Forms of medical care emergency urgent planned. Types, conditions and forms of medical care

Types, forms and conditions of rendering medical care

Within the framework of the Territorial Program, the following are provided free of charge:

1. Primary health care, including pre-medical, medical and specialized;

2. Specialized, including high-tech, medical care;

3. Ambulance, including specialized ambulance, medical care;

4. Palliative care in medical organizations.

Primary health care includes activities for the medical prevention of diseases, including activities for preventive vaccinations and preventive examinations, formation healthy lifestyle life, diagnosis and treatment of diseases and conditions, dispensary observation of women during pregnancy, healthy children and persons with chronic diseases, prevention of artificial termination of pregnancy (abortion), sanitary and hygienic education of citizens, as well as the implementation of other activities related to the provision of primary health care. health care for citizens.

​ Within the framework of primary health care, the formation of a healthy lifestyle among citizens is carried out, starting from childhood, is provided by carrying out activities aimed at informing citizens about risk factors for their health, the formation of motivation for a healthy lifestyle and the creation of conditions for a healthy lifestyle, including physical education and sports.

Primary health care is provided free of charge in emergency and planned forms on an outpatient basis and in a day hospital in medical organizations and their respective structural divisions, including family planning and reproduction centers, as well as outside medical organizations of the state healthcare system of the city of Moscow .

Primary health care is provided by local general practitioners, district pediatricians, doctors general practice(family doctors), as well as relevant paramedical personnel.

Primary specialized health care is provided by specialist doctors, including specialist doctors of medical organizations providing specialized, including high-tech, medical care.

​ Specialized, including high-tech, medical care is provided in inpatient and day hospital conditions by specialist doctors and includes the prevention, diagnosis and treatment of diseases and conditions (including during pregnancy, childbirth and the postpartum period) requiring the use of special methods and sophisticated medical technologies, as well as medical rehabilitation.

High-tech medical care is provided to residents of the city of Moscow medical organizations of the state healthcare system of the city of Moscow in accordance with the list of types of high-tech medical care approved by the Moscow Department of Health on the basis of the list of types of high-tech medical care approved by the authorized federal executive body in the field of healthcare, and the list of medical organizations approved by the Department of Health of the city of Moscow.

Ambulance, including specialized ambulance, medical care is provided in an emergency or emergency form in case of diseases, accidents, injuries, poisoning and other conditions requiring urgent medical intervention by institutions and ambulance units of the state health care system outside the medical organization (at the place of call ambulance crews, including specialized ambulances, as well as in vehicle during medical evacuation), in outpatient and inpatient conditions by visiting ambulance advisory teams, including when called by a medical organization that does not employ medical workers of an emergency emergency medical advisory team, if it is impossible to provide the necessary medical care in the specified medical organization help.

When providing emergency medical care, if necessary, medical evacuation is carried out, which is the transportation of citizens in order to save lives and preserve health (including people who are being treated in medical organizations that do not have the ability to provide the necessary medical care in life-threatening conditions, women during pregnancy, childbirth, the postpartum period and newborns, persons affected by emergencies and natural disasters).

Palliative care is a set of medical interventions aimed at relieving pain and alleviating other severe manifestations of the disease in order to improve the quality of life of terminally ill patients. Palliative care is provided in specialized medical organizations of the state healthcare system of the city of Moscow - hospices and palliative care departments of medical organizations.

Medical care under the Territorial Program is provided to:

1. Station of emergency and emergency medical care (ambulance) and its structural subdivisions;

2. Outpatient clinics and other medical organizations or their respective structural units, as well as day hospitals of all types (outpatient and emergency medical care);

3. Hospital institutions and other medical organizations or their respective structural units (inpatient medical care).

The Territorial Program also provides emergency medical care.

When providing outpatient care for urgent indications, reception by district general practitioners, district pediatricians, obstetrician-gynecologists is carried out on the day the patient contacts.

​ Rendering emergency care mobile teams of outpatient clinics (departments and emergency rooms) are carried out within two hours from the moment of application. The provision of primary health care in a planned manner is carried out by prior appointment of patients, including in electronic form.

Inpatient medical care is provided in cases of diseases, including acute, exacerbations chronic diseases, poisoning, injuries, pathology of pregnancy, childbirth, artificial termination of pregnancy (abortion), as well as during the neonatal period, which require round-the-clock medical supervision, the use of intensive methods of treatment and (or) isolation, including for epidemiological indications.

Inpatient medical care in a planned form (planned hospitalization) is carried out no later than ten days from the date of the patient's request. Planned hospitalization is provided if there is a referral from an outpatient clinic. Inpatient medical care in an emergency form is carried out without delay. In order to meet the standards of medical care, citizens are provided with free transport services in the manner established by the Moscow City Health Department.

One of the parents, legal representative or other family member is entitled to free joint stay with the child in a medical organization when providing medical care to him in a hospital during the entire period of treatment, regardless of the age of the child. When jointly staying in a medical organization in a hospital with a child until he reaches the age of four years, and with a child older than this age - if there are medical indications, the fee for creating conditions for staying in a hospital, including for providing a bed and food, from the indicated persons are not charged. Payment for the stay of one of the parents, legal representative or other family member is carried out at the expense of the budget of the city of Moscow and the budget of the Moscow City Compulsory Medical Insurance Fund.

For medical and (or) epidemiological indications, patients are placed in small wards (boxes).

1. Measures for the rehabilitation of patients are carried out in medical organizations of the state healthcare system of the city of Moscow or their respective structural divisions, including centers for restorative medicine and rehabilitation, including children's, as well as sanatoriums, including children's and for children with parents.

2. When providing medical care to citizens entitled to receive state social assistance, the organization of the provision of which with medicines is provided for by law Russian Federation, and certain categories of citizens who have the right to provide social support in accordance with the legal acts of the city of Moscow, these categories of citizens are provided with the necessary medicines and products medical purpose, as well as specialized medical nutrition products for disabled children.

3. When providing within the framework of the Territorial program of primary health care in a day hospital and in an emergency form of specialized, including high-tech, medical care, emergency, including emergency specialized, medical care, palliative care in a hospital, the provision of citizens with medicines for medical use included in the list of vital and essential medicines in accordance with the Federal Law of April 12, 2010 N 61-FZ "On the circulation medicines", and medical devices, as well as medical nutrition, including specialized medical nutrition products, which are provided for by the standards of medical care.

Provision of donor blood and its components is carried out in the provision of specialized, including high-tech, medical care under the Territorial Program, in accordance with federal law.

Within the framework of the Territorial Program, dispensary observation is carried out, which is a dynamic observation, including necessary examination, for the health status of persons suffering from chronic diseases, functional disorders, other conditions, in order to timely identify and prevent complications, exacerbations of diseases, other pathological conditions, their prevention and implementation of medical rehabilitation of these persons.

Order of conduct dispensary observation and the list of studies included in it are approved by the City Department of Health

Moscow in accordance with the procedure and list approved by the authorized federal executive body in the field of healthcare.

1. Citizens are informed about the possibility of receiving medical care within the framework of the Territorial Program.

2. In order to receive medical care, citizens have the right to choose a doctor, including a general practitioner (family doctor) and an attending physician (subject to the consent of the doctor), as well as to choose a medical organization in accordance with the legislation of the Russian Federation.

3. Extraordinary provision of medical care in medical organizations of the state healthcare system of the city of Moscow is carried out by certain categories of citizens in accordance with federal legislation and legal acts of the city of Moscow.

4. Within the framework of the Territorial Program, citizens are provided with medical assistance when they are registered for military service, drafted or entering military service under a contract or equivalent contract service, entering military educational institutions vocational education and conscription for military training, as well as when sent to alternative civilian service, with the exception of a medical examination in order to determine the suitability of citizens for military service.

5. Within the framework of the Territorial Program, medical assistance, medical and other services are provided in the center for the prevention and control of acquired immunodeficiency syndrome, medical prevention centers, sanatoriums, including children's and for children with parents, bureaus forensic medical examination, medical information and analytical centers, bureaus medical statistics, in family planning and reproduction centers, orphanages, including specialized ones, hospices, milk distribution points (at outpatient clinics) and other medical organizations included in the nomenclature of healthcare institutions approved by the authorized federal executive body in the field of healthcare, which are not carry out activities in the field of compulsory medical insurance in the city of Moscow in 2013.

6. Within the framework of the Territorial Program, the following is provided:

Carrying out mandatory preliminary and periodic medical examinations of employees of the budgetary sphere of the city of Moscow, included in the list for such medical examinations;

Provision of medical assistance during official physical culture, sports and mass sports and entertainment events if the organizer of such events is the Moscow Government;

Medical examinations of children in order to obtain permission for physical education and sports;

Medical examination of athletes, including rehabilitation treatment and rehabilitation.

24-hour hospital

it medical institution, designed for round-the-clock stay of patients, continuous monitoring and providing them with the necessary assistance.

Hospitalization in a round-the-clock hospital is carried out in the direction of the attending physician or a doctor - a specialist in an outpatient clinic, as well as when the patient independently applies for emergency medical care if there are indications for hospitalization.

PROCEDURE FOR PROVIDING HOSPITAL ASSISTANCE

1. Inpatient medical care is provided in conditions that provide round-the-clock medical supervision and treatment.
2. Emergency medical care is provided regardless of the place of residence, the presence of personal documents, an insurance medical policy in conditions that threaten the life or health of a citizen or those around him, caused by sudden illnesses, exacerbations of chronic diseases, accidents, injuries and poisonings, in case of pathology of pregnancy and childbirth to all who applied.
3. In order to receive planned medical care, a citizen is obliged to present an insurance medical policy of compulsory insurance and an identity document in medical organizations financed from the funds of compulsory medical insurance.
4. The referral of the patient to inpatient treatment is carried out by the attending physician in a planned manner.
5. When providing planned medical care in a hospital, it is allowed to have a queue (in accordance with the "waiting list") for planned hospitalization no more than 25 working days from the date of receipt of a referral for hospitalization, with registration of the date of treatment in the prescribed manner.
6. The sequence of providing inpatient medical care in a planned form depends on the severity of the patient's condition, the severity clinical symptoms requiring hospital treatment, active therapy and round-the-clock medical supervision.
7. The priority is registered by the doctor of the medical organization in the "waiting list", about which a corresponding entry is made in the direction for hospitalization.
8. Patients with emergency and emergency conditions served out of order.
9. When providing medical care in a hospital:
   • patient being examined by a doctor admissions office no later than 30 minutes from the moment of application in case of emergency medical care, in case of hospitalization for emergency indications - immediately. If there are indications for planned inpatient treatment, the patient is examined no later than 2 hours;
   • the patient can stay in the observation room of the admission department for up to 12 hours in order to carry out medical and diagnostic measures in cases where dynamic monitoring is required for the final diagnosis.
10. The patient is accommodated in wards for 4 or more beds in compliance with the current sanitary and hygienic standards. In the absence of free places in the specialized department, it is allowed to place patients admitted for emergency indications outside the ward for a period of not more than one day.
11. Patients are placed in small rooms (boxes) according to medical and (or) epidemiological indications. The list of medical and epidemiological indications for placing patients in small wards (boxes) was approved by order of the Ministry of Health and social development of the Russian Federation dated May 15, 2012 No. 535-n “On approval of the list of medical and epidemiological indications for placing patients in small wards (boxes)”.
12. Providing the patient with medical nutrition is carried out in accordance with the standards approved by the Ministry of Health of the Russian Federation;
13. If it is necessary to care for a child under the age of four inclusive (with a child over four years old - if there are medical indications), the family member (adoptive parent, guardian) who provides care has the right to provide a bed and food (in compliance with applicable sanitary and hygienic standards ), as well as the execution of a temporary disability certificate in the manner prescribed by the current legislation of the Russian Federation.
14. The volume of diagnostic and therapeutic measures for a particular patient is determined by the attending physician in accordance with the Procedures for the provision of medical care, clinical guidelines and guidelines, other normative legal documents. The patient should be informed about the volume of diagnostic and therapeutic measures.
15. In case of life-threatening conditions or the impossibility of providing medical care in the conditions of this medical organization, the patient is sent to another medical organization for the next stage of medical care in accordance with the Procedures for the provision of medical care approved by the Ministry of Health of the Russian Federation.

It is well known that every citizen of Russia is obliged to receive compulsory medical insurance policy. It is with his help that he can receive various forms of medical care absolutely free of charge, since the state compensates for all costs, declaring medicine in the country, thus, free of charge. However, as you know, such a policy does not at all affect the entire range of problems. Therefore, it is important to know what types, conditions and forms of medical care exist in the Russian Federation, which any resident of the country can count on. It's about this issue and will be discussed in this article.

concept

Before starting to analyze the conditions and forms of medical care existing in the country, it is necessary to give a concept to this term. In fact, it is quite complex, and therefore there is no single definition covering all aspects. However, at the legislative level, it is approved that medical care is a set of measures that are aimed exclusively at maintaining and restoring people's health. In particular, it includes the provision of a range of medical services that are required for this. That is why another important question arises, what is a medical service?

The concept of medical service

Currently, under medical services in a broad sense, scientists mean medical intervention, or a whole range of similar measures that are designed for prevention, timely diagnosis and competent treatment of the existing disease. This includes rehabilitation. Such interventions should be performed exclusively by medical professionals or other persons who are authorized to provide medical care. It is directed exclusively at the patient and can affect both his physical and mental state.

The legislative framework

At the moment, the Constitution, that is, the main law of the country, clearly states that every citizen of any age, nationality, status and financial situation has the right to various types and forms of medical care. This rule is undeniable and applies throughout the country. In addition, in this matter, attention should be paid to two more regulatory legal acts - No. 323-FZ "On the Fundamentals of Health Protection" dated November 2011, as well as various programs of state guarantees for the provision of free medical care to Russian citizens in various regions of the country. It is with their help that one can find out where the possibilities of citizens to receive various forms providing medical care to the population in order to fully be able to exercise their own general civil rights.

Types of medical care

Based on existing laws, doctors can provide the following types of medical care, which are widely practiced in the Russian Federation:

1. Primary care.

2. Specialized and high-tech assistance.

3. Ambulance, including specialized Ambulance.

4. Palliative care.

Now let's try to understand them in more detail.

In-Depth Understanding

Before moving on to understanding the various forms of health care, it is necessary to understand its existing types.

1. Primary health care is understood as the basic system for the provision of medical services, including pre-hospital. It includes the following set of measures: prevention, diagnosis, treatment, rehabilitation. At the same time, this concept also includes the formation public opinion and education of the population on sanitary and hygienic issues. In addition, doctors are also required to monitor the course of pregnancy within the framework of this program.

2. Specialized care must be provided by specialist doctors in a narrow profile, which directly includes the disease. Such assistance usually requires special techniques and the use of modern technologies for diagnosis and treatment. To solve the problem, new methods of treatment are often used, up to genetic engineering and other scientific achievements.

3. Any ambulance is provided to citizens if there is a need for immediate medical intervention in case of injuries, accidents, poisoning or other situations that require it.

4. Palliative care is complex, it is designed to relieve a person of pain or relieve other manifestations of symptoms serious illnesses. They are not so much aimed at completely curing the disease, but at improving their quality of life when modern medicine can no longer help.

First aid, which is provided on the spot, does not belong to the types of medical care at all, since it can be provided by persons who are not medical workers, but simply who have completed the necessary training.

Forms

At the moment, the following actions are and are widely recognized as forms of medical care:

• emergency form - it is understood as medical assistance provided only in the presence of sudden dangerous health conditions that do not pose a danger to the life of the patient;
• under the emergency form it is customary to understand a complex of medical actions aimed at the patient in the presence of sudden acute diseases or conditions, as well as exacerbations of chronic diseases, which, by their characteristics, can threaten the patient's life;
• the planned form is intended for preventive measures, as well as for diseases that cannot threaten the life of the patient, and also do not require emergency or emergency care. Such illnesses must not, by delay, injure the health or otherwise aggravate the condition of the individual.

Conditions for the provision of medical care

Regardless of the type and form of medical care, there are a number of conditions defined by law, on which they directly depend.

1. Assistance can be provided outside a medical organization by calling an ambulance or in mobile transport during medical evacuation. Other types of assistance, except for an ambulance, are impossible.

2. On an outpatient basis, that is, situations where the disease does not require round-the-clock supervision of doctors, but can occur at home. Also under this condition suitable house call. It is impossible to provide specialized and high-tech types of assistance.

3. Day hospital - a person's illness requires medical supervision, however, only during the daytime, so round-the-clock supervision is unnecessary. Physicians are not authorized to provide emergency or palliative care.

4. In stationary conditions, that is, in cases where a person's condition requires round-the-clock monitoring and treatment to normalize well-being. Physicians do not provide primary health care.

Principles for the provision of medical care

Any form of medical care must necessarily be provided based on a number of the following principles:

• timeliness of medical intervention;
• the speed and accuracy of the actions performed, however, at the same time they must be decisive and calm, without medical errors;
• all actions of doctors must be correct and expedient, it is impossible to treat at random without making a clear diagnosis;
• doctors should provide assistance according to their focus, and it is also desirable to act prophylactically, preventing the development of the disease;
• medicine should be accessible, however, a clear distribution of patients by area must be observed;
• long-term treatment, often requiring more than one doctor, should be carried out on the basis of continuity and stages.

As you can see, there are a lot of various kinds, forms and conditions under which medical care is provided in the Russian Federation. You should clearly know your list of rights in order to receive the most complete range of assistance in a necessary situation.

B. outpatient;

V. in a day hospital;

G. permanently.

What does not apply to the forms of medical care (Federal Law No. 323, Chapter 5, Article 32)?

A. emergency;

B. urgent;

B. ambulance;

G. planned.

137. Medical assistance provided in case of sudden acute diseases, conditions, exacerbation of chronic diseases that pose a threat to the life of the patient is (Federal Law No. 323, Chapter 5, Article 32):

A. emergency;

B. urgent;

B. planned.

138. Medical care provided in case of sudden acute diseases, conditions, exacerbation of chronic diseases without obvious signs of a threat to the patient's life is (Federal Law No. 323, Chapter 5, Article 32):

A. emergency;

B. urgent;

B. planned.

139. Medical assistance provided during the preventive measures, in diseases and conditions that are not accompanied by a threat to the life of the patient, that do not require emergency and urgent medical care, and the delay in the provision of which for a certain time will not entail a deterioration in the patient's condition, a threat to life and health is (Federal Law No. 323, Ch. 5 , Article 32):

A. emergency;

B. urgent;

B. planned.

Who establishes the regulation on the organization of medical care by types, conditions and forms (Federal Law No. 323, Chapter 5, Article 32)?

B. Government of the Russian Federation.

141. Primary health care includes all of the listed activities, except (Federal Law No. 323, Chapter 5, Art. 33):

A. prevention, diagnosis and treatment of diseases and conditions;

B. special methods of diagnostics, treatment and use of complex medical technologies;

B. medical rehabilitation;

G. monitoring the course of pregnancy;

D. formation of a healthy lifestyle;

E. sanitary and hygienic education of the population.

What is the principle by which the organization of the provision of primary health care to citizens is carried out (Federal Law No. 323, Chapter 5, Article 33)?

A. traveling;

B. territorial-district.

Who provides primary pre-medical health care (Federal Law No. 323, Chapter 5, Article 33)?

A. paramedic;

B. general practitioner;

B. a medical specialist;

G. obstetrician;

D. a pediatrician;

E. general practitioner.

Who provides primary medical care (Federal Law No. 323, Chapter 5, Article 33)?

A. paramedic;

B. general practitioner;

B. a medical specialist;

G. obstetrician;

D. pediatrician

E. general practitioner.

Who provides primary specialized health care (Federal Law No. 323, Chapter 5, Article 33)?

A. paramedic;

B. general practitioner;

B. a medical specialist;

G. obstetrician;

D. a pediatrician;

E. general practitioner.

Under what conditions is primary health care provided (Federal Law No. 323, Chapter 5, Article 33)?

A. outside a medical organization;

B. outpatient;

V. in a day hospital;

G. permanently.

Who provides specialized medical care (Federal Law No. 323, Chapter 5, Article 34)?

A. general practitioners;

B. pediatricians;

B. general practitioners;

G. medical specialists.

What does specialized medical care include (Federal Law No. 323, Chapter 5, Article 34.)?

A. prevention, diagnosis and treatment of diseases and conditions, using special methods and complex medical technologies;

B. formation of a healthy lifestyle;

B. medical rehabilitation;

G. sanitary and hygienic education of the population.

Under what conditions is specialized medical care provided (Federal Law No. 323, Chapter 5, Article 34)?

A. outside a medical organization;

B. outpatient;

V. in a day hospital;

G. permanently.

150. High-tech medical care is part of (Federal Law No. 323, Chapter 5, Article 34):

A. primary health care;

B. specialized medical care;

B. ambulance;

G. palliative care.

151. Medical care, which includes the use of new complex and unique, as well as resource-intensive methods of treatment with scientifically proven effectiveness, developed on the basis of the achievements of medical science and related branches of technology, is (Federal Law No. 323, Chapter 5, Art. 34):

A. primary health care;

B. high-tech medical care;

B. ambulance;

D. palliative care.

Who approves the list of types of high-tech medical care (Federal Law No. 323, Chapter 5, Article 34)?

A. authorized municipal executive body;

B. authorized federal executive body;

B. Government of the Russian Federation.

Who establishes the procedure for financial support for the provision of high-tech medical care to citizens of the Russian Federation at the expense of budget allocations (Federal Law No. 323, Chapter 5, Article 34)?

A. authorized municipal executive body;

B. authorized federal executive body;

B. Government of the Russian Federation.

In what cases is emergency medical care provided to citizens (Federal Law No. 323, Chapter 5, Article 35)?

A. in case of diseases, accidents, injuries, poisoning and other conditions requiring urgent medical intervention;

B. in diseases and injuries requiring special methods of diagnosis and treatment;

B. in diseases and injuries requiring the use of complex, unique or resource-intensive medical technologies.

Article 11 Federal Law No. 323-FZ dated November 21, 2011“On the fundamentals of protecting the health of citizens in the Russian Federation” (hereinafter referred to as Federal Law No. 323) says that in an emergency form a medical organization and a medical worker is provided to a citizen immediately and free of charge. Refusal to provide it is not allowed. A similar wording was in the old Fundamentals of Legislation on the Protection of the Health of Citizens in the Russian Federation (approved by the Supreme Court of the Russian Federation on 07/22/1993 N 5487-1, became invalid from 01/01/2012), although the concept "" appeared in it. What is emergency medical care and what is its difference from the emergency form?

An attempt to isolate emergency medical care from emergency or emergency medical care familiar to each of us was previously made by officials of the Ministry of Health and Social Development of Russia (since May 2012 -). Therefore, approximately since 2007, we can talk about the beginning of some separation or differentiation of the concepts of "emergency" and "urgent" care at the legislative level.

However, in explanatory dictionaries Russian language, there are no clear differences between these categories. Urgent - one that cannot be postponed; urgent. Urgent - urgent, emergency, urgent. Federal Law No. 323 put an end to this issue, approving three different forms medical care: emergency, urgent and planned.

emergency

Medical care provided in case of sudden acute diseases, conditions, exacerbation of chronic diseases that threaten the patient's life.

urgent

Medical care provided in case of sudden acute diseases, conditions, exacerbation of chronic diseases without obvious signs of a threat to the patient's life.

Planned

Medical assistance provided during preventive measures, in case of diseases and conditions that are not accompanied by a threat to the life of the patient, that do not require emergency and urgent medical care, and the delay in the provision of which for a certain time will not entail a deterioration in the patient's condition, a threat to his life and health.

As you can see, emergency and emergency medical care are opposed to each other. At the moment, absolutely any medical organization is obliged to provide only emergency medical care free of charge and without delay. So are there any significant differences between the two concepts under discussion?

The main difference is that the EMF appears in cases constituting life threatening person, and urgent - without obvious signs of a threat to life. However, the problem lies in the fact that the legislation does not clearly define which cases and conditions are considered a threat, and which are not. Moreover, it is not clear what is considered a clear threat? Diseases, pathological conditions, signs that indicate a threat to life are not described. The mechanism for determining the threat is not indicated. Among other things, the condition may not be a life-threatening condition at a particular moment, but failure to provide assistance will lead to a life-threatening condition in the future.

In view of this, a completely fair question arises: how to distinguish a situation when emergency care is needed, how to draw a line between emergency and emergency care. An excellent example of the difference between emergency and emergency care is indicated in the article by Professor A.A. Mokhova "Features of legislative regulation of the provision of emergency and urgent care in Russia":

But unfortunately, this is also not enough. In this matter, it is unequivocally impossible to do without the participation of our "legislators". The solution of the problem is necessary not only for theory, but also for "practice". One of the reasons, as mentioned earlier, is the obligation of each medical organization to provide free medical care in an emergency form, while emergency care can be provided on a paid basis.

It is important to note that the "image" of emergency medical care is still "collective". One of the reasons is territorial programs of state guarantees of free provision of medical care to citizens (hereinafter referred to as TGGP), which contain (or do not contain) various provisions regarding the procedure and conditions for the provision of EMT, urgency criteria, the procedure for reimbursement of expenses for the provision of EMT, and so on.

For example, TPSG 2018 of the Sverdlovsk Region indicates that the case of emergency medical care must meet the criteria for an emergency: suddenness, acute condition, life-threatening. Some TPGG mention the criteria of urgency, referring to the Order of the Ministry of Health and Social Development of the Russian Federation dated April 24, 2008 No. 194n “On approval of the Medical criteria for determining the severity of harm caused to human health” (hereinafter - Order No. 194n). For example, TPSG 2018 of the Perm Territory indicates that the criterion for the urgency of medical care is the presence of life-threatening conditions defined in:

• clause 6.1 of Order No. 194n (harm to health, dangerous to human life, which by its nature directly poses a threat to life, as well as harm to health that caused the development life threatening conditions, namely: head wound; injury cervical spinal cord with violation of its function, etc. *);
• clause 6.2 of Order No. 194n (harm to health, dangerous to human life, which caused a disorder of the vital functions of the human body, which cannot be compensated by the body on its own and usually ends in death, namely: severe III-IV degree shock; acute, profuse or massive blood loss, etc. *).

* The full list is defined in Order No. 194n.

According to ministry officials, emergency medical care is provided if the available pathological changes the patient is not life-threatening. But from various regulatory legal acts of the Ministry of Health and Social Development of Russia, it follows that there are no significant differences between emergency and emergency medical care.

Some TPSG indicate that the provision of medical care in an emergency form is carried out in accordance with emergency medical care standards, approved by orders of the Ministry of Health of Russia, according to conditions, syndromes, diseases. And, for example, TPSG 2018 of the Sverdlovsk region means that the provision emergency assistance carried out on an outpatient, inpatient and day hospital basis in the following cases:

• in the event of an emergency condition in a patient on the territory of a medical organization (when a patient seeks medical care in a planned form, for diagnostic studies, consultations);
• when a patient independently applies or is delivered to a medical organization (as the closest one) by relatives or other persons in the event of an emergency;
• in the event of an emergency condition in a patient at the time of treatment in a medical organization, carrying out planned manipulations, operations, studies.

Among other things, it is important to note that in case of a citizen’s health condition requiring emergency medical care, the citizen’s examination and medical measures are carried out at the place of his appeal immediately by the medical worker to whom he applied.

Unfortunately, Federal Law No. 323 contains only the analyzed concepts themselves without the criteria “separating” these concepts. In view of this, a number of problems arise, the main of which is the difficulty of determining in practice the presence of a threat to life. As a result, there is an urgent need for a clear description of diseases and pathological conditions, signs indicating a threat to the life of the patient, with the exception of the most obvious (for example, penetrating wounds chest, abdominal cavity). It is not clear what the mechanism for determining the threat should be.

Order of the Ministry of Health of Russia dated June 20, 2013 No. 388n “On approval of the Procedure for the provision of emergency, including emergency specialized, medical care” makes it possible to deduce some conditions that indicate a threat to life. The order states that the reason for calling an ambulance in emergency form are sudden acute diseases, conditions, exacerbations of chronic diseases that pose a threat to the patient's life, including:

• disturbances of consciousness;
• respiratory disorders;
• disorders of the circulatory system;
• mental disorders accompanied by the patient's actions that pose an immediate danger to him or other persons;
• pain syndrome;
• injuries of any etiology, poisoning, wounds (accompanied by life-threatening bleeding or damage to internal organs);
• thermal and chemical burns;
• bleeding of any etiology;
• childbirth, threatened miscarriage.

As you can see, this is only an approximate list, but we believe that it can be used by analogy in the provision of other medical care (not emergency).

However, it follows from the analyzed acts that often the conclusion about the presence of a threat to life is made either by the victim himself or by the ambulance dispatcher, based on the subjective opinion and assessment of what is happening by the person who applied for help. In such a situation, both an overestimation of the danger to life and a clear underestimation of the severity of the patient's condition are possible.

It is to be hoped that the most important details will soon be spelled out in the acts in a more “complete” volume. At the moment, medical organizations probably still should not ignore the medical understanding of the urgency of the situation, the presence of a threat to the life of the patient and the urgency of action. In a medical organization, it is mandatory (or rather, strongly recommendatory) to develop local instruction on emergency medical care on the territory of the organization, which should be familiar to all medical workers.

Article 20 of Law No. 323-FZ states that a necessary precondition for medical intervention is the giving of informed voluntary consent (hereinafter - IDS) of a citizen or his legal representative for medical intervention on the basis of complete information provided by a medical worker in an accessible form about the goals, methods of providing medical care the risks associated with them, possible options for medical intervention, its consequences, as well as the expected results of medical care.

However, the situation of medical care in emergency form(which is also considered a medical intervention) is exempt. Namely, medical intervention is allowed without the consent of the person for emergency reasons to eliminate the threat to human life, if the state does not allow expressing one's will, or there are no legal representatives (paragraph 1 of part 9 of article 20 of the Federal Law No. 323). Similarly, the basis for the disclosure of medical confidentiality without the consent of the patient (paragraph 1 of part 4 of article 13 of the Federal Law No. 323).

In accordance with paragraph 10 of article 83 of the Federal Law No. 323, the costs associated with the provision of free medical care to citizens in an emergency form by a medical organization, including a medical organization private system health care are reimbursed. Read about reimbursement of expenses for the provision of EMP in our article: Reimbursement of expenses for the provision of free medical care in an emergency form.

After entry into force Order of the Ministry of Health of Russia dated March 11, 2013 No. 121n“On approval of the Requirements for the organization and performance of work (services) in the provision of primary health care, specialized (including high-tech) ...” (hereinafter - Order of the Ministry of Health No. 121n), many citizens have a well-founded misconception that emergency medical care must be included in the license medical activity. View medical service"emergency medical care", subject , is also listed in Decree of the Government of the Russian Federation dated April 16, 2012 No. 291"On Licensing Medical Activities".

However, the Ministry of Health of the Russian Federation in its Letter No. 12-3 / 10 / 2-5338 dated July 23, 2013 gave the following explanation on this topic: “As for the work (service) in emergency medical care, this work (service) was introduced for licensing the activities of medical organizations that, in accordance with Part 7 of Article 33 of Federal Law N 323-FZ, have created units in their structure for the provision of primary health care in an emergency form. In other cases of providing medical care in an emergency form, obtaining a license providing for the performance of works (services) in emergency medical care is not required.

Thus, the type of medical service "emergency medical care" is subject to licensing only by those medical organizations, in the structure of which, in accordance with Article 33 of the Federal Law No. 323, medical care units are created that provide the specified assistance in an emergency form.

The article uses materials from the article Mokhov A.A. Peculiarities of emergency and emergency care in Russia // Legal issues in health care. 2011. No. 9.

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