The thesis is devoted to the scientific substantiation of methodical approaches to optimization of work of crews of emergency (ambulance) medical care at an acute coronary syndrome.
According to the results of the analysis of the international experience of providing care to patients in the prehospital stage, it can be stated that in developed countries, including Great Britain, Germany, Italy, Israel, Spain, USA, Switzerland, Sweden, France, EMD systems have been created and are successfully functioning. on public, volunteer, private forms of activity and two basic tactics: "scoop and run", which provides a minimum amount of medical care on the spot and the maximum speed of patient delivery to a specialized medical institution, or "stay and stabilize", based on maximum stabilization the patient's condition before transport.
As a result of studying the sources of scientific literature, it was found that corticosteroids, namely NA and MI, have a common anatomical substrate. Pathological, angioscopic and biological studies conducted in recent decades have shown that NA and MI are characterized by different clinical manifestations, but have the same pathophysiological mechanism: rupture of atherosclerotic plaque or its erosion with varying degrees of thrombosis or embolism.
The main approach to the pathogenetic treatment of patients with AMI, which includes initial symptomatic therapy (antiplatelet, anticoagulant, antiischemic) and subsequent thrombolysis in STEMI, and in the case of NSTEMI - stenting or coronary artery stenting.
A comparative analysis of global treatment tactics for patients with ACS, which are consistent with domestic approaches to the treatment of the studied category of patients, revealed a number of shortcomings, including: late medical treatment at the prehospital stage, low frequency of reperfusion therapy and low level of educational work among patients.
It has been established that minimizing the delay in initiating treatment associated with organizational and diagnostic measures in patients with signs of corticosteroids in the prehospital stage can reduce mortality and disability due to this disease.
Studies on the epidemiological situation suggest that in the structure of mortality of the population of Ukraine from HSC one of the leading positions is occupied by coronary heart disease and myocardial infarction, the share of which is 69.6% and 2.4%, respectively.
The main problems in the organization of providing EMD to the population are revealed, among which: imperfection of the legislative base; a significant part of the workload at the pre-hospital stage is associated with the provision of care to chronic patients and transportation of patients to hospitals and trauma centers; the focus of EMD staff on the possibility of treating patients at home; a significant number of cars with a limited service life; high turnover of medical staff of the EMD system; inefficient system of charging and remuneration of EMD employees; insufficient scientific and methodological support of EMD.
The results of the questionnaire survey of patients with cardiac profile allowed to obtain a description of the organization of EMD to patients with HSC in the Kharkiv region on aspects not reflected in the statistical reporting. Thus, it was found that half of the respondents (44.9%) applied for EMD 1-2 times a year, 15.1% of respondents - several times a month and only 5.1% of patients caused E(A)C several times a week.
According to the results of the survey of patients with cardiac profile, it was found that the main reasons for dissatisfaction with EMD in HSC, according to most respondents, are the waiting time - 86.4% of respondents, inattentive attitude of medical staff - 33.1%, low level of free drugs - 30, 5% and insufficient effectiveness of treatment - 22%.
The results of the analysis of the time spent by the teams E(A)C in ACS with elevation of the ST segment indicate a significant variability in the performance of the instructions in different ambulance crews. At the same time, the most significant differences are present at the stage of direct medical care, while at the stage of transportation they are much smaller.
