RU2365515C1 - Mobile medical-diagnostic complex of therapeutic profile - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention concerns the mobile equipment of emergency medicine. The mobile medical-diagnostic complex is executed in the form of functional modules: laboratory-diagnostic, clinicodiagnostic, radiographic, operative-dressing, intensive care, hyperbaric oxygenation, detoxification, pharmaceutic, mounted on the basis of vehicles, four-wheeled trailers with box bodies with the medical equipment providing throughput of not less than 100 affected and victims of a therapeutic profile and wounded persons of a surgical profile a day. The users and base broadband radio stations are used as means of distant reception-transfer of medical data of management with salvage of patients, interconnected on the main channels with its local computing computer radio network and a wireless computer network of a separate medical division battalion.

EFFECT: improvement of quality, technical and economic efficiency of functional medical units.

8 cl, 1 dwg

Description

The invention relates to mobile equipment of extreme, military medicine and can be used for evacuation, rescue and emergency assistance to victims of emergency situations of war and peace time.

The closest technical solution, selected as a prototype, is an airmobile medical transport [1], which solves the problem and contains technical means of resuscitation, surgical care, anti-shock and intensive care, life support and energy supply systems, an automobile health and hygiene system, and an automobile container technical unit, including power, heating and air-gas complexes, an automated system of operas tive management rescue the wounded, coupled with a system of providing emergency medical assistance to victims and containing a system of wire, radio and television communications, coupled with information and help system with a subsystem electronic patient injuries connected to the computer-aided medical records of the wounded.

The main disadvantages of the prototype device are:

1. The absence of medical platoons (mobile medical groups) in the medical detachments of the special purpose of the MOSN that are capable of receiving wounded and sick patients during autonomous deployment, providing them with the first medical and qualified medical care, followed by evacuation as prescribed, which reduces the capabilities of the units that are ineffectively crushing them the main units losing time on moving and emergency assistance to seriously wounded, i.e. MOSN does not include a mobile treatment and diagnostic complex for the therapeutic profile of a special-purpose medical detachment for emergency diagnostics, treatment of injuries and injuries of victims in the military and operational units, which is an integral part of MOSN located in KamAZ truck bodies and equipped with medical equipment, instruments and devices , technical means of automation, television data transmission and radio communications.

2. Currently, in most military units, military field and garrison military hospitals, the collection, processing, analysis of laboratory data obtained and the preparation of reporting documents are carried out mechanically. Despite the availability and ease of use, the mechanical method and the forms of medical accounting and reporting documents used for this have a number of disadvantages, namely: low efficiency in preparing the necessary information, which is associated with the impossibility of obtaining them in a short time from various sources, the complexity and great the complexity of manually extracting the necessary information from the documents of primary medical records, the data of annual reports do not fully reflect the picture of medical and diagnostic work, materials Medical reports do not allow the analysis of injuries and morbidity of servicemen of different periods of service, various groups of health status, ages, military specialties, the calculation of statistical indicators of the activity of medical and diagnostic departments requires distracting medical specialists from performing direct professional duties. The ever-increasing demands on the forms and methods of managing military medical laboratories, units of detachments and hospitals show that the current system of medical records and reporting needs to be reviewed and improved.

3. In the clinical diagnostic laboratory, in the operational-resuscitation and other departments of the Ministry of Emergency Situations, they do not use modern equipment and devices for primary and secondary processing, analysis and storage of data on injuries and injuries, automated equipment for diagnosing and making urgent decisions for each request from primary military units medical links due to the lack of local computer networks at doctors of laboratories and departments in the field, sea and rear conditions, the lack of network managing workers tions, graphics and video server applications, colored Printservers and scanners, as well as wearable computer laptops, wireless mobile network computers of the latest type.

The main disadvantage of special-purpose medical units is the lack of an effective control system, connected by wired and radio communication channels to the departments, as well as with an automated information and reference system, which includes a subsystem for maintaining electronic records of injured patients. At the same time, the main task of the Ministry of Health Care is emergency and effective diagnosis, the provision of the first medical, qualified and specialized assistance in order to save the lives of the largest number of injured and wounded for their quickest return to duty. To accomplish this task, it is necessary to increase the efficiency of mobile medical complexes by creating the highest quality systems, apparatus, instruments and modern equipment.

The objective of the invention is the creation and use of a mobile medical unit of high alertness and mobility to provide qualified, with elements of specialized, therapeutic care to the injured, injured, wounded and sick in the field by increasing throughput, technical equipment of the surgical dressing and hospital wards of the Ministry of Medical Sciences due to improvement quality, reliability, medical and technical level of the priority option of the complex, by increasing its technical and environmental ohmic efficiency on the basis of new deployment tools, technical, medical equipment and new biotechnologies main functional units.

The proposed mobile treatment and diagnostic complex of the therapeutic profile MLDK-T differs from the prototype in that it is designed for medical sorting, recording, providing qualified and specialized therapeutic care, diagnostic, anesthetic and resuscitation measures, the use of active oxygenation methods and extracorporeal detoxification, temporary hospitalization and preparation of the injured, wounded and affected for evacuation and consists of medical fu national modules mounted on the basis of cross-country vehicles with increased mounting capabilities of the KamAZ-43118 (KamAZ-5350) type with oversized van bodies of the KMM-4310 type (internal dimensions 6100 × 2400 × 1950), KamAZ 45114 (KamAZ 5350) vehicles with unified K4310 (K5350) box body vans, KP4 (KP4M) biaxial trailers with medical equipment, mobile autonomous electrical units, water supplies and fuel and lubricants.

The list of functional modules of the complex includes laboratory diagnostic, clinical diagnostic, X-ray diagnostic, surgical dressing, intensive care, hyperbaric oxygenation, detoxification, sorting and evacuation and pharmacy. The complex provides a capacity of at least 100 affected and injured therapeutic profile and wounded surgical profile per day with a total duration of work in the lesion focus of up to three days of continuous shift work. MLDK-T is transported by all means of transport and under its own power and arrives at the lesion center at a distance of 500 km (under its own power) or 4000 km (by aircraft of the Il-76 type) in 6-12 hours. It is possible to strengthen the complex with deployment, supply and support tools, as well as medical specialists for 2-3-shift work.

The object of the invention is solved by the unit of increased readiness and mobility, which is made in the form of a mobile therapeutic and diagnostic complex of a therapeutic profile, additionally containing a laboratory diagnostic module, including clinical diagnostic and X-ray diagnostic modules, as well as surgical dressing, intensive care, hyperbaric oxygenation, detoxification , sorting, evacuation and pharmacy functional modules containing van bodies equipped with technical Kimi means medical, drug, logistics and management.

At the same time, the MLDK-T additionally includes an automotive complex of sanitary-hygienic equipment, containing domestic “live machines” that have no analogues in the modern market of high nanotechnologies, created at industrial enterprises of the Russian defense complex based on the works of Nobel laureates and the USSR Academy of Sciences, namely: Edelweiss-type automotive quantum nanocontroller, Rapid Septic-type alttechnological quantum accelerator for cleaning van septic tanks and toilets, special-purpose products I am of the type “Universal Soldier”, “transdermal injector”, “quantum SIM drugs”, “undulatory medical complex for removing radionuclides from the body of an injured person”, a complex for the preparation of drinking water supply such as “Cinderella” and “Chamomile”, as a further continuation of the development of medical nanotechnology, the installation and activation of which was carried out using special equipment and software with the recording of the parameters of each installation in the chip chip. Moreover, the claimed complex also contains an energy unit, an automated system for the operational management of rescue of the wounded, connected to an introscopic emergency medical assistance system, containing devices for the initial assessment of the functional state of injuries, life indicators, an automated subsystem for emergency sorting and prediction of survival of the wounded, a wired, radio system - and television communications, connected to a reference system with a subsystem of electronic histories of injuries connected to the computer-aided medical records of the wounded. A subscriber broadband radio station and a basic broadband radio station of a mobile diagnostic and treatment complex interconnected via trunk channels at frequencies of 5.15-5.25 GHz and 5.25-5.35 GHz were used as technical equipment for the long-term reception and transmission of medical data for managing the wounded with a local computing computer radio network of mobile functional medical modules of the MOSN complex and a wireless computer network of a separate medical battalion of the division through a basic broadband a division’s radio station with a range of at least 120 km, interconnected with subscriber broadband radio stations of a separate medical battalion and the headquarters of the motorized rifle division, and the division’s wireless mobile broadband fixed access standard of the division’s 802.16a-2007 standard, which includes a module of wireless backbone radio channels that provides telecom operators with a set of required 802.16е-2008 telecommunication services, while the wireless mobile broadband access system is used In urban and field conditions, it is a 5G Art Communicatin MOSN type of wireless military computer multi-service computer networks and military field hospitals operating in the frequency range 5.25-5.35 GHz with a bandwidth of 20 Mbps, 75 Mbps and 105 Mbps / s, moreover, this technological access system contains subscriber and base radio stations, terminal nodes of the modules of the main radio channels, radio transmitters and radio routers, with all the subscriber stations having the technical means of supporting IP-telephony, and the stations themselves are designed for September applications, have built-in lightning protection, integrated and external parabolic antennas, while the wireless mobile broadband fixed access system implements the network layer based on the IP protocol and the packet switching principle, and access to the transmission medium is provided by a multiple access protocol based on routing in all nodes of the radio network , which allows us to solve the issues of operation of these networks without involving additional equipment and software.

The laboratory and diagnostic module MLDK-T includes the following departments: laboratory, two energy, fluorographic and ultrasound studies, X-ray diagnostics.

The laboratory department is intended for general clinical, biochemical and serological studies as part of MLDK-T. The laboratory department is located in a K 4310 (K 5350) box body mounted on the basis of a KamAZ-43114 type off-road vehicle (KamAZ-53501). The laboratory department has the following equipment, apparatus, instruments, medicines and other medical equipment:

- laboratory table - 4 pcs.

- single-section sink - 1 pc.

- Combined folding couch - 1 pc.

- hemoglobinometer "Mini-Gem-540" - 1 pc.

- Mikmed microscope - 2 pcs.

- bath for staining blood smears on a glass slide - 1 pc.

- a chamber for counting blood cells (Goryaeva) - 2 pcs.

- an electric thermostat with transparent walls - 1 pc.

- dry-air thermostat for tablets - 1 pc.

- laboratory centrifuge TsLMN-P10-01 - 2 pcs.

- graduated centrifuge tubes - 50 pcs.

- a set for determining the Rhesus factor and blood groups "Rhesus-2" - 1 pc.

- air sterilizer GP-20 - 1 pc.

- a device for drying laboratory glassware - 1 pc.

- hematological electronic counter "Minilab 903" - 1 pc.

- laboratory counter for counting various types of blood cells during microscopic examination - 1 pc.

- semi-soft chair - 2 pcs.

- a refrigerator with a volume of at least 50 liters from the POZIS family - 1 pc.

- a set for determining hemoglobin by the hemoglobin-cyanide method - 4 pcs.

- ESR-meter Panchenkova - 1 pc.

- test strips and indicator papers for rapid analysis with a visual assessment - 1 set.

- stabilizer steel enameled with a cover - 2 pcs.

- installation for distilled and deionized water - 1 set.

- hood above laboratory table No. 4 - 1 pc.

Power department - small-sized portable diesel-electric unit of the GEKO type.

Clinical diagnostic module KDM is designed to equip the MLDK-T MOSN. The van body used to deploy the clinical diagnostic diagnostic laboratory has the following systems and devices: power supply system; emergency power system; lighting system; forced ventilation system (regular and special from the filtering installation); air conditioning system; heating system; hot and cold water supply system; sewage system for used water; devices for stacking, loading, unloading and securing property during transportation; means of communication; sun awning.

The following are installed in the laboratory: intercom for communication with a driver from a box body; a device for storing personal items, weapons, ammunition; drinking tanks, personal protective equipment for medical personnel; turning lights to illuminate the site. The laboratory’s power supply is a small-sized portable diesel unit with a capacity of 13 kW, as well as additional batteries for emergency operation and on the move for its lighting and life support systems, except for the air conditioner, which turn on automatically and provide emergency operation for at least 8 hours. Equipping the laboratory with equipment, instruments and property ensures its operation for at least 30 days. The duration of continuous operation KDM per day is at least 16 hours.

The staff of the KDM consists of 7 people, including:

Head of Laboratory (Laboratory Assistant) one laboratory assistant 3 laboratory assistant 2 electric driver one

The capacity of the laboratory, research per day:

- for general clinical blood analysis up to 75 - by biochemical analysis of blood up to 20 - urinalysis up to 50 - by definition of blood group and Rh factor up to 20 Total: up to 165

The time of deployment (coagulation) of KDM and its preparation for work does not exceed 60 minutes. On the left side of the van body, counting in the direction of travel, on its front wall are placed air conditioner units of the KTN-4 type, then, departing from the front wall, six laboratory tables are placed in series: table No. 1 - for receiving and general clinical blood tests; table No. 2 - for receiving and general clinical and biochemical blood tests; table No. 3 - to determine the group and Rh factor of the blood (a set of devices for determining the blood group and Rh factor). Left behind the front door on the nightstand is a refrigerator with a volume of at least 50 liters. On the right side of the van body, counting from the rear entrance door, a cabinet with personal belongings and weapons of weapons, a unit for receiving deionized and demineralized water, a centrifuge stand, and an air sterilizer GP-20 are sequentially located. Next are table No. 4 for general clinical urine tests and a single-section sink with a tank of cold (80 l) and hot (10 l) water. An extractor hood is fixed to the ceiling above the laboratory bench. A folding couch, mounted on the front wall of the body, is used for taking blood, as well as for rest (sleep) of personnel at night.

KDM complex contains a local computer network using a high-performance bus with a data transfer rate of at least 500 Mbit / s to connect at least six personal computers to automated workstations of the automated workstation of the MOSN clinical diagnostic laboratory, which includes the Control hardware-software unit and workstations on one server network and six laptops for general clinical, biochemical, isoserological and immunological studies. Moreover, the technical result of the invention is to increase the efficiency of clinical diagnosis of injured and wounded by increasing the class of simultaneously solved tasks of laboratory diagnostics to provide emergency, first medical, qualified and specialized assistance to victims in the field through the use of information laboratory technologies and modern computer technology.

The technical result of the invention is implemented by increasing the automation of mobile KDM by creating a computer local area network through the use of a high-performance bus with a data transfer rate of at least 500 Mbps for connecting personal computers for a working group of the laboratory CD connected to an automated information and reference system including a subsystem for electronic medical records of the wounded. The computer local area network includes six automated workstations: AWP "Head of Laboratory" - place No. 1 for general clinical research contains: a hematological analyzer, a hemoglobinometer, a hematological electronic counter, a microscope, a Panchenkov apparatus, a programmable photometer; AWP "Deputy Head of the Laboratory" - place No. 2 for general clinical research includes a urine sediment analyzer, a centrifuge, a set of test strips for urine analysis with a visual assessment; AWP "Laboratory Physician-Laboratory Assistant" - place No. 3 for biochemical studies contains a combined analyzer of blood gases, electrolytes and metabolites, a biochemical analyzer, an ion-selective microanalyzer, a coagulometer - an analyzer of hemostatic parameters, a thermostat; AWP "Doctor-researcher" - place No. 4 for isoserological and immunological studies includes a photometer for UVA with a thermostat and a usher, a set of "Rhesus-2"; AWP "Elder sister" - place number 5 contains a single-section sink; AWS "Laboratory assistant" - place No. 6 is provided for registration of tests, blood sampling and statement of results on a laboratory assistant’s mobile table. The module additionally contains a second thermostat, 2 reusable thermo containers, an air sterilizer, an installation for receiving deionized water, 4 bactericidal wall irradiators.

Currently, the medical service of the Armed Forces of the Russian Federation is equipped with obsolete X-ray complexes AR-2U, in some medical units the radiology departments are located in tents. Therefore, the mobile complex includes a mobile X-ray diagnostic module RDM, developed by order of the Main Military Medical Directorate of the Ministry of Defense of the Russian Federation and accepted for supply to the Armed Forces of the Russian Federation. It is intended for conducting radiographic, fluoroscopic, fluorographic and ultrasound medical examinations in wartime and peacetime, both as part of medical units and institutions, and independently. The regular affiliation of the RDM for wartime and peacetime is a separate medical battalion of the division and MOSN. In addition, in peacetime, it is planned to use the complex as part of district military hospitals for conducting preventive examinations of military personnel. RDM in its equipment and performance is not inferior to foreign counterparts. The positive qualities of the RDM complex are:

1) increased mobility and readiness for use;

2) increased throughput due to the expansion of the technical capabilities of digital X-ray and ultrasound devices, the introduction of high-performance low-dose fluorographic studies into practice, and the creation of optimal conditions for work and leisure for staff;

3) short deployment time (coagulation) of the radiological department. It is carried out by the staff during the time allotted for the priority deployment of the functional units of medical units and institutions;

4) the long standard life of the base chassis before overhaul (200-220 thousand km) allows for the efficient use of RDM in peacetime over the average life of the radiological equipment. The RDM consists of three departments: fluorographic and two ultrasound examinations in a K4310 box van on the chassis of a KamAZ-43114 (KamAZ-5350) automobile with automated workstations of an automated workplace of a radiologist and radiologist; X-ray in the pneumatic frame construction of the medical PSM-4 with the workstation of an X-ray laboratory and power station - 16 kW power station. It is equipped with digital devices: a mobile X-ray diagnostic unit RTS-612M for surgery, a low-dose fluorograph FTs-01 Electron, and a multifunction ultrasound scanner Sonomed-400.

The performance characteristics:

Throughput, people / h with fluoroscopy 6-12 during radiography 10-15 with fluorography not less than 60 in ultrasound 2-3 Image performance / h, not less roentgenograms thirty fluorogram 60

Power consumption 16 kW

Power source:

external electric network, V 380/220 own source - mobile electric power unit diesel type AD-16-T / 400, kW 16 6ST-90 rechargeable battery 6

Deployment (coagulation) time by the staff and preparation for X-ray (fluorographic) studies, min, not more

in summer 60 in winter 90

The attendants of the PRDK consists of four people, including

Head - Radiologist one radiologist one X-ray technician one electric driver one

Service life 15 years

Shelf life 10 years

As a result of the creation of a mobile therapeutic and diagnostic complex of a therapeutic profile, its deployment scheme changed, preoperative and hospital departments were added for short-term hospitalization, intensive care unit, power supply unit, surgeons training and rest department, and a sterilization department are placed in two KP4 (KP4M) box bodies. The preoperative room joins the transitional vestibule between the operating room and the intensive care and resuscitation department. A device for loading and unloading the victims is installed in the vestibule. The surgeon training and recreation department and the sterilization department are located in the KMM 4310 type box body.

The operational dressing module of the OPM MLDK-T is designed to provide qualified medical assistance to the wounded, injured and injured in the field while ensuring military operations and during the liquidation of natural disasters and industrial disasters.

The composition of the PKO includes: operating; preoperative; hospital ward; sterilization unit; energy department; material and surgeon training department for operations, transitional end platform with folding floor; docking platform (2 pcs.); transitional side vestibule.

The operating room is designed to provide emergency qualified surgical care to the wounded and injured and is housed in the KMM 4310 medical van body on the chassis of a KamAZ-43118 car (KamAZ 53501). The operating room is coupled with the intensive care unit and intensive care unit of the intensive care unit functional module of the rear walls of the box body using a transitional end platform with a folding floor.

The operating room has the following equipment, medical equipment, instruments, medicines and other medical property - units:

- mobile operating table type PK-K-01 one; - stationary surgical lamp, single-unit type SR-3 "P" one; - tool table one; - table of the anesthetist one; - table for solutions one; - table for sterile surgical instruments one; - stand (table) for sterilization boxes one; - a table (rack) for equipment one; - screw stool one; - table of the registrar (folding) 2; - folding table one; - folding seat one; - washbasin one; - a case for cylinders with oxygen and nitrous oxide one; - thermochemical oxygen generator "Poplar" 2; - opening curtain one; - ventilator with electric field “Phase-5HP” with anesthetic prefix one; - aspirator type OHVR-2-1 "Avionics" 2; - wall mounted irradiator-recirculator "Desar 3", (bactericidal recirculator RBB-2 × 15) 2; - wall bactericidal irradiator type OBN-150 2; - portable air sterilizer (purifier) type "Biobriz" (Potok-M-01) one.

Preoperative is intended for registration of incoming wounded and their placement, intra-point sorting, undressing, preparation of the surgical field, re-mediation and short-term emergency intensive care (if necessary), moving the wounded to the intensive care and resuscitation department or to the operating room. The preoperative room is located in a PSM-4 type pneumatic facility and mates with a transitional vestibule (between the operating room and the intensive care and resuscitation department) using a docking vestibule. The preoperative capacity is at least 7 people.

Preoperative has the following main equipment, pcs:

- dressing field table in laying SPPU 1; - table for dressings (laying dressing table) one; - table of the anesthetist one; - stands for stretchers high 3 pairs; - a table for medicines (a table from a set Camping furniture KEU) one; - table for the registrar (table from the kit Camping furniture KEU) one; - folding stool (from a set of camping furniture KEU) four; - tool table one; - stand (table) for sterilization boxes one; - ventilator with electric field "Phase-5HP" with anesthetic prefix one; - medical shadowless mobile lamp with emergency power supply type SBPA-15 in the laying box one; - field wash basin one; - washbasin basin holder one; - stand uniform high 9; - vial holder with blood substitutes or solutions 7; - device for loading and unloading wounded on a stretcher (wheelchair lift) one.

The hospital department is designed to temporarily hospitalize non-transportable wounded and injured people and prepare them for medical evacuation, is placed in a pneumatic facility of the PSM-4 type and mates with a transitional vestibule (between the operating room and the intensive care and resuscitation department) using a docking platform. The evacuation capacity of the hospital department is at least 8 people. It has the following main equipment, pcs:

- field bed with metal mesh 2; - Stands for stretchers low 3 pairs); - table for sterile materials one; - a table for medicines (a table from a set Camping furniture KEU) one; - field wash basin one; - stand uniform high 8; - washbasin basin holder one; tool table one; - device for loading and unloading wounded on a stretcher (wheelchair lift) one; - folding stool (from a set of camping furniture KEU) four.

The sterilization unit is located in front of the army unified box body type KP-4 (KP-4M) on the chassis of a biaxial trailer and is transported by KamAZ-43118 (KamAZ-53501). The sterilization compartment is interfaced with the side door of the operating room using the side transitional vestibule and consists of: a sterilization compartment; material and department of preparation of surgeons for operations.

The sterilization department is designed to sterilize clothes, dressings, surgical instruments, syringes, rubber products (gloves, tubes, catheters, probes, etc.), glassware and has the following basic equipment, pcs:

household table one; sterilizer (autoclave) type VKU-50 one; air sterilizer type GP-20 one; steam sterilizer type GK-10 one; washbasin (sink) one.

The material and the department for preparing surgeons for operations are located in the rear of the army unified box body type KP-4 (KP-4M) and have

the following equipment:

- cabinet for medicines, devices, apparatus and household property one; - wardrobe for clothes, personal items, weapons one; - washbasin one; - bunk couch one; - folding table one; - folding seat one.

The power supply unit is located in an army unified van body type KP-4 (KP-4M) on the chassis of a two-axle trailer, transported by a KamAZ-43118 (KamAZ-53501) vehicle and consists of two compartments: aggregate and utility. The unit compartment has the following equipment, pcs:

- power plant type AD-30 one; - 20 l canister (with fuel) one; - 20 l canister (with oil) one; - Spare parts for power station AD-30 one; - trailer spare parts one.

The utility department has two coils with electrical cables. The power supply unit is located at a distance of no closer than 20 m from the functional compartments. FOPM and FMIT are designed to equip a medical platoon and medical company of a separate medical unit for special purposes and have the following equipment, pcs:

KamAZ-43118 car with a box body medical KMM-4310 2; 2-axle car trailer oversized type KMM-4310 2; - pneumatic construction type PSM-4 2; medical equipment for vans and pneumatic facilities 1 set

Mobile functional modules of the complex have the following systems and devices: power supply system; emergency power system; lighting system; forced ventilation system - regular and special from filtering installations; heating system; air conditioning system; hot and cold water supply system; oxygen supply system; nitrous oxide nutrition system; sewage system for used water; devices to facilitate the deployment of tents (ladders, etc.), as well as devices for stacking, loading, unloading and securing property during transportation; means of communication; sun shades. The pneumatic facilities used to deploy the MLDK-T departments have the following systems and devices: an electromechanical air supply system for pneumatic frame cylinders; a system for automatically maintaining pressure in the pneumatic frame; heating and ventilation system; a control unit for said systems (electrical panel); a set of additional insulated floors.

The personnel of MLDK-T consists of 27 people:

doctors 9; including: - surgeon 2; - anesthetist one; - therapist one; - diagnostic biologist one; - laboratory assistant four nursing staff 10; including: - senior operating sister 2; - operating sister 3; - nurse anesthetist 2; - nurse 3; drivers 8; including: - driver nurse one; - driver-electrician one.

The throughput of the complex is not less than 100 affected and injured therapeutic profile and wounded surgical profile per day with a total duration of work in the lesion focus of up to three days of continuous shift work. Capacity of the wounded - at least 23 people:

- in the operating room one; - in the intensive care and resuscitation department 7; - in preoperative 7; - in the hospital ward 8; including: on a stretcher 6; on field beds 2.

The intensive care module includes two intensive care units: compartment No. 1 in the KMM 4310 box body on the chassis of an off-road vehicle with increased mounting capabilities KamAZ-43118 with a capacity of four victims and compartment No. 2 in the box body type KP-4 (KP- 4M) on the chassis of a biaxial trailer with a capacity of two victims.

The intensive care and resuscitation department is designed for intensive care before and after surgery and resuscitation. It is located in a KMM-4310 medical type van body on a KamAZ-43118 (KamAZ-53501) type car chassis and has the following main equipment, pcs:

- mobile operating table type PK-K-01 one; - stationary surgical lamp single-block type SR-3 "P" one; - bunk couch for injured and wounded 3; - cabinet for medicines and linen one; - washbasin one; - folding table one; - folding seat one; - a case for cylinders with oxygen and nitrous oxide one; - opening curtain 2; - thermochemical oxygen generator "Poplar" one; - ventilator with electric field “Phase-5HP” with anesthesia prefix 2; - combined power electrocardiograph EK1T-04 one; Axon 2; - defibrillator one; - aspirator type OHVR-2-1 "Avionics" 2; - wall bactericidal irradiator type OBN-150 2; - wall mounted irradiator-recirculator "Desar 3" (bactericidal recirculator RBB-2 × 15) 2; - portable sterilizer (cleaner) air of the Biobriz type (Potok-M-01) one.

The department №1 of the intensive care unit includes an introscopic unit and a wearable set of diagnostics and resuscitation of the wounded on the basis of an automated workstation of a biologist and doctor-diagnostician. The wearable kit is structurally designed as a virtual “laboratory on a chip” device, capable of detecting and analyzing ultra-small quantities of various substances, and contains a virtual service module such as VSM, which supports up to 1 million I / O operations per second and is based on an ASIC type integrated circuit. The virtual “laboratory on a chip” device itself is made in the form of a plate, on the surface of which receptors for the necessary substances, for example antibodies, are arranged in an orderly manner, and sensors for many substances are placed on one plate. The “Diagnostic Biologist Doctor” AWP contains a computer with a display, large molecular machines, among which a three-dimensional ribosome includes a complex of proteins and ribonucleic acids that produces any protein “products” according to the programs recorded in the genes of the injured or injured, and also contains a scanning a probe microscope, a microintegration board of a software algorithm and a unit for conducting early warning biodiagnostics of the functional state of the wounded, connected to the technological determination unit the blood composition of the victim, an enzyme immunoassay, immunofluorescence assay unit and a nucleic acid amplification unit using a polymerase chain reaction.

The on-board set of the subscriber telemedicine point of the intensive care module contains an access server connected to the personal computer of the resuscitator, configured for telemedicine and connected to the digital color camera and digital video recorder of the diagnostic video system, a visual and audio information display unit, wireless and wired analog transmission means, digital audio and video signals, hardware interface to medical equipment, client control shell telemedicine with connecting basic and auxiliary elements, an interface module to the telemedicine database environment, a communication interface module for interacting the control shell with radio channels, testing and optimizing data transfer protocols, an interface module for reproducing still images, sound and video images, a communication unit between objects telemedicine, a radio router, a unit of wireless and wired access to the local computing computer radio network MLDK-T.

At the same time, the on-board set of a subscriber telemedicine station includes wireless network and telecommunications facilities, including radio modems for communication via switched radiotelephone and broadband radio access channels, network wireless high-speed adapters, subscriber and base radio stations of broadband access MLDK-T, interacting with other terrestrial subscriber and base subscriber and base 802.16е-2007 standard broadband access radios interconnected by wireless backbone modules x channels of the same standard that are part of the 802.16e-2007 standard wireless broadband access system connected to military broadband computer access networks of the same standard as medical special forces, military hospitals, in the frequency ranges 5.15-5.25 GHz and 5.25-5.35 GHz operating at speeds of at least 20 Mbit / s, 54 Mbit / s, 75 Mbit / s and 105 Mbit / s on at least ten non-overlapping frequency channels. The wireless on-board automated system for managing the rescue of the wounded of the functional intensive care unit of the complex contains a local computer computer radio network of broadband access standard 802.16е-2007, including interconnected handheld, portable and airborne personal computers connected via radio channel through a subscriber and base radio station of broadband access of the medical unit MDK-T special purpose with global broadband access computer network me itsinskoy Service Branch Motorized Rifle Division.

The MIT MLDK-T introscopic unit is intended for the treatment of a wide range of ischemic diseases. This range of diseases includes angina pectoris resistant to drug therapy, if it is not possible to perform balloon angioplasty or undergo surgical treatment; acute left ventricular failure, cerebrovascular disease - rehabilitation after a stroke, transient cerebrovascular accident, vertebrobasilar ischemia, arterial hypertension, peripheral vascular disease, atherosclerotic lesions of the lower extremities, quick recovery of the functional state of the injured and injured after exhausting physical and psychological stress wounds, treatment of chronic vascular lesions of the limbs, brain, erdtsa, retina and other organs. The main resuscitation and medical purpose of MFISM is carried out using devices for external and internal intra-aortic balloon counterpulsation of the “laboratory on a chip” device. The technique of the external counterpulsation procedure consists in placing cuffs on the legs, hips and gluteal region of the victim, in which air with pressure from 200 to 500 mm Hg is pumped in successively from the bottom up during diastole, during the systole the air is actively pumped out of the cuffs . The device synchronizes the time of inflation and deflation of the cuffs according to the pulse wave and the electrocardiogram of the victim. A sequential short-term increase in the pressure created by the cuffs on the patient’s legs creates a retrograde pulse wave in the arterial bed, which leads to an increase in diastolic pressure in the aorta. As a result, the laboratory device on the chip of the device for external intra-aortic balloon counterpulsation enhances the production of endothelial growth factor, which is a powerful stimulator of vascular growth, contributing to the restoration of normal blood supply to damaged tissues due to the development of collaterals. During counterpulsation, vascular reactivity increases due to a decrease in the formation of endothelin, natriuretic peptides and stimulation of the formation of nitric oxide, which favorably affects vascular reactivity, systemic and tissue hemodynamics. Local formation of blood vessels from bone marrow cells of endotheliocyte precursors is an additional mechanism that contributes to the development of vascular collaterals. Reduced erythrocyte regidity and serum fibrinogen concentration under the influence of counterpulsation positively affects the rheological properties of blood. The “laboratory on a chip” device additionally contains a technical model of a microchip for implantation of a salvage into the human body, made in the form of a bracelet - a watch. The microchip consists of sensors and a wireless transmitter that sends radio pulses, thus transmitting information to physicians about the location of the bracelet wearer, body temperature and heart rate. The microchip model has the dimensions of wheat grain - several millimeters in width, not more than 6 mm in length - and is implanted into the body as a result of a simple surgical operation using local anesthesia. There are no seams after the operation, and also, if necessary, the chip can be easily removed back. The radio waves emitted by the chip in response to the requested radio signal are transmitted to the computer on-board local area computer network connected to the Internet, and then to the place of request. The movable introscopic unit МИТ МЛДК-Т contains balloon catheters for internal intra-aortic balloon counterpulsation, sterile sets for introducing intra-aortic balloon catheters, including: saline, anesthetic, syringe with a needle for local anesthesia, scalpel, syringe with a volume of 20 cm ³ , wipes, one clip like a mosquito. Each sterile balloon catheter insertion kit contains all the necessary equipment: one 18-gauge angiographic needle, one J-tip conductor, one conical dilator, one three-way stopcock, one 60 cm ³ syringe, one Luer plug (plug) . An introducer sheath with a hemostatic valve and dilator is used if the introduction of no introducer contraindication or failure.

The introduction of an intra-aortic balloon catheter for intra-aortic balloon counterpulsation is as follows. First, prepare the victim, delineate the surgical field for catheterization of the femoral artery and perform local anesthesia at the puncture site. If angiographic data are available, evaluate the system of the iliac arteries and select the puncture site from the side where it is less convoluted or less affected by atherosclerosis. Then the femoral artery is punctured using an angiographic needle from the kit. The artery is punctured at an acute angle to avoid subsequent bending of the catheter at the puncture site. A conductor with a J-shaped tip is passed through the needle. Moreover, they use the conductor from the kit, as it is specially designed for optimal insertion of the catheter. The conductor is advanced until its tip is at the level of the proximal part of the thoracic aorta, then the needle is removed without removing the conductor, the puncture site is pressed to stop the bleeding and the conductor is wiped with a wet sterile cloth.

The delicate dilatation of the femoral artery at this stage helps prevent artery damage and reduces the risk of hematoma formation. Now the skin is incised at the puncture site and a conical dilator is passed through the conductor into the femoral artery to dilate the tissue at the puncture site. Then the dilator is removed and discarded without removing the conductor, and the puncture site is pressed to stop the bleeding. Wipe the conductor again with a damp sterile cloth.

If a catheter is inserted without an introducer, then the subcutaneous tissue is expanded at the puncture site with a clamp - a “mosquito”. Accurate tissue expansion and delicate dilatation of the artery at the puncture site is the key to successful catheter insertion. At this stage, anticoagulant therapy is started. Why open a sterile tray with a catheter. The yellow stylet for the pneumatic channel is connected to a unidirectional pneumatic valve and is designed to facilitate the insertion of a catheter. In this case, the pneumatic valve is connected to the pneumatic line of the catheter. Aspirate 30 ml of air using a 60 ml syringe from the kit. This will make the folded balloon membrane more compact and facilitate the removal of the catheter from the tray and its insertion. Disconnect the syringe from the pneumatic valve, leaving the pneumatic valve on the cylinder airway. Now the cylinder is pulled out of the protective tray by the Y-shaped fitting. Pull the cylinder from the containment shells straight. Pull evenly. Protective covers remain in the tray. Try not to bend the catheter and not pull too much.

If possible, try to insert a catheter under the control of fluoroscopy. If it is not possible to use fluoroscopy, measure the length of the catheter by measuring the distance from the jugular notch to the navel and further diagonally to the site of puncture of the femoral artery. Use catheter marks to control insertion.

Before the introduction, the catheter is moistened in physiological saline. The inner stylet of the container is removed by unscrewing the cap on the base of the Y-shaped fitting and pulling it out. Throw out the stylet. A catheter is now inserted. Insert the straight end of the conductor into the lumen of the catheter, opening at its tip, and advance the catheter until the tip of the conductor appears from the port of the Y-shaped fitting. Make sure the conductor is not moving and insert the catheter into the artery. During insertion, try to hold the catheter as close to the puncture site as possible to avoid kink. Do not use excessive force during administration. The catheter is advanced until its tip is in the descending aorta, distal to the departure of the left subclavian artery.

A catheter is inserted above the discharge of the deep femoral artery; with the introduction try not to block the mouth of the left subclavian artery. Proper administration allows maximum unloading and diastolic enhancement to be achieved and complications avoided. If the balloon catheter was inserted without the use of fluoroscopy, then immediately after its introduction, a control x-ray will be taken to make sure the balloon is in the correct position.

If it is not possible to insert a catheter without an introducer, remove it, leaving the guide in place, and then insert the catheter using the introducer. The introducer is prepared for administration by inserting a dilator into it through a hemostatic valve. The hemostatic valve has a diaphragm that prevents bleeding during the dilator and catheter. Be sure to fix the dilator on the hemostatic valve. This will prevent the introducer from sliding over the dilator and, accordingly, damage to it and artery.

Then put the tip of the dilator with the introducer into the conductor and introduce the introducer into the artery with rotational movements. Leave the guide, dilator and introducer in place while preparing the catheter for insertion. After the catheter is prepared, remove the dilator, leaving the introducer in place.

A balloon catheter is inserted through the conductor until its tip appears from the port of the Y-shaped fitting. Make sure that the conductor does not move and insert a catheter into the introducer sheath. Try to keep the catheter as close to the introducer as possible to avoid kink.

As long as the folded balloon membrane passes through the introducer sheath, blood may leak through the longitudinal folds until the folded balloon and its junction with the catheter pass through the introducer sheath. This phenomenon, called "canalization," does not cause blood loss. It stops immediately after the cylinder membrane is fully inserted into the introducer sheath. A balloon is introduced, as in the case of the non-introducer method. After insertion of the balloon catheter, if the first single catheter mark is visible, a six inch introducer sheath is retracted so that the mark goes into it. This ensures that the cylinder membrane is completely out of the introducer into the artery and can smoothly straighten. Straighten the protective sleeve and put it on the hemostatic valve. This STAT-GARD sleeve allows you to change the position of the balloon if necessary.

Both with and without an introducer sheath, the conductor is removed immediately after insertion of the balloon catheter. Aspirate and remove 3 ml of arterial blood from the internal lumen of the catheter to ensure its patency. After that, immediately wash the internal lumen of the catheter with 3-5 ml of the solution using a syringe. This will prevent thrombosis in the lumen of the catheter. After that, the internal lumen is used to monitor blood pressure by connecting the pressure sensor line to it. Then remove the pneumatic valve and the stylet of the pneumatic channel attached to it. Attach the catheter airway to the console through the airway extension and begin counterpulsation.

The operation of the intra-aortic balloon catheter for intra-aortic balloon counterpulsation is as follows. After the surgeon is satisfied that the balloon is in the correct position and that the balloon is inflated and deflated, he fixes the Y-shaped fitting and the catheter protective sleeve to the patient’s skin. Datascope launches the StatLock IAB device for fixing the Y-shaped fitting and catheter protective sleeve to the patient’s skin. In the absence of it can be fixed with sutures. To commit using StatLock IAB:

1. Treat the fixation point with alcohol to degrease the skin and remove traces of betadine.

2. Apply the skin composition from the kit to the skin at the fixation site.

3. Then apply tincture of benzoin from the kit to the place of fixation.

4. Guide the StatLock mounting device under the suture pad on the catheter's protective sleeve. Press the suture pad into the StatLock device holder and close the holder doors at the same time.

5. Place the StatLock mounting device on your skin and remove the paper cover from it to hold it in place.

6. Repeat the above steps to secure the Y-shaped catheter fitting.

The StatLock device provides quick and easy catheter attachment, comfortable and safe for the patient.

Check the puncture site for hemostasis and attach an aseptic sticker. Check the pulsation distal to the puncture site by palpation or using a portable Doppler sensor and record the data in the medical history.

The diameter of the internal lumen of modern intra-aortic balloon catheters is smaller than that of similar previous-generation catheters. As a result, to ensure optimal signal quality, the following recommendations for catheter care should be followed: use a standard device for monitoring blood pressure to ensure a constant flushing of the internal lumen at a level of 3 cm ³ per hour; use the arterial line from the Y-fitting to the pressure transducer no longer than 8 feet.

Whenever blood appears in the arterial line, it is necessary to open the flushing valve for 15 seconds to flush it. Ensure that all air bubbles are removed from the internal lumen, arterial line, and pressure transducer. Stop counterpulsation before rinsing quickly. At the end of this manipulation, resume the counterpulsation.

If damping the pressure curve, aspirate from the inner lumen approximately 3 cm ³ before rinsing it. If you feel resistance, consider that the inner lumen is occluded, and stop using it by closing it with a Luer lock.

To remove a balloon catheter installed by puncture, you must:

Discontinue anticoagulant therapy before catheter removal. Stop the counterpulsation and disconnect the catheter from the airway extension. After removing all retaining sutures / devices and labels, pull out the balloon catheter until you feel it exit into the distal femoral artery. If an introducer sheath has been used, do not attempt to pull the catheter through it. Instead, remove the catheter and sheath together. Immediately after removal of the catheter, pressing the artery distal to the puncture site, allow the blood flow to push out possible blood clots within 2-3 seconds. Then, pressing the artery proximal to the puncture site and stopping the distal pressure, check the retrograde blood flow. Then press the puncture site until complete hemostasis is achieved. Put a pressure bandage on this place. Verify that pulsations are distal using a portable Doppler sensor or palpation. After removal of the catheter, the patient should observe bed rest. Observe the patient, paying particular attention to signs of limb ischemia and bleeding from the puncture site.

Clinical recommendations for managing patients on intra-aortic balloon counterpulsation are as follows. After the start of counterpulsation, for some reason, diastolic amplification may be insufficient. If this is the case, first of all, check the degree of balloon inflation (AUGMENTATION CONTROL) and, if necessary, adjust it to achieve the optimal level of diastolic amplification. Next, pay attention to clinical conditions that may lead to a decrease in stroke volume. Any of them can lead to a decrease in diastolic amplification. These include: mean arterial pressure less than 50 mm Hg, a decrease in systemic vascular resistance; hemodynamic disturbances, such as tachycardia, bradycardia, and frequent ventricular extrasystole. In such cases, the spray will continue to support the patient, but to achieve the effect, the root cause must be eliminated. When using an introducer sheath, diastolic amplification may be insufficient due to the fact that the balloon did not completely pass the introducer. To verify this, just pay attention to the catheter marks. The first single catheter mark should enter the six-inch introducer sheath. After correcting the position of the catheter, resume counterpulsation and check diastolic enhancement. Sometimes, after the start of counterpulsation, the balloon membrane does not completely straighten. Verify balloon expansion using fluoroscopy, if available. If there is any doubt that the balloon has completely straightened, disconnect the balloon catheter from the airway extension and attach a 60 ml syringe to the airway of the catheter through a three-way valve. Aspirate to make sure there is no blood in the balloon airway. Inflate and deflate the balloon manually using a 60 ml syringe with air or helium. Reconnect the balloon airway to the airway extension and, resuming counterpulsation, check diastolic gain. Diastolic reinforcement can also be affected by the position of the balloon in the aorta. When a catheter is inserted through the femoral artery, its tip should be between 2 and 3 intercostal spaces. The position of the catheter can be checked using fluoroscopy or chest x-ray. If necessary, adjust the position of the cylinder. Occasionally, a balloon catheter can enter the false aortic lumen. To eliminate this, introduce a small amount of a radiopaque drug into the inner lumen of the catheter during fluoroscopy. If the balloon is in the lumen of the aorta, then the contrast medium will be washed out after several cycles. If the contrast medium remains near the tip of the balloon, then the balloon is probably in the false lumen of the aorta and urgent removal is necessary. Counterpulsation cannot be stopped for more than 30 minutes due to the possible formation of blood clots on the balloon membrane. During counterpulsation, the balloon membrane may be damaged. The reason for this may be calcified plaques in the aorta, which have an abrasive effect on the balloon. Large balloon membrane breaks are a rarity. But if a rupture is suspected, the balloon catheter should be removed immediately. If blood appears in the airway of the balloon, stop the counterpulsation and remove the balloon catheter.

When replacing a catheter with a new one, there is a high probability of a repeated rupture. Small defects in the membrane can be sealed, but a small amount of blood can get into the lumen of the balloon. In the future, this blood in the lumen can dry and condense. Later, when the catheter is removed, this dried clot can lead to artery injury. Therefore, in case of difficulty during removal of the balloon catheter and suspicion of a clot in the lumen of the balloon, the catheter should be removed surgically.

The hyperbaric oxygenation module MGO MLDK-T, designed for the treatment and prophylaxis of victims, provides effective treatment and prophylaxis of patients' diseases in the pressure chamber by increasing safety, productivity, saving oxygen and expensive helium by increasing operational reliability, stability of parameters, facilitating expiration and reducing gas consumption a mixture or oxygen of the respiratory system of the patient's DS.

The device of the transformable pressure chamber contains an axisymmetric container with a sealed inner shell of elastic fabric and a power shell covering it, along the edges of which end caps are placed, one of which is made with a sealed connector for introducing a tool tray into the tank, the power shell is made of a multilayer structural fabric with edges in the form closed ring-shaped loops, inside of which at least one embedded element is placed with the possibility of connection with the end cover, the bottom element is made profiled with a cross section formed by two cylindrical surfaces, conjugated on one side in a hemisphere, and on the other on a conical surface. The pressure chamber device is distinguished by the fact that it additionally includes life support equipment and audio-video monitoring of the patient, connected to portable cylinders of oxygen, compressed air, other gases and a portable control panel, on which pressure monitoring devices for the microclimate of the pressure chamber are mounted, a portable patient monitoring video monitor , pressure chamber intercom, light and sound signaling devices, buttons for controlling the operation of electrical equipment, moreover, to the head cover of the baroque Measuring devices for filling it with a gas mixture are connected to stationary cylinders of oxygen, compressed air and other gases through reducers with inlet and outlet pressure gauges for measuring the pressure of the supplied gases to the patient’s breathing using flexible communication hoses, in which quick-disconnect fittings are placed for supplying gases first to a closed volume of pneumatic pressure chamber devices, and then to the pressure chamber and electrical connectors. In the lower part of the folding lodgement for placing the patient in a pressure chamber, a unit for cleaning the respiratory gas mixture from carbon dioxide is mounted, consisting of a fan unit and a cartridge with a carbon dioxide absorber of the HP-I type. The pressure chamber device further comprises a respiratory gas mixer for the patient, made in the form of a casing made in the form of a half-cylinder closed on the contour, on the surface of which openings with a diameter of at least 2.0 mm are located with equal angular pitch for uniform dispersion of the respiratory gas mixture supplied to the transformable pressure chamber moreover, on the inner volume of the casing-mixer is fixed a tape-shaped elastic drive that provides noise absorption and uniform mixing of the gas mixture d feeding it into the pressure chamber capacity for breathing of the patient.

The respiratory system of the hyperbaric chamber patient contains sources of oxygen-helium mixture and oxygen installed outside the hyperbaric chamber, connected through a flow regulator with a closed respiratory circuit of the patient, including a flexible respiratory bag with a safety device, a supercharger, a regeneration cartridge, a dehumidifier, a heat exchanger and a breathing mask, containing straps for fastening to the face, an inhalation machine connected to the gas mixture supply hose from the storage cylinder on one side and the machine the volume of the exhalation is a sabotage on the other hand, as well as pipelines with fittings. DS differs in that an overpressure regulator is installed in the outlet and communication lines of the safety device with the pressure chamber atmosphere, and the line itself is connected to the cavity of the rigid body of the breathing bag and the regulator for the supply of oxygen-helium mixture or oxygen. In parallel with the gas mixture or oxygen supply regulator, a purge line for a closed breathing circuit with a shut-off valve is introduced, one end of which is connected to the input of the gas supply regulator and the other end is connected to its output. Moreover, in a closed breathing circuit between the connection points of the safety device and the oxygen-helium mixture and oxygen supply regulator, a non-return valve is installed, and a gas distributor is connected at the entrance to the cavity of the rigid body of the breathing bag. The gas distributor is made in the form of a two-position valve connected through an air reducer with an inlet air fitting connected to the air source, and through the first reducer the gas distributor is connected to the oxygen cylinder and to the air source, and (or) through the second reducer it is connected to the cylinder with oxygen-helium mixture.

The respiratory system of the pressure chamber patient contains an emergency or reserve source of oxygen - an oxygen cylinder, an oxygen-helium balloon, a damper balloon, a breathing mask, a first gearbox, a second gearbox, a third damper gearbox, a regulator for supplying an oxygen-helium mixture or oxygen. The system additionally includes a control line for the gas supply regulator, a shut-off valve, an automation unit, a supercharger, a regeneration cartridge, a dehumidifier, a heat exchanger, an exhalation machine, a breathing bag, a rigid case of a breathing bag, an overpressure regulator, an air outlet to the pressure chamber atmosphere, a safety device, a return valve, gas distributor, air reducer, air inlet fitting, closed breathing circuit, air source. An oxygen-helium cylinder, or an oxygen cylinder, or a damper cylinder, respectively, through a second oxygen-helium, first oxygen, third damper gears are connected to a closed breathing circuit formed by a series-connected supercharger, regeneration cartridge, dehumidifier, heat exchanger, breathing mask, breathing bag and return valve. The safety device is connected to the outlet of the elastic breathing bag and the inlet of the overpressure regulator. In addition, the outlet of the safety device is connected to the control line of the gas supply regulator. In parallel with the gas mixture or oxygen supply regulator, a purge line is installed, including a shut-off valve. One end of the purge line is connected to the feed control, and the other to its output. The non-return valve is installed in a closed breathing circuit after exiting the breathing bag into a safety device. At the entrance to the rigid case, a gas distributor is installed, made in the form of a two-position valve connected through an air reducer to an inlet air fitting connected to an air source, and through a second reducer to an oxygen-helium cylinder or to an oxygen cylinder.

The respiratory system of the patient’s hyperbaric chamber works as follows. Ventilating air entering the system through an air inlet fitting, an air reducer, a gas distributor is discharged into the pressure chamber atmosphere through an overpressure regulator and an outlet pipe. As a result, in the rigid bag housing and in the control line, the regulator of oxygen supply or oxygen-helium mixture (CGS) sets the required excess pressure, which is determined by the setting of the excess pressure regulator. If the pressure in the closed breathing circuit, i.e. in an elastic breathing bag, less than the pressure in the rigid case of the bag and in the control line of the oxygen supply regulator or oxygen-helium mixture, the supply regulator opens and fills the closed breathing circuit with oxygen-helium mixture or in case of emergency with oxygen. When the pressure in the elastic breathing bag is equal to the pressure in the rigid bag body, the gas supply regulator closes, stopping the access of KGS or oxygen from the source to the closed breathing circuit. The supercharger drives the gas mixture or oxygen contained in the closed breathing circuit through the regeneration cartridge, dehumidifier, heat exchanger. During the absorption of oxygen or oxygen in the breathing process and the absorption of carbon dioxide during regeneration, the pressure in the closed breathing circuit drops, while the flow regulator periodically opens, replenishing the consumption of oxygen or oxygen in the closed breathing circuit. In the process of breathing, the shut-off valve is periodically triggered by a signal from the automation unit, providing purging of the closed respiratory circuit with pure oxygen or an oxygen-helium mixture. The flow of pure gas in this case passes through a supercharger, a regeneration cartridge, a desiccant, a heat exchanger, a breathing mask, an elastic breathing bag, a safety device, an overpressure regulator and an outlet pipe. During interruptions in the supply of ventilated air, as well as during checks of the functioning of the respiratory system, the gas distributor is set to the extreme right position, allowing oxygen-helium mixture or oxygen to enter the rigid case, ensuring reliable operation of the closed system for a short period of time. The gas distributor can be switched manually and automatically. The positive effect of the proposed respiratory system of the pressure chamber patient is to eliminate leakage of oxygen or oxygen-helium mixture and, as an important result, reduce its consumption. As a result of this, weight reduction due to cylinders is achieved. The operational reliability of the respiratory system is increased, since there is no pneumatic valve at the entrance to the rigid housing of the breathing bag, which performs a large number of opening and closing cycles and therefore wears out quickly during operation. The design of the breathing bag is greatly simplified, since the need to install a spring and mechanically controlled valves is eliminated. When purging a closed breathing circuit by installing a check valve, ventilation of the breathing bag is ensured, which contributes to better purification of the circuit from nitrogen and harmful impurities. During interruptions in the supply of ventilated air and during the purging of the closed respiratory circuit, the stability of the parameters of the gas mixture in the closed circuit is maintained due to the supply of oxygen or oxygen-helium mixture to the rigid case. So, the desired technical result is achieved by the fact that the control line of the regulator for the supply of oxygen-helium mixture or oxygen is connected to the output and communication lines of the safety device DC with the pressure chamber atmosphere, an overpressure regulator is installed in this output and communication line, and the output and communication line itself connected to the rigid body of the breathing bag and the gas flow regulator. In parallel with the gas mixture or oxygen supply regulator, a purge line for a closed breathing circuit with a shut-off valve is introduced, one end of which is connected to the input of the gas supply regulator and the other end is connected to its output. Moreover, in a closed breathing circuit between the connection points of the safety device and the gas supply regulator, a check valve is installed, and a gas distributor is connected at the entrance to the rigid case of the breathing bag. The latter is made in the form of a two-position valve connected through an air reducer to an air inlet connected to an air source, and through the first reducer, the gas distributor is connected to an oxygen cylinder, and (or) through a second reducer it is connected to an oxygen-helium cylinder.

Thus, MGO MLDK-T in the composition with the patient’s respiratory system of the pressure chamber provides long-term breathing of a person in conditions of high and low pressure, as well as in the presence of aggressive environments and harmful impurities, when external conditions differ from normal hygienic conditions of human breathing.

The detoxification module DM MLDK-T is intended for extreme activities of officials of the department “Artificial kidney, artificial liver, harvesting and organ transplantation” of the Ministry of Medical Sciences in the treatment of acute renal and hepatic insufficiency, extrarenal and extrahepatic blood purification of the wounded and patient, automation of analysis of the data from their examination, input, adjustment and storage of information about the treatment of acute renal and hepatic insufficiency, issuing reporting information. Moreover, to ensure the work of the department, the detoxification module includes automated systems "Artificial kidney", "Artificial liver", surgical equipment for harvesting and organ transplantation. The main task of creating a DM is to reduce the time and complexity of entering, processing, storing and summarizing information about treatment and examination of victims in order to increase the efficiency of the treatment process, the speed of obtaining information about the examination of wounded, medicinal and functional diagnostic appointments, as well as testing use in the field new information technologies - in particular, a reader and writer for laser cards of the CONLUX OPTICAL CARD READER / WRITER type. The users of DM are the head of the department, the attending physician, the senior nurse, the ward nurse. DM users are provided with automated workstations with automated workstations; the number and composition of established tasks may vary depending on the structure of the ISS. The following tasks are part of the DM task complex: "Case history"; "List of the wounded and sick department"; "Planning and consultation"; "Planning and conducting operations"; "Printing diary entries"; "Templates"; "Dictionary" Surgery ";" Medicines Department ";" Dictionary "Medical staff"; "Branch Passport"; "Branch statistics"; "Preparation of a list of preliminary discharge of victims"; "Preparation of a list of preliminary transfers of the wounded"; "View card injured"; "House / estate"; "Ordinary Food Requirement"; "Entering the dynamic parameters of the wounded"; "Consolidated list of medicines for delivery to the department for a day"; "Appointment Lists"; "Printing of assignment sheets for victims"; “List of dialysis patients”; "Schedule of dialysis and hemodiafiltration"; "Dialysis"; "Schedule of administration of erythropoietin and blood transfusion"; “Formation of a waiting list”; "View the waiting list"; "Outpatient reception"; "Administrator". Composition 5 AWP DM “Artificial kidney, harvesting and organ transplantation”: 1. AWP “Head of Department”; 2. AWP "Attending physician"; 3. AWP “Standing nurse”; 4. AWP "Senior nurse"; 5. AWP “Hemodialysis and organ transplantation”. A complete set of tasks for the workstation: Workstation "Head of Department": "Planning and conducting consultations"; "Planning and conducting operations"; "List of wounded and sick patients"; "Templates"; "Dictionary" Surgical operations "; "Medicines separation"; "Dictionary" Medical staff ";" Department statistics ";" Department passport. Workstation physician: "Medical history"; "List of wounded and sick patients"; "Planning and conducting consultations"; "Planning and conducting operations"; "Printing diary entries"; "View patient card"; "Ward / condition"; "Templates"; "Dictionary" Surgical operations "; "Dictionary" Medical staff ";" Medicines of the department. AWP "Senior nurse": "List of wounded and patients of the department"; "Preparation of a preliminary statement list"; "Preparation of a list of preliminary translations"; "House / estate"; "Consolidated list of medicines for delivery to the department for a day"; "Ordinary Food Requirement." AWP “Standing nurse”: “List of the wounded and sick of the ward”; “Entering the patient’s dynamic parameters”; “Printing diary entries”; “Lists of appointments”; “Printing lists of appointments for the wounded and sick.” AWP “Hemodialysis and organ transplantation” : “Formation of a waiting list”; "View waiting lists"; “List of dialysis patients”; "Schedule of dialysis and hemodiafiltration"; "Dialysis"; "Outpatient reception"; "Schedule of administration of erythropoietin and blood transfusion"; "Administrator". Initiation and solution of tasks included in the PDM is carried out using the menu in the Windows 2008 environment. In order to control the launch of tasks, messages are displayed on the monitor screen about the start of the corresponding task (for example, “Wait”, “Database Administrator Work”). The readiness of the software package for work is determined by the illumination on the monitor screen of a unified invitation form with the name of the workstation, which also presents a list of tasks of the official in the form of a menu. The passage of information in the automated circuit of the DM corresponds to the technological process in the department of MOSN.

The DM consists of two detoxification departments: department No. 1 in the KMM 4310 box van on the chassis of an all-terrain vehicle with increased mounting capabilities of the KamAZ-43118 (KamAZ-53501) type with a capacity of two victims; detoxification department No. 2 in a box body type KP-4 (KP-4M) on the chassis of a biaxial trailer with a capacity of two victims.

The drugstore module MLDK-T is designed to provide medical property to omedb, omo, mosn. It includes the pre-aseptic, aseptic, assistant departments in the KMM-4310 van body on the chassis of the KamAZ-43118 (KamAZ-53501) car, the sterilization and washing compartment in the KMM van body-4310 of the KP-4 (KP-4M) two-axle trailer, Prescription and material - in the KMM van body - 4310 on the KamAZ-43118 car chassis, the energy department - in the body - KP-4 (KP-4M) van. Productivity - (two shifts of 10 hours each), l: injection solutions - 300, solutions for internal and external use -120, eye drops - 0.5, eye ointments, kg - 0.1, powders, pcs. - 500, ointments, kg - 5. Attendants - 6 people, including 1 pharmacist and 2 pharmacists. Deployment time - 60 minutes.

AM MLDK-T contains a device for the manufacture of sterile medicinal solutions, an SDK sterilization-distillation complex, a steam generator, a device for preparing sterile drug solutions in plastic bags, a dispenser of solutions, steam sterilizers, a device for labeling medicinal products, a control and indication unit for a steam sterilizer, installation for multi-stage water treatment, a complex of quality control and water treatment, an information management system for the activities of the mobile military Olevia pharmacy on the basis of intellectual computer virtual network.

A device for the manufacture of sterile medicinal solutions of LR contains collections of distilled water and filtrate, interconnected by flexible pipelines, a mixer, a filtering unit and a metering unit, a timer and a manometer. New in the device are the mixer control unit, the unit of the peristaltic pump of the filtering installation, consisting of a pump head with a reducer, the electric motor, the pump control unit, the filter unit of the filtering installation, consisting of a housing, a cover, a filtering membrane and a pump with a manual drive, a dosing unit consisting of the base of the rack of the dispenser housing, a graduated cylinder with a floating piston located in it, two three-way valves with an electromagnetic actuator and an electronic control unit for the dose unit rations. In place of a removable automatic stirrer, a hand-driven stirrer is inserted for the manufacture of LR in the absence of electricity, and the mixer is connected through the filter assembly to the filtrate collector for filling the finished solution into drug bottles at the level using a three-way manual valve with a stand. In this case, the nozzle of the mixer for supplying the solution is connected by a pipeline through the first valve to the pump unit and through the second valve to the filter unit, and the nozzle of the mixer for draining the finished solution is connected by a pipe through the third valve to the pump unit of the filtering unit.

The sterilization-distillation complex is designed to produce purified, boiled and water for injection, pre-sterilization and sterilization treatment of medical supplies and pharmaceutical dishes, sterilization of drug solutions. It includes technological, material and energy sectors. The first is to obtain purified, boiled and water for injection, sterilization of drug solutions, pre-sterilization and sterilization treatment of medical supplies, pharmacy dishes. Material - for storage of medical supplies, pharmacy dishes, obtained water, detergents and disinfectants. Energy - for the production of electricity, ensuring the operation of the AM complex. AM provides: water for injection, dm ³ / h, at least 100, purified water, dm ³ / h, at least 100, boiled water, dm ³ / h, at least 100, electricity, kW, no more than 16, steam , kg / h, not more than 120. СДК AM contains: a diesel power unit, a heat generator with a nozzle burner, an air fan for boosting air into the heat generator flame zone, an ignition-protective unit, an automatics consisting of three control units, monitoring and signaling the operation of the main units module; a fuel electric pump and a boiler water electric pump, introduced in addition to hand pumps; the main unit of pyrogen-free water treatment, based on electrodialysis and ultraviolet treatment of water, with a productivity of at least 100-150 l / h. SDK contains a steam boiler with a water heater, connected to the first inlet of a dummy heating boiler, connected to a distillation apparatus for evaporating water, connected to a condensation refrigerator connected to a container for collecting distilled water. The potable water tank is connected to the second inlet of the refrigerator, the hand pump, and the first inlet of the hot-water boiler having a water meter tube. The liquid fuel tank is connected to a steam boiler. The hot water electric pump is connected to a hot water boiler and to a hot water tank. Steam sterilizers are connected to the water supply network and the steam supply network. A portable stand-by petrol unit is connected to an external electric power storage battery and instrumentation. The input of the spare unit for water treatment is connected to the rubber-fabric reservoir, and its output is connected to a pyrogen-free water collector connected to the solution mixer. In this case, the first outlet of the hot water tank is connected to a vessel for washing vessels connected to the vessel for locking the vessels, and the second outlet of the hot water tank is connected to a mixer connected to the first outlet of the drinking water tank, the second outlet of which is connected to the first drinking spraying mechanism water. The outlet of the pyrogen-free water collection is connected to the second mechanism for spraying vessels with pyrogen-free water. To increase the operational reliability of the electric steam generator by improving the starting properties, purifying steam from water and operating conditions, the steam generator device contains axisymmetric chambers for water and steam located in the casing, the AC source is connected to the casing and to the chambers. The steam generator is equipped with a control system. To maintain the established air and sanitary-hygienic regimen when transferring drugs and equipment from one department of the pharmacy to another in the partition near the side wall of the box body, a window is made in which a transfer box is installed with supporting bars placed along it along the body wall and rigidly fixed on it, and on the uneven bars with the possibility of longitudinal movement along the rolling bodies fixed on them, a conveyor for a sterilization box is installed. The local Client-Server computer network has hardware and software for recording medical property and dosage forms, supplying them with the MLDK-T MOSN departments for emergency assistance to the wounded in the field of peacetime and wartime. Wireless range - at least 170 km. Bandwidth - at least 20 Mbps. The range of radio waves is 902-928 MHz. The power of the radio transmitter is at least 300 mW. The basic computer of the network is Pentium with a clock frequency of at least 2.3 GHz, RAM capacity is at least 2 GB, and HDD is at least 80-100 GB.

In the analyzed literature there are no sources that describe this set of distinctive features, and the proposed technical solution does not explicitly follow for a specialist from the level of modern technology. Thus, the mobile therapeutic and diagnostic complex of the therapeutic profile of MLDK-T meets the criteria of the invention of "novelty" and "inventive step". The proposed MLDK-T can be used in extreme, military, aviation, marine medicine, and, thus, it meets the criteria of the invention "industrial applicability".

The drawing shows a functional block diagram of a mobile medical diagnostic complex of the therapeutic profile MLDK-T, intended for emergency rescue and medical assistance to victims. The composition of the mobile therapeutic and diagnostic complex of the therapeutic profile MLDK-T:

1 - mobile therapeutic and diagnostic complex of a therapeutic profile, 2 - laboratory diagnostic module, 3 - clinical diagnostic module, 4 - X-ray diagnostic module, 5 - laboratory department, 6 - first energy department, 7 - fluorographic and ultrasound studies department, 8 - X-ray diagnostics department, 9 - the second energy department, 10 - the operating and dressing module, 11 - the operating room, 12 - the preoperative, 13 - the hospital department, 14 - the sterilization department, 15 - the third energy department, 16 - material and surgeon training department for operations, 17 - intensive care unit, 18 - intensive care unit No. 1, 19 - intensive care unit No. 2, 20 - hyperbaric oxygenation module, 21 - hyperbaric oxygenation department, 22 - auxiliary department, 23 - detoxification module, 24 - detoxification department No. 1, 25 - detoxification department No. 2, 26 - pharmacy module, 27 - pre-aseptic, aseptic, assistant department, 28 - sterilization and washing department, 29 - prescription and material department, 30 - h tvertoe energy department. MLDK-T is additionally attached to the sorting and evacuation module as part of the receiving and sorting department and the evacuation department.

The wireless automated autonomous control system for saving the wounded is used for real-time medical video teleconferencing, preliminary preparation of data on the wounded for inquiry, forwarding them to the hospital doctors and the actual discussions by the doctors of the medical treatment and diagnostic complex of the therapeutic profile MLDK-T 1 and medical consultants of tactical hospitals treatment of seriously wounded, analysis of the data obtained from medical consultants and making optimal decisions in time and place first aid to every wounded. The wireless automated autonomous control system for saving the wounded includes an on-board kit of a subscribed telemedicine station, an on-board local computer network containing an external counterpulsation device and a mobile kit for diagnosing and resuscitating a wounded person, including an automated workstation for a biologist's biologist. The wireless automated autonomous control system for the rescue of the wounded is made in the form of an onboard local area computer network connecting handheld, portable and onboard personal computers to each other and connected via a radio channel to the global computer network of the broadband access of the medical service of the military motorized rifle division, a medical unit for special purposes. Pocket, laptop and on-board personal computers inside the wagon bodies are interconnected using redundant wireless mobile data transmission equipment with a speed of at least 4 Mbps by using infrared port connections of digital communications in the radio frequency range and sets of standard interfaces for a digital communication network. Practical examples of the implementation and operation of a wireless automated control system for rescue of the wounded are given in the descriptions of the prototype patent [1] and patent N2172068 “Teleinformurology complex” published on August 10, 2001 in bulletin No. 22. The automated workstation of the biologist’s biologist’s biologist is intended for early warning diagnosis of the functional state of the wounded by technological determination of his blood composition and the use of enzyme-linked immunosorbent, immunofluorescence analysis, amplification nucleic acids using polymerase chain reaction. The doctor’s workstation contains large molecular machines, among which the ribosome in the form of a three-dimensional formation includes a complex of proteins and ribonucleic acids that produces any protein “products” according to the programs recorded in the genes of the injured or wounded. Moreover, structures of similar structures of large molecules used to diagnose blood composition by studying the structure of natural molecular devices, by creating similar “structures” by a diagnostic biologist at their workplace using a computer make it possible to use complexes of biological molecules that have one large the molecule recognizes another large molecule, i.e. as a result, they form a complex of molecules, which then includes a signal - a light indication at a specific wavelength. As a result, various molecular devices for detecting certain nucleotide sequences are created with the aim of detecting mutations and constructing biosensors to identify substances necessary for early biodiagnostics that are present in the body of the injured or wounded person, as well as in the surrounding internal and external habitats of medical personnel and the wounded. Structurally, the workstation is made in the form of a mobile set of diagnostics and resuscitation of a wounded man who is part of a local computer network, which includes an automated workstation of a biologist-diagnostician, made on the basis of a microcomputer.

The mobile set of diagnostics and resuscitation of the wounded includes a micro-integrated circuit board of the program algorithm and a unit for conducting early warning biodiagnostics of the functional state of the wounded, connected to the unit for the technological determination of the blood composition of the victim, a unit for the use of enzyme-linked immunosorbent, immunofluorescence analysis and the unit for amplification of nucleic acids using polymerase chain reaction . A mobile set of diagnostics and resuscitation of a wounded person carries out the detection of infectious diseases and toxic substances in aviation, ground, stationary and field conditions. To solve this problem, the kit was made on the basis of a scanning probe microscope, which is a device unique in its capabilities that allows you to achieve an increase sufficient to examine individual molecules and atoms. At the same time, a mobile diagnostic and resuscitation kit studies objects without destroying them, and even, which is especially important from the point of view of biomedical applications, in some cases it studies living objects. A scanning microscope also allows you to manipulate individual molecules and atoms using scanning probe microscopy of biopolymers to study, first of all, the molecular structure of the affected cell membranes. Scanning probe microscopy of biopolymers is an example of manipulators that allow you to move any objects up to atoms. Manipulators are devices designed to manipulate particle objects, molecules, and individual atoms. At present, two main variants of “nanopincers” have been created. In the first case, two carbon nanotubes with a diameter of 50 nm are used, located parallel to the sides of the glass fiber with a diameter of about 2 microns. When voltage is applied to them, the nanotubes diverge and converge like halves of tweezers. In the second case, DNA molecules are used that change their geometry during the conformational transition or breaking of bonds between nucleoid bases on parallel branches of the molecule. However, the manipulator for nano-objects may differ in its structure from macro-tools. Thus, the ability to move nano-objects using a laser beam was demonstrated in a recent work by scientists at Cornell and Massachusetts universities who were able to “unwind” a DNA molecule from a nucleosome. At the same time, they pulled her by the end with the help of such "laser tweezers." The device for external counterpulsation is made on the basis of a microcomputer with a liquid crystal display and is part of the mobile kit for diagnosing and resuscitating a wounded man, which is a “laboratory on a chip” device that can also detect and analyze ultra-small amounts of various substances. This laboratory device on a chip is made in the form of a plate, on the surface of which receptors for the necessary substances, for example, antibodies, are arranged orderly. The attachment of a molecule of a substance to a receptor is detected electrically or by fluorescence. Sensors for many thousands of substances can be placed on one plate. Such a “laboratory on a chip” device, capable of detecting literally separate molecules, can be used to determine the sequence of DNA or amino acids - for the purposes of identification, identification of genetic or oncological molecules, and detection of infectious agents and toxic substances. A device a few millimeters in size can be placed on the surface of the skin to analyze substances released later or inside the body (in the oral cavity, gastrointestinal tract, under the skin or in the muscle). At the same time, it can report on the state of the internal environment of the victim’s body, and signal any suspicious changes. Chip models of the laboratory-on-a-chip device can be used instead of identification documents - the primary medical card of the wounded - form No. 100, an individual carrier of accounting information - an identity card. For clinical biodiagnostics, pharmaceuticals, under the conditions of MLDK-T 1 operation, biochips can be made working with microscopic amounts of liquids with poisons sensors, drug analyzers or machines capable of distinguishing between certain types of dangerous bacteria and having a microscopic mechanism capable of randomly selecting the necessary proteins from a mixture of substances. Until now, such chips have been made a complex and expensive method of photolithography - the whole cycle took several weeks. Now all you need is a glass plate, tweezers, fiberglass, polymer and two to three hours of time. The fiber is placed on a plate and clamped with a piece of polymer. Microchannels form to the left and right of the fiber. A specially selected substance must be sprayed onto the glass fiber itself, which will determine which proteins the chip passes through the channel and which do not. A subscriber broadband radio station and the base broadband radio station of the mobile complex, interconnected via trunk channels at frequencies of 5.15-5.25 GHz and 5.25-5.35 GHz with local computing, were used as technical means for the long-term reception and transmission of medical data for managing the wounded the computer radio network of the mobile complex and the wireless computer network of a separate medical battalion of the division through the base broadband radio station of the division with a range of at least 200 km, osvyazannuyu with broadband subscriber stations separate medical battalion and divisional headquarters. The system of wireless mobile broadband fixed access of the division standard 802.16е-2007, including the module of the main wireless radio channels, was made by the Russian company InfiNet Wireless and allows telecom operators to provide the set of required telecommunication services. This access system is designed for the creation and use in urban and field conditions of wireless military computer multiservice networks of the 5G Art Communicatin type in military field hospitals operating in the frequency range 5.25-5.35 GHz with a bandwidth of 20 Mbps, 75 Mbps and 105 Mbps.

The access system contains subscriber and base radio stations, terminal nodes of the modules of the main radio channels, radio transmitters and radio routers. All subscriber stations have built-in technical support for IP-telephony, and the stations themselves are designed for all-weather use, have built-in lightning protection, integrated and external parabolic antennas. The system implements the IP layer network layer and the principle of packet switching. Access to the transmission medium is provided by a multiple access protocol based on routing in all nodes of the radio network, which allows us to solve the problems of operating these networks without involving additional software.

The device for external counterpulsation contains a microcomputer, a liquid crystal display, a pulse oximeter sensor, an electrocardiograph, overhead cuffs to a stretcher site of a seriously injured patient with an integrated compressor, an arterial blood oxygen saturation meter, cuff pressure during inflation and compressor pressure, a counterpulsation timer, a mobile counterpulsation control unit. Thus, the wireless automated autonomous control system for the rescue of the wounded includes an on-board local computer network, an on-board set of a subscriber telemedicine station, an instrument for external counterpulsation, as well as intercoms and communication radio stations.

The device for external counterpulsation works according to the non-invasive technology of auxiliary blood circulation, based on the movement of blood in the arterial and venous channels under the influence of squeezing the lower extremities of the victim with cuffs filled with air under pressure. During diastole, the cuffs are inflated in quick succession from calves up. This leads to retrograde arterial blood flow and an increase in diastolic pressure in the aorta. Instant pumping of air from the cuffs at the beginning of ventricular contraction reduces vascular resistance in systole and, accordingly, afterload. Hemodynamic effects during injection of air pressure into the cuffs - inflation: increased diastolic pressure, increased coronary perfusion pressure, increased myocardial blood supply, increased venous return to the right heart (preload), with stenosis of the coronary arteries, increased perfusion pressure in the diastole leads to the opening and formation of collateral and external counterpulsation increases cardiac output by 25% as a result of an increase in venous return to the heart due to compression of the venous vessels. The effects of external counterpulsation during pressure relief in cuffs are deflation: decreased vascular resistance (afterload), decreased heart function, decreased myocardial oxygen consumption, increased cardiac output. Preparation of the device for external counterpulsation for the procedure includes connecting the cuffs to the stretcher site of a seriously injured person with an integrated compressor and turning on the computer, the liquid crystal display and the mobile counterpulsation control unit. After this, the cuffs are fixed on the body of the victim: on the legs, hips, buttocks; connecting electrodes of the electrocardiograph to the patient’s body and counter-pulse device, connecting the pulse oximeter sensor to the patient’s finger and the console of the device. Then, it is turned on and patient data is entered into the computer memory; setting counterpulsation parameters, device self-testing, activation of ECG monitoring and pulse oximetry of the patient, compressor activation and the beginning of counterpulsation. Synchronization of counterpulsation with the cardiac cycle is achieved by comparing the patient's plethysmogram and ECG, in which diastolic amplification is visualized on the pulse wave curve. The synchronization of the phases of air injection and pumping into the cuffs with the heart cycle is carried out as follows: to synchronize counterpulsation with the pulse wave, the QRS complex on the ECG is used, synchronization with the ECG is carried out so that the retrograde pulse wave reaches the aortic root. Therefore, the synchronization of air injection in the cuff 13 is carried out with the end of the systole. The wave propagation velocity is affected by the impedance characteristics of the aortic walls, which leads to the delay in reaching the wave of the aortic root. Therefore, the synchronization of air injection into the cuffs is carried out with the end of systole. The duration of treatment is 35 hours for 7 weeks. In 139 patients with angina pectoris who had positive results of a stress test (treadmill) and hemodynamically significant damage to the coronary arteries documented according to coronary angiography, after a course of counterpulsation, an increase in exercise tolerance, an increase in the time of ST depression during the treadmill test, a decrease in the number of episodes of angina pectoris, dose reduction of nitrates. In some patients, improvement was noted after 12 hours of counterpulsation therapy. In most patients, after 24 hours of treatment, by 36 hours the effectiveness reached a plateau. The effect lasts for six to twelve months, in some cases up to two years. Counterpulsation effects: 78% of the patients who completed the course showed improved myocardial perfusion according to positron emission tomography and scintigraphy with Thallium, 2/3 showed a decrease in ischemic defects, 3/4 of the studied patients showed an improvement of one or more (up to 3 x) classes of angina pectoris, compared with invasive techniques, the number of side effects is much less. Thus, the external counterpulsation device includes a stretcher seat of the seriously wounded with a built-in compressor, a set of interchangeable patch cuffs for the legs, hips, pelvic and buttock region, pneumatic leads of the channels for counterpulsation with reed joints for connecting to the terminals, the device console, plethysmograph, counterpulsation safety system and characterized in that it further comprises a microcomputer, a liquid crystal display, a pulse oximeter sensor, an electrocardiograph, an arterial blood saturation meter and the oxygen pressure in the cuff when inflated and the compressor pressure counterpulsation counterpulsation timer and the mobile control unit. So, the clinical hospital unit of high alertness and mobility, which is made in the form of a mobile therapeutic and diagnostic complex of the therapeutic profile MLDK-T 1 MOSN, additionally contains interconnected medical laboratory diagnostic 2, clinical diagnostic 3, and X-ray diagnostic 4 modules in which the laboratory department is located 5, the first energy department 6, department 7 - fluorographic and ultrasound studies, department 8 of x-ray diagnostics, the second department of energy 9; surgical dressing module 10, including operating room 11, preoperative 12, hospital department 13, sterilization department 14, third energy department 15, material department 16 and the department for preparing surgeons for operations; the intensive care unit 17, comprising the intensive care unit No. 1 with an introscopic unit 18 and the intensive care unit No. 2; a hyperbaric oxygenation module 20 with a hyperbaric oxygenation compartment 21 and an auxiliary compartment 22; detoxification module 23 with detoxification department 24 No. 1 and detoxification department 25 No. 2; pharmacy module 26, including pre-aseptic, aseptic, assistant departments 27, sterilization and washing departments 28, prescription and material departments 29 and the fourth energy department 30, structurally executed and placed in box bodies, equipped with new medical, medical, material and technical equipment provision and management.

The proposed mobile treatment and diagnostic complex of the therapeutic profile MLDK-T 1 provides for the evacuation, sorting, resuscitation, diagnosis, intensive care, accounting and rescue of injured, injured therapeutic profile and wounded surgical profile, consists of medical functional modules mounted on the basis of cross-country vehicles with increased mounting capabilities of the KamAZ-43118 (KamAZ-53501) type with biaxial trailers, and provides qualified, with specialized elements, Therapeutic care for the injured, injured, wounded and sick in the field by increasing throughput, technical equipment of the surgical dressing room 10, 11, 12 and hospital 13 departments of the Ministry of Health Care by improving the quality, reliability, medical and technical level of the priority option of the complex, by increasing its technical and economic efficiency on the basis of advanced deployment tools, technical, medical equipment and new biotechnologies of the main functional units of the medical poison.

Information sources

1. Airborne basic mobilization hospital "Russia". - Patent for utility model No. 61557 dated March 10, 2007 - Federal State Institution “State Research Institute of Military Sciences of the Ministry of Defense of the Russian Federation”. - Application 2005106402/14, publ. 03/10/2005. - Bull. Number 7. - (prototype).

Claims (8)

1. A mobile diagnostic and treatment complex containing technical means of resuscitation, emergency surgical dressing, anti-shock and intensive care, hyperbaric oxygenation, extracorporeal detoxification, sorting, evacuation and pharmacy, life support and energy supply systems, a car sanitation and hygiene system, Automobile container technical unit containing power, heating and air-gas complexes, automated an operational management system for rescue of the wounded, connected to a system for rendering medical and qualified assistance to the injured, containing a wired, radio and television communication system, connected to an information and reference system with a subsystem for maintaining electronic records of the wounded's disease, connected to an automated medical records system for the injured , characterized in that it is structurally made in the form of a mobile diagnostic and treatment complex, intended mainly for therapeutic and surgical profile, consisting of functional modules: laboratory diagnostic, including clinical diagnostic and X-ray diagnostic modules, surgical dressing, intensive care modules, hyperbaric oxygenation, detoxification, pharmacy, sorting and evacuation modules mounted on the basis of cars, biaxial trailers with vans with medical equipment, mobile autonomous electrical units, water supplies ensuring throughput less than 100 injured and injured therapeutic profile and wounded surgical profile per day with a total duration of work in the lesion focus of up to three days of continuous shift work, while a broadband radio station and base broadband radio station were used as technical means for the long-term reception and transmission of medical data for managing the rescue of the wounded a mobile complex interconnected via trunk channels with its local computing computer radio network and wireless the computer network of a separate medical battalion of the division through the base broadband radio station of the division with a range of at least 120 km, interconnected with subscriber broadband radio stations of the separate medical battalion and the headquarters of the division, and the divisional system of wireless mobile broadband fixed access, including a module of the main wireless radio channels, contains subscriber and radio stations, terminal nodes of modules of the main radio channels, radio transmitters and radio routers, all subscriber stations have technical means of supporting IP-telephony, and the stations themselves are designed for all-weather use, have built-in lightning protection, integrated and external parabolic antennas, while the laboratory diagnostic module includes departments: laboratory, two energy, fluorographic and ultrasound, X-ray diagnostics, which contain a local computer network using a high-performance bus for connecting at least e six personal computers of automated workstations of the clinical diagnostic laboratory of the complex, including a hardware and software unit, one network server and five laptops, while the computer local network includes the following automated workstations: AWP "Head of Laboratory" - location No. 1 for general clinical research contains: hematological analyzer, hemoglobinometer, hematological electronic counter, microscope, Panchenkov apparatus, programmable photometer; AWP "Deputy Head of the Laboratory" - place No. 2 for general clinical research includes a urine sediment analyzer, a centrifuge, a set of test strips for urine analysis with a visual assessment; AWP "Laboratory Physician-Laboratory Assistant" - place No. 3 for biochemical research contains a combined analyzer of blood gases, electrolytes and metabolites, a biochemical analyzer, an ion-selective microanalyzer, a coagulometer - an analyzer of hemostasis, a thermostat; AWP "Doctor - researcher" - place No. 4 for isoserological and immunological studies includes a photometer with a thermostat and a usher, a set for determining the rhesus; AWP "Senior Nurse" - place number 5 contains a single-section wash-basin; AWS "Laboratory assistant" - place No. 6 is provided for recording analyzes, blood sampling and extracting results on a laboratory technician’s mobile table, the module itself additionally containing a second thermostat, 2 reusable thermocontainers, an air sterilizer, an installation for receiving deionized water, 4 bactericidal wall irradiators, This X-ray diagnostic module consists of three departments: fluorographic and two ultrasound examinations in a box body on a car chassis with automated workstations of a doctor radiologist and radiologist; it is equipped with digital devices: a mobile X-ray diagnostic unit, a low-dose fluorograph, a multifunctional ultrasound scanner, and the functional modules of the surgical dressing and intensive care unit contain an operating room; two intensive care units and intensive care units; hospital ward; preoperative; sterilization unit; power supply unit; transitional end platform with folding floor; two docking tambours, a transitional lateral vestibule, while the preoperative one joins the transitional vestibule between the operating room and the intensive care and resuscitation department, a device for loading and unloading the victims is installed in the vestibule, and the intensive care unit includes two intensive care units: department No. 1 in van body on a chassis of a car with a capacity of four injured and compartment No. 2 in a van body on a chassis of a biaxial trailer with a capacity of two injured, while I No. 1 of the intensive care unit includes a mobile functional introscopic unit and a wearable, a kit for diagnosing and resuscitating a wounded person based on an automated workstation of a biologist and diagnostician, and the introscopic unit of the intensive care unit of the complex for primary resuscitation and treatment contains devices for external and internal intra-aortic balloon pulsations and a “laboratory on a chip” device in the form of a wristwatch, including a microchip for implantation in a human organ ism rescued, while the microchip consists of sensors and a wireless transmitter for monitoring the location of the bracelet wearer, its body temperature and heart rate, in addition, the introscopic unit additionally contains balloon catheters for intra-aortic balloon counterpulsation, sterile kits for introducing intra-aortic balloon catheters, including: physiological saline , anesthetic, syringe with a needle for local anesthesia, a scalpel, a syringe with a volume of 20 cm ³ , napkins, one clip type "mosquito", while the preparation department Surgeons and rest rooms of the surgeons and the sterilization department are located in a van body, while the hyperbaric oxygenation functional module contains an oxygen system including an oxygen source connected via a flow regulator to a closed breathing circuit, including an elastic breathing bag placed in a rigid case with a safety device, connected in series supercharger, regeneration cartridge, dehumidifier and heat exchanger, moreover, the control line of the oxygen-helium supply regulator of the mixture or oxygen is connected to the outlet and communication line of the safety device of the respiratory closed system with the pressure chamber atmosphere, an overpressure regulator is installed in this outlet and communication line, and the outlet and communication line is simultaneously connected to the rigid housing of the breathing bag and the gas supply regulator, while in parallel a purge line for a closed gas circuit or oxygen has been introduced to the gas mixture or oxygen supply regulator with a shut-off valve, one end of which is connected to the input of the gas supply regulator, and the right end is connected to its outlet; at the same time, the mobile detoxification module contains two medical detoxification departments - “Artificial kidney, artificial liver, harvesting and organ transplantation” of the complex, and to ensure the work of the departments the detoxification module includes automated systems “Artificial kidney” and “Artificial liver” for treatment acute renal and hepatic insufficiency, extrarenal and extrahepatic blood purification of the wounded and sick, surgical equipment for harvesting and transplantation of rganov, as well as automated workstations to automate the analysis of data from their examination, input, adjustment and storage of information about the treatment of acute renal and hepatic insufficiency, the issuance of reporting information: "Workstation" Head of Department "; AWP “The attending physician”; AWP “Standing Nurse”; AWP "Senior Nurse"; AWP “Hemodialysis and organ transplantation”; moreover, the mobile pharmacy module of the complex includes a pre-aseptic, aseptic, assistant compartment in a box body on a car chassis, a sterilization and washing compartment in a box body of a biaxial trailer, a prescription and material compartment in a box body on a car chassis, and an energy section in the box biaxial trailer van. 2. The mobile diagnostic and treatment complex according to claim 1, characterized in that the wearable kit for diagnosing and resuscitating a wounded person on the basis of an automated workstation of a biologist and diagnostician of the biologist of intensive care unit No. 1 of the intensive care unit is structurally designed as a “laboratory on a chip” device, and contains a virtual service module based on an integrated microcircuit, and the virtual “laboratory on a chip” device itself is made in the form of a plate, on the surface of which sensors and receptors for antibodies, and the AWP “doctor-biologist” contains a wearable computer with a display, a scanning probe microscope, a micro-integrated circuit and a unit for conducting early warning biodiagnostics of the functional state of the wounded, connected to a unit for determining the blood composition of the injured, a unit for applying an enzyme-linked immunosorbent, immunofluorescence analysis and amplification unit of nucleic acids using polymerase chain reaction, and the set of subscriber telemedicine module point intensive The therapy contains an access server to which the personal computer of the resuscitator is connected, configured for telemedicine and connected to the digital color camera and digital video recorder of the diagnostic video system, a visual and audio information display unit, wireless and wired means for transmitting analog, digital audio and video signals, hardware the interface to medical equipment, the client control shell of telemedicine with the connection of the main and auxiliary elements, the module and interface to the telemedicine database environment, a communication interface module for interaction between the control shell and radio channels, their testing and optimization of data transfer protocols, an interface module for reproducing still images, sound and video images, a communication unit between telemedicine objects, a radio router, a wireless and wire access unit into the local computing computer radio network of the complex. 3. The mobile diagnostic and treatment complex according to claim 1, characterized in that in the surgical dressing module, starting from the back wall of the box body on the left with respect to the docking platform, are placed: a hanger, a folding stool, a reception desk, a packing box, stands under stretchers - 2 pairs, unified stretchers - 4 pcs., utility table, medicine table; on the right, starting from the back wall of the van body: the stands for stretchers - 1 pair, the unified stretchers - 2 pcs., the anesthetist’s table, artificial lung ventilation apparatus with anesthesia attachment, the field dressing table in the installation, next to which are installed: instrumental table, lamp field with autonomous power supply, a stand unified with bottle holders for blood substitutes and solutions, further, a stand for sterilization boxes, a table for dressings, a field wash basin; racks unified with bottle holders are installed in the head of the stretcher, while the operating room is located in the van body - the operating table is installed along the longitudinal axis of the van body with the head part to the front wall, a surgical stationary single-unit three-reflex lamp suspended from the operating table on the ceiling, and the head lamp part of the operating table on the right, in the direction of the car’s movement, there is an artificial lung ventilation apparatus with an anesthetic attachment, a screw stool in and the head of the table, to the left - the anesthesiologist table, and in the foot of the operating table instrument table, surgical aspirator; to the left, in the direction of the car, starting from the rear corner, there are: a washbasin that divides the curtain separating the washbasin from the sterile zone, a stand - a table for sterilization boxes, a table for sterile surgical instruments closer to the front wall; a solution table is installed near the front wall of the van body, an air purifier above the table on the wall, a folding table for equipment, a thermochemical oxygen generator underneath, a cabinet for oxygen and nitrous oxide cylinders in the front right corner, a curtain that separates the side door and cabinet for cylinders with oxygen and nitrous oxide from the sterile zone; on the right side of the van body there are folding tables for the recorder and a seat; on the bevels of the side walls of the van body opposite the operating table, bactericidal recirculators and bactericidal wall irradiators are installed, one on each wall. 4. The mobile diagnostic and treatment complex according to claim 1, characterized in that the preoperative layout is distinguished by the use of one pair of stretchers on the right - to ensure the necessary width of the passage of orderlies with a stretcher, as well as the placement of the dressing table, as a result, the preoperative layout provides free access for medical personnel to a stretcher, dressing table and equipment, the maximum use of the working space, as well as the possibility, if necessary, to increase the evacuation capacity of the preoperative using a tent. 5. The mobile diagnostic and treatment complex according to claim 1, characterized in that the hospital ward is mounted and deployed on the basis of automobiles, the tambour of the box body is connected to the transitional tambour between the operating room and the intensive care and resuscitation department, and a loading device and unloading of victims, moreover, to the left, in relation to the docking platform, starting from the front wall of the box body, sequentially installed along the side wall: table for sterile materials; table for medicines, tool table; supports for stretchers - 1 pair, unified stretchers - 1 pc., unified rack with bottle holder; at the back wall of the entrance vestibule - a field washbasin, and on the right, with respect to the docking vestibule, along the side wall are: a folding stool, three pairs of supports with a stretcher, standardized racks with bottle holders; the stool is folding, and the operating table is installed along the longitudinal axis of the van body with the head part to the rear wall, and in the area where the operating table is placed, a surgical stationary single-unit lamp is mounted on the ceiling, and on the left side of the body, in the direction of the car, starting from the rear wall, are installed : cabinet for medicines and linen, two bunk beds for the injured, on the right wall, in the direction of the vehicle, starting from the rear wall, there are: a folding table, a bunk bed for distressed, reclining seat, washbasin; In the corner, near the front wall, on the right, in the direction of the car’s movement: a cabinet for cylinders with oxygen and nitrous oxide, a folding table, a thermochemical oxygen generator underneath, an air purifier is installed on the shelf above the table, and an artificial lung ventilation apparatus with an electric field drive with an anesthetic prefix, and on the bevels of the side walls of the van body opposite the operating table, a bactericidal recirculator and bactericidal wall irradiators are installed, one on each wall. 6. The mobile diagnostic and treatment complex according to claim 1, characterized in that each sterile kit for introducing a balloon catheter of a functional introscopic unit contains all the necessary equipment: one 18-gauge angiographic needle, one conductor with a J-shaped tip, one conical dilator, one three-way shut-off valve, one syringe with a volume of 60 cm ³ , one Luer lock plug. 7. The mobile diagnostic and treatment complex according to claim 1, characterized in that the pharmacy module further comprises a device for the manufacture of sterile drug solutions, a sterilization-distillation complex, a steam generator, a device for preparing sterile drug solutions in polymer bags, a dispenser of solutions, steam sterilizers, device for labeling medicinal products, control and display unit for a steam sterilizer, a complex of quality control, purification and obtaining purified water and for injection, a military field pharmacy information management system based on a computer local network, while the pharmacy module’s performance - two shifts of 10 hours each produce injection solutions in the amount of 300 l, solutions for internal and external use - 120 l, eye drops - 0.5 l, eye ointments, - 0.1 kg, powders, pcs. - 500, ointments, kg - 5; The staff of the pharmacy module is 6 people, including 1 pharmacist and 2 pharmacists. 8. The mobile diagnostic and treatment complex according to claim 1, characterized in that the movable functional modules of the complex have the following systems and devices: power supply system; emergency power system; lighting system; forced ventilation system - regular and special from filtering installations; heating system; air conditioning system; hot and cold water supply system; oxygen supply system; nitrous oxide nutrition system; sewage system for used water; devices to facilitate the deployment of tents, as well as devices for stacking, loading, unloading and securing property during transportation; means of communication; sun shades, while pocket, laptop and on-board personal computers of the complex are additionally interconnected using backup infrared equipment for wireless mobile data transmission using infrared port connections of digital communications in the radio frequency range and sets of standard interfaces for a digital communication network.

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