We spoke with Dr. Sergei Goncharov, head of the Zaschita Center for Emergency Medicine, about why provision of first aid should be mandated by law, how emergency medicine is leading to new treatment methods and other important issues.
– Following the summer fires flared up again and arms depots exploded in Bashkiria and Udmurtia, you spoke of the need to obligate people by law to provide first aid to the injured. Don’t you think you’re going overboard here?
– The law on provision of first aid was amended to stipulate this a year and a half ago. The problem is that few people know this. And even fewer are prepared to do so. But the time has come for us to understand that we live in an epoch in which natural disasters, terrorist acts, manmade catastrophes and road accidents take more loves than war. The position of “my house is the last on the block” is leading to the death of those who otherwise could survive. I am confident that the amendment to the law on provision of first aid is needed like a breath of fresh air. And the faster that it starts working in full force the better for the all of us.
– If a person is driving on the highway and a sees that an accident victim is in need of help but keeps on driving, according to the new law what consequences will there be for this person who refuses to help?
– I am not prepared to speak about the legal aspects. That’s not my field. But I would like to point out that road safety inspectors are being trained to provide first aid. If someone is afraid to provide assistance, they can call to the near post or just provide what help they can. This could just mean providing one’s mobile phone if the victims do not have a means of communication or taking them to the hospital of emergency medical center, if that is possible.
– Why are drivers now allowed to only carry bandages in their first aid kits? Is that really enough?
– As far as the presence of medicine in the first aid kits is concerned, the Ministry of Health and Social Development, Emergencies Ministry and Ministry of Internal Affairs had many discussions about this. As a result of this debate, the conclusion was that international practice is best: medical assistance through the assignment of medicines should be provided by doctors, whereas first aid implies having all that is necessary to restore breathing and blood circulation and to stop bleeding. Being able to stop bleeding is one of the most important things in first aid. The rest should be left to doctors.
Considering the climatic conditions, for example, last year’s anomalous heat and winter frosts which break down medicines, why should we add an additional health risk. It’s a different matter for those taking medicine prescribed by doctors, and they should always have these medicines on hand.
– Is it true that there is great turnover at Zaschita Center, and many ‘emergency doctors’ see their work as an advantages career launch pad?
– That’s not quite the case. Usually new employees either quickly, and I mean within several weeks, quit or they get ‘infected’ by the job and stay for good. I think that an emergency medicine doctor or rescue doctor is something like a diagnosis. Those who have this diagnosis do not leave, and those who leave – that’s their own concern. Our doctors are forced to leave their families for long periods of times, sleep in tents or wagon cars, eat packed food rations… The work of any doctor in an emergency situation differs from that of a doctor in a clinic. At a facility, the doctor seeks to help a specific patient with a recorded medical history, whereas our doctors have no idea what they will encounter in a given emergency situation. And sometimes there is no one to assist – the local medical staff could have suffered from the disaster themselves, as was the case in the earthquakes in Iran and Haiti. Medical facilities can be destroyed. For example, during the earthquake in Neftegorsk on Sakhalin the entire medical team of the only medical facility in the area died. And so there was no one available to organize medical assistant until help arrived from the outside. And so in such a situation, the question arises: how can people provide each other first aid? And for this first aid needs to be taught. And the rescue doctor who moves from one extreme situation to the next requires even more – a nonstandard approach.
– What kind of approach? How does a rescue doctor differ from an ordinary doctor?
– He can quickly determine who needs assistance first, second, third, etc. Nikolai Pirogov once said that this is drama of medicine. One patient yells out “Help me!” although only affected by number of non-vital scratches while another lays silently in shock and requires attention first. One cannot learn how to carry out this medical priority sorting though some book. You need to create and imitate situations. Or if the situation arises, as was the case in Beslan in 2004, you need to train people. Only continuous training give people the skills that later switch one, as they say, automatically. I cannot imagine a medic, particularly a rescue doctor, who just sits around waiting for the next emergency situation without working somewhere else. So our doctors also work in medical clinics.
– I have heard that emergency medicine today is becoming a testing ground for the assimilation of new treatment methods. In your own practice, what new methods have been developed?
– Well, for example, during earthquakes those who get trapped under rubble often have crush syndrome. This means that tissues have been compressed and do not receive blood, from which a person can die. In order to save these people, they need an artificial kidney. One of these dialysis machines can serve 4-5 people per day in a clinic. But with an earthquake, you might have 500 to 1000 people in need of dialysis. One of the ways of dealing with this is plasmafilters, which were invented by military doctors. With their assistance you can clean your own blood, for example, while being transported in an aircraft.
Anton Samarin
