paramedic who had gone on vacation.

Anna Nikolaevna Perevozchikova: “I feel sorry for people, so I have to help them out. I am in Rostilovo in the morning, and from 14:00 I am at my first aid station. The ambulance comes to us in Sidorovskoye on the first call, but only when I consider it necessary, since our roads leave much to be desired. I have no problems with communication with patients. Our FAP has never had a telephone connection at all, but now my mobile phone helps me out. Three SIM cards, three numbers, so I am always available to my residents. There are no problems with the delivery of patients either. Now many people have personal transport, so I always reassure my patients: “If the ambulance doesn’t arrive, we’ll get into any car parked near the house and go.”

Paramedic of Zaemsky FAP Olga Vladimirovna Guryeva lives several kilometers from his place of work. She solved the transport problem herself when she got behind the wheel of her own car 6 years ago.

Olga Vladimirovna Guryeva: “Of course, it’s easier to work with a machine. Previously, we had to walk a lot, since the service radius is 9 kilometers: 8 villages, 288 people. During non-working hours, our site is served by an ambulance. There is access to all settlements, so there are no problems with calls. In addition to my work phone, calls also come to my mobile phone.

Each patient has an individual approach. If, for example, I received a call in the morning, and I know that my grandmother has an exacerbation of a chronic disease and she took necessary medications, I come to her as planned. For emergency calls, I go directly from seeing children, heart attack patients, patients with acute conditions, injuries.”

The Zaemsky FAP is located in a store building that does not have any amenities. According to the paramedic, the medical center currently needs repairs and heating. In summer, the building is not heated by a stove, and if it is cold, you have to turn on the heater. Unfortunately, there is no prospect of moving to another building near the medical post.

A caring person, the head of the Rostilovskoe municipality, Nadezhda Gennadievna Ostryakova, provides great assistance to the FAP. It was she who helped me purchase modern children's electronic scales. Before their appearance, babies had to be weighed the old fashioned way. First, the mother and child were weighed on the scales, then the mother alone. The resulting difference was based on the baby's weight. Yes, that happened too. Nadezhda Gennadievna also helped me purchase a glucometer to determine sugar. Patients no longer need to go to Gryazovets to determine their blood sugar levels.

There are no problems with medicines at the FAP, but there are problems with equipment. There has been no autoclave at the medical post for a year now.

It is said that the rural population is declining. The paramedic of the Kornilievsky FAP, which is located in the village of Lnozavod, does not agree with this, Nina Nikolaevna Bolotova. There are almost 600 people in its service, and the population is not decreasing, but only increasing. Since 1990, she has lived and worked here, so patients can be said to be lucky: a paramedic is at hand. The first-aid post is located in a wooden building built in 1989 - there can be no talk of any amenities. There is no heating here since the Flax Plant closed, and with it the local boiler house “sank into oblivion,” so an oil heater saves the doctor and patients from the cold.

Nina Nikolaevna calls almost every day. She receives them both by landline and mobile phone.

Nina Nikolaevna Bolotova: “I would like citizens to come for a paramedic, as they did before, when there were no telephones, and then escort them back, because now it is sometimes dangerous to get to a patient at night. I serve 9 villages covering 9 kilometers. If during an appointment I receive an urgent call to a remote village, then I forward it to an ambulance, since the FAP does not have transport. The population has now become more demanding, but I always try to find mutual language with your patients. Of course, I want people to treat our work with understanding.”

The paramedic complained that the problem with food vouchers causes great inconvenience to patients. general analysis blood and urine. Previously, coupons could be issued by a paramedic, but now you need to make an appointment with a therapist, who will issue the necessary coupon.

Retired for three years Nina Adolfovna Potemkina- paramedic of Slobodsky FAP. The paramedic has 40 years of experience (!), of which 30 years were given to the Slobodsky first-aid post. Nina Adolfovna left for a well-deserved rest, but was forced to return again, since her area was left without a doctor. Young people are not attracted to a room in a hostel, and the earnings of a paramedic are small. So for now Nina Adolfovna is helping out her residents.

Nina Adolfovna Potemkina: “For now I’m working until September, and then I don’t know. Two years ago, when I returned to work, I wrote a statement to the chief physician not to answer calls after 9 pm. I can no longer handle such a load, I’m not young after all... Residents know about this and call an ambulance at night. There is a lot of work at the first-aid post: there are 1,385 people on its own territory, and I also receive patients from the Palkinsky first-aid post. Only ambulance services handle calls in Palkino. Every day I have to come at half past six in the morning: otherwise I don’t have time. There are a lot of people: whether it’s summer or winter, it makes no difference. It’s good that the administration helps with transport. We travel by car with patronage, and they also deliver medicines and vaccination material.”

Nina Adolfovna’s soul hurts for her site, she hopes that a young and energetic paramedic will come to replace her...

Head of Anokhinsky FAP Sbrodova Lyubov Sergeevna came to Anokhino from Veliky Ustyug immediately after graduation medical school. 36 years have flown by, it seems like one moment. The sons grew up, whom my mother almost never saw, since she was at work most of the time. But Lyubov Sergeevna does not regret, the guys began good people, got higher education. During this time, she has become so integrated with the profession that she cannot imagine herself any other way. For many years of conscientious work, in 2013 the paramedic was awarded the Letter of Gratitude from the Governor of the Vologda Region.

Sbrodova Lyubov Sergeevna: “Our work is like this. Call at any time. Some citizens first call an ambulance, and the ambulance calls me back. Of course, work is easier now. Previously there were no roads or cars. It happened that you were riding in one tractor, and the woman in labor was in another. A lot has changed over the years. But now you can’t lure anyone into the village. Our work requires a lot of dedication, so we need to slowly prepare for retirement and leave without regret...”

Reception of the population, calls, preventive examination, various procedures - the everyday life of a rural paramedic consists of this and much more. And not only weekdays - one might say, weekends and holidays... After all, help may be needed at any time. It’s just scary to imagine what will happen in a few years, because most of the rural doctors are of retirement age. If they leave, the villagers will be left without medical care.

But let’s not talk about sad things on the eve of the holiday. Every day, people in white coats work miracles, helping patients strengthen and restore their health, and bring them back to life. And for this I would like to say a huge and sincere thank you to them. It seems that the problems identified by rural paramedics will soon be resolved.

Paramedic and midwife station I Medical and midwifery station (FAP)

a medical and preventive institution that is part of a rural medical district and carries out, under the leadership of a local hospital (outpatient clinic), a complex of therapeutic, preventive and sanitary and anti-epidemic measures in a certain territory. It is the primary (pre-hospital) health care unit in rural areas.

As a rule, FAPs are located in the most remote localities of the district hospital, which brings medical care closer to the rural population. Serves part of the territory of a rural medical district (Rural medical district) , subordinate for medical issues to the local hospital (Hospital) or outpatient clinic (outpatient clinic) (when there are no these institutions in the area - the central district hospital). On the FAP staff: head - (with completed secondary education medical education; midwife (visiting nurse), also with completed secondary medical education, and a nurse. FAP provides patients with pre-medical care (within the competence and rights of a paramedic and midwife) at outpatient appointments and at home, consults them with a doctor, and carries out medical orders. During the period of field work, the FAP, if necessary, provides assistance directly at the field camps.

The doctor at the local hospital (outpatient clinic), in accordance with a pre-drawn schedule of visits to the FAP, systematically monitors the quality and timeliness of medical care provided at the FAP, and also advises patients.

The medical staff of the FAP systematically monitors healthy children under 1 year of age and treats children aged 1 to 3 years, provides medical care to sick children,, if necessary, refers them to a doctor or calls a doctor to their home, and refers patients to hospitalization. The duties of FAP employees include medical care of preschool institutions (Preschool institutions) , without medical workers on staff.

FAP staff monitors the health status of the rural population, examines patients as directed by the doctor to refer them for medical examination (Dispenserization) , compiles dispensary records, calls patients for scheduled examinations, examines the working conditions and life of persons registered with dispensaries, monitors the implementation of recommendations for their employment.

FAP workers carry out sanitary and anti-epidemic work, in particular, identify infectious patients by conducting door-to-door visits. Before hospitalization of the patient, FAP employees ensure the implementation of anti-epidemic measures in the outbreak - ongoing disinfection, removal of persons who were in contact with the patient from work in food, children's and medical institutions, etc. The final disinfection is carried out by the district or the corresponding sanitary and epidemiological supervision. The medical staff of the FAP also carries out preventive vaccinations.

FAP workers carry out sanitary and epidemiological supervision over the territory of populated areas, water supply, production premises, municipal facilities, catering establishments, trade, schools and other children's institutions, as well as the storage and use of pesticides, etc.

The FAP premises must consist of at least three rooms. Many FAPs have several beds for women in labor, as well as beds (in a separate isolated room) for temporary isolation of infectious patients. A separate examination room is also required for the reception and sanitary treatment of women in labor.

The equipment of the paramedic and midwifery stations is intended to provide measures to provide emergency pre-medical care, incl. emergency obstetric care. It includes devices, apparatus, kits, medical instruments, patient care items, medical furniture and disinfection equipment, sanitary equipment, items for health education work (see Healthy Lifestyle Development Service) . Each FAP has patient care items: medical, eye baths, etc.

The necessary ones are contained in the paramedic kit, as well as in wall cabinet for medicines. Equipping the FAP is carried out within the limits of the annual allocations allocated for these purposes. At the same time, funds from state, cooperative and other organizations are attracted. The list of medicines for emergency first aid is determined taking into account local conditions and approved by the chief physician of the central district or local hospital.

At the FAP, certificates are issued about the birth of the child, about vaccinations performed, as well as death certificates if the patient was monitored and. About the issuance procedure sick leave at the FAP - see Certificate of incapacity for work . The FAP maintains documentation (see Medical documentation) and reporting according to approved statistical forms, which are submitted to the local hospital (outpatient clinic) within the prescribed time frame.

II Medical and midwifery station

a medical and preventive institution, part of a complex of medical institutions of a rural medical district, designed to provide the population with pre-hospital medical care and obstetric care by a paramedic (head of a medical center) and a midwife, to provide patronage to pregnant women and children, to carry out sanitary and preventive and anti-epidemic measures; F. items are created in small, separately located settlements.

1. Small medical encyclopedia. - M.: Medical encyclopedia. 1991-96 2. First aid. - M.: Great Russian Encyclopedia. 1994 3. encyclopedic Dictionary medical terms. - M.: Soviet encyclopedia. - 1982-1984.

See what a “paramedic-midwife station” is in other dictionaries:

- (FAP) a medical and preventive institution that provides the initial (pre-hospital) stage of providing medical care in rural areas. FAPs work as part of a rural medical precinct under the guidance of an outpatient clinic, precinct or district... ... Wikipedia

Paramedic and midwife station- 2. The medical obstetric station (hereinafter referred to as the FAP) is a structural unit medical organization(its structural division). 2. FAP is organized to provide primary pre-medical health care (hereinafter referred to as pre-medical... ... Official terminology