The Moscow emergency medical care service includes over 1,000 teams, the country’s largest and most modern ambulance fleet, and EMS helicopters. The Puchkov Station responds to 16,000 call-outs and its medical crews deal with 12,000 patients a day. Over a period of the past six months, the time it takes an ambulance to reach a place has improved too.
Alisa Nasyrova, a paramedic of the Regional Department Number 9 of Substation Number 1 that covers Moscow’s Central District, told mos.ru how emergency care works, what difficulties there are in diagnostics and psychological aid for patients. She won the Best Emergency Care Paramedic award this year.
Question: What helped you win the title of best paramedic in the Moscow Masters competition?
Alisa Nasyrova: I think I approached my assignments with more awareness at some point. It is impossible to know everything. Perhaps, I managed to get rid of the fear of public speaking and gained some inner balance. I am sure that in a real situation all the other contestants would have performed their job by 100% as well.
Question: What did the victory in the competition give you?
Alisa Nasyrova: The competition was a perfect opportunity to test myself in an emergency situation, to meet new people and it also motivated me to expand my professional knowledge.
I would recommend my colleagues to try their hand at this competition because many of them deserve the title of best paramedic.
Question: What assignments did the competition include?
Alisa Nasyrova: The competition consisted of several stages. The selection process involved testing, blitz questions, and resolving various situations. The final task was to provide aid to a man who had drilled his chest with a drill several times, then fell down and injured his leg. It seems unrealistic to drill your chest. But it actually did happen, according to an emergency care crew.
However, the most challenging circumstance was that the patient refused to go to hospital, and we had to secure his consent.
Question: How do you usually persuade your patients?
Alisa Nasyrova: This is a professional secret. Each of us found our own way to get the patient to the hospital.
Question: Do patients often refuse to be taken to hospital?
Alisa Nasyrova: There can be different situations. Sometimes, there are objective reasons but sometimes refusals are unreasonable. In each case, we have to act depending on the circumstances but within the set algorithms.
For example, if a patient is in a critical condition and does not understand what he or she is doing, the issue is addressed via guardians or the police.
Question: Why did you choose to become a paramedic?
Alisa Nasyrova: Perhaps, it chose me. My medical education began from basics. I went to college to train as a nurse, and after that my dream was to work with an emergency crew. I have been working in healthcare for ten years now, including seven of those as a paramedic.
Question: Do you remember your first day at work?
Alisa Nasyrova: I remember my first night shift. My body was fighting against sleep. Popular solutions like strong coffee did not help, and I therefore had to keep in check my irritation. Some patients called the ambulance at 2-3 am, although the problem started at 6-8 pm, which means they tried to endure the pain and wait. I still don’t understand what the point is in waiting. Sometimes, it can make things worse. The sooner you call, the better.
There are many ways to do it in Moscow. Many, for example, have no idea that duty doctors and some specialists work in outpatient clinics over the weekends, and that anybody can call out A&E doctors as well as, in a complete emergency, an emergency crew.
The most moving thing is when an elderly couple treat each other with tenderness and love
Question: What attracts you to this job?
Alisa Nasyrova: Many things. Each working day that is different and never the same. Every day tests my character, knowledge, social skills. The opportunity to see Moscow at night without traffic jams, and of course, the flexible schedule.
You know what I remember most, what I find most moving? It is when an elderly couple treat each other with love and tenderness. Despite all the troubles, they try to support each other. Older people who do not only live together but also continue loving each other are a real rarity. Their attitude inspires me to remain human, respect people and each other.
Diagnostics is the most difficult task
Question: What is the most difficult part of your job?
Alisa Nasyrova: The most important and the most difficult part for an emergency crew is the diagnosis. Each team has the necessary portable devices to do the pre-hospital diagnosis (EGG analysers, blood glucose monitors, pulse oximeters) that help identify the diagnosis. The team decides on the diagnosis based on the patient’s complaints, examination and test results. In the most complex and unusual cases, we can get a telephone consultation with more experienced doctors.
Question: How does your expertise help you in the diagnostics? Symptoms can be the same for different conditions, how do you make the right decision?
Alisa Nasyrova: Expertise helps in any profession. Of course, a single symptom can be found in several illnesses but it is the combination of symptoms that allows us to decide on the preliminary diagnosis. As the majority of inpatient clinics in Moscow are multi-profile, we can quickly help patients with an untypical clinical history or patients suffering from several conditions.
Question: Emergency crews now have tablets to go online and check individual medical records. Does this make your work easier?
Alisa Nasyrova: It does in a way. Though, sometimes, a patient does not go to his outpatient clinic or has not been included into the system, then we cannot make use of the online medical data.
We also try to provide psychological support to patients
Question: How do you cope with such psychological stress?
Alisa Nasyrova: Time heals, makes us stronger. We gradually learn not to project the patient’s suffering onto ourselves. Some people believe this to be unprofessional or cynical. But I think otherwise. When you work at an emergency care station, it is teamwork and we can support each other.
We try to provide psychological support to patients too. If it is a personal drama, we try to explain that they can be happy again in the future.
Question: How many callouts do you receive per shift?
Alisa Nasyrova: About 16–18 callouts per 24 hours. Apart from the driver, the team includes two paramedics, or a doctor and a paramedic. If several teams are available at the substation, the operator finds out the reason for the callout and decides which team to send. If it is a child or a complicated case, they would normally send a team with a doctor.
Now both doctors and paramedics are perfectly well trained
In fact, the majority of emergency crews, be it a doctor or a paramedic, are perfectly well trained. Although doctors have to study some subjects longer and more in-depth than paramedics, still a lot depends on the person, on self-education. It is better to be a good paramedic than a bad doctor.
Question: How does your working day start?
Alisa Nasyrova: An emergency crew begins its day by checking the equipment and the medicine supply.
A paramedic’s role depends on the crew. If it is a doctor’s crew, the paramedic is the doctor’s main assistant and has to promptly perform diagnostic and treatment manipulations.
If it is a paramedics’ team, they have to provide pre-hospital aid without a doctor, which is a big responsibility. Our leadership has organised numerous training courses for paramedics and doctors to improve their knowledge.
Question: What medical conditions do you have to deal with most frequently?
Alisa Nasyrova: Hypertension. It may have serious complications: changes in blood pressure may cause heart attacks, strokes, loss of vision, and dementia. In other words, a seemingly insignificant condition may develop into something fairly serious. High blood pressure, on its own, is a real test for a human body.
Question: What is it like to know that a human life is in your hands?
Alisa Nasyrova: Essentially, it is rather a philosophical question – is it really in our hands? I feel responsible for the quality of care I provide. But lots of factors affect a human life. Fifty percent of our health is our lifestyle, 20% - genetics, another 20% - the environment, and only 10% depend on the medical care.
Question: What changes have you noticed in the Moscow healthcare system in recent years?
Alisa Nasyrova: The standards and algorithm of medical care are regularly revised, which improves its quality. There are difficult and disputable aspects but that’s something to work on.
Online medical records are helpful for the emergency services, it is a huge step forward. Online medical files are important when a patient is unable to talk due to his poor condition.
Patients’ stay in hospital has been reduced dramatically. It is good because it prevents infections from spreading inside the hospital, and it also cuts down on expenses. Sometimes, a patient needs to stay longer but I think this can be addressed individually.
Question: Do you plan to continue your education to become a doctor?
Alisa Nasyrova: I am seriously considering it and what to do next. I would love to be a good professional.