Relevance. Mortality from accidents, poisoning, acute diseases and injuries in Russia and the world remains high. For a number of urgent conditions, fast medical evacuation to a medical facility and prompt specialized care are critical. In a metropolis, there are a number of features that limit the work of ambulance ground teams (AGT). Intention. To analyze medical evacuation of patients to a hospital in a metropolis (the city of Moscow as an example) using ground transportation, with its shortcomings and limitations. Methodology. Patterns prehospital and early hospital mortality of patients in need of emergency medical care were analyzed, main reasons for the fastest possible transportation to a specialized hospital were determined. The statistics of road traffic accidents involving ambulances in Moscow for 2019-2020 were analyzed. Average traffic loads in Moscow for the period of 2017-2019 were estimated. Cases of rendering emergency medical care to Muscovites outside the city and in places without a road transport system were analyzed. Results and Discussion. The main causes of death before arrival of ambulance teams are blood loss of various origins (28 %), burn shock (6 %), poisoning with various substances (31 %), traumatic brain injury and stroke (12 %), acute coronary syndrome (7 %) and a number of other conditions. If resuscitation measures are required, risks of death increase by 10.7 % for every 10 minutes of waiting for an ambulance. One-day outcomes were influenced by time to hospital admission for cardiovascular diseases (26.9-30.1 % mortality rate ); diseases and injuries of the central nervous system, i.e. stroke, head injury (25.2-25.5 % mortality rate); internal bleeding (12.6-15.2 % mortality rate). In Moscow in 2019, an average of 2.8 ambulance vehicles got into road accidents daily. This probability amounted to 2.78 x10-3 and was 2.5 times higher than for other vehicles (1.11 x10-3). The main restrictions for ground transportation in a metropolis are as follows: unpredictable traffic conditions increase time to hospital admission, difficulty transporting patients from remote areas, including off-road locations. Conclusion. When urgent patients are admitted to a specialized hospital by road in a metropolis, there are a number of restrictions that must be taken into account when organizing emergency medical care. The main potential risks of increased time to hospital admission in Moscow is unpredictable road traffic.

The article presents a literature review on the assessment of defects and medical care, as well as the prevention of defects and conflict situations that arise during the treatment of patients with emergency surgical abdominal pathology. Unfortunately, mortality among urgent surgical patients and diseases of the abdominal organs is in the leading positions among all causes of death, despite the improvement of diagnostic methods, the emergence of new medical equipment and drugs, as well as the developed standards of approaches to the treatment of this category of patients. The paper presents statistics on the incidence of abdominal pathology and the mortality rate among the population of our country. We have studied clinical guidelines and standards for the provision of medical care to patients with acute abdominal pathology and analyzed the work on the assessment of medical care, medical errors, conflicts between the patient and the surgeon, as well as the works describing the individual characteristics of various diseases over the past decades. The article discusses in detail the causes of professional errors and defects in medical care, which include: information and deontological defects, defects in the organization of the treatment process, defects in diagnosis and defects in the treatment itself. Studied in detail the stages of the examination to assess the medical care provided. Examples of the course of the main surgical diseases of the abdominal organs in various groups of patients are described. The possible measures to prevent professional errors in doctors and patients have been studied in detail.

Relevance. The use of ultrasound diagnostics at the place of providing medical care to an urgent patient is one of the promising directions in the development of emergency medicine. At the same time, of particular interest is the possibility of using diagnostic ultrasound in an ambulance helicopter, given the lack of clear algorithms and standards for its application, as well as the limited number of publications on this problem.Intention. Analysis of publications on the use of urgent ultrasound examination in an ambulance helicopter.Methodology. A search was made for scientific publications on the topic on the electronic resource PubMed, in the Google Scholar search system for the period from 2000 to 2021.Results and discussion. The main algorithms used for ultrasound diagnostics of an urgent patient in an ambulance helicopter are Focused Assessment with Sonography for Trauma (FAST), point-of-care ultrasound (POCUS), Rapid Ultrasound in SHock (RUSH), Bedside Lung Ultrasound in Emergency (BLUЕ), prehospital ultrasonography (PHUS), etc. They help exclude damage to vital organs and emergency pathology – pneumo- and hemothorax, hemoperitoneum, hemopericardium, large fractures and others that affect the tactics of treatment and patient routing; there is also the possibility of ultrasound navigation for a number of medical and diagnostic procedures. According to the results of published studies and clinical observations, prehospital ultrasound examination of urgent patients is successfully used during medical evacuation by an ambulance helicopter in emergency medical services in many countries of the world (both by doctors and other medical personnel), making it possible to diagnose a number of lifethreatening conditions with a fairly high accuracy, without loss of time and without damage to patient’s health. An important aspect of the successful application of the method during flight is the training of qualified personnel. The prospects for the development of the method are the development of more advanced ultrasound scanners and sensors adapted to flight conditions, as well as the use of telemedicine technologies for remote analysis of ultrasound images.Conclusion. The experience of using prehospital diagnostic ultrasound in an ambulance helicopter requires further data accumulation and systematic analysis, but the method is already undoubtedly useful in determining the tactics of treatment and the route of hospitalization of urgent patients with acute trauma and a number of other pathological conditions.

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