Multidisciplinary remote counselling service as an independent unit within the structure of emergency medical care.
Emergency medical care is an integral part of any country's health care system, providing care in extreme situations. Due to the need to provide high speed and high volume of expensive help, the economic costs of the emergency medical service have always been quite high. For this reason, the questions of optimizing this service, how in terms of resource saving, directly to field teams (and as a result, and increasing the availability of assistance in cases, when it is vitally important), and their ongoing advisory support are extremely important. It should be noted that although multidisciplinary distance counselling services have been successfully realized in some large megalopolises of the Russian Federation, such as Moscow, Kazan, Tver a long time ago (for example, it has been operating in Moscow since 1938), experience of its successful organization in large regions, heterogeneous in their territorial, climatic, economic-infrastructural and demographic characteristics are still unknown. Meanwhile, a big part of the population in need of qualified, emergency and urgent care lives in them, which determines the importance of our project. In the Moscow region, we realized a project to set up a multi-disciplinary remote counselling service, in the situation of a region that is large in its territory, heterogeneous in its sub-regions in the level of infrastructural and general economic development and population density. It was based on the following factors: 1. Relative autonomy (independence from a single dispatch service); 2. Organization of a network of regional centers of counselling, connected according to the hierarchical principle into a single structure; 3. Creating and refining mechanisms to enable quickly and flexible adaptation to peak daily and seasonal activity; 4. A separate personnel system; 5. Developing and implementing a lean human resources management system, which made it possible to create and save the most exclusive team of professionals in the conditions of general staff deficit of medical specialists. The main problems, which have mostly been successfully resolved with the realization of our project: I. Reducing the number of calls to the ambulance service, which objectively do not need a team visit and, as a result, reducing the load on the brigades; II. Counselling support for people who call the ambulance service (or their family members) on self-help before the arrival of the ambulance team; III. Consultative support of ambulance teams by ‘narrow’ specialists during service of profile calls by general-purpose teams during the whole duration of the call;
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Based on the available experience, the average time required to deploy the service in any region of the Russian Federation or BRICS member country is from 1 week to 2 months. Of which: from 2 days to 1 month takes the assessment of the region of implementation, its main characteristics, from 3 days to 40-45 days selection and material and technical equipment of workplaces (including the overlay of communication, installation of specialized programming software), from 2 days to 14 days formation of personnel, primary adaptation to the specifics of the consultative service. Liquidation of minimal local tasks that have arisen. In the future, the project can function indefinitely.
Now, a multi-disciplinary remote counselling service has been realized in the Moscow region. The successful functioning of the model developed by us in a large region heterogeneous in its demographic, infrastructural, economical and natural characteristics allows us to consider the experiment successful and optimal for any region of the Russian Federation, the country as a whole, as well as for any BRICS member country.
The opportunity to realize in any region of the Russian Federation or any BRICS member country, regardless of size, climate, the population density and other demographic characteristics, the level of economic and infrastructural development; The possibility of realization of this service as an independent structural unit within the emergency medical service, without the need for its full and hard integration into the structure of a single dispatching service (organization of which, in remote and low-populated regions, is not always sensible, first of all from the economic aspect); A mobile organizational and management structure that allows it to be deployed quickly and with reasonable economic costs; By using a system of regional consoles organized into a single service according to the hierarchical system principle, the stability of the system and its relative independence from local staff overloads are achieved; Quickly adapting to peak load fluctuations; The developed method of careful human resource management allows using the emergency personnel potential effectively, but with care. It is based on the attraction of staff with invaluable breadth and uniqueness of experience (especially necessary in counselling work), but also to age and health conditions, are no longer able to function fully as part of the medical travelling teams. This point is especially important in remote, low-populated regions, where there is a stable human resources deficit, and the personnel policy based on constant rotation with ‘fresh’ staff is unacceptably expensive.
The project and its results were reported at the 23rd all-Russian scientific and practical congress with international participation ‘Emergency medical aid-2024’. A report is planned at the XIX Republican scientific and practical conference ‘Actual problems of the organization of emergency medical care: critical conditions in emergency medicine. Questions of pathogenesis, diagnostics and intensive therapy’ Republic of Uzbekistan.
The project is the basis for writing a dissertation for the degree of candidate of medical sciences for the project leader C. Oksana Alekseevna. There are plans to carry out a set of scientific works to improve the fundamental and methodological base of the counselling service. Based on the practical material collected during the work of the cardiology department of the multi-disciplinary remote counselling service in the Moscow region, it is planned to publish an atlas of rarely occurring ECG pathologies, with a special focus on the work of a doctor - cardiologist of the consultative emergency medical service, which will be a unique publication.
