FEATURES OF ARRANGEMENT OF MEDICAL CARE FOR VICTIMS OF ROAD TRAFFIC ACCIDENTS IN REGIONS OF RUSSIA WITH LOW POPULATION DENSITY Baranov A.V., Kubasov R.V., Lukashov A.G.
Northern State Medical University, Arkhangelsk, Russia
Cherepovets State University, Cherepovets, Russia
The beginning of the 21st century is associated with return of Russia to Arctic after abandonment of the Russian North in 1990s. This new interest towards native Russian territories is related to fundamental requirements of the new age, global climatic changes in the region, new possibilities and need for intensifying national safety in our region. The northern and arctic regions have the strategic significance for economic and military power of the Russian Federation, as well as for protection, advancement and reinforcement of national arctic interests [8, 13, 26].
The problem of road traffic accidents acquires special significance owing to arctic direction of development of our country. The Russian Arctic and the neighboring regions includes the large territories: Murmansk region, Nenets, Yamalo-Nenets and Chukotcha Autonomous Districts, northern regions of Arkhangelsk Region, Sakha (Yakutia), Karelia, Komi Republics and Krasnoyarsk region. The specific features of these territories are very low density and unevenness of population, significant geographic extent of territories, insufficient network and infrastructure of available federal and regional roads, presence of multiple water obstacles and swamps, remote and hard-to-reach mono-cities, and insufficient coverage of mobile communications [7, 17, 22, 36].
Multi-year time course of road traffic accidents (RTAs) in these regions of subjects of the Russian Federation shows the total negative trend to RTAs with medical consequences and mortality rate at all stages, with exceeding the general Russian values in many cases [27, 37].
It can be fair to say that undeveloped road infrastructure, specific and difficult climatic and geographic conditions, high level of alcoholization of almost all age groups of the population, and other specific features of such territories of the Russian North with low density of population determine the features of road traffic accidents with medical consequences, as well as the features of rendering of medical care and its organization at the prehospital and hospital stages of medical evacuation [41].
The main ways, which connect these regions with other Russia, are federal roads. However, according to the statistical data, the severity of medico-sanitary consequences on these roads is three times higher than on city and regional roads owing to high velocity vehicles, resulting in occurrence of severe high-energy injuries − polytrauma [2, 6, 10, 16].
Much more severe condition of patients with polytrauma, as compared to patients with single injuries, is observed by all researchers dealing with studies of road traffic accidents in Russia and in the world, and results of treatment of patients who receive injuries on roads in rural areas or in remote regions are usually unsatisfactory, which can be the common feature of regions of the Russian Federation with low population and living in compact areas [1, 3, 9, 12, 14].
The level of medico-sanitary consequences of road traffic injuries in regions of Russia with low population density depends on multiple factors, but one of the most important values of efficiency of arrangement of prehospital and hospital medical care is certainly coverage of specific medical surgical, traumatological-orthopedic and critical care for population living in these subjects. This issue is very critical for regions with territorial dispersion or remoteness of communities [4, 21].
However, even in case of successful urgent surgical care for a victim of RTA, sometimes, a patient, who is treated in a surgical unit of a central regional hospital, has no possibility of full-featured observation by all required specialists due to their absence in a medical facility owing to climatic and geographic features of the territory [23, 38, 40].
The important problem of healthcare in these regions is migration of qualified medical specialists with both higher and intermediate professional education to other regions of Russia. It is actual for young graduates of medical institutions and profile colleges and for experienced doctors who are attracted to other more favorable regions from the perspective of climatic and social conditions. The high insufficiency of qualified medical, nurse and obstetric staff, deficiency of qualitative medical equipment, and chronic underfunding of medical facilities, which has been lasting during decades in most central regional and city hospitals in Russian territories with strategic importance cause the decrease in quality of medical care realization, the increase in hospital mortality, rate of complications and disability in patients with road traffic accidents [5, 25, 46].
According to unfavorable geographic and climatic conditions in these subjects of the Russian Federation, the one and only acceptable solution is the use of sanitary aviation for realization of sanitary aviation evacuation of RTA victims from remote communities or federal roads to specialized medical facilities (trauma regions) of a region, which are usually located in a regional center. It allows significant increasing the efficiency of relief and minimization of consequences of medico-sanitary urgent situations on the roads [18, 20, 24, 34, 42].
The appropriate arrangement of specialized medical care for RTA victims in the regions and subjects of the Russian Federation is possible only with development of the system, which combine all necessary departments, which arrange medical care for RTA victims at all stages of management [15, 19, 28, 39].
There is a need for substantiation of organizational and medico-tactical issues at the prehospital and hospital periods of treatment of patients with consideration of quite evident regional features of these subjects and regions of the Russian Federation [29, 32]. It is especially important for northern and arctic regions of the Russian Federation with low population and inconsistency of its living, where the level of medical care for patients with multiple, concomitant and combined injuries does not correspond to world and Russian standards, with failure of development of the uniform and full-featured system for medical care arrangement for patients after RTAs [30, 33, 43].
There is no efficient mechanism of accumulation, systematization and interchange of actual data of road traffic injuries and their medico-sanitary consequences in the Russian Federation. Currently, the main contribution is made by population registers used in various fields of medicine [35, 44, 45].
To improve the condition of health of the Russian population in 21st century, it is necessary to develop new approaches to management of negative consequences of road traffic injuries, as well as to develop and implement the systemic register of medico-sanitary consequences of road traffic injuries in the Russian Federation.
This register will allow forming and saving of data on injuries, diagnosis and treatment of RTA victims at all stages of medical evacuation, tracing the patient's condition and medical care quality, and performing the analysis of death causes. Also the register will allow estimating the scale of road traffic injuries in a single region and in Russia at whole, will help with development and correction of schemes of routes for transportation of RTA victims, and will allow estimation the requirements of regional healthcare system for staff and material resources and planning its activity.
After discharge from a medical facility, the form 1 is made for a patient with road traffic injuries. The form is registered in Medical Center for Information and Analysis of a subject of the Russian Federation. The form includes 4 blocks of information: 1 − general data, 2 − circumstances of RTA, 3 − prehospital stage of care, 4 − hospital stage of care.
Realization of the offered register will allow reliable estimation and realization of monitoring of medico-sanitary consequences of road traffic injuries, will create the mechanism of information exchange in the healthcare system, and will give conditions for persistent reduction of the volume of negative consequences of road traffic injuries.
CONCLUSION
Therefore, the analysis of the available data on the studied problems, shows that the main principle of improvement in quality of medical care in regions with low population density in Russia is presence of sufficient transport park (especially aviation) for sanitary evacuation of RTA victims, with extension of possibilities of arrangement of specialized medical care during evacuation that is required for hard-to-achieve and extensive territories of the North and Arctic. It is necessary to accept and implement serious socioeconomic measures for attraction of medical, obstetric and nurse staff to strategic regions of Russia, considering the fact that development of these subjects is impossible without medical specialists. The register of medico-sanitary consequences of road traffic injuries is to be implemented in the Russian Federation.
Information on financing and conflict of interests
The study was conducted without sponsorship. The authors declare the absence of clear and potential conflicts of interests relating to this article.