Medical union: ambulance workers die on duty due to overwork

Action medical workers' union believes that overworking in conditions of constant overtime work played a fatal role.

Yulia Suntsova

A fatal accident involving an ambulance and a truck took place on the morning of August 18, on the M-5 "Ural" highway in the Ufa region of Bashkortostan.

An official Fiat medical car traveling from the village of Zubovo to the central regional hospital in the village of Iglino collided with a KamAZ truck, which was standing on the edge of the roadway due to a breakdown.

The entire crew died on the spot: 55-year-old driver Mikhail Medvedev and 26-year-old paramedic Damir Khisamutdinov.

“It is known that the ambulance team transported the patient to the covid hospital in the village. Zubovo and returned home to the Iglinsky district. An investigation has begun, during which the reasons and circumstances of the incident will be established, ”reports the State Traffic Safety Inspectorate of the Ministry of Internal Affairs for the Republic of Bashkortostan.

The truck driver said that he made a stop to replace a flat tire. “Got up on the side of the road, turned on the alarm, put up a sign. He took off the spare wheel and went to turn it off. The wheel did not turn away because it was well tightened. I got into my car and called my superiors to come to help me. And about three minutes later there was a blow - an ambulance crashed from behind”, - the driver said.

In addition to the traffic police, the prosecutor's office and the trade union of medical workers announced their own investigation into the causes of the accident with deaths in the line of duty.

“The prosecutor’s office has established control over the course and results of the pre-investigation check. In addition, the Iglinsky District Prosecutor's Office coordinates the activities of the State Labor Inspectorate in the Republic of Belarus, law enforcement agencies involved in the investigation of the incident”, - the supervisory authority said.

“Gone for a heavenly day,” - this is how doctors say about their colleagues who died at work - the tragedy that took the lives of the entire crew shocked the professional community.

Interregional trade union of medical workers "Action" presented a detailed analysis of the incident.

- Personally, I see in this tragedy, among other things, the disastrous consequences of the systemic problems of Russian health care, to which our union has already paid attention more than once: the commercialization of the medical care service, the lack of staffing of teams, a catastrophic shortage of personnel and a colossal load on the personnel who remain, - comments the coordinator trade union "Action" in the Republic of Bashkortostan Anton Orlov.

The activist bases his findings on facts and figures.

The well-built compulsory medical insurance system forces all medical institutions, without exception, to, in fact, earn money on the provision of medical care. Accordingly, the management of each medical institution views its employees through this prism, squeezing all the juices out of them and wanting each employee to work as cheaply and as long as possible, additional employees are not recruited. Hence - the state, which will never be staffed, according to regulations and departmental orders, since it will be too expensive for the administration.

The Ministry of Health of the Republic of Bashkortostan, in response to an official request from the media about the accident, confirmed that 15 ambulance paramedics were employed in the Iglinskaya CRH. It sounds like a lot, but let's count.

The composition of ambulance teams is strictly regulated by Order of the Ministry of Health of the Russian Federation No. 388n. As you know, the most widespread team of Hide medical care is the paramedic team. So, clause 7 of Appendix No. 2 to The procedure for the provision of ambulance, including specialized ambulance, medical care , approved by By order of the Ministry of Health of the Russian Federation No. 388n , it reads: "A general-purpose paramedic mobile ambulance brigade includes either two ambulance paramedics and a driver, or an ambulance paramedic, a nurse (nurse) and a driver...". Without any "recommended", which for some reason we like to interpret as "not necessary for execution." Paramedics cannot work every day for days, although the overwhelming majority of heads of institutions would be delighted if they could.

The normal schedule of daily work should be "a day after three", ie, by simple mathematical calculations, we find that 15 paramedics in a normal schedule are a little less than two ambulance teams fully staffed by two medical workers. However, in Iglinskaya CRH there are no ambulance teams staffed by two paramedics, as well as in most ambulance departments of the Republic of Bashkortostan!

The dead crew is confirmation of this, there was only one paramedic instead of the minimum required two paramedics.

The problem of staffing the staff in the face of a shortage of personnel is solved by the management mainly by encouraging internal part-time jobs, i.e. when one natural person - an employee occupies more than one staff unit. Low wages for one rate force workers to take "part-time jobs", i.e. for a part-time job. Employees agree to combine not from a good life. Ask any ordinary health worker if it is possible to live a normal life working at one rate, and you will hear that, firstly, there will be no one to go online without "part-time jobs", and, secondly, all employees “earn extra money,” that is, they donate their personal time, which is actually allotted to recuperate after hours of shifts and daily shifts.

In the Iglinsky District, as of October 01, 2021, according to the District Administration, 67 thousand people live. Order of the Ministry of Health of the Russian Federation No. 182 approved Methodological recommendations on the application of standards and norms of resource provision of the population in the field of health care , i.e. number of beds, ambulance teams, etc. So, clause 8 of this order recommends in areas with low population density with a service radius of 40 km to have 1 general-purpose brigade for 8 thousand people. That is, if you follow the norms of this order, there should be at least 8 general ambulance brigades in the Iglinsky region. But here in the order we meet this terrible word "recommended". Recommended 8, but you can at least as many. And 8 fully staffed ambulance teams with a normal work schedule "after three days" are already 64 paramedics (in 4.3 times less than the actual staffing level), which means a significantly increased salary fund, of course.

What are the listed problems and "recommended" results for patients? In very long waiting times for ambulance crews. Taking into account the imposition of covid, the brigades have been working for the last two years practically without stopping and driving into the station, for wear and tear.

The rescuers of our lives literally crawl out of work, physically and mentally exhausted, and even experienced ambulance drivers who have been working for years cannot stand it.

The crew crashed on the track is not an isolated incident in recent years in Bashkiria, not to mention the scale of tragedies throughout Russia.

At the end of June in Kaltasy, an ambulance overturned into a ditch, an ambulance paramedic died in an accident , she left three children. The surviving driver then testified: "I'm tired of the schedule." By that time, he had already been driving for 6 hours, and before that he had worked 2 shifts of 12 hours each.

In May in the same Iglinskaya Central District Hospital on duty 48-year-old ambulance driver died Alexey Pobol. Previously, he suffered a heart attack and had to be transferred to light labor, however, for some reason, the management felt that it was possible to put him on the line in an ambulance on 12-hour shifts. The next month, he died right behind the wheel of the OKS.

In the spring in Neftekamsk, an ambulance driver with special signals turned on drove to the intersection at a red traffic light and collided with an Audi. In October last year in Ufa, an ambulance, also with special signals on, crashed into an Audi Q7 at full speed. One of the doctors was hospitalized with head injuries.

Earlier, the drivers of the Iglinskaya Central District Hospital reported that due to the lack of paramedics, they go to patients alone, at their own peril and risk.

The situation with the drivers is the same as with the nursing staff. Over the years of "optimization" of healthcare, both categories were demoted and ceased to be medical personnel, because "why pay more?" in fact, all drivers carry, load and unload patients and help their paramedics in every possible way, including coping with the equipment.

The drivers' salary is now 5,771 rubles, the rest is incentive and compensation payments. And in order to receive a salary of 20-25 thousand, drivers need to directly rely on the blessings from their bosses, because it is the bosses who determine the size of the column "incentive payments / PC / PPK / bonus" in the calculation.

After working overtime in an ambulance, many drivers again go to earn extra money, already outside the framework of medical institutions, because it is impossible to feed a family on 25 thousand rubles of the received salary.

These are the consequences of the "optimization" and imbalance of the CHI system.