Hospice House, Institute of Emergency Medicine. N.V

History of the Research Institute of Emergency Medicine. N.V. Sklifosovsky originates from the Hospice House, founded for charitable purposes by Count N.P. Sheremetev in 1803 and officially opened in 1810. The house consisted of a hospital for 50 "suffering from illnesses" and a shelter for 25 orphan girls. It was one of the first institutions in Russia to provide medical care the poorest segments of the population and for the charity of orphans and the homeless.

During the Patriotic War of 1812, the building of the Hospice House housed a hospital, first of the French, then of the Russian army, and later - a hospital for the wounded in the Russian-Turkish war of 1887. The wounded from the fronts of the Russian-Japanese and the First World War also came here. Permanent surgical practice has been conducted here since 1815. In 1923, on the basis of the Sheremetev Hospital (formerly the Hospice House), the Institute of Emergency Care was organized, bearing the name of N.V. Sklifosovsky and widely known to Muscovites and residents of other cities of Russia as a medical institution that provides highly qualified assistance at any time and to any patient. As a branch, the Institute was given the Ambulance Station located on its territory, which was headed by the chief physician of the Sheremetev Hospital G.M. Gerstein. In the same 1923, the Ambulance Station was headed by A.S. Puchkov. Under his leadership, organizational principles were developed, a documentation and reporting system was created, technical re-equipment was carried out, as a result of which the work of the station reached a new qualitative level. The station remained a part of the Institute until 1940, and then it was separated into an independent organization. The staff of the Institute was one of the first in the country to begin the development and practical construction of a state system for providing emergency medical care for acute diseases and injuries. The Institute was the first to raise the issue of the need for preventive work to prevent accidents and contributed to the adoption of a number of measures that secured various aspects of the everyday life of the population of Moscow. The Institute was also a pioneer in the creation of an emergency surgical service. Its main principles are formulated and developed here: qualified operational assistance at any time, uniformity of tactics and techniques of operations, participation in the diagnosis of radiologists and clinical laboratory staff, the practice of morning conferences to discuss the results of work over the past day. During the Great Patriotic War, the Research Institute. N.V. Sklifosovsky received tens of thousands of wounded. Here, the most complex operations were carried out to save the lives of fighters and return them to duty. Many surgeons, nurses and orderlies worked at the front. After the end of the war, the surgical and therapeutic services of the Institute were reorganized and brought into line with peacetime tasks. The pre-war and war periods of the Institute's activities were marked by major scientific achievements in the field of medicine. Through the works of outstanding scientists V.A. Krasintseva, A.S. Puchkov, Academicians of the Academy of Medical Sciences S.S. Yudina, B.A. Petrova, A.N. Kryukov, Corresponding Member of the Academy of Medical Sciences D.A. Arapov, professors P.I. Androsova, B.S. Rozanova, A.V. Rusakov and other prominent specialists of the Institute laid the foundations for the theory and practice of emergency medical care as a special branch of healthcare. The principles of emergency surgical care developed by the luminaries remain in force at the present time, which convincingly indicates their correctness. The development of medical science was facilitated by the creation of the Institute's Dissertation Council for the defense of candidate dissertations in the field of surgery, traumatology and orthopedics, anesthesiology and resuscitation. In 1978, at the Presidium of the USSR Academy of Medical Sciences, the Scientific Council on the Problems of Emergency Medical Care was formed, created to plan, coordinate and manage scientific research in this area. The head institution was determined by the Research Institute of Emergency Medicine. N.V. Sklifosovsky, who began to carry out a unified management of research work throughout the city and the country. The need to open multidisciplinary emergency hospitals in the country was scientifically substantiated. Thanks to the emergence of almost two hundred such hospitals in a short time and the creation of specialized ambulance teams (cardiology, toxicology, resuscitation, etc.), the quality of treatment of emergency conditions has improved significantly. The commissioning in 1982 of the clinical and surgical building with 15 well-equipped operating rooms contributed to the further development of emergency surgery, as well as neurosurgery and traumatology. As a result, the Institute has become a leading center for emergency surgery not only in Moscow, but also in the country. In the period 1992–2006 significant changes were made in the research institutes, brought to life by the requirements of modern medical science. Departments for acute endotoxicosis, liver transplantation, emergency plastic and reconstructive microsurgery, a laboratory for new surgical technologies, a department for emergency cardiac surgery, and a city burn center have been established. The buildings were reconstructed, where the departments of acute thermal injuries (City Burn Center) and acute poisonings (City Toxicological Center), the department of liver transplantation and the department of crisis states and psychosomatic disorders are located. A new building was built for the Department of Emergency Cardiac Surgery. Completed the restoration of the first building of the old building of the Institute - an architectural monument early XIX century. The Museum of Surgery and the History of the Institute, created in 1948 on the initiative of Academician S.S. Yudin. A number of other historic buildings have been restored, including the chapel. The old park, which is an integral part of a unique institute ensemble, is maintained in exemplary order. In order to significantly accelerate and improve the quality of the diagnostic and treatment process and improve the working conditions of the personnel, in recent years the reconstruction of the admission department, the operating unit, a number of intensive care units, a complex of laboratory and instrumental diagnostic units and a disinfection unit has been carried out. Today, the Research Institute of Emergency Medicine. N.V. Sklifosovsky is the largest multidisciplinary scientific and practical center for emergency medical care in Russia. All its divisions provide free round-the-clock highly qualified medical care to all who apply for it. The objectives of the institute are scientific activities, medical care for the sick and injured, training and consulting of specialists in the field of emergency medicine. The Institute has more than 40 scientific divisions, more than half of which are clinical. The great scientific and practical potential of the staff, modern equipment allow us to successfully develop new and improve existing methods diagnosis and treatment of the most severe injuries and complicated acute surgical diseases. More than 800 researchers and doctors work at the Institute, including 2 academicians and 2 corresponding members of the Russian Academy of Medical Sciences, 37 professors, 78 doctors and 167 candidates of medical sciences. There are 918 inpatient beds, including 90 resuscitation beds. Over 20,000 different surgeries are performed on the basis of the Institute's departments throughout the year. Scientific research is carried out in five main areas: diagnosis and treatment of mechanical and thermal injuries; diagnosis and treatment acute diseases and damage to the vessels of the heart, brain, aorta and its branches; diagnosis and treatment of acute surgical diseases of the abdominal organs; diagnostics and treatment of acute exo- and endotoxicoses; organization at the stationary stage of specialized emergency care for the sick and injured. Over the past 10 years, about 235 case studies have been carried out aimed at improving the quality of diagnosis and treatment. Published 62 monographs, about 4100 scientific articles and other publications, including 86 collections of papers. The staff of the Institute also wrote a large number of chapters and sections in books published by other institutions. 43 patents and certificates for inventions were received, 32 rationalization proposals were accepted for use. 140 dissertations were defended, including 25 doctoral ones. Implementation of the results of scientific research into practice has a positive effect on the improvement of medical work. The growth in the level of scientific research led in 2001 to the creation at the Institute of the Dissertation Council for the defense of doctoral dissertations in the field of surgery, anesthesiology and resuscitation, traumatology and neurosurgery To improve the professional level of doctors, more than 100 scientific and practical conferences and seminars were held, more than 130 information and methodological documents. Big role in solving scientific and practical problems and in coordinating scientific research on the territory of the Russian Federation, the Problem Commissions of the Scientific Council for Emergency Medical Care in the field of combined trauma, cardiology and clinical toxicology and the Problem Commission for Emergency Surgery play. The research results are analyzed in the department of external scientific relations. This significantly accelerates the introduction of advanced achievements of medical science. Many employees of the Institute have been awarded State Prizes, Prizes of the Government of the Russian Federation and the Moscow Mayor's Office. 8 employees were awarded the honorary title "Honored Scientist of the Russian Federation", and 32 - the honorary titles "Honored Doctor of the Russian Federation" and "Honored Health Worker of the Russian Federation". Medical work. The Institute provides free emergency medical care to the general public. Over the past 10 years, more than 450 thousand patients have received it. In 2005 alone, medical assistance was provided to 48,895 patients, 24,186 of whom were hospitalized (the main channel of receipts is emergency medical care); performed about 20,700 operations. At the same time, mortality was the lowest in recent years - 4.5%. 62% of hospitalized patients (about 15 thousand patients) were diagnosed with various types of trauma, including mechanical, thermal and chemical. Research Institute. N.V. Sklifosovsky has the ability to provide specialized care, which is often not available in other medical institutions for this reason, in just one year, 1074 patients were transferred to the Institute from hospitals in Moscow, the Moscow region and other regions of Russia. In addition, Moscow hospitals are provided with consultative and specialized assistance by specialists of visiting teams in neurosurgery, endoscopy and endotoxicosis. Resuscitation at critical conditions. The most powerful resuscitation service in Russia has been created at the Institute, consisting of 9 resuscitation departments. During the year, more than 8,500 patients with craniocerebral and combined trauma, burns, acute poisoning, diseases of the heart, blood vessels, kidneys, liver, and gastrointestinal tract undergo intensive therapy. In a special department, severe clinical and laboratory manifestations of endotoxicosis, which develop as a result of multiple organ failure, are treated. Due to the well-equipped Institute and highly qualified personnel, mortality in cases of traumatic brain injury, cerebrovascular diseases, extensive burns, acute poisoning is the lowest in Russia and corresponds to the international level. Scientific research allows the Institute to develop recommendations for other emergency medicine institutions. This concerns the introduction of unique technologies- systems of emergency multicomponent detoxification, neuromonitoring, hyperbaric oxygenation with the possibility of breathing prosthetics, blood-saving methods in emergency surgery, etc. Trauma. The most common causes of mechanical damage are road trauma, falls from high altitude and gunshot and stab wounds. The most numerous are patients with mechanical trauma (only in 2005 there were 8672 of them). The heaviest contingent - patients with concomitant, combined trauma, whose proportion was about 35%. For the treatment of such patients, an anti-shock suit "Kashtan" (Gold medal of the Brussels exhibition in 1996) was developed and introduced into industrial production. Its use at the prehospital stage made it possible to reduce the frequency of deaths associated with the development of severe shock. Internal osteosynthesis for severe fractures and ruptures of the pelvic joints and blocking osteosynthesis for "large" fractures with multiple trauma were also introduced - over 800 such operations have been performed in recent years. A system for diagnosing, preventing and treating life-threatening complications has been developed, which has made it possible to reduce their frequency by 2–4 times. Thanks to the introduction of scientific developments, the mortality rate in concomitant trauma has been reduced in recent years from 29 to 18% - more than 1.5 times. In addition, hip arthroplasty, osteosynthesis with cannulated screws, patella replacement and cruciate ligament arthroplasty in case of ruptures have been introduced as early surgical treatment of injuries. For 2005 at the Research Institute of Emergency Medicine. N.V. Sklifosovsky received 800 victims with chest and neck injuries and 230 with injuries or diseases of the esophagus (respectively, 135 and 95). In a significant proportion of cases (more than 160), there were combined wounds of the chest and abdomen, which are among the most severe types of open trauma, as they are often accompanied by damage to many internal organs and massive blood loss. For such cases, the department of emergency thoracoabdominal surgery actively uses videothoracoscopy, with which you can quickly determine the nature of damage to the chest organs and perform the necessary surgical interventions, which often eliminates the need for extensive operations and allows much more accurate planning of the treatment process. In addition, the department conducts unique interventions that are performed only at the Institute: surgical treatment of wounds and injuries of the esophagus and the consequences of its chemical and mechanical trauma, as well as emergency and reconstructive operations for mechanical injuries of the trachea and their consequences (tracheoesophageal fistulas, tracheal strictures ). Great progress has been made in the field of immunoprophylaxis and immunotherapy of purulent-septic complications in patients with penetrating wounds of the chest and abdomen. A technique has been developed for the treatment of clotted hemothorax, which makes it possible to reduce the number of traumatic thoracotomies. The undoubted achievement of the Institute is the reduction of mortality in trauma from 5.7% in 2002 to 3.7% in 2005. Thermal injury. In 2005, 1740 patients with burns were treated in the department of acute thermal injuries. One of the most effective methods treatment of a burn injury is an early active surgical intervention (removal of non-viable tissues, skin grafting), thanks to which it is possible to save victims who were considered doomed until relatively recently. Other methods are being developed to improve the quality of treatment: cell therapy, complex treatment of burns of the upper respiratory tract with irradiation of the affected mucosa of the tracheobronchial tree (TBD) with a low-energy laser, supravenous laser blood irradiation. Their use significantly reduces the healing time of burns with a good functional and cosmetic result. On average, the healing time for defects in the mucosa of the TBD was reduced by 4–5 days, the number of pneumonias decreased by more than 20%, and economic indicators. Damage to the brain and spinal cord. More than 2,500 patients are hospitalized in the neurosurgical clinic annually and about 1,000 operations are performed using modern technologies. Scientific developments concerning various sections of emergency neurosurgery are reflected in more than 20 monographs and 800 printed works and reports at international and all-Russian scientific conferences. For more than 40 years, the Institute has been hosting annual city scientific and practical conferences and seminars in the specialty, and since 2003, master classes have been held on the basis of the department. Many employees of the department were trained in foreign clinics (Italy, France, USA, Belgium, Holland, Germany). Since 1998, at the initiative of the head of the department, corresponding member of the Russian Academy of Medical Sciences, Professor V.V. Krylov and professor V.V. Lebedev, the journal Neurosurgery is published; it now has over 2,000 subscribers and is distributed free of charge. Mortality in the department is 1.5 times lower than the average for Moscow. The priority of the department is the early surgical treatment of cerebral hemorrhages as a result of rupture of vascular aneurysms, which reduces the incidence of deaths in these conditions by almost 3 times (from 25 to 9%). Significantly better than all-Russian indicators and results of treatment of subdural hemorrhages. Techniques for minimally invasive treatment of hemorrhagic strokes using microsurgical techniques have been developed. The treatment of gunshot craniocerebral wounds in peacetime and complications of spinal injury has been greatly improved. The use of osteoplastic trepanation, drainage of hematomas through burr holes, microsurgery of aneurysms and malformations, and local fibrinolysis of traumatic intracranial hematomas are expanding. We use neurovideo endoscopy, minimally invasive thoracoscopic fusion, the Stryker neuronavigation system, and systems for correcting and stabilizing the injured spine. Emergency surgery. In 2005, emergency surgical interventions were performed in 1560 patients. In the field of emergency surgery over the past decade, methods for early topical diagnosis and surgical treatment of mechanical liver damage using minimally invasive technologies have been developed and put into practice, which significantly reduces the frequency of reoperations. For the diagnosis and treatment of perforated pyloroduodenal ulcers, diagnostic videolaparoscopy is widely used, and, if necessary, a direct transition to minimally invasive operations from laparoscopic access, which is possible in 90% of cases. Techniques for the staged treatment of complications of cholelithiasis have been developed, including, in case of high postoperative risk, the use of video-laparoscopic equipment, which significantly improves the prognosis for this pathology. In the treatment of pancreatitis, preference is given to minimally invasive puncture-draining and video-laparoscopic interventions and manipulations for fluid accumulations containing a large amount of toxic substances. Videoretroperitoneoscopy and minilaparotomy are being introduced using the MiniAssistant apparatus. For more than 20 years, in a specially created department, big job in such a difficult area as the prevention and treatment of purulent complications in surgery. Improved methods for eliminating sources of purulent complications, including the treatment of the most severe of them - peritonitis and intestinal fistulas. The principles of highly effective closed aspiration-flushing treatment of suppurative processes have been developed and widely introduced into practice; equipment for its implementation; antibacterial sutures and preparations for topical wound treatment. Surgical staplers (AKA-2, AKA-4, AKA-5M and LPK) have been created and used in many hospitals of the country, the use of which significantly improves the results of operations on the digestive tract. The Institute is one of the four centers in Russia where liver transplantation has been performed since 2000. To date, out of 47 patients who underwent this operation, 31 (66%) are alive. The department also performs other high-tech operations - hemihepatectomy, segmental and atypical liver resection. Introduced blood-saving technologies. In the departments of emergency vascular surgery and emergency cardiac surgery of the Institute, operations are performed for ruptured aneurysms of the thoracic and abdominal aorta, and for the prevention of ischemic strokes, operations are performed on the vessels of the neck, aorta and its branches. The number of coronary bypass operations in 2005 was 139, of which 95 were emergency. At the same time, the Med-IK thermal imaging complex is actively used to visualize blood vessels during the diagnostic period and during cardiac surgery. Auto-arterial grafts are used to achieve more stable long-term results of coronary bypass surgery. Together with the Department of Emergency Thoracoabdominal Surgery, in the Department of Emergency Plastic and Reconstructive Microsurgery, in addition to emergency recovery operations (replantations) for traumatic amputations of fingers and larger segments of the limbs, as well as operations for damage to the vessels and nerves of the hand and forearm, microsurgical methods are being introduced using their own tissues of patients (autotransplantation) for plastic surgery of the esophagus and trachea. In the laboratory of new surgical technologies, new methods of endosurgery are intensively developed. Performed: elimination of adhesive intestinal obstruction, suturing of perforated ulcers, thoracoscopic operations for wounds and complications of a closed chest injury, for bullous disease complicated by spontaneous pneumothorax, evacuation of clotted hemothorax, pneumolysis, pleurectomy, decortication, suturing of lung wounds, coagulation of lung and pleura wounds, removal foreign bodies, revision and drainage of the pleural cavity, lung resection. Together with the clinic of emergency thoracoabdominal surgery, a new operation for severe closed chest trauma was introduced into practice - thoracoscopic extrapleural subfascial fixation of floating rib fractures with knitting needles. Videolaparoscopic operations are also being implemented in emergency gynecology. In the endoscopic department, low-energy laser irradiation of the mucous membrane of the tracheobronchial tree in case of thermal inhalation injury, chromogastroscopy and to control gastroesophageal reflux in esophageal burns, as well as endoscopic ligation of varicose veins of the esophagus and cardia are being introduced into practice. In 2005, 10,270 medical and diagnostic procedures were performed. X-ray surgical methods of diagnosis and treatment are also being developed - angiographic studies, X-ray endovascular embolization of aneurysms of the brain, gastric and uterine arteries in case of bleeding from them. In 2005, about 3,600 medical and diagnostic interventions were performed. Acute complications of ischemic heart disease. Among 318 patients with acute myocardial infarction (AMI) admitted in 2005, mortality was 8.8%, which is almost two times lower than the average for Russia. The Institute widely uses thrombolytic therapy (including at the prehospital stage), emergency angioplasty and coronary artery bypass grafting. The institute is one of the few medical institutions in the country where PCI, percutaneous coronary interventions, is being developed and successfully applied, not only in the first 12 hours, but also for several days from the onset of a heart attack. PCI is successfully practiced in AMI with a high risk of death, and in various forms unstable angina pectoris, the use of PCI allows to achieve full recovery. At the same time, lethality from AMI is reduced by 5-7 times and is absent in unstable angina and myocardial infarction without "Q". In the latter case, the incidence of AMI is reduced by more than 10 times, and the duration of inpatient treatment is significantly reduced. The Institute has the world's largest and the first in Russia experience of five successful PCIs in traumatic myocardial infarction with damage to the intima of the coronary artery concomitant with concomitant chest trauma. Acute poisoning and endotoxicosis. The Institute is the founder of the toxicological service in the country. Following the example of its toxicological department, it was decided to organize similar specialized centers in the USSR, the number of which today exceeds 40. The mortality rate from acute poisoning has decreased in them by 2-3 times. This is especially important, since injuries and poisonings are the second leading cause of death in the population. Improving the quality of treatment of severe poisoning became possible due to the use of technologies for the accelerated removal of toxicants from various sectors of the body (blood, intestines). These technologies, developed in recent years in the Department of Treatment of Acute Poisoning (headed by Academician of the Russian Academy of Medical Sciences E.A. Luzhnikov), are based on the phased application of methods that help cleanse the body (hemosorption, hemodialysis, intestinal lavage) and stimulate its own defenses during blood irradiation ultraviolet and laser beams, exposure to it magnetic fields and indirect electrochemical oxidation. With this approach to the treatment of acute poisoning, the safety of the interventions used is significantly increased due to the use of low-intensity exposures. In 2005, 4,362 patients were hospitalized for poisoning with drugs and non-medical toxic substances (alcohol, etc.). About half of them (1954) were treated, due to the severity of the condition, in the intensive care unit. The gradual introduction of highly effective treatment technologies in this department has led to a significant reduction in the frequency of deaths - from 14% in 1983 to 7.7% in 2005. The Institute also operates the Federal government agency"Scientific-practical toxicological center", associated in its activities with the toxicological clinic. Behind last period annually up to 4-6 thousand telephone consultations (clinical and laboratory) are provided - to ambulance teams, hospitals, the population of Moscow, as well as other cities and institutions of Russia. In addition, visiting consultations are practiced in the city and beyond, as a result of which a significant part of patients are transferred from other hospitals to the toxicological department of the Institute. The service operates around the clock (tel. 628–16–87). For the treatment of acute endotoxicoses, the relevant department uses modern high-tech methods of extracorporeal detoxification, including prolonged intensive sorption-membrane apheresis (PRISMA-technology), the advantages of which are mobility and wide therapeutic possibilities. In 2005, 1060 extracorporeal detoxification procedures were carried out in the departments of the Institute. Hyperbaric oxygenation. During 2005, 6854 sessions of hyperbaric oxygen therapy were performed for acute surgical and neurosurgical pathology, trauma, acute poisoning, endotoxicosis, somatopsychiatric and other diseases, as a result of which it was possible to reduce the frequency of purulent-septic complications, accelerate detoxification processes, regression of neuropsychiatric disorders and other painful manifestations. Recovery treatment. Rehabilitation treatment includes physiotherapy and exercise therapy and is carried out for patients who are in all clinics of the institute, as well as for outpatients who need aftercare after discharge from the hospital. This allows in as soon as possible achieve physical rehabilitation of patients after major operations and various injuries. In 2005, 3,903 patients received rehabilitation treatment, with a total of 48,450 procedures performed. Crisis states and acute psychosomatic disorders. The Institute has created a unique emergency department for patients with acute mental disorders combined with injuries of internal organs requiring surgical interventions. Over the past year, about 2,300 patients have been treated in this department. In recent years, the influx of people affected by man-made accidents, air and car accidents, terrorist attacks and other emergencies has significantly increased. These patients experience severe mental stress, which requires psychological help to eliminate. In 2001, a group of psychotherapists was formed and is functioning as part of the department. Clinical and psychological correction is carried out daily with patients experiencing mental stress associated with trauma, burns, detection of surgical diseases and the upcoming operation. Conducted about 700 sessions of group and individual psychotherapy for almost 170 patients affected by emergencies. In recent years, psychotherapy according to the developed technology was included in the complex of treatment for more than 2,000 patients, with whom about 5,000 psychotherapeutic sessions were performed. The organization of psychological assistance in emergency conditions has no analogues in the domestic health care. Blood and Tissue Preservation Service. The institute is the founder of the program "Blood-saving surgery in emergency care". This milestone in improving the treatment of acute blood loss in surgery using autohemotransfusion, including its implementation in emergency and delayed surgical interventions. The blood poured inside and collected during operations is processed using a special technology and returned to the bloodstream. The Institute's emergency surgery currently uses up to 1.5-2 thousand liters of autologous blood per year (in 2005 - 1.8 thousand liters), which largely solves the problem of the safety of transfusion of blood and its components. In the event of mass admissions of people affected by disasters or terrorist attacks, the transfusiological service of the Institute accepts a large flow of gratuitous donors (up to 1800 people per week against 100 per week). regular time), while at the same time working to promote gratuitous donation and its rational use. Among the city's blood transfusion departments, the Institute's department ranks first in terms of the number of attracted donor-relatives, whose donation is 98% gratuitous. In addition, allo-skin, bone, dura mater grafts and cell preparations are harvested in the laboratory, which are then used in clinical units to treat various injuries of the limbs and the brain. Laboratory and instrumental diagnostic complex. The Institute has a large laboratory base for early diagnosis of emergency conditions. In 2005 alone, about 27 thousand electrocardiographic, more than 150 thousand radiographic, about 50 thousand ultrasound, more than 20 thousand computed tomography, more than 6 thousand radionuclide and more than 15 thousand functional studies (various types of electroencephalography, spirometry , rheovasography, intragastric pH-metry, etc.), more than 450 angiographies. About 2.3 million clinical, biochemical, immunological, rheological, microbiological and toxicological analyzes were performed. During 2005, about 330,000 people (patients, donors, population) were examined in the laboratory for the diagnosis of viral hepatitis and HIV infection, about 1.2 million studies were performed. Identification of infected persons allows timely implementation of treatment and preventive measures to prevent the spread of infection. Elimination of medical consequences of emergencies. Employees of the Institute actively provided assistance to the wounded and injured in the events of 1993. The Institute also provided assistance to victims of disasters and terrorist acts, such as: an earthquake in Armenia (the cities of Spitak and Leninakan, 1988); gas explosion during the passage of passenger trains in Bashkiria (1989); explosion in the underground passage on Pushkin Square (Moscow, 2000); explosion at Belorusskaya metro station (Moscow, 2001); hurricane in Moscow (2001); helicopter crash in the mountains. Khankala (2002); the consequences of the terrorist attack in the Palace of Culture on the street. Dubrovka (Nord-Ost, Moscow, 2002); explosion at the Wings festival in Tushino (Moscow, 2003); fire in the dormitory of the Peoples' Friendship University of Russia (Moscow, 2003); explosion at the Rizhskaya metro station (Moscow, 2004); explosion at the Avtozavodskaya metro station (Moscow, 2004); collapse of the water park building (Moscow, 2004); consequences of the terrorist act in the mountains of Beslan (2004). In addition, the employees of the Institute systematically provide assistance to victims of mass poisoning by various chemicals. Scientific-organizational and educational work. For more than 10 years, the Institute has been offering postgraduate studies, doctoral studies in 6 specialties, clinical residency in 19 specialties, programs additional education carried out in accordance with federal programs. Not only citizens of the Russian Federation, but also citizens of the CIS and far abroad study at the Institute. About 150 clinical residents, 6-8 graduate students and 500 doctors are trained annually in additional education programs. The educational and clinical department is developing teaching aids, allowing physicians to use them as reference books in the provision of medical care to the population. Departments of higher educational institutions- Russian Medical Academy of Postgraduate Education (Department of Emergency Surgery and Clinical Toxicology), Moscow State Medical Dental University (Department of Neurosurgery, Faculty of Medicine), Educational and Scientific Center at the Medical Center of the Administration of the President of the Russian Federation (Department of Emergency Medicine and Intensive Care). The editorial and publishing department, which has been successfully functioning for more than 10 years, prepares and publishes the works of the institute and its employees. The Institute also has a rich scientific and medical library. The Department of External Scientific Relations coordinates scientific research carried out outside the institute, searches for and processes scientific information, and conducts work in the field of the history of medicine. Recognition of the achievements of the Institute staff. Behind long history The institute of merit of his team has been repeatedly noted by the highest bodies of the state and the city of Moscow. The great achievements of the Institute are mentioned in the documents of the People's Commissariat of Health of the RSFSR and the Presidium of the Moscow Council, published already in the first period of its work (1935). The most significant awards over late period- Order of the Red Banner of Labor (Decree of the Presidium of the Supreme Soviet of the USSR of July 22, 1960) and the Order of Lenin (Decree of the Presidium of the Supreme Soviet of the USSR of August 14, 1973). The institute was also awarded big amount diplomas, certificates and prizes, testifying to his significant contribution to the health care of the country. Hospice home - Sheremetev Hospital - Research Institute of Emergency Medicine. N.V. Sklifosovsky has always played a prominent role in domestic medicine. Being a model for building an ambulance service for many countries in Europe and America, the Institute, despite the changed living conditions of our society, successfully continues its activities. The Institute has created a modern material base and employs a large team of highly qualified specialists who store and multiply best traditions domestic healthcare. This allows you to save the sick and injured, who were previously considered hopeless, to return to vigorous activity thousands of people while maintaining their physical and mental health.

History of the Research Institute of Emergency Medicine. N.V. Sklifosovsky originates from the Hospice House, founded for charitable purposes by Count N.P. Sheremetev in 1803 and officially opened in 1810. The house consisted of a hospital for 50 "suffering from illnesses" and a shelter for 25 orphan girls. It was one of the first institutions in Russia to provide medical care to the poorest segments of the population and to care for orphans and the homeless.

During the Patriotic War of 1812, the building of the Hospice House housed a hospital, first of the French, then of the Russian army, and later - a hospital for the wounded in the Russian-Turkish war of 1887. The wounded from the fronts of the Russian-Japanese and the First World War also came here. Permanent surgical practice has been conducted here since 1815. In 1923, on the basis of the Sheremetev Hospital (formerly the Hospice House), the Institute of Emergency Care was organized, bearing the name of N.V. Sklifosovsky and widely known to Muscovites and residents of other cities of Russia as a medical institution that provides highly qualified assistance at any time and to any patient. As a branch, the Institute was given the Ambulance Station located on its territory, which was headed by the chief physician of the Sheremetev Hospital G.M. Gerstein. In the same 1923, the Ambulance Station was headed by A.S. Puchkov. Under his leadership, organizational principles were developed, a documentation and reporting system was created, technical re-equipment was carried out, as a result of which the work of the station reached a new qualitative level. The station remained a part of the Institute until 1940, and then it was separated into an independent organization. The staff of the Institute was one of the first in the country to begin the development and practical construction of a state system for providing emergency medical care for acute diseases and injuries. The Institute was the first to raise the issue of the need for preventive work to prevent accidents and contributed to the adoption of a number of measures that secured various aspects of the everyday life of the population of Moscow. The Institute was also a pioneer in the creation of an emergency surgical service. Its main principles are formulated and developed here: qualified operational assistance at any time, uniformity of tactics and techniques of operations, participation in the diagnosis of radiologists and clinical laboratory staff, the practice of morning conferences to discuss the results of work over the past day. During the Great Patriotic War, the Research Institute. N.V. Sklifosovsky received tens of thousands of wounded. Here, the most complex operations were carried out to save the lives of fighters and return them to duty. Many surgeons, nurses and orderlies worked at the front. After the end of the war, the surgical and therapeutic services of the Institute were reorganized and brought into line with peacetime tasks. The pre-war and war periods of the Institute's activities were marked by major scientific achievements in the field of medicine. Through the works of outstanding scientists V.A. Krasintseva, A.S. Puchkov, Academicians of the Academy of Medical Sciences S.S. Yudina, B.A. Petrova, A.N. Kryukov, Corresponding Member of the Academy of Medical Sciences D.A. Arapov, professors P.I. Androsova, B.S. Rozanova, A.V. Rusakov and other prominent specialists of the Institute laid the foundations for the theory and practice of emergency medical care as a special branch of healthcare. The principles of emergency surgical care developed by the luminaries remain in force at the present time, which convincingly indicates their correctness. The development of medical science was facilitated by the creation of the Institute's Dissertation Council for the defense of candidate dissertations in the field of surgery, traumatology and orthopedics, anesthesiology and resuscitation. In 1978, at the Presidium of the USSR Academy of Medical Sciences, the Scientific Council on the Problems of Emergency Medical Care was formed, created to plan, coordinate and manage scientific research in this area. The head institution was determined by the Research Institute of Emergency Medicine. N.V. Sklifosovsky, who began to carry out a unified management of research work throughout the city and the country. The need to open multidisciplinary emergency hospitals in the country was scientifically substantiated. Thanks to the emergence of almost two hundred such hospitals in a short time and the creation of specialized ambulance teams (cardiology, toxicology, resuscitation, etc.), the quality of treatment of emergency conditions has improved significantly. The commissioning in 1982 of the clinical and surgical building with 15 well-equipped operating rooms contributed to the further development of emergency surgery, as well as neurosurgery and traumatology. As a result, the Institute has become a leading center for emergency surgery not only in Moscow, but also in the country. In the period 1992–2006 significant changes were made in the research institutes, brought to life by the requirements of modern medical science. Departments for acute endotoxicosis, liver transplantation, emergency plastic and reconstructive microsurgery, a laboratory for new surgical technologies, a department for emergency cardiac surgery, and a city burn center have been established. The buildings were reconstructed, where the departments of acute thermal injuries (City Burn Center) and acute poisonings (City Toxicological Center), the department of liver transplantation and the department of crisis states and psychosomatic disorders are located. A new building was built for the Department of Emergency Cardiac Surgery. The restoration of the first building of the old building of the institute, an architectural monument of the early 19th century, has been completed. The Museum of Surgery and the History of the Institute, created in 1948 on the initiative of Academician S.S. Yudin. A number of other historic buildings have been restored, including the chapel. The old park, which is an integral part of a unique institute ensemble, is maintained in exemplary order. In order to significantly accelerate and improve the quality of the diagnostic and treatment process and improve the working conditions of the personnel, in recent years the reconstruction of the admission department, the operating unit, a number of intensive care units, a complex of laboratory and instrumental diagnostic units and a disinfection unit has been carried out. Today, the Research Institute of Emergency Medicine. N.V. Sklifosovsky is the largest multidisciplinary scientific and practical center for emergency medical care in Russia. All its divisions provide free round-the-clock highly qualified medical care to all who apply for it. The objectives of the institute are scientific activities, medical care for the sick and injured, training and consulting of specialists in the field of emergency medicine. The Institute has more than 40 scientific divisions, more than half of which are clinical. The great scientific and practical potential of the staff, modern equipment allow us to successfully develop new and improve existing methods for diagnosing and treating the most severe injuries and complicated acute surgical diseases. More than 800 researchers and doctors work at the Institute, including 2 academicians and 2 corresponding members of the Russian Academy of Medical Sciences, 37 professors, 78 doctors and 167 candidates of medical sciences. There are 918 inpatient beds, including 90 resuscitation beds. Over 20,000 different surgeries are performed on the basis of the Institute's departments throughout the year. Scientific research is carried out in five main areas: diagnosis and treatment of mechanical and thermal injuries; diagnosis and treatment of acute diseases and injuries of the vessels of the heart, brain, aorta and its branches; diagnosis and treatment of acute surgical diseases of the abdominal organs; diagnostics and treatment of acute exo- and endotoxicoses; organization at the stationary stage of specialized emergency care for the sick and injured. Over the past 10 years, about 235 case studies have been carried out aimed at improving the quality of diagnosis and treatment. Published 62 monographs, about 4100 scientific articles and other publications, including 86 collections of papers. The staff of the Institute also wrote a large number of chapters and sections in books published by other institutions. 43 patents and certificates for inventions were received, 32 rationalization proposals were accepted for use. 140 dissertations were defended, including 25 doctoral ones. Implementation of the results of scientific research into practice has a positive effect on the improvement of medical work. The growth in the level of scientific research led in 2001 to the creation at the Institute of the Dissertation Council for the defense of doctoral dissertations in the field of surgery, anesthesiology and resuscitation, traumatology and neurosurgery To improve the professional level of doctors, more than 100 scientific and practical conferences and seminars were held, more than 130 information and methodological documents. An important role in solving scientific and practical problems and in coordinating scientific research on the territory of the Russian Federation is played by the Problem Committees of the Scientific Council for Emergency Medical Care in the field of combined trauma, cardiology and clinical toxicology and the Problem Committee for Emergency Surgery. The research results are analyzed in the department of external scientific relations. This significantly accelerates the introduction of advanced achievements of medical science. Many employees of the Institute have been awarded State Prizes, Prizes of the Government of the Russian Federation and the Moscow Mayor's Office. 8 employees were awarded the honorary title "Honored Scientist of the Russian Federation", and 32 - the honorary titles "Honored Doctor of the Russian Federation" and "Honored Health Worker of the Russian Federation". Medical work. The Institute provides free emergency medical care to the general public. Over the past 10 years, more than 450 thousand patients have received it. In 2005 alone, medical assistance was provided to 48,895 patients, 24,186 of whom were hospitalized (the main channel of receipts is emergency medical care); performed about 20,700 operations. At the same time, mortality was the lowest in recent years - 4.5%. 62% of hospitalized patients (about 15 thousand patients) were diagnosed with various types of trauma, including mechanical, thermal and chemical. Research Institute. N.V. Sklifosovsky has the ability to provide specialized care, which is often not available in other medical institutions for this reason, in just one year, 1074 patients were transferred to the Institute from hospitals in Moscow, the Moscow region and other regions of Russia. In addition, Moscow hospitals are provided with consultative and specialized assistance by specialists of visiting teams in neurosurgery, endoscopy and endotoxicosis. Resuscitation in critical conditions. The most powerful resuscitation service in Russia has been created at the Institute, consisting of 9 resuscitation departments. During the year, more than 8,500 patients with craniocerebral and combined trauma, burns, acute poisoning, diseases of the heart, blood vessels, kidneys, liver, and gastrointestinal tract undergo intensive therapy. In a special department, severe clinical and laboratory manifestations of endotoxicosis, which develop as a result of multiple organ failure, are treated. Due to the well-equipped Institute and highly qualified personnel, mortality in cases of traumatic brain injury, cerebrovascular diseases, extensive burns, acute poisoning is the lowest in Russia and corresponds to the international level. Scientific research allows the Institute to develop recommendations for other emergency medicine institutions. This concerns the introduction of a number of unique technologies - an emergency multicomponent detoxification system, neuromonitoring, hyperbaric oxygenation with the possibility of breathing prosthetics, blood-saving methods in emergency surgery, etc. Trauma. The most common causes of mechanical damage are road trauma, falls from a great height, as well as gunshot and stab wounds. The most numerous are patients with mechanical trauma (only in 2005 there were 8672 of them). The heaviest contingent - patients with concomitant, combined trauma, whose proportion was about 35%. For the treatment of such patients, an anti-shock suit "Kashtan" (Gold medal of the Brussels exhibition in 1996) was developed and introduced into industrial production. Its use at the prehospital stage made it possible to reduce the frequency of deaths associated with the development of a severe form of shock by a factor of three. Internal osteosynthesis for severe fractures and ruptures of the pelvic joints and blocking osteosynthesis for "large" fractures with multiple trauma were also introduced - over 800 such operations have been performed in recent years. A system for diagnosing, preventing and treating life-threatening complications has been developed, which has made it possible to reduce their frequency by 2–4 times. Thanks to the introduction of scientific developments, the mortality rate in concomitant trauma has been reduced in recent years from 29 to 18% - more than 1.5 times. In addition, hip arthroplasty, osteosynthesis with cannulated screws, patella replacement and cruciate ligament arthroplasty in case of ruptures have been introduced as early surgical treatment of injuries. For 2005 at the Research Institute of Emergency Medicine. N.V. Sklifosovsky received 800 victims with chest and neck injuries and 230 with injuries or diseases of the esophagus (respectively, 135 and 95). In a significant proportion of cases (more than 160), there were combined wounds of the chest and abdomen, which are among the most severe types of open trauma, as they are often accompanied by damage to many internal organs and massive blood loss. For such cases, the department of emergency thoracoabdominal surgery actively uses videothoracoscopy, with which you can quickly determine the nature of damage to the chest organs and perform the necessary surgical interventions, which often eliminates the need for extensive operations and allows much more accurate planning of the treatment process. In addition, the department conducts unique interventions that are performed only at the Institute: surgical treatment of wounds and injuries of the esophagus and the consequences of its chemical and mechanical trauma, as well as emergency and reconstructive operations for mechanical injuries of the trachea and their consequences (tracheoesophageal fistulas, tracheal strictures ). Great progress has been made in the field of immunoprophylaxis and immunotherapy of purulent-septic complications in patients with penetrating wounds of the chest and abdomen. A technique has been developed for the treatment of clotted hemothorax, which makes it possible to reduce the number of traumatic thoracotomies. The undoubted achievement of the Institute is the reduction of mortality in trauma from 5.7% in 2002 to 3.7% in 2005. Thermal injury. In 2005, 1740 patients with burns were treated in the department of acute thermal injuries. One of the most effective methods of treating a burn injury is early active surgical intervention (removal of non-viable tissues, skin grafting), thanks to which it is possible to save victims who were considered doomed until relatively recently. Other methods are being developed to improve the quality of treatment: cell therapy, complex treatment of burns of the upper respiratory tract with irradiation of the affected mucosa of the tracheobronchial tree (TBD) with a low-energy laser, supravenous laser blood irradiation. Their use significantly reduces the healing time of burns with a good functional and cosmetic result. On average, the healing time for defects in the mucosa of the LDP was reduced by 4–5 days, the number of pneumonias decreased by more than 20%, and economic indicators improved. Damage to the brain and spinal cord. More than 2,500 patients are hospitalized in the neurosurgical clinic every year and about 1,000 operations are performed using modern technologies. Scientific developments relating to various sections of emergency neurosurgery are reflected in more than 20 monographs and 800 publications and reports at international and all-Russian scientific conferences. For more than 40 years, the Institute has been hosting annual city scientific and practical conferences and seminars in the specialty, and since 2003, master classes have been held on the basis of the department. Many employees of the department were trained in foreign clinics (Italy, France, USA, Belgium, Holland, Germany). Since 1998, at the initiative of the head of the department, corresponding member of the Russian Academy of Medical Sciences, Professor V.V. Krylov and professor V.V. Lebedev, the journal Neurosurgery is published; it now has over 2,000 subscribers and is distributed free of charge. Mortality in the department is 1.5 times lower than the average for Moscow. The priority of the department is the early surgical treatment of cerebral hemorrhages as a result of rupture of vascular aneurysms, which reduces the incidence of deaths in these conditions by almost 3 times (from 25 to 9%). Significantly better than all-Russian indicators and results of treatment of subdural hemorrhages. Techniques for minimally invasive treatment of hemorrhagic strokes using microsurgical techniques have been developed. The treatment of gunshot craniocerebral wounds in peacetime and complications of spinal injury has been greatly improved. The use of osteoplastic trepanation, drainage of hematomas through burr holes, microsurgery of aneurysms and malformations, and local fibrinolysis of traumatic intracranial hematomas are expanding. We use neurovideo endoscopy, minimally invasive thoracoscopic fusion, the Stryker neuronavigation system, and systems for correcting and stabilizing the injured spine. Emergency surgery. In 2005, emergency surgical interventions were performed in 1560 patients. In the field of emergency surgery over the past decade, methods for early topical diagnosis and surgical treatment of mechanical liver damage using minimally invasive technologies have been developed and put into practice, which significantly reduces the frequency of reoperations. For the diagnosis and treatment of perforated pyloroduodenal ulcers, diagnostic videolaparoscopy is widely used, and, if necessary, a direct transition to minimally invasive operations from laparoscopic access, which is possible in 90% of cases. Techniques for the staged treatment of complications of cholelithiasis have been developed, including, in case of high postoperative risk, the use of video-laparoscopic equipment, which significantly improves the prognosis for this pathology. In the treatment of pancreatitis, preference is given to minimally invasive puncture-draining and video-laparoscopic interventions and manipulations for fluid accumulations containing a large amount of toxic substances. Videoretroperitoneoscopy and minilaparotomy are being introduced using the MiniAssistant apparatus. For more than 20 years, a lot of work has been done in a specially created department in such a difficult area as the prevention and treatment of purulent complications in surgery. Improved methods for eliminating sources of purulent complications, including the treatment of the most severe of them - peritonitis and intestinal fistulas. The principles of highly effective closed aspiration-flushing treatment of suppurative processes have been developed and widely introduced into practice; equipment for its implementation; antibacterial sutures and preparations for topical wound treatment. Surgical staplers (AKA-2, AKA-4, AKA-5M and LPK) have been created and used in many hospitals of the country, the use of which significantly improves the results of operations on the digestive tract. The Institute is one of the four centers in Russia where liver transplantation has been performed since 2000. To date, out of 47 patients who underwent this operation, 31 (66%) are alive. The department also performs other high-tech operations - hemihepatectomy, segmental and atypical liver resection. Introduced blood-saving technologies. In the departments of emergency vascular surgery and emergency cardiac surgery of the Institute, operations are performed for ruptured aneurysms of the thoracic and abdominal aorta, and for the prevention of ischemic strokes, operations are performed on the vessels of the neck, aorta and its branches. The number of coronary bypass operations in 2005 was 139, of which 95 were emergency. At the same time, the Med-IK thermal imaging complex is actively used to visualize blood vessels during the diagnostic period and during cardiac surgery. Auto-arterial grafts are used to achieve more stable long-term results of coronary bypass surgery. Together with the Department of Emergency Thoracoabdominal Surgery, in the Department of Emergency Plastic and Reconstructive Microsurgery, in addition to emergency recovery operations (replantations) for traumatic amputations of fingers and larger segments of the limbs, as well as operations for damage to the vessels and nerves of the hand and forearm, microsurgical methods are being introduced using their own tissues of patients (autotransplantation) for plastic surgery of the esophagus and trachea. In the laboratory of new surgical technologies, new methods of endosurgery are intensively developed. Performed: elimination of adhesive intestinal obstruction, suturing of perforated ulcers, thoracoscopic operations for wounds and complications of a closed chest injury, for bullous disease complicated by spontaneous pneumothorax, evacuation of clotted hemothorax, pneumolysis, pleurectomy, decortication, suturing of lung wounds, coagulation of lung and pleura wounds, removal foreign bodies, revision and drainage of the pleural cavity, lung resection. Together with the clinic of emergency thoracoabdominal surgery, a new operation for severe closed chest trauma was introduced into practice - thoracoscopic extrapleural subfascial fixation of floating rib fractures with knitting needles. Videolaparoscopic operations are also being implemented in emergency gynecology. In the endoscopic department, low-energy laser irradiation of the mucous membrane of the tracheobronchial tree in case of thermal inhalation injury, chromogastroscopy and to control gastroesophageal reflux in esophageal burns, as well as endoscopic ligation of varicose veins of the esophagus and cardia are being introduced into practice. In 2005, 10,270 medical and diagnostic procedures were performed. X-ray surgical methods of diagnosis and treatment are also being developed - angiographic studies, X-ray endovascular embolization of aneurysms of the brain, gastric and uterine arteries in case of bleeding from them. In 2005, about 3,600 medical and diagnostic interventions were performed. Acute complications of ischemic heart disease. Among 318 patients with acute myocardial infarction (AMI) admitted in 2005, mortality was 8.8%, which is almost two times lower than the average for Russia. The Institute widely uses thrombolytic therapy (including at the prehospital stage), emergency angioplasty and coronary artery bypass grafting. The institute is one of the few medical institutions in the country where PCI, percutaneous coronary interventions, is being developed and successfully applied, not only in the first 12 hours, but also for several days from the onset of a heart attack. PCI is successfully practiced in AMI with a high risk of death, and in various forms of unstable angina, the use of PCI can achieve full recovery. At the same time, lethality from AMI is reduced by 5-7 times and is absent in unstable angina and myocardial infarction without "Q". In the latter case, the incidence of AMI is reduced by more than 10 times, and the duration of inpatient treatment is significantly reduced. The Institute has the world's largest and the first in Russia experience of five successful PCIs in traumatic myocardial infarction with damage to the intima of the coronary artery concomitant with concomitant chest trauma. Acute poisoning and endotoxicosis. The Institute is the founder of the toxicological service in the country. Following the example of his toxicological department, it was decided to organize similar specialized centers in the USSR, the number of which today exceeds 40. Mortality in acute poisoning decreased in them by 2-3 times. This is especially important, since injuries and poisonings are the second leading cause of death in the population. Improving the quality of treatment of severe poisoning became possible due to the use of technologies for the accelerated removal of toxicants from various sectors of the body (blood, intestines). These technologies, developed in recent years in the Department of Treatment of Acute Poisoning (headed by Academician of the Russian Academy of Medical Sciences E.A. Luzhnikov), are based on the phased application of methods that help cleanse the body (hemosorption, hemodialysis, intestinal lavage) and stimulate its own defenses during blood irradiation ultraviolet and laser beams, exposure to magnetic fields and indirect electrochemical oxidation. With this approach to the treatment of acute poisoning, the safety of the interventions used is significantly increased due to the use of low-intensity exposures. In 2005, 4,362 patients were hospitalized for poisoning with drugs and non-medical toxic substances (alcohol, etc.). About half of them (1954) were treated, due to the severity of the condition, in the intensive care unit. The gradual introduction of highly effective treatment technologies in this department has led to a significant reduction in the frequency of deaths - from 14% in 1983 to 7.7% in 2005. On the basis of the Institute, the Federal State Institution “Scientific and Practical Toxicological Center” also operates, which is associated in its activities with the toxicological clinic. Over the last period, up to 4-6 thousand telephone consultations (clinical and laboratory) are provided annually to ambulance teams, hospitals, the population of Moscow, as well as other cities and institutions of Russia. In addition, visiting consultations are practiced in the city and beyond, as a result of which a significant part of patients are transferred from other hospitals to the toxicological department of the Institute. The service operates around the clock (tel. 628–16–87). For the treatment of acute endotoxicoses, the relevant department uses modern high-tech methods of extracorporeal detoxification, including prolonged intensive sorption-membrane apheresis (PRISMA-technology), the advantages of which are mobility and wide therapeutic possibilities. In 2005, 1060 extracorporeal detoxification procedures were carried out in the departments of the Institute. Hyperbaric oxygenation. During 2005, 6854 sessions of hyperbaric oxygen therapy were performed for acute surgical and neurosurgical pathology, trauma, acute poisoning, endotoxicosis, somatopsychiatric and other diseases, as a result of which it was possible to reduce the frequency of purulent-septic complications, accelerate detoxification processes, regression of neuropsychiatric disorders and other painful manifestations. Recovery treatment. Rehabilitation treatment includes physiotherapy and exercise therapy and is carried out for patients who are in all clinics of the institute, as well as for outpatients who need aftercare after discharge from the hospital. This allows in the shortest possible time to achieve physical rehabilitation of patients after major operations and various injuries. In 2005, 3,903 patients received rehabilitation treatment, with a total of 48,450 procedures performed. Crisis states and acute psychosomatic disorders. The Institute has created a unique emergency department for patients with acute mental disorders combined with injuries of internal organs requiring surgical interventions. Over the past year, about 2,300 patients have been treated in this department. In recent years, the influx of people affected by man-made accidents, air and car accidents, terrorist attacks and other emergencies has significantly increased. These patients experience severe mental stress, which requires psychological help to eliminate. In 2001, a group of psychotherapists was formed and is functioning as part of the department. Clinical and psychological correction is carried out daily with patients experiencing mental stress associated with trauma, burns, detection of surgical diseases and the upcoming operation. Conducted about 700 sessions of group and individual psychotherapy for almost 170 patients affected by emergencies. In recent years, psychotherapy according to the developed technology was included in the complex of treatment for more than 2,000 patients, with whom about 5,000 psychotherapeutic sessions were performed. The organization of psychological assistance in emergency conditions has no analogues in the domestic health care. Blood and Tissue Preservation Service. The institute is the founder of the program "Blood-saving surgery in emergency care". This is an important step in improving the treatment of acute blood loss in surgery using autohemotransfusion, including its implementation in emergency and delayed surgical interventions. The blood poured inside and collected during operations is processed using a special technology and returned to the bloodstream. The Institute's emergency surgery currently uses up to 1.5-2 thousand liters of autologous blood per year (in 2005 - 1.8 thousand liters), which largely solves the problem of the safety of transfusion of blood and its components. With mass admissions of people affected by disasters or terrorist attacks, the transfusiological service of the Institute accepts a large flow of gratuitous donors (up to 1800 people per week against 100 at normal times), while simultaneously working to promote gratuitous donation and its rational use. Among the city's blood transfusion departments, the Institute's department ranks first in terms of the number of attracted donor-relatives, whose donation is 98% gratuitous. In addition, allo-skin, bone, dura mater grafts and cell preparations are harvested in the laboratory, which are then used in clinical units to treat various injuries of the limbs and the brain. Laboratory and instrumental diagnostic complex. The Institute has a large laboratory base for early diagnosis of emergency conditions. In 2005 alone, about 27 thousand electrocardiographic, more than 150 thousand radiographic, about 50 thousand ultrasound, more than 20 thousand computed tomography, more than 6 thousand radionuclide and more than 15 thousand functional studies (various types of electroencephalography, spirometry , rheovasography, intragastric pH-metry, etc.), more than 450 angiographies. About 2.3 million clinical, biochemical, immunological, rheological, microbiological and toxicological analyzes were performed. During 2005, about 330,000 people (patients, donors, population) were examined in the laboratory for the diagnosis of viral hepatitis and HIV infection, about 1.2 million studies were performed. Identification of infected persons allows timely implementation of treatment and preventive measures to prevent the spread of infection. Elimination of medical consequences of emergencies. Employees of the Institute actively provided assistance to the wounded and injured in the events of 1993. The Institute also provided assistance to victims of disasters and terrorist acts, such as: an earthquake in Armenia (the cities of Spitak and Leninakan, 1988); gas explosion during the passage of passenger trains in Bashkiria (1989); explosion in the underground passage on Pushkin Square (Moscow, 2000); explosion at Belorusskaya metro station (Moscow, 2001); hurricane in Moscow (2001); helicopter crash in the mountains. Khankala (2002); the consequences of the terrorist attack in the Palace of Culture on the street. Dubrovka (Nord-Ost, Moscow, 2002); explosion at the Wings festival in Tushino (Moscow, 2003); fire in the dormitory of the Peoples' Friendship University of Russia (Moscow, 2003); explosion at the Rizhskaya metro station (Moscow, 2004); explosion at the Avtozavodskaya metro station (Moscow, 2004); collapse of the water park building (Moscow, 2004); consequences of the terrorist act in the mountains of Beslan (2004). In addition, the employees of the Institute systematically provide assistance to victims of mass poisoning with various chemicals. Scientific-organizational and educational work. For more than 10 years, the Institute has been offering postgraduate studies, doctoral studies in 6 specialties, clinical residency in 19 specialties, additional education programs implemented in accordance with federal programs. Not only citizens of the Russian Federation, but also citizens of the CIS and far abroad study at the Institute. About 150 clinical residents, 6-8 graduate students and 500 doctors are trained annually in additional education programs. Methodological manuals are being developed in the educational and clinical department, allowing doctors to use them as reference books when providing medical care to the population. On the basis of the Institute there are departments of higher educational institutions - the Russian Medical Academy of Postgraduate Education (Department of Emergency Surgery and Clinical Toxicology), Moscow State Medical Dental University (Department of Neurosurgery of the Faculty of Medicine), the Educational and Scientific Center at the Medical Center of the Administration of the President of the Russian Federation (Department of Emergency Medicine and intensive care). The editorial and publishing department, which has been successfully functioning for more than 10 years, prepares and publishes the works of the institute and its employees. The Institute also has a rich scientific and medical library. The Department of External Scientific Relations coordinates scientific research carried out outside the institute, searches for and processes scientific information, and conducts work in the field of the history of medicine. Recognition of the achievements of the Institute staff. Over the long history of the Institute, the merits of its staff have been repeatedly noted by the highest bodies of the state and the city of Moscow. The great achievements of the Institute are mentioned in the documents of the People's Commissariat of Health of the RSFSR and the Presidium of the Moscow Council, published already in the first period of its work (1935). The most significant awards of a later period are the Order of the Red Banner of Labor (Decree of the Presidium of the Supreme Soviet of the USSR of July 22, 1960) and the Order of Lenin (Decree of the Presidium of the Supreme Soviet of the USSR of August 14, 1973). The Institute was also awarded a large number of diplomas, certificates and prizes, indicating its significant contribution to the country's health care. Hospice home - Sheremetev Hospital - Research Institute of Emergency Medicine. N.V. Sklifosovsky has always played a prominent role in domestic medicine. Being a model for building an ambulance service for many countries in Europe and America, the Institute, despite the changed living conditions of our society, successfully continues its activities. The Institute has a modern material base and employs a large team of highly qualified specialists who preserve and multiply the best traditions of national health care. This makes it possible to save the sick and injured, who were previously considered hopeless, to return thousands of people to active work, while maintaining their physical and mental health.

Moscow is one of the largest and most expensive cities in the world. Tourists from other countries constantly come to the capital. The flow of people from the villages is also huge, since Moscow has long been considered a place where you can realize all your plans. Due to the size of the capital, it is impossible to even imagine how many different medical institutions there are. One of them is the well-known Sklifosovsky Hospital, the fame of which spreads far beyond Russia.

History of the development of the research institute

The famous medical institution was founded in the 19th century, then it was called the Hospice House. It was founded by Count Sheremetiev to help orphans and the sick, who had no one to look after. In time, it became a hospital in which soldiers were served. In 1929, the institution was renamed the Sklifosovsky Institute for Emergency Medicine. Specialists provided assistance to all needy residents of Moscow, and also led an active scientific activity. From the very beginning of its work, the hospital had a surgical profile, as well as one of the most demanded traumatology departments in the city. It was expanded in the 90s of the last century. Since that time, new departments dealing with the problems of transplantology, plastic, micro- and cardiac surgery began to open.

Research Institute activities today

Currently, the Sklifosovsky hospital meets all the parameters of a modern medical institution. It is one of the leading medical institutions not only in the capital, but throughout the country. Sklifosovsky hospital specialized in two big destinations. Within the walls of the medical institution, both scientific and medical activities are carried out. Thanks to modern equipment and highly qualified specialists, patients from other hospitals in the city and nearby regions are admitted to the hospital. Millions of lives have been saved over the long years of productive work at the Research Institute of Emergency Care. The building of the Sklifosovsky Research Institute (hospital), whose address is known to almost every resident of Moscow, is located at 3. It can be reached by metro or on foot from Mira Avenue.

Scientific work of the research institute

As you know, continuous research is being conducted in a medical institution. They are divided into five main areas, among which are the following:

1. Mechanical and thermal injuries.

2. Diagnosis and treatment of acute coronary and cerebral insufficiency.

3. Pathologies of the abdominal organs.

4. Treatment of endo- and exotoxicoses.

5. Organization of an ambulance and in a hospital setting.

Remarkable specialists work on the basis of the research institute, many of them have the titles of professors, doctors and candidates of medical sciences. Sklifosovsky Hospital can be proud of its employees.

Medical activity

Within the walls of the hospital, urgent and planned surgical care is provided in almost all areas. The intensive care units are among the most high-tech in the city. Neurosurgeons and traumatologists can boast of great success. Emergency departments are equipped with the latest equipment, they perform complex operations, including many abdominal interventions. In addition, the hospital has all the conditions for recovery after severe surgical procedures, and also has its own diagnostic complex. It operates its own blood transfusion unit.

The Sklifosovsky Hospital is rightfully considered one of the leading medical centers in the city. Moscow, thanks to this institution, is famous for its achievements in the medical field.

Moscow City Research Institute of Emergency Medicine named after N. V. Sklifosovsky(colloquially - Sklif) - state budgetary healthcare institution of the city of Moscow; one of the first in Russia and the largest scientific and methodological center in the capital, which organizes the work of ambulance and emergency services. The Institute was founded in 1923 on the basis of the Sheremetev Hospital of the former Hospice House (3 Sukharevskaya Square). Since 1929 it has been named after N.V. Sklifosovsky.

Story [ | ]

Founding of the Hospice House[ | ]

Building of the Hospice House, 2009

The opening of the Hospice House, which became one of the first in Russian Empire institutions to provide free medical care to the poor, took place in 1810. In addition to the hospital and almshouse, the building housed the Church of the Holy Trinity. According to the original plan, the Hospice House was designed for 150 places, 100 of which were intended for the conscripts, and 50 for medical and service personnel.

Count Sheremetev left donations to the Hospice, which continued to provide for the institution after his death. Emperor Alexander I freed the medical institution "from all sorts of philistine duties", ensured the protection of the building by a military guard.

Historic building architecture[ | ]

The original design of the Hospice House belonged to the Moscow architect Elizva Nazarov, a student of Vasily Bazhenov. The building with a semicircular front yard, convenient for the transportation of patients, was built following the example of the traditional noble estate. The center of the building was the Trinity Church, from which two wings diverged, one of which was supposed to house a hospital, the other - an almshouse. The austere portico with twin columns at the main entrance, according to the architect's idea, was supposed to emphasize the civil purpose of the building. The arrangement of the institution was entrusted to the manager of the house office of Count Sheremetev A.F. Malinovsky.

In the early 2000s, the Hospice House was restored, which made it possible to return the historical appearance to the interiors of the halls, as well as to adapt the old building to the needs of a modern medical institution. Today, the premises of the historical building house the directorate, the scientific department and the laboratory complex of the Research Institute for Emergency Medicine named after V.I. Sklifosovsky.

Activities in the 19th century[ | ]

IN during XIX century, about two million people received assistance from the Hospice House for a total amount exceeding 6 million rubles.

The doctors of the hospital were mostly graduates of the medical faculty of Moscow University. Chief physicians of the Sheremetev Hospital in different time there were famous Moscow doctors: Pavel Kildyushevsky, Alexei Tarasenkov, Ya. V. Kir, S. M. Kleiner.

Here, earlier than in other Moscow hospitals, X-ray machines began to be used, physiotherapy and water procedures, such as Charcot's douche, were used.

The hospice served as a hospital for the wounded during the Patriotic War of 1812 and the Russo-Turkish War of 1878, the Russo-Japanese War and the First World War.

1917-1945 [ | ]

View of the Sheremetev Hospital, 1914

In 1919, the institution was reorganized into City Hospital No. 27 under the leadership of surgeon Grigory Gershtein. In July 1919, the collegium of the medical and sanitary department of the Moscow City Council decided to open a city emergency station (AMS) in Moscow on the basis of the former Sheremetev hospital. The result of the creation of the station was the coordination of the work of the city hospital No. 27 with the central city station of the SMP.

In 1924, 1783 patients received medical care at the institute, and in 1926 - 5000.

The development of the work of the ambulance and emergency services of the institute is associated with the name of the head of the Moscow NSR station Alexander Puchkov. Puchkov organized a home emergency service and a psychiatric emergency service in 1927.

In 1928, the institute was headed by the surgeon Sergei Yudin, who expanded the activities of the surgical department and increased the capacity from 220 to 425 beds.

In 1931, three departments (CIU) began to operate at the institute: emergency and military field surgery, emergency therapy, and military field traumatology. In 1926, the institute received about 5,000 patients, and in 1939 the figure increased to 23,000 people.

During the Great Patriotic War, the institute also worked as a military hospital. By order of the Government of the USSR No. 24450-r dated December 28, 1943, the Institute of Emergency Medicine was reorganized into a research institute with the expansion of tasks, staff, and powers. In 1944, on the basis of the Scientific Research Institute, the activities of the Scientific Council were organized.

After 1945 [ | ]

Main entrance to the institute (view from Grokholsky Lane), 2011

Between 1943 and 1947 the number of beds provided to patients increased from 700 to 1150.

In 1969, designing began, and in 1971, the construction of a new multi-storey clinical and surgical building. Laboratories for the organization of ambulances, departments of anesthesiology, resuscitation, hyperbaric oxygenation, appeared at the institute, and a clinical diagnostic department was created. In 1971, the Academic Council for the Defense of Candidate's Dissertations was formed.

For high performance, the institute was awarded the Orders of the Red Banner of Labor (1960) and Lenin (1973).

From 1960 to 1986 one of the founders of transplantology V.P. Demikhov, who headed the organ transplant laboratory. The laboratory developed methods for transplanting the head, liver, adrenal glands with kidney, esophagus and limbs.

Since the 1980s, the institute has been developing a scientific direction - disaster medicine. In 1987, the first department of disaster medicine in the USSR was opened here.

In 2006-2017, Professor Mogeli Khubutia was in charge of the institute. New scientific and clinical subdivisions have been formed at the Institute: the Department of Emergency Cardiology and Cardiovascular Surgery, the Department of Cellular and Tissue Technologies, and the Department of Laboratory Diagnostics.

In 2011, the Scientific and Practical Society of Emergency Medicine Physicians was established, which has regional branches. With the support of the society, the scientific journal "Emergency Medical Care" is published, and congresses of emergency doctors are also held.

Current state[ | ]

For 2017 NII SP them. N. V. Sklifosovsky is the largest multidisciplinary scientific and practical center of emergency medical care in Russia. It has more than 40 scientific departments, half of which are clinical. The Institute employs about 800 doctors and researchers.

Every year, the Institute provides assistance to more than 67 thousand patients from Moscow and other regions of Russia. The capacity of the hospital, which receives more than 37 thousand patients every year, is 944 beds (including 132 intensive care units). More than 20,000 different surgeries are performed at the institute every year.

According to the Federal Treasury, the budget of research institutes in 2016 amounted to 4.2 billion rubles, including income from paid services - 3.3 billion rubles. Expenses were at the level of 4 billion rubles.

Health care[ | ]

The Institute has a resuscitation service, consisting of 9 departments. Patients with craniocerebral injuries, burns, acute poisoning and other injuries are treated here. Another area of ​​practical activity of the Institute is the provision of emergency surgical care. Organized toxicological service.

The institute's own laboratory base contributes to early diagnosis emergencies and serious illnesses.

In early June 2017, the director of the institute, Mogeli Khubutia, left his post following allegations of violating patients' rights and extortion. According to the findings of Roszdravnadzor, which revealed these facts, doctors deceived money from patients who needed emergency care. An administrative protocol was drawn up against Khubutia under Article 19.5 for failure to comply with the requirements of the supervisory authority.

Scientific, organizational and educational activities[ | ]

175 years since the birth of N. V. Sklifosovsky, postcard, 2011

NII SP im. Sklifosovsky develops Scientific research in the following main areas: diagnosis and treatment of mechanical and thermal injuries; acute diseases and damage to the vessels of the heart, brain, aorta and its branches; diagnosis and treatment of acute surgical diseases; acute exo- and endotoxicoses; provision of specialized emergency care to the sick and injured.

On the basis of the Institute, departments of Moscow medical universities- Russian Medical Academy of Postgraduate Education (Department of Emergency Surgery and Clinical Toxicology), Moscow State Medical Dental University (Department of Neurosurgery, Faculty of Medicine), Educational and Scientific Center at the Medical Center of the Administration of the President of the Russian Federation (Department of Emergency Medicine and Intensive Care).