Comrades in Arms

In October 2005, 17 American EMS professionals traveled to Moscow and St. Petersburg, Russia, for a series of meetings with Russian EMS and disaster organizations. The 10-day tour was developed by the National Association of EMTs (NAEMT) and the National Association of EMS Educators (NAEMSE), and was coordinated as an Ambassador Program by the U.S. People to People organization.

According to delegation leader and NAEMT Past President Paul Maniscalco, Russia was chosen because it is in the process of developing and refining critical infrastructure in the post-Soviet era. During the meetings, delegates were exposed to a wide range of state-of-the art prehospital care, massive mobile disaster medicine capabilities, public/private partnerships and completely different views on maintaining responder health.

At every meeting, the delegates were treated with respect. As a sign of the Russian professionals' attitudes toward their American visitors, every meeting was conducted by the person in charge of the facility or service being visited. Overviews of these entities follows.

Moscow Rescue Service
This public/private partnership was founded in 1995 to fill the gap between fire and ambulance services and to provide a single point to receive telephone calls for emergency assistance. Moscow Rescue Service (MRS) enters the danger zone, extricates patients and brings them to the ambulance crews waiting at the scene perimeter.

According to Director Andrey O. Kravtsev, MRS began with privately gathered start-up funding and remains self-supporting, primarily through fee-for-service informational and expert witness services. Anyone can call MRS for any type of information and documents for a fee-like an online or cellular phone 4-1-1 service. MRS also provides expert testimony in cases arising from scenes it has worked. Every MRS call is videotaped, and the videotape of every call it has ever run in its 10-year history has been kept. MRS does not charge for performing rescue services.

At MRS, 35-40 on-duty call receivers handle 25,000 telephone calls per day. The caller is interviewed about the incident, hazards, fuel leaks, wires down, etc. The dispatcher then notifies all services needed-fire, police, rescue, ambulance.

There are five MRS crews on duty at all times. Each unit has a minimum of four staff with training in EMS, high- and low-angle rope rescue, diving, automobile extrication and building collapse.

In addition to the response crews, MRS operates its own education center, initial and ongoing rescue training for its crews and operator training. It also has the volunteer-based Children's Rescue Service comprised of youths aged 14-18 years. These teens receive training to participate in rescue operations and perform community service, such as chore services for the elderly.

All-Russian Center for Disaster Medicine (Zaschita)
After experiences like Chernobyl and earthquakes, Zaschita was created to provide a civilian healthcare system capable of responding to large-scale disasters, both manmade and natural. Its organizational headquarters is in Moscow, but it responds all over Russia and other countries.

Headquarters components include:

• Logistics agency for main units, field hospitals and mobile units
• Educational institute for doctors and field responders
• Rescuer rehabilitation center
• Disaster response medical journal publishing
• Reserve stocks of medicines
• Research laboratories for personal protection in extreme circumstances such as space, underwater, fires and rescues
• Psychiatric training, testing and treatment.

Director Sergey F. Goncharov says his three main challenges are: bureaucracy in government channels; funding (although some improvement has been made as government officials at all levels begin to see the need for services and full funding); and how to assimilate the experience of military medical personnel into a civilian model. He said this is tricky, as it has been impossible to predict all potential problems.

In addition to its headquarters, Zaschita operates 82 regional disaster medicine centers, 483 units in hospitals and 32,801 field teams consisting of more than 10,000 doctors and 20,000 nurses.

Two medical groups are on constant duty at headquarters, along with six rescue vehicles. For a larger-scale emergency, contracted doctors and nurses from around Moscow deploy with crews to provide medical care specific to the type of emergency. Ground and air transportation are provided by the Ministry for Extraordinary Situations (EMERCOM).

Zaschita maintains a database of all medical facilities in Russia and exchanges real-time information with EMERCOM. Video-conferencing equipment allows consultations, diagnoses and telemetry from medical units in the field to experts at headquarters.

Rehabilitation Center
Rescue is a fairly new profession in Russia. There are now 300,000 trained rescue personnel nationwide, who must remain healthy to survive on-the-job stress and continue doing rescue work. A medical history is maintained on all responders so physical and mental changes can be tracked, especially after a deployment. The purpose is to assess and find at-risk responders and rehabilitate them so they can return to work.

Reflex diagnostics, acupuncture, bio-resonance diagnostics and cardiometric indicators (from space medicine) are used to determine psychosomatic and physical diagnoses. Zaschita doctors say this works well to keep field responders healthy and is less expensive than biological and chemical laboratory testing.

Zaschita responders with a stress-related health problem are treated with bio-resonance therapy using electromagnetic waves. Their research from the last 10 years has identified the electromagnetic signatures of healthy cells and how to identify unhealthy cells. They have packaged these signatures into as many as 50 different computer programs targeted at realigning unhealthy cells into their proper, healthy electromagnetic state.

A responder's diagnosis determines which program is used. He then undergoes 7 to 10 one-hour treatments during which electromagnetic waves are passed over the affected area(s) of the body to bring cells into healthy alignment. Zaschita physicians say they have an 80% success rate, without using drugs of any kind.

St. Petersburg City Ambulance Station
Delegates received a lengthy briefing at the headquarters from Head Doctor Alexey A. Boikov, then toured three of their specialty ambulances.

The St. Petersburg Ambulance service began in March 1899 with two horse-drawn carriages and two workers per station to treat and transport. By World War II, it had grown to nine district centers operating 100 to 110 medical teams daily. During the 900-day German siege of the city, these teams treated an average of 2,000 patients per day. Also during the siege, the service lost 67 employees in line-of-duty deaths; and another 77 died of starvation.

The first trauma station and specialized ambulance teams for cardiac, anti-shock, neurological and trauma care began in the late 1950s. Today, St. Petersburg Ambulance, which serves 4.5 million citizens, is funded by the city of St. Petersburg and operates under the city's Committee for Emergency Situations.

The service includes three dispatch centers in ambulance headquarters, 24 substations and 180 teams working mostly 24-hour shifts, with some shorter peak-load shifts. The system runs 450,000 calls per year with an average 12-minute response time.

Thirty percent of patients seen are transported to a hospital; the remainder are treated and left at home or referred to a local clinic. Average call time is one hour from dispatch to hospital. More definitive care is done in the ambulance by higher trained personnel than are found in most American models.

Minimum training for call receivers is nurse or physician assistant (PA); however, despite their medical training, they give no prearrival instructions. If a response is needed, the caller is transferred to the next center, where dispatchers contact the appropriate substation or ambulance team. Once on scene, if the ambulance crew decides to transport the patient, they contact a third dispatch center for destination. These dispatchers have constant, real-time information on bed counts and patient loads for all 100 local hospitals.

Ambulances are staffed at minimum by a nurse and PA. The driver is simply that-a driver with no medical or even specialized driver's training. In addition to the basic ambulance teams, six types of specialty units can respond, depending on what advanced patient care is needed. Specialty ambulances include cardiac, surgical, OB, pediatric, intensive care and respiratory. These units carry state-of-the-art equipment, a specialty physician and some combination of physician's assistant and nurse.

In case of disaster, St. Petersburg Emergency Center can field as many as 100 ambulance teams within one hour from its own crews. In such times, the public is advised to access clinics and hospitals on their own for emergency care. Additional resources are requested from Zaschita and EMERCOM, which arrive and operate within the city's existing structure and communications system.

Elizavetinsky (St. Elizabeth) Hospital
St. Elizabeth Hospital is a 1,200-bed facility with a full emergency department.

Chief Physician Boris M. Taits led the group through the emergency department, showing various treatment rooms-shockingly simple by American standards, but light years ahead of what they were just 10 years ago, he said. At one point, Dr. Taits lamented that he wished he had more money so the facilities and equipment could be brought more up to date.

The eight largest hospitals in St. Petersburg are called "ambulance hospitals" and provide the majority of emergency care. Each has primary responsibility for a particular area of the city. St. Elizabeth's zone includes a population of one million and averages 200 emergency patients per day.

The reception area of the original hospital, which was built in the 1970s, was remodeled and reopened as a full department of emergency health on June 26, 2002. The department employs 314 doctors and 650 nurses. Its goal is to have every patient either admitted or treated and released within two hours, unless their condition is complicated.

The emergency department is staffed around the clock with a minimum of three trauma specialists, two neurosurgeons, two gynecologists and one anti-shock team. If a patient requires specialty care from another hospital department, he is referred to the on-duty physician in that department. Patients needing highly specialized care are transferred to an appropriate specialty hospital.

Insurance companies review all medical records of patients under their coverage and deduct payment for any care they judge to be improper. The City Committee for Emergency Situations also reviews medical records. An internal team at St. Elizabeth can review records and discipline anyone committing errors.

Overall Impressions
The diversity of the professional meetings perfectly matched the delegation, with its combination of prehospital, hospital, administrative and educational backgrounds. The group got a real sense of how each organization operated and the different levels of equipment available to prehospital and disaster medicine versus the inner-city hospital.

The group also left an impression on its guides, who were surprised many times by their passion for their work and desire to learn, even at the expense of free time. The guides also learned their own countrymen share the same professional pride, dedication and sense of family.

Ed Mund is a captain, EMT-B and EMS officer for East Olympia (WA) Fire District 6, a fire-based BLS agency bordering Washington's capital city, Olympia. He may be contacted at ems@emedstrat.com.