current Federal Law No. 323-FZ dated November 21, 2011“On the fundamentals of protecting the health of citizens in Russian Federation”(hereinafter referred to as the Health Protection Law), for the first time at the level of law, defines. Which is understood as a set of measures aimed at maintaining and (or) restoring health and including the provision of medical services. Medical care in the Russian Federation is provided by medical organizations and is classified according to the types, conditions and form of such assistance.

Prior to the adoption by the State Duma of the Russian Federation of the Law on Health Protection, the concept medical care" was contained in the Industry classifier "Simple medical services". OK PMU 91500.09.0001-2001, approved by the Order of the Ministry of Health of the Russian Federation of April 10, 2001 No. 113. In this document, medical care was considered as a set of measures (including medical services, organizational - technical measures, sanitary and anti-epidemic measures, drug supply etc.), aimed at meeting the needs of the population in maintaining and restoring health.

Types of medical care for the population are named in Art. 32 of the Health Protection Act. These include:; , including high-tech, medical care; , including emergency specialized medical care; . It should be emphasized that the Law on the Protection of the Health of Citizens not only names the types of medical care in health care, gives their definitions, but also fixes the forms and conditions for the provision of medical care, which, of course, can be attributed to its merits. Forms and conditions for the provision of medical care are also determined by the Regulations on the organization of the provision of relevant types of medical care.

Conditions for the provision of medical care

Medical assistance may be provided under the following conditions:

• Outside a medical organization (at the place where an ambulance brigade is called, including specialized ambulance, medical care, as well as in vehicle during medical evacuation);
• Outpatient (in conditions that do not provide for round-the-clock medical supervision and treatment), including at home when a medical worker is called;
• In a day hospital (under conditions that provide for medical supervision and treatment in daytime, but not requiring round-the-clock medical supervision and treatment);
• Stationary (in conditions that provide round-the-clock medical supervision and treatment).

The forms of medical care are:

• - medical care provided in case of sudden acute diseases, conditions, exacerbation chronic diseases that pose a threat to the life of the patient;
• - medical care provided in case of sudden acute diseases, conditions, exacerbation of chronic diseases without obvious signs threats to the life of the patient;
• Scheduled - medical care that is provided during the preventive measures, in case of diseases and conditions that are not accompanied by a threat to the life of the patient, 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.

Subscribe to us

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 in the course of 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 (FZ No. 323, Chapter 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 diagnostics, treatment and use of complex medical technologies;

B. medical rehabilitation;

G. monitoring the course of pregnancy;

D. formation healthy lifestyle life;

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. doctor general practice.

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 29. Organization of health protection

Article 27. Obligations of citizens in the field of health protection

1. Citizens are obliged to take care of their health.

2. Citizens in the cases provided for by the legislation of the Russian Federation are required to undergo medical examinations, and citizens suffering from diseases that pose a danger to others, in cases provided for by the legislation of the Russian Federation, are required to undergo medical examination treatment and prevention of these diseases.

3. Citizens undergoing treatment are required to comply with the treatment regime, including those determined for the period of their temporary incapacity for work, and the rules of patient behavior in medical organizations.

Chapter 5. ORGANIZATION OF HEALTH PROTECTION

1. The organization of health protection is carried out by:

1) state regulation in the field of health protection, including regulatory legal regulation;

2) development and implementation of measures to prevent the occurrence and spread of diseases, including socially significant diseases and diseases that pose a danger to others, and to promote a healthy lifestyle of the population;

3) organizing the provision of first aid, all types of medical care, including to citizens suffering from social significant diseases, diseases that pose a danger to others, rare (orphan) diseases;

4) ensuring the sanitary and epidemiological well-being of the population;

5) provision of certain categories of citizens of the Russian Federation medicines, medical devices and specialized health food products in accordance with the legislation of the Russian Federation;

6) management of activities in the field of health protection on the basis of state regulation, as well as self-regulation carried out in accordance with federal law.

2. The organization of health protection is based on the functioning and development of the state, municipal and private healthcare systems.

5. The private health care system is formed by legal and individuals medical organizations, pharmaceutical organizations and other organizations operating in the field of health protection.

1. Medical assistance is provided by medical organizations and is classified according to the types, conditions and form of such assistance.

2. The types of medical care include:

1) primary health care;

2) specialized, including high-tech, medical care;

3) ambulance, including emergency specialized, medical care;

4) palliative care.

3. Medical assistance may be provided under the following conditions:

1) outside a medical organization (at the place where an ambulance brigade is called, including specialized ambulance, medical care, as well as in a vehicle during medical evacuation);

2) on an outpatient basis (in conditions that do not provide for round-the-clock medical supervision and treatment), including at home when a medical worker is called;

3) in a day hospital (in conditions that provide for medical supervision and treatment in the daytime, but do not require round-the-clock medical supervision and treatment);

4) stationary (in conditions that provide round-the-clock medical supervision and treatment).

4. Forms of medical care are:

1) emergency - medical care provided in case of sudden acute diseases, conditions, exacerbation of chronic diseases that pose a threat to the patient's life;

2) emergency - 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;

3) planned - medical care, which is provided during preventive measures, in diseases and conditions that are not accompanied by a threat to the life of the patient, 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.

According to the Federal Law of November 21, 2011 No. 323-FZ “On the Fundamentals of Protecting the Health of Citizens in the Russian Federation”, medical care is provided by medical organizations.

Ways to provide medical care:

0 diagnostics using anamnestic, organoleptic, express, laboratory and instrumental methods research;

О correction of the state of the organism due to surgical, pharmacological, physiotherapeutic and psychotherapeutic methods of influence;

• 0 creation of comfortable conditions due to immobilization, protection skin, wounded and burn surfaces, warming or cooling, anesthesia;
• 0 medical care (food, toilet, catheterization).

Medical assistance is provided:

• 0 outside the medical organization;
• 0 outpatient - in conditions that do not provide for round-the-clock medical supervision and treatment, including at home when a medical worker is called;
• 0 in a day hospital - in conditions that provide for medical supervision and treatment in the daytime, but do not require round-the-clock medical supervision and treatment;
• 0 stationary - in conditions that provide round-the-clock medical supervision and treatment.

The provision of medical care is carried out in the following forms:

• 0 emergency - medical care provided in case of sudden acute diseases, conditions, exacerbation of chronic diseases that pose a threat to the patient's life;
• 0 emergency - 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;
• 0 planned - medical care that is provided during preventive measures, for diseases and conditions that are not accompanied by a threat to the life of the patient, 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.

Allocate the following types medical care: primary health care, specialized, including high-tech, ambulance, including specialized ambulance, palliative care.

Primary Health Care is the basis of the system of medical care and is provided on an outpatient basis and in conditions day hospital.

The main sections are prevention, diagnosis, treatment of diseases and conditions, medical rehabilitation, monitoring the course of pregnancy, the formation of a healthy lifestyle, sanitary and hygienic education of the population.

Primary pre-medical health care is provided by paramedics, obstetricians and others. medical workers with secondary medical education.

Primary medical care is provided by general practitioners, district general practitioners, pediatricians, district pediatricians and general practitioners (family doctors).

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

turns out to be medical specialists in stationary conditions and in a day hospital and includes the prevention, diagnosis and treatment of diseases and conditions (including during pregnancy, childbirth and postpartum period), requiring the use of special methods and complex medical technologies, as well as medical rehabilitation.

Ambulance, including specialized ambulance, medical care is provided to citizens in case of diseases, accidents, injuries, poisoning and other conditions requiring urgent medical intervention, in an emergency or urgent form outside the medical organization, as well as in outpatient and inpatient settings.

If, after providing emergency medical care, the victims need further treatment, and therefore evacuation, they receive an evacuation appointment.

AT emergency situations peacetime and wartime, depending on the conditions, emergency medical care can be provided in full or limited scope.

Depending on the situation and nature medical manipulations assistance can be provided: pre-medical, first medical, qualified, specialized.

Pre-medical and first medical aid is provided in medical teams and medical organizations that have survived near the lesion (at the first stage of medical care for victims).

First aid- therapeutic and preventive measures performed by doctors (or at the direction of a doctor) and aimed at eliminating the consequences of exposure to hazardous factors, directly life threatening the victim, to prevent the development of complications and prepare the victim, if necessary, for further evacuation. First medical aid can be provided in full or reduced scope.

With a reduced volume, emergency measures are taken, the refusal of which threatens the victim with death or the occurrence severe complication. Activities that can be forced to be delayed (urgent), and activities that can be provided at the next stage, are carried out later.

To the typical therapeutic measures of the first medical assistance include: stopping external bleeding, maintaining of cardio-vascular system, resuscitation, tracheostomy or tracheal intubation, application of an airtight bandage for open pneumothorax, drainage pleural cavity, immobilization of the head, neck, spine, limbs, infusion therapy and etc.

Qualified medical care includes therapeutic and prophylactic emergency and urgent measures performed by general practitioners - surgeons and therapists.

At the same time, surgeons through various surgical interventions eliminate severe, life-threatening conditions caused by damage, and take measures to prevent subsequent complications and ensure further evacuation. The amount of help and methods of treatment depend on the specific medical situation. It is necessary to strive to expand the volume of assistance.

In emergencies in health care, all activities of a qualified surgical care forcedly divided into three groups of surgical interventions - emergency, urgent first stage, urgent second stage.

emergency surgical interventions qualified medical care, i.e. life-saving interventions are:

• 0 final stop of external and internal bleeding;
• 0 complex therapy acute blood loss, shock and traumatic toxicosis;
• 0 elimination of asphyxia;
• 0 surgical treatment and suturing of wounds with open pneumothorax, thoracocentesis with valvular pneumothorax;
• 0 laparotomy for wounds and closed injuries abdomen with damage to internal organs;
• 0 operations in case of damage Bladder and rectum;
• 0 amputation for detachments and destruction of limbs;
• 0 surgery for anaerobic infection;
• 0 decompressive trepanation of the skull for wounds and injuries accompanied by compression of the brain.

Emergency surgical interventions of qualified first-line medical care- operations, the delay of which leads to obviously serious complications:

• 0 overlay suprapubic fistula in case of damage to the urethra;
• 0 overlay unnatural anus with retroperitoneal damage to the rectum;
• 0 amputation for ischemic necrosis of the limb;
• 0 primary surgical treatment of wounds with significant soft tissue damage.

Emergency surgical interventions of qualified medical care of the second priority- operations, the delay of which, subject to the early and systematic use of antibiotics, does not necessarily lead to the development of dangerous complications:

• 0 surgical treatment of soft tissue wounds that are not subject to surgical treatment;
• 0 treatment of heavily contaminated burn surfaces;
• 0 suturing for patchwork wounds of the face;
• 0 ligature bonding of teeth for fractures mandible with a defect.

Specialized medical care includes a set of exhaustive medical measures performed by medical specialists of various profiles in specialized medical organizations using special equipment.

In accordance with the specialization of doctors, surgical specialized care can be: ophthalmic, neurosurgical, otorhinolaryngological, dental, traumatological, obstetric-gynecological, angiosurgical.

Varieties of therapeutic specialized care are toxicological, radiological, neuropsychiatric.

When providing emergency medical care, if necessary, medical evacuation is carried out - transportation of the injured (sick) in order to save lives and preserve health, including persons 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.

Medical evacuation is carried out mobile teams ambulance with medical assistance during transportation, including the use of medical equipment, and includes:

• 0 air ambulance evacuation carried out by air transport;
• 0 sanitary evacuation carried out by land, water and other modes of transport.

Palliative care is a complex medical interventions aimed at getting rid of pain and alleviating other severe manifestations of the disease, in order to improve the quality of life of terminally ill citizens and is provided on an outpatient basis and inpatient conditions by medical workers who have been trained to provide such assistance.

The organization and provision of medical care in emergency situations, including medical evacuation, are carried out by the All-Russian Disaster Medicine Service in the manner prescribed by the authorized federal executive body.

All-Russian Disaster Medicine Service carries out:

О rapid response, mobilization of material and technical means and personnel in emergency situations in order to save lives and preserve the health of the greatest number of people by providing them with all types of medical care in a timely manner and in full;

About liquidation of the epidemic centers;

About creation of a reserve of material stocks;

О training in the provision of medical care to citizens, including medical evacuation, in emergency situations.

The organization of medical support for the population is carried out in accordance with the decisions of the chiefs of civil defense.

TEST QUESTIONS

• 1. List the main tasks of the civil defense medical forces.
• 2. What is included in the civil defense medical forces?
• 3. Describe the role of the heads of health authorities and medical organizations in the preparation and conduct of civil defense.
• 4. What is medical support population? Where is it carried out?
• 5. Expand the participation of medical specialists in civil defense activities.
• 6. What do you need to have in each medical organization to provide emergency medical care at the scene of the disease?
• 7. What should every doctor be able to do triage?
• 8. What types and conditions of medical care are established federal law of the Russian Federation dated November 21, 2011 No. 323-FZ “On the fundamentals of protecting the health of citizens in the Russian Federation”?
• 9. What forms of medical care are established by this law?
• 10. What functions are assigned to the All-Russian Service for Disaster Medicine?

24-hour hospital

This is 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 doctor - specialist on an outpatient basis - polyclinic institution, 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 poisoning, in case of pathology of pregnancy and childbirth to all who applied.
3. In order to receive planned medical care, a citizen is required to present insurance medical policy 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:
   • the patient is examined by a doctor in the admission department no later than 30 minutes from the moment of contact in case of emergency medical care, in case of emergency hospitalization - 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. Patient care medical nutrition 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 is medical indications) a family member (adoptive parent, guardian) who provides care is entitled to bed and food (in compliance with the current sanitary and hygienic standards), as well as the issuance 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 to 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.