Manages to save the lives of the military during the "golden hour"
Medical support of the armed forces is a complex set of measures, from the timely, correct and effective implementation of which in the full sense of the word depends on the life and health of all military personnel. The NVO correspondent Nikolai POROSKOV met with the head of the 3 Central Military Clinical Hospital. A.A. Vishnevsky, Honored Doctor of the Russian Federation, Doctor of Medical Sciences, Major General of the Medical Service Alexander ESIPOV and asked him to answer a number of questions.
Modern specialized equipment and comfortable conditions allow patients to solve their problems as fully as possible. Photo courtesy of the 3rd TsVKG im. A.A. Vishnevsky
“Not so long ago, my relative, Vice-Admiral, retired, had to wait more than two weeks in a queue to go to the hospital for treatment. If admirals are forced to wait, what to say about officers of a lesser rank! Why do queues for treatment occur? What is the situation in one of the most well-known medical institutions of the Ministry of Defense of Russia - 3-th Central A.A. Vishnevsky?
- In the Moscow region there are many citizens who have the right to be treated in military hospitals. In addition, there are rushing patients who can not help in the regions, remote garrisons. The bed network meets the needs for their hospitalization, but many want to receive medical care in the hospital before the warm season, with the onset of which you can spend time already in a sanatorium or in the country. Therefore, there are so-called seasonal queues in the fall and winter, and the relative calm - in the summer.
But the main criterion for hospitalization is not a military rank, not merit, but the need for urgent medical assistance. Patients who need it for vital reasons are immediately sent to operating rooms, intensive care and resuscitation units. Patients are hospitalized without delay and medical assistance must be provided within a few hours in order to prevent the development of possible complications. This is a category of emergency and urgent patients for whom the doors of the hospital are open at any time of the day or night. There are always reserved places for their hospitalization, and the care of such patients is provided by the duty medical staff working around the clock. Every day, in our hospital, almost fifty doctors of various medical specialties, whose knowledge and skills can save someone's life, take over “combat duty”.
As for the patients referred by polyclinics for planned medical care, they are hospitalized as the hospital can: if there are free places - quickly, however, if the specialized departments are fully loaded, you have to wait a bit. This is a common international practice in the work of healthcare institutions. Even in Western countries with a so-called developed economy, it is normal to wait for hospitalization of several months. In our country, the maximum waiting period for planned hospitalization is considered to be no more than 30 days.
The situation in our hospital is complicated by the fact that many patients, especially those who have already been treated with us, want to come to us. Due to the intensification of labor, the introduction of minimally invasive treatment technologies, it is still possible to reduce the average length of stay of patients. Due to this, the average waiting time for planned hospitalization is kept at the level of 2 – 3 weeks.
Benefits for priority service (with the same urgency of intervention) are provided by law to participants in the Great Patriotic and other wars and conflicts, to the Heroes of the Soviet Union and Russia.
Patients who receive services for a fee are hospitalized without detriment to those eligible for treatment in military hospitals and only upon availability.
“The military, especially the retirees, are almost certain that all the attention of the hospital staff is directed to paid patients, and honored officers and even generals are served on a residual basis. Is it so? And what is the place of paid medicine in the hospital?
- Of course, this is not so, the current military personnel and military service veterans have always been and will be the center of attention, surrounded by care in our hospital. In any case, we strive to inculcate such an attitude towards them to all the medical and attendants of the hospital. What kind of residual principle can we talk about, if we direct almost all the funds received from paid patients to improve the medical care of the main contingent, to repair the hospital, to create comfort in it! Especially in the current economic situation, when it is necessary to lend a hand to the state, to help it cope with the financing of very expensive health care.
Today, in the provision of medical care, innovative medicines and equipment, medical supplies are used. All this costs a lot of money, and it is not always possible to provide for the allocation of sufficient funds. Moreover, two years ago, the Ministry of Defense decided to change the legal status and form of management of the hospital - from public to a budget institution. This means that the hospital, in addition to the subsidy received from the budget, should participate in financing the maintenance of the hospital from extrabudgetary sources. Therefore, we are forced to develop the so-called paid medicine, but not to the detriment of our main purpose, but for the benefit of those for whom the hospital was created.
- What is the main part of patients undergoing treatment?
- Up to 85% of patients treated annually, these are servicemen and pensioners of the Russian Ministry of Defense, as well as members of their families. More than 70% of military personnel and retirees - military service veterans older than 50 years.
- Does the concept of “mobilization readiness” extend to your medical institution? What hospital accounted for in case, "if the war tomorrow"? Did the hospital doctors take part in the hostilities? How is their experience used?
- Our hospital is primarily military, and has a purpose for wartime, and participates in the elimination of medical consequences of emergency situations. Therefore, along with the diagnostic and treatment process in the hospital units, all personnel are trained to act in special conditions. Training and exercises are regularly conducted, and appropriate skills are developed. Wounded soldiers and patients with the so-called thematic pathology close to the combat trauma are often brought to the hospital. A great experience was gained by our surgeons during combat operations in the North Caucasus, when they traveled to assist in front-line hospitals. Then the “air bridge” was also established: the wounded found themselves on the beds of our hospital during the day.
During this period, we learned to do unique reconstructive surgeries after mine-explosive wounds, literally collect the remains of limbs, restore their blood supply and maintain a support function.
Today, more than 120 doctors with combat experience work in the hospital. These are participants in the events in Afghanistan, local conflicts in the North Caucasus. Many of them have combat awards.
- Is it possible to list the operations that hospital doctors are justly proud of, who left a mark on stories your medical institution?
“Those rare minimally invasive organ-preserving operations that were performed in our hospital just five years ago were put on stream and became“ routine ”. Today, more than half of surgical interventions are high-tech, among them there are mastered only in some clinics in Moscow. These are operations on the heart and large vessels performed in a minimally invasive way, prosthetics of the aorta and other large blood vessels, operations on the main arteries of the head, neurosurgical operations using microsurgical techniques, endoprosthetics of large joints.
The science of healing today has reached great heights. Photo provided by the 3-th CVKG them. A.A. Vishnevsky
- Can you name famous people undergoing treatment? If not names, then at least the position.
- Such cases undoubtedly occur, but the very fact of the stay of these people in a medical institution is already a medical secret.
“More than two thirds of the patients in the hospital are preferred by the only Center of Traditional Medicine in the Russian Armed Forces. What is this Center?
- Indeed, the Center for Traditional Medicine of our hospital is the only one in the Armed Forces of Russia. Founded in January 1993, based on the Department of Nontraditional Treatment. It has two beds of a therapeutic profile, a department of reflexotherapy, a manual therapy room, a psychotherapeutic room where patients with diseases of the cardiovascular system, the gastrointestinal tract, the pulmonary apparatus, persons with hypertension, disorders of fat metabolism and allergic diseases are treated. Unloading and dietary therapy, acupuncture, manual therapy are carried out in departments and cabinets; homeopathic remedies and medicines from medicinal herbs collections are prescribed to patients. Good results have been achieved in the treatment of patients with coronary artery disease, stenosing atherosclerosis of the coronary arteries.
- Under your leadership of the hospital, a helipad appeared near him. How did it happen? What is the role, so to speak, aviation component of the hospital?
- Before the wounded, they were directly delivered from the combat areas by airplanes to the airfields near Moscow, and further transported to hospitals by ambulances. In the city, it takes a lot of time and does not benefit the condition of patients. With the advent of the helipad, we were able to quickly deliver the most difficult patients directly to the hospital. This will increase the likelihood of saving lives, avoid complications, quickly restore the health of the wounded.
In addition, the ability to take helicopters sanatoria allows you to interact with the services of the Ministry of Emergency Situations, and in the future, and emergency medical services that bring patients from the scene of events in a state where every minute is expensive. In medicine, there is a rule of the “golden hour”: it is for the first hour that the victim can be given the most effective assistance. The human body is arranged by nature in such a way that the maximum compensatory functions in case of sudden and serious injuries effectively maintain a stable state for about one hour. This rule works with severe injuries, heart attacks, strokes and a number of other conditions. Thus, the helipad is not only an important logistical measure, it allows the patient to fully return to normal life and work.
That is why, as soon as I was entrusted with the management of the hospital, I made every effort to create a helipad. I note, in the conditions of the Moscow region is a very difficult thing. A detailed story will take too much time: a lot of bureaucratic and other obstacles had to be overcome in order to make an obviously useful thing for everyone. Now we are almost ready to receive air ambulance.
- Today, at the time of sanctions, they often talk about import substitution. Is this term applicable to medicine and to your hospital?
- Completely. After all, the goal of import substitution is not to ban foreign equipment, but to strengthen its own base for the production of medical equipment and consumables, drugs. Yes, the preference for their purchases in a number of positions will now be given to Russian manufacturers. This does not mean that all foreign will be prohibited. Moreover, we still have nothing to replace some foreign medical equipment, there is not even a technology for its production.
Not to do, for example, without imported angiographs, magnetic resonance imagers, ultrasound machines of expert class and others. But today it is easy to find an adequate replacement for something from foreign medical equipment: 90% X-ray equipment in our hospital is of domestic production. The share of Russian anesthesia machines, electrocardiographs, consumables for ophthalmology, orthopedics, and traumatology is large. In general, we have a lot of worthy alternative. This is confirmed by the monitoring of breakdowns, equipment downtime: often there are no differences between Russian and foreign equipment. There are, rather, entrenched myths that imported is better than ours.
- Your employees (I quote one of the reviews) even advise colleagues from abroad - via Skype in English. Do you have many such doctors? Where do you get them from?
- Our doctors regularly participate in international congresses, conferences, make reports there. This requires knowledge of foreign languages. In addition, our doctors travel abroad to exchange experience, master new technologies, and practical skills in the operation of innovative machinery and equipment.
By the way, delegations of military medics from different countries come to our hospital to study the experience every year. In 2015 – 2016, we were visited by colleagues from Switzerland, Belgium, and Thailand. When communicating, doctors establish close ties with each other and often consult each other, including with the use of modern distance communication devices.
- On the territory of your hospital is a functioning church. Is it also for patient recovery?
- The church is a spiritual hospital. As you know, "the soul hurts - the body suffers." There is a causal relationship between sin and disease.
The temple is open to one and all. Go to it during the service and you will see representatives of the medical staff and mainly patients and their relatives. Before the operation, the patients and their relatives, and often surgeons take the blessing from the priest, confess and take communion.
The church is named after St. Luke, in the world Valentin Feliksovich Voyno-Yassenetsky, who in Stalin's time wore a doctor's robe over his bishop's robes, as a rule, did not start the operation without prayer, and the result was surgical - the operations were completed successfully. Priest Luka was the chief physician of various hospitals, a professor at the Simferopol Medical Institute, and was awarded the Stalin Prize for the classic scientific work Essays on Purulent Surgery.
- Tell your favorite medical anecdote.
- Jokes are born in our daily life. There is a morning report of the surgeon on duty: “During the night two light incidents came: a car accident and a work injury, and one heavy one: the husband refused to wash the dishes.”
Modern specialized equipment and comfortable conditions allow patients to solve their problems as fully as possible. Photo courtesy of the 3rd TsVKG im. A.A. Vishnevsky
“Not so long ago, my relative, Vice-Admiral, retired, had to wait more than two weeks in a queue to go to the hospital for treatment. If admirals are forced to wait, what to say about officers of a lesser rank! Why do queues for treatment occur? What is the situation in one of the most well-known medical institutions of the Ministry of Defense of Russia - 3-th Central A.A. Vishnevsky?
- In the Moscow region there are many citizens who have the right to be treated in military hospitals. In addition, there are rushing patients who can not help in the regions, remote garrisons. The bed network meets the needs for their hospitalization, but many want to receive medical care in the hospital before the warm season, with the onset of which you can spend time already in a sanatorium or in the country. Therefore, there are so-called seasonal queues in the fall and winter, and the relative calm - in the summer.
But the main criterion for hospitalization is not a military rank, not merit, but the need for urgent medical assistance. Patients who need it for vital reasons are immediately sent to operating rooms, intensive care and resuscitation units. Patients are hospitalized without delay and medical assistance must be provided within a few hours in order to prevent the development of possible complications. This is a category of emergency and urgent patients for whom the doors of the hospital are open at any time of the day or night. There are always reserved places for their hospitalization, and the care of such patients is provided by the duty medical staff working around the clock. Every day, in our hospital, almost fifty doctors of various medical specialties, whose knowledge and skills can save someone's life, take over “combat duty”.
As for the patients referred by polyclinics for planned medical care, they are hospitalized as the hospital can: if there are free places - quickly, however, if the specialized departments are fully loaded, you have to wait a bit. This is a common international practice in the work of healthcare institutions. Even in Western countries with a so-called developed economy, it is normal to wait for hospitalization of several months. In our country, the maximum waiting period for planned hospitalization is considered to be no more than 30 days.
The situation in our hospital is complicated by the fact that many patients, especially those who have already been treated with us, want to come to us. Due to the intensification of labor, the introduction of minimally invasive treatment technologies, it is still possible to reduce the average length of stay of patients. Due to this, the average waiting time for planned hospitalization is kept at the level of 2 – 3 weeks.
Benefits for priority service (with the same urgency of intervention) are provided by law to participants in the Great Patriotic and other wars and conflicts, to the Heroes of the Soviet Union and Russia.
Patients who receive services for a fee are hospitalized without detriment to those eligible for treatment in military hospitals and only upon availability.
“The military, especially the retirees, are almost certain that all the attention of the hospital staff is directed to paid patients, and honored officers and even generals are served on a residual basis. Is it so? And what is the place of paid medicine in the hospital?
- Of course, this is not so, the current military personnel and military service veterans have always been and will be the center of attention, surrounded by care in our hospital. In any case, we strive to inculcate such an attitude towards them to all the medical and attendants of the hospital. What kind of residual principle can we talk about, if we direct almost all the funds received from paid patients to improve the medical care of the main contingent, to repair the hospital, to create comfort in it! Especially in the current economic situation, when it is necessary to lend a hand to the state, to help it cope with the financing of very expensive health care.
Today, in the provision of medical care, innovative medicines and equipment, medical supplies are used. All this costs a lot of money, and it is not always possible to provide for the allocation of sufficient funds. Moreover, two years ago, the Ministry of Defense decided to change the legal status and form of management of the hospital - from public to a budget institution. This means that the hospital, in addition to the subsidy received from the budget, should participate in financing the maintenance of the hospital from extrabudgetary sources. Therefore, we are forced to develop the so-called paid medicine, but not to the detriment of our main purpose, but for the benefit of those for whom the hospital was created.
- What is the main part of patients undergoing treatment?
- Up to 85% of patients treated annually, these are servicemen and pensioners of the Russian Ministry of Defense, as well as members of their families. More than 70% of military personnel and retirees - military service veterans older than 50 years.
- Does the concept of “mobilization readiness” extend to your medical institution? What hospital accounted for in case, "if the war tomorrow"? Did the hospital doctors take part in the hostilities? How is their experience used?
- Our hospital is primarily military, and has a purpose for wartime, and participates in the elimination of medical consequences of emergency situations. Therefore, along with the diagnostic and treatment process in the hospital units, all personnel are trained to act in special conditions. Training and exercises are regularly conducted, and appropriate skills are developed. Wounded soldiers and patients with the so-called thematic pathology close to the combat trauma are often brought to the hospital. A great experience was gained by our surgeons during combat operations in the North Caucasus, when they traveled to assist in front-line hospitals. Then the “air bridge” was also established: the wounded found themselves on the beds of our hospital during the day.
During this period, we learned to do unique reconstructive surgeries after mine-explosive wounds, literally collect the remains of limbs, restore their blood supply and maintain a support function.
Today, more than 120 doctors with combat experience work in the hospital. These are participants in the events in Afghanistan, local conflicts in the North Caucasus. Many of them have combat awards.
- Is it possible to list the operations that hospital doctors are justly proud of, who left a mark on stories your medical institution?
“Those rare minimally invasive organ-preserving operations that were performed in our hospital just five years ago were put on stream and became“ routine ”. Today, more than half of surgical interventions are high-tech, among them there are mastered only in some clinics in Moscow. These are operations on the heart and large vessels performed in a minimally invasive way, prosthetics of the aorta and other large blood vessels, operations on the main arteries of the head, neurosurgical operations using microsurgical techniques, endoprosthetics of large joints.
The science of healing today has reached great heights. Photo provided by the 3-th CVKG them. A.A. Vishnevsky
- Can you name famous people undergoing treatment? If not names, then at least the position.
- Such cases undoubtedly occur, but the very fact of the stay of these people in a medical institution is already a medical secret.
“More than two thirds of the patients in the hospital are preferred by the only Center of Traditional Medicine in the Russian Armed Forces. What is this Center?
- Indeed, the Center for Traditional Medicine of our hospital is the only one in the Armed Forces of Russia. Founded in January 1993, based on the Department of Nontraditional Treatment. It has two beds of a therapeutic profile, a department of reflexotherapy, a manual therapy room, a psychotherapeutic room where patients with diseases of the cardiovascular system, the gastrointestinal tract, the pulmonary apparatus, persons with hypertension, disorders of fat metabolism and allergic diseases are treated. Unloading and dietary therapy, acupuncture, manual therapy are carried out in departments and cabinets; homeopathic remedies and medicines from medicinal herbs collections are prescribed to patients. Good results have been achieved in the treatment of patients with coronary artery disease, stenosing atherosclerosis of the coronary arteries.
- Under your leadership of the hospital, a helipad appeared near him. How did it happen? What is the role, so to speak, aviation component of the hospital?
- Before the wounded, they were directly delivered from the combat areas by airplanes to the airfields near Moscow, and further transported to hospitals by ambulances. In the city, it takes a lot of time and does not benefit the condition of patients. With the advent of the helipad, we were able to quickly deliver the most difficult patients directly to the hospital. This will increase the likelihood of saving lives, avoid complications, quickly restore the health of the wounded.
In addition, the ability to take helicopters sanatoria allows you to interact with the services of the Ministry of Emergency Situations, and in the future, and emergency medical services that bring patients from the scene of events in a state where every minute is expensive. In medicine, there is a rule of the “golden hour”: it is for the first hour that the victim can be given the most effective assistance. The human body is arranged by nature in such a way that the maximum compensatory functions in case of sudden and serious injuries effectively maintain a stable state for about one hour. This rule works with severe injuries, heart attacks, strokes and a number of other conditions. Thus, the helipad is not only an important logistical measure, it allows the patient to fully return to normal life and work.
That is why, as soon as I was entrusted with the management of the hospital, I made every effort to create a helipad. I note, in the conditions of the Moscow region is a very difficult thing. A detailed story will take too much time: a lot of bureaucratic and other obstacles had to be overcome in order to make an obviously useful thing for everyone. Now we are almost ready to receive air ambulance.
- Today, at the time of sanctions, they often talk about import substitution. Is this term applicable to medicine and to your hospital?
- Completely. After all, the goal of import substitution is not to ban foreign equipment, but to strengthen its own base for the production of medical equipment and consumables, drugs. Yes, the preference for their purchases in a number of positions will now be given to Russian manufacturers. This does not mean that all foreign will be prohibited. Moreover, we still have nothing to replace some foreign medical equipment, there is not even a technology for its production.
Not to do, for example, without imported angiographs, magnetic resonance imagers, ultrasound machines of expert class and others. But today it is easy to find an adequate replacement for something from foreign medical equipment: 90% X-ray equipment in our hospital is of domestic production. The share of Russian anesthesia machines, electrocardiographs, consumables for ophthalmology, orthopedics, and traumatology is large. In general, we have a lot of worthy alternative. This is confirmed by the monitoring of breakdowns, equipment downtime: often there are no differences between Russian and foreign equipment. There are, rather, entrenched myths that imported is better than ours.
- Your employees (I quote one of the reviews) even advise colleagues from abroad - via Skype in English. Do you have many such doctors? Where do you get them from?
- Our doctors regularly participate in international congresses, conferences, make reports there. This requires knowledge of foreign languages. In addition, our doctors travel abroad to exchange experience, master new technologies, and practical skills in the operation of innovative machinery and equipment.
By the way, delegations of military medics from different countries come to our hospital to study the experience every year. In 2015 – 2016, we were visited by colleagues from Switzerland, Belgium, and Thailand. When communicating, doctors establish close ties with each other and often consult each other, including with the use of modern distance communication devices.
- On the territory of your hospital is a functioning church. Is it also for patient recovery?
- The church is a spiritual hospital. As you know, "the soul hurts - the body suffers." There is a causal relationship between sin and disease.
The temple is open to one and all. Go to it during the service and you will see representatives of the medical staff and mainly patients and their relatives. Before the operation, the patients and their relatives, and often surgeons take the blessing from the priest, confess and take communion.
The church is named after St. Luke, in the world Valentin Feliksovich Voyno-Yassenetsky, who in Stalin's time wore a doctor's robe over his bishop's robes, as a rule, did not start the operation without prayer, and the result was surgical - the operations were completed successfully. Priest Luka was the chief physician of various hospitals, a professor at the Simferopol Medical Institute, and was awarded the Stalin Prize for the classic scientific work Essays on Purulent Surgery.
- Tell your favorite medical anecdote.
- Jokes are born in our daily life. There is a morning report of the surgeon on duty: “During the night two light incidents came: a car accident and a work injury, and one heavy one: the husband refused to wash the dishes.”
Information