“Soft Security” concept is wide and includes environment, fire-safety measures and food component which recently became so much topical for many people. However, the most important for Russians is now medical aspect and in its interface with other soft security components (first and foremost, people rescue in case of various emergencies) the state and community should focus on the disaster medicine development.
Catastrophe in a god-forsaken place
It is noteworthy that lately disaster medicine has enjoyed enhanced interest – maybe it was tragic consequences of various man-caused and natural cataclysms or such “man-made” catastrophes as acts of terrorism which triggered this interest. The consequences which could have been at least minimized. Where human health and life is at stake, the cold casualties’ statistics reduction by this specific “figure” is a top priority and justifies any infrastructure investments.
As far as the infrastructure investments are concerned, here the vistas for the state are really enormous. Suffice is to mention the Nevsky Express train crush in 2009. We remind you that as a result of the act of terrorism (according to the official report) the deluxe express train No. 166 going from Moscow to St. Petersburg underwent an accident resulting in 28 dead and at least 132 injured persons. The catastrophe happened in Uglovka-Alyoshinka span, at the boundary of Tver and Novgorod Regions, in a god-forsaken place which, as everybody knows, are quite numerous in Russia. A lot of the victims could have been saved if in the area had been at least any roads (to say nothing of the helipad), and if the local emergency ambulance teams had had at least a set of the medicines required (to say nothing of the new, preferably, all-terrain, vehicles).
The well-known fact vividly demonstrating the equipment availability (or rather, non-availability) of the ambulance teams was described by the Rossiyskaya Gazeta, Trud and AiF newspapers. Thus, the first medics to arrive on the scene just after half an hour after the accident were doctors from the medical penitentiary house for tuberculosis patients situated in Mikhaylovskoe village (Bologoye District, Tver Region). They did not have a special-purpose ambulance vehicle at all; they used a fire engine to reach the scene (a standard bus which was at their disposal did not pass 7 km along the off-road terrain).
The brigade tried to help an injured person – his leg was squeezed in the railway car crushed by the accident. There was nothing to cut the metal with, the doctors had to amputate the limb on the spot. Hereby they had no pain-killers and they just gave the patient a glassful of ethanol to drink as the anesthetic. All the doctors’ efforts and patient’s suffering proved to be in vain: the man died of severe haemorrhage and pain shock on the way to the hospital (it was a long way and the earth roads were washed out and bumpy). All in all, two persons died then on the way to Bologoye central district hospital – excluding those who died after the admission.
Rescue from Moscow is impossible
It was not accidental that we described the example with the Nevsky Express – according to the experts it was the consequences of that catastrophe which spurred the country’s leadership to the creation of full-blooded infrastructure of the disaster medicine. The point is, among the victims and injured persons there were high-ranking officials and prominent businesspeople from both the capitals. It turned out that neither ground vehicles, nor helicopters from Moscow could arrive at the scene to rescue them. And the Russian EMERCOM Il-76 aircraft equipped with all the facilities necessary, including resuscitation vehicles could land as far away as 45 km from the scene, at Khotilovo aerodrome (and only 7 hours after the accident).
We remind you that shortly before that, on August 13, 2007 the Nevsky Express already experienced an accident. It happened at Burga-Malaya Vishera span in Novgorod Region where the road situation is significantly better. Then there were no lethal casualties though 60 persons suffered, more than 30 of them were hospitalized, including three in a severe state. So, no lessons had been learnt concerning this route over two years.
Now the situation has changed for the better, and although the creation of the Territorial Disaster Medicine Centres’ network started from Moscow and Moscow Region, now they are being created all over the country. For example, just recently, in September 2014 Astrakhan Centre was given a new building including state-of-the-art dispatching operation centre. According to the Centre staff, the new information technologies enable 20% reduction of the ambulance brigades’ response time.
The Centre now has six resuscitation vehicles, a resuscitation helicopter and an ambulance boat. All of them are equipped with cutting-edge facilities: lung ventilators, defibrillators, units for the monitoring of all the body systems status as well as present-day communication systems and tablet computers – it enables prompt holding of on-line consultations with doctors from not only Astrakhan but Moscow clinics as well.
Autumn exercises
This autumn will witness a whole range of activities to demonstrate the achievements of the present-day Russian disaster medicine and various forums for the discussion of still pending area problems. In September All-Russian Research and Practice Conference “Burns and Disaster Medicine” was held in Ufa. The activity marked the 25th anniversary of providing assistance to the victims who suffered from burns as a result of the railway catastrophe in Ulu-Telyak. It was not accidental that Ufa was selected the conference venue – the work of Bashkortostan and Ufa medical services during the 1989 tragedy was acknowledged as perfect.
We remind you that on June 4, 1989, as a result of the gas/petroleum pipeline explosion two trains burnt, about 1,300 persons suffered. The doctors’ shift lasted 36 hours and as a result of concerted actions of the medics and emergency services’ officers hundreds of human lives were saved. The experience gained at that time was the basis of the present-day system of granting assistance to the people suffered from the massive injuries. The scene of this catastrophe also turned out to be in hard-to-reach and sparsely populated area. On the scene 258 bodies were found, 806 persons received burns and injuries of different severity degree, 317 of them died in hospitals. All in all 575 persons suffered then.
Nearly simultaneously with the Ufa conference first-aid master classes supervised by the disaster medicine experts were held in Volgograd. Anybody could receive first-aid provision skills within the framework of the regional forum “Medicine and Health-Care”. Local police officers took first-aid training too (in most developed countries a policeman must possess these skills in accordance with the job description). We remind you that it was in Volgograd where the latest (in Russia) major terroristic attacks took place. On December 29 and 30, 2013 two explosions happened – at the city railway station and in the trolley-bus. 34 persons died, about 70 were injured.
Readers may get an erroneous impression that disaster medicine is developed primarily in the regions where certain emergencies have already taken place. In effect, this is not quite true. For example, in Ulyanovsk, in September 2014 an agreement was signed between Nikolai Karamzin Airport and regional Ministry of Healthcare. It provides improved interface between the services of disaster medicine, emergency medical aid and the airport in case of emergencies.
The agreement did not prove to be a mere formality: exercises on first-aid provision in emergencies have already been held at Nikolai Karamzin, Ulyanovsk-Tsentralny and Ulyanovsk-Vostochny airports. The reason for the special attention paid to the airports was the recent accident at Sheremetyevo Airport when a passenger died because the medics who had already arrived at the scene could not provide the required aid to him.
And virtually always military medics work in close cooperation with the disaster medicine centres. However, for this purpose they need to receive, let’s call them, “dual purpose” skills. Therefore, in the framework of Vostok 2014 command and head-quarters exercises Eastern Military District medical institutions practiced the techniques for the provision of medical aid to the civilians who suffered from man-caused and natural catastrophes. In the District a network of field military hospitals was deployed, cooperation with the Ministry of Healthcare was established. 5 military sanitary trains, 10 military transport airplanes (including 3 special-purpose ones), 20 helicopters and the Irtysh hospital boat of the Pacific Fleet took part in the exercises.
Boris Nikonov
