Golden Hour Service on Ural Highways

21.12.2012 — Analysis

Sverdlovsk region is the only region in Russia with a centralized medical assistance program on motorways.

The so-called "highway service" is part of the Center for Disaster Medicine. Special support stations, constantly monitoring every kilometer of their respective zones and ready to provide assistance in the event of any accident, are located along all federal highways in the region.

No equivalent mechanisms exist in any other region in Russia. In the majority of Russian regions, highway medical stations are created at the municipal level and almost never interact with each other. And nowhere but in the Sverdlovsk region does the medical service monitor all the region’s federal highways. For example, Kurgan region and Tatarstan have only one highway station each, while there are 12 in the Middle Urals.

They are located approximately 60 kilometers apart. The following highways are under their jurisdiction: Perm – Ekaterinburg, Ekaterinburg – Tyumen, Ekaterinburg – Chelyabinsk, Ekaterinburg – Kurgan.

As soon as an accident occurs on the highway, all subdivisions of the highway service are automatically mobilized. A signal indicating an incident is normally received by the central dispatcher. And an ambulance departs the nearest highway station for the scene of the accident in just a few seconds.

In addition to a solid set of medical equipment, each vehicle is equipped with a complete set of life-saving instruments – hydraulic scissors, jacks, etc. And all three crew members – the driver and two medics – have a second qualification as emergency medical technicians. Each instance of intensive therapy generally begins by extracting the patient from a mangled body of metal.

The workers of the service are not exaggerating when they say that every second counts during a life-saving operation. In 2008 -2011, the average travel time from the supporting station to the site of the accident was 10 minutes. This was decreased to 9 minutes in 2012. And, as explained to RusBusinessNews by Mikhail Sushko, head of the Center for Disaster Medicine highway service, this is a good achievement that was not easy to attain.

While the vehicle is en route from the supporting station, the dispatcher gathers as many details as possible about the accident, the number of people injured and whether there are any critically injured patients and children. If possible, the dispatcher identifies the nature of the injuries and traumas. If the accident is serious, a second ambulance is dispatched from a neighboring station and ambulance services from nearby villages and cities are also called in.

When there are a lot of victims or someone needs highly specialized assistance, the dispatcher requests aviation assistance.

The Sverdlovsk highway service is the only service in Russia with its own "air force". Medics previously used two leased Mi-8 helicopters. The helicopters were good but too large and also had no special medical equipment. In 2012, regional authorities allotted funds for the purchase of three light Mi-2 helicopters. They were outfitted with necessary medical equipment and one was adapted for the highway life-flight service. In contrast to the heavy, leased Mi-8s and thanks to their smaller size, Мi-2s can land right on a road that has been shut down by the Federal Authority for Road Traffic Safety. In the second half of this year, they transported 9 victims including one child from accident sites to trauma centers.

As noted by Mikhail Sushko, a major advantage in the centralization of the highway service is that it was possible to develop and instill a unified method for training personnel. The service has enough specialists and, as a result, time was invested in creating the most effective possible courses, trainings and training manuals. Today, every emergency medical technician arriving at the scene of an accident, literally like a fighting cyborg, starts working instinctively.

The main thing that he needs to decide on site is which of the victims needs to be taken where for treatment. Sufficiently simple cases use the local hospital, while some patients can only be saved in Ekaterinburg clinics. There are also some cases when patients cannot be transported.

If necessary, a field specialist can request assistance from the central dispatcher, who is first of all a high-class physician and can also contact any focused specialist right away.

If a victim needs to be transported from the supporting station to Ekaterinburg and if a helicopter cannot land at the scene of the accident, then the "rendezvous" plan is executed. An automobile takes the victim to the nearest highway station. The helicopter is sent to the same location with necessary specialists on board. The brigade meets on the landing pad (which exists at 9 of the 12 stations). With adults on board, the helicopter heads for the landing pad in Ekaterinburg near Shirokaya Rechka. Here, a vehicle is already waiting to transport the victim to the operating table in 7-8 minutes.

The helicopter transports children that are in critical condition to city hospital number 9. The landing pad is located next to its territory.

If an accident victim cannot be transported far, the ambulance will take him to the nearest hospital even if it does not have specialists and the necessary equipment. At the same time, a brigade of physicians and the required equipment arrives at the hospital, either via land or air. After a few days, when the patient's condition has stabilized, he can be transferred to an institution with necessary equipment for further treatment.

The director of the All-Russian Center for Disaster Medicine, academician in the Russian Academy of Medical Sciences, major general Sergei Goncharov, acquainted himself with the work of the Sverdlovsk region highway service and noticed that the methodology formulated here considerably increases victims’ chances of survival.

The sole goal of such services all over the world is to transport the victim of a traffic accident to the operating table before the so-called "Golden Hour" expires. Experience has shown that if a seriously injured person receives care in the first 60 minutes after the trauma, then his chances of survival are high. The most advanced traumatologists feel that the best "golden hour" is 40 minutes. Accordingly, highway and medical services in developed countries are working towards guaranteeing that this standard is met. And Sverdlovsk region looks very respectful in comparison. M. Sushko reported that, despite a less established network of medical institutions, the region holds stably to the standard of the 40-minute "golden hour".

As reported to RusBusinessNews by Viktor Popov, director of the Center for Disaster Medicine in the Sverdlovsk region, deaths from accidents on federal highways in the region decreased 10-15% since the highway service started operations.

Andrei Gubanov