The main objective of the centres is forecasting the medical and tactical situation and organising medical and sanitary support for the population in emergency situations (ES) across the region, monitoring the readiness of medical institutions to work in emergencies. The specialists of the centres provide medical assistance around the clock, including specialised in the entire Russian Federation.

Acting Chief Physician of the Nizhny Novgorod Territorial Center for Disaster Medical Services Mikhail Sozonov 

One of the features of this center is the aeromedical unit formed in it, which performs both emergency and planned medical evacuation of residents from areas of the region.

- Mikhail Mikhailovich, the Center for Disaster Medicine of the Nizhny Novgorod Region operates around the clock 7 days a week. How did the coronavirus pandemic affect the usual mode of operation and did it affect ambulance aircraft?

- During the current epidemiological situation in the country as a whole, and in the Nizhny Novgorod region in particular, the medical teams of the NKHZ “Nizhny Novgorod Territorial Center for Disaster Medicine” work in high alert mode, like all employees of the region’s medical organisations. During the period of daily hard work associated with a new coronavirus infection, we should not and do not disregard and care for patients with various acute pathologies, such as acute myocardial infarction, acute cerebrovascular accident, injuries of various aetiologies and other diseases that require treatment in specialised hospitals in Nizhny Novgorod. And, if emergency hospitalisation is necessary, the patient is delivered to the medical organisations of Nizhny Novgorod as soon as possible by air.

- Have the requirements for sanitary control measures changed? What personal protective equipment are available today for doctors and pilots?

- Since a new coronavirus infection is especially dangerous, we must take all measures to protect our employees. In this regard, the disinfection regime has been strengthened, all teams work in personal protective equipment, provided for by the temporary methodological recommendations of the Ministry of Health of the Russian Federation, which include a disposable suit of sufficient protection, glasses, a respirator and gloves. The crew members of the aircraft and the technical personnel of JSC “RVS” are also provided with disposable personal protective equipment, antiseptic agents, a bactericidal irradiator - recirculator at the expense of our Center, if used, the members of the flight technical staff of JSC “RVS”, as well as members of the medical the teams of the State Public Institution of Education and Science of the Scientific and Technical Center “NTTsMK”, carrying out sanitary and aviation evacuation, will be provided with an additional set of PPE. All medical staff and members of the flight technical staff are monitored, a test control is carried out to identify the causative agent COVID-19.

- Which helicopters are currently performing medical evacuation in the Nizhny Novgorod region? How much do they meet the modern requirements of high-tech medicine?

- Today, in the territory of the Nizhny Novgorod Region, Russian-made Ansat helicopters equipped with a medical module are used to provide emergency medical care. Medical equipment on board the helicopter allows you to evacuate patients not only in a stable condition, but also to respond in a timely manner to the slightest changes in it. On board there is equipment for monitoring vital functions and a life support system, for example, an apparatus for conducting artificial ventilation of the lungs.

- How many patients were evacuated by ambulance aircraft in 2020? Have there been cases of evacuation of patients with coronavirus infection? Is there any specificity in the evacuation of patients with coronavirus infection?

- From January 1 to May 17, 2020, medical teams of the GKUZ “NTTsMK” performed 127 departures, 123 patients were evacuated, including 8 children. To date, we have had no cases of airborne evacuation of patients with a new coronavirus infection. However, for such cases, we have developed algorithms for the actions of medical teams, flight personnel and conducted training at each stage of the sanitary-aviation evacuation. The issue of disinfection of the aircraft after the implementation of air-medical evacuation was also worked out.

- As a doctor with many years of experience, how significant is the contribution of air ambulance to the region’s healthcare system? Is it really necessary?

- Nizhny Novgorod region has a significant territory. Access to some district hospitals is 300-350 km. And if necessary, the evacuation of a seriously ill patient with diseases such as acute cerebrovascular accident or severe trauma, the evacuation time by ambulance will take 4-6 hours. And the evacuation of such a patient using a helicopter equipped with medical equipment will be no more than 1.5 hours, which significantly reduces the waiting time for the necessary high-tech assistance, which can only be obtained in specialised hospitals in Nizhny Novgorod. In addition, helicopter air-medical evacuation frees up the resources of emergency medical units and allows them to be used to reduce the travel time to patients with other diseases. This is especially important in an unfavourable epidemiological environment. Therefore, it would not be true to doubt the necessity or expediency of ambulance aircraft. It is necessary, it is needed and must develop.

- The profession of a doctor or pilot requires a high level of professional training, how far is the Center staffed with highly qualified personnel and what do you primarily pay attention to in your personnel policy? Do young employees work at the center?

- Each specialist must be a professional in his field. All employees of our Center, carrying out airborne medical evacuation, underwent a training course at the All-Russian Central Exhibition Center "Protection". Given the specifics of our work, all candidates for the post of doctor or secondary medical doctor undergo a psycho-physiological examination, as a result of which the psycho-emotional stability of medical workers is assessed in emergency situations. Practical skills of candidates are evaluated by methodologists (teachers) of the training department of our Center. If the candidate successfully goes through all these stages, then he can be hired by our Center. Also, at the center of disaster medicine, algorithms have been developed for the actions of members of the aviation medical team in various situations. Trainings and workshops are regularly held with all personnel involved in air medical evacuations.

- A few years ago, in the Nizhny Novgorod region, air ambulance was restarted. In your opinion, what problems in the development of air ambulance are most relevant today and what solutions will allow to remove pressing issues?

- A problematic issue is the underdeveloped aviation infrastructure. Now in 15 municipalities near medical organisations there are helipads owned by third-party legal entities, with a trip time from a medical organisation to a helipad of less than 15 minutes. For other medical organisations, during the implementation of airborne medical evacuation, aircraft landing is carried out by selecting the place of landing from the air. The contractor of aviation services (Russian Helicopter Systems OJSC) installed light-signalling equipment at five helipads, which allows landing at night. Decree of the Government of the Nizhny Novgorod Region dated July 31, 2019 No. 523 approved the "Strategy for the development of air ambulance in the Nizhny Novgorod Region until 2024". This strategy plans to build 54 helipads at state medical organisations. A schedule has been drawn up for the construction of helipads, broken down by year until 2024. Currently, work is underway to clarify and coordinate the construction sites of helipads and to develop design estimates.

Director of the Kurgan Regional Center for Disaster Medicine Alexander Yuryevich Shumaev

- Alexander Yuryevich, how did the pandemic affect the work of your center, what has changed in the work of physicians and, in particular, aeromedicists?

- We, like everyone else, are working with maximum efficiency: all doctors are scheduled, go on additional shifts. Despite the load and existing threats, no one refused to work with us. We still come to the rescue of those who need it. Also, there are assigned students of a medical college for our CMC, whom we can attract to work if necessary. We don’t transport patients infected with coronavirus infection by helicopters, there is no urgent need, because infection is detected at an early stage, we are delivered to hospitals by ground transport.

- How did self-isolation affect ambulance aircraft? The number of emergency cases of transportation of patients by helicopter decreased?

- Of course, the closure of production and remote work affected the statistics, but not significantly. In addition, now we began to understand that these statistics are very deceiving: people are sitting at home and so afraid of the virus that they don’t ask for help until the very end, prefer to endure it. Alas, we are witnessing a trend of increasing mortality at home. We are increasingly confronted with severe cases when we can no longer help the patient. Therefore, I urge everyone to take responsibility for their health and seek help if it is needed.

- Doctors take the Hippocratic oath, and pilots always act on the basis of safety requirements, but on board they work in a single bundle: as one team, one crew. Are there disagreements and how are they overcome?

- Doctors are not used to complaining, we always try to find a compromise. In our practice, there were cases when the brigade was expecting a crew near a closed helicopter, such situations nullify the very idea of ​​ambulance aircraft. This is unprofessional from any point of view, doctors should not stand idle when someone needs their help at this moment. Therefore, we hold competitions in the selection of service providers, including on the basis of experience with him. When the goal is the same - to provide assistance as quickly and safely as possible, compromises are always found. Now we are working with Russian Helicopter Systems and relations are built so that any situations are resolved in advance, kindly and on the ground. We are comfortable working with this partner.

- They say a lot that the world will no longer be the same. How do you think ambulance aircraft in Russia will change after coronavirus?

- Air ambulance has gained vast experience in the new conditions, close to an emergency. It seems to me that this is an experience that in the future will allow us to respond faster to any changes, new requirements and conditions. I also think that aviation medicine will become more accessible for citizens: the number of helicopters and saved lives will increase. And I also want to believe that engineering thought will keep pace with the changing environment. Unfortunately, now we receive new developments, equipment, equipment only after a while: after the completion of many procedures. There are many useful developments, but we cannot install them on a helicopter, the legislation does not allow it. I want the pandemic to teach us all to be more flexible and realistic.

- If you now had the opportunity to fundamentally change something in the medical aviation of Russia, what would it be and why?

- I would create a unified system for ordering ambulance aircraft, bring all service providers to the table and voice this state task to them. I want the suppliers to not have fights for contracts, because this is not the best way affects the quality of services. If disagreements continue on the ground, then patients will suffer first of all. Doctors should save lives, not litigation with those who did not win the tender. I would gather everyone at one negotiating table, set common requirements, a level of quality, and distribute the forces of the operators as efficiently as possible.