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;