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. Last Updated: 07/27/2016

Mobile Medics Struggle to Make Ends Meet




First Aid


In response to "Mobile Medics Struggle to Make Ends Meet," Sept. 24.





Editor,


The story promised to offer a first-hand look at the history, dedication and ingenuity of a group struggling to service a cash-strapped and often thankless city. Yet, Dr. Fuzeau abused his "opportunity to observe Moscow's ambulance service in action" in order to produce a shameless advertisement for the European Medical Center. The second half of the article is devoted to touting the merits of the EMC (and its sister organization the American Medical Center) over Russian medical care. In doing this, it reduces an urgent, complex and socially destabilizing problem -- which mainly affects Russians -- to nothing more than a backdrop for an EMC advertisement directed to Western expatriates.


Alex Schenck














It is 8:30 p.m. at the Moscow Mobile Emergency Service Station No. 34 when the telephone rings.


The loudspeaker of the central switchboard booms through the station, as Igor Kobzari gets ready to go out on the call to examine a bedridden woman in her 80s. The woman's daughter has dialed 03 -- Moscow's emergency telephone number -- and has described her mother's condition as a "cardiac emergency case."


Kobzari's ambulance moves quickly through the traffic and arrives at the apartment within 10 minutes of receiving the call. In five minutes, the emergency doctor gives the woman a blood-pressure test and a cardiovascular examination.


Leaving the apartment, Kobzari says the daughter likely called 03 to get her mother a free, quick checkup at their home without having to make an appointment. It's a typical day at the ambulance service, called skoraya pomoshch in Russian.


About three years ago, Kobzari, who used to work as a surgeon, joined Station No. 34, one of 55 stations of the Moscow Mobile Emergency Service. As an emergency doctor, Kobzari said he goes out on as many as 20 emergency calls during a 24-hour shift. He works one such shift every three days.


Although Kobzari makes only about 1.2 million rubles (about $200) a month, it is more than what he was making as a surgeon and it is paid without delay, he said.


But the job is not without its drawbacks. Kobari said he often must use obsolete equipment. For example, the city ambulance service still helps patients breathe more easily using a ventilation system similar to those used about 20 years ago in the West.


Kobzari is one of 1,500 doctors who work each day for the Moscow's ambulance service. In total, the service employs 10,000 medical personnel, including 5,000 doctors. They are grouped into teams of two to three; sometimes just a doctor and a driver go on a call, but more often they are joined by a nurse or medical assistant. Doctors of different specialities are employed by the service, including general practitioners, reanimatologi, or doctors who treat patients with life-threatening injuries or illnesses, cardiologists and pediatricians.


Russia's first motorized ambulance came into service in 1919. Until 1926, there was only one ambulance -- often in need of repair -- and only one physician on duty in Moscow. The ambulance driver had to go look for a doctor at his office, creating long delays in service. Only traumatic emergency calls were accepted at first, but in the 1930s, medical and psychiatric calls started to be answered too, with five ambulances permanently on duty.


The 03 toll-free number to summon the ambulance service was created under Stalin in 1941 to prepare the city for war, said Dr. Mikhail Burtsev, medical chief of emergency services in the Moscow region. After 1945, the medical staff and equipment were modernized, and the concept of a mobile emergency service developed the framework it has today.


Today, the Mobile Emergency Service, a non-profit, federally run organization, has 1,500 ambulances in Moscow.


Regionally, there are the same problems, said Burtsev, who is in charge of ambulance services outside of the city and has represented Moscow's Mobile Emergency Services in various conferences in the West.


"For the improvement of the ambulance service it is necessary, in my opinion, first to increase 03 financing for the purchase of modern medical equipment and raising the workers' salaries," Burtsev said in a written answer to questions. "Second, the special choice of employees for 03 and the testing of each specialist at the job interview."


The service boasts some modern features, such as several hundred Mercedes ambulances -- partially funded by the state natural-gas monoploy Gazprom -- a scanner and a unit to treat severely burned victims.


But many Russian ambulances do not use the most updated equipment available, which can lead to misdiagnoses and poor care, Western doctors say.


Dr. Jacques Roy of Mediclub Moscow said Russian ambulances, with the possible exceptions of the cardiology or traumatology units, typically are not equipped to stabilize patients on the way to the hospital. Also, unlike in the West, where diagnoses are done in hospital emergency rooms, Russian ambulance doctors must diagnose patients before reaching the hospitals, which are divided along the lines of what illnesses and injuries they treat.


"It's almost impossible to do a diagnosis at first glance," Roy said.


Kathleen Gulledge, chief nurse at the American Medical Center, said that because of concern over misdiagnosis, "We basically start from the beginning with each patient."


Recently, a patient who had been misdiagnosed by a Russian ambulance crew was brought to the European Medical Center. In the ambulance, the young British patient was thought to have had a heart attack. The Russian ambulance doctors reportedly gave him an injection of anticoagulant and took him to the appropriate Russian hospital. However, at the hospital, the cardiologist changed the diagnosis to a complication with the nervous system. When the patient finally went to the European Medical Center for help, doctors there diagnosed him as having a pancreatic problem.


Another problem Western doctors in Moscow have seen is a lack of knowledge among Russian ambulance doctors about Western medications, which at times leads to overdoses or sometimes misuse. In one case, adult medications were given to a child. When the parents noticed the child's condition was not improving, they called the European Medical Center, where the child was treated by Western doctors. The child recovered, but the mistake prolonged her illness.


Such cases can probably explain the popularity, especially among expatriates and wealthier Russians, of private mobile emergency services. The few private ambulance services cost from $80 to $300 per call. Russian private ambulances have up-to-date equipment, but use Russian methods of care, while the Western services provide Western-style treatment and modern equipment.


Back at Station No. 34, the last call of the shift is for another emergency doctor, Lyosha Lozoboi. It's a simple case, but after a while Lozoboi calls back to the station to report: "It's impossible to find the address." The central station cancels the emergency call.





Fuzeau is a doctor who specializes in emergency care with the European Medical Center. Recently, he had the opportunity to observe Moscow's ambulance service in action.





-- Heather Clark contributed to this article.