It got bad on the train. What to do? How is medical assistance provided to passengers on long-distance trains?

Organizing task medical care during train journeys, as a rule, it is solved by the sick people themselves. And what measures have been taken by Russian Railways and other people who are obliged to make decisions and actions in order to at least reduce the risks of losing people or worsening their health along the way?

Medical industry

In accordance with the order of the Ministry of Health and Social Development of the Russian Federation dated May 5, 2012 No. 498 N “On Approval of the Requirements for Completing Medical Devices for First Aid for Railway Transport Injured Persons in the Provision of Passenger Transportation Services”, special medical packages have been issued - sets of medical preparations placed in special container for storage and transportation.

Thus, to say that in terms of equipment inaction reigns is not true. In particular, the issue of providing medical supplies and medicines has been resolved.

At Moscow railway stations

There are medical stations at all nine stations in Moscow. On Rizhsky and Savelovsky health care represented by one paramedic. On the rest, except for the paramedic, there is also a doctor. The Health Department of Russian Railways, together with the polyclinic, are responsible for passengers. The station management is obliged to provide the Department with equipped premises and make special navigation (badges) for passengers, by which one can easily find a medical center. The duties of the staff include reporting to the medical center that someone has become ill, as well as transporting this person to the first-aid post.

During parking

The paramedic or doctor receives information about a call to the train by telephone or radio communication from the station attendant. The problem is that if you need help, the train will have to leave. The parking of the train due to the fact that there is a sick person in it cannot be extended. In any case, the train will leave on schedule, and since at some stops the stopping time is extremely limited, in practice it can be quite problematic to get medical assistance on time.

Russian Railways, according to their information, has the ability to control a sick person on the road during stops throughout the entire route of the train using the relay method.

Going on the road

You will have to rely only on yourself. When considering your trip or the trip of your relative, you do not need to rely on the help of strangers. They are, of course, most likely to help in a critical situation. But you need to make a decision in favor of the trip only when you are sure that you will move the road on your own, without resorting to outside help.

1. Take your medication. Firstly, for some reason, the first-aid kit may not be in your car, and secondly, even if it is, the necessary drug may not be found. Since there are many different diseases, the medicines in it are intended for the most common cases, and sometimes your personal one simply cannot be foreseen. Thirdly, by taking medicine, you can help other people, and not look indifferently at how a person dies before your eyes.

2. Remember that if you feel bad, the conductor is obliged to provide first aid and inform you of the need to call an ambulance, so do not be silent about your problem if it has arisen and you cannot cope on your own.

3. Do not attempt to stop the train. Often, after a stop, people died only because the train was moving to the station for a long time and the sick person could not receive medical care on time.

4. Remember: in a critical situation, it is better to leave the car upon arrival at the station, use the services of a doctor and continue moving later than, taking risks, go further and “fall short”.

Have you ever been on a train with medical compartments, with a laboratory and a receptionist in the car? I have not been and, anticipating a visit to the clinic on wheels, hurried along the platform railway station Minino. The Mobile Consultative and Diagnostic Center "Doctor Voyno-Yasenetsky - St. Luke" settled here for two days. The Health Train, as it is more often called, will celebrate its 10th anniversary this year.

From the outside, the Health Train looks like a regular train. Only the last one with the image of the Holy Princess Olga stands out from the snake of carriages. This is a temple car. On the threshold of the fourth car - the conference room - I meet the eyes of Professor Voyno-Yasenetsky. The patron of the train looks thoughtfully from a wall portrait. “Hello, come in!”, Yekaterina Samsonyuk invites from behind a long table. She has been running the Health Train for two years. “Our train is a joint project of the Russian railways”and the Government of the Krasnoyarsk Territory,” recalls Ekaterina Georgievna. - We provide residents of remote areas with free quality medical care. We cruise on Krasnoyarsk Territory, Khakassia, we capture part of the Kemerovo and Irkutsk regions.

The health train arrives at each station once a year. When the mobile polyclinic was just starting to work, doctors were receiving at 55 stations. Today there are 75 of them. For 10 years, the Health Train had 552 stops and 94 business trips. 147,257 people were examined in the medical center on wheels. Behind the dry figures are the saved lives of people who were diagnosed with serious illnesses on the train. “Last year, a patient with a dissecting aortic aneurysm was rescued. They suspected that he had a dangerous pathology and sent him to be examined in a regional hospital. There, the man was immediately operated on, - Ekaterina Samsonyuk gives an example. “We also detect a lot of oncology, heart disease (including in children), peptic ulcer, tuberculosis.”

For accurate diagnosis, the Health Train has the most modern equipment. Let's go watch it. Ekaterina Georgievna confidently leads me between the cars and tells me on the go: “More than 70 people work on the train: 17 doctors, 20 paramedics, security guards, cooks, conductors. The conductors clean the cars three times a day, the guards keep order, help elderly patients get into the car. Behind technical side- uninterrupted supply of water, fuel, electricity and much more - the head of the train Svetlana Anatolyevna Vagner answers.

We enter the check-in car. The reception desk is also the reception desk on the train: a counter with windows, stacks of medical cards on the shelves. There are no usual queues. “The main flow of patients comes in the morning. Today there were more than 100 people, ”explains the registrar Daria to the noise of a freight train rushing past the window. And we move on. We pass the offices of the therapist and the pediatrician - they are not up to me now, they are busy with patients. “We have two therapists,” says the leader of the Health Train. - Patients can visit a general practitioner first or go straight to a specialist without a referral. It's comfortable". During the day, visitors to the mobile clinic manage to get around all the necessary doctors. ENT, gynecologist, urologist, dentist, endocrinologist, neurologist, ophthalmologist, surgeon...

In the office of the surgeon Yevgeny Potapov is still free. Congratulations from colleagues flaunt on the walls of the compartment.

- Is it your birthday today?

Yes. Colleagues made a surprise, - the doctor says embarrassed. - There were also balloons, I gave them to little patients.

- Congratulations! What do patients usually come to you for?

With everything (smiles). With pains in the joints, abdomen, back, chest, arms and legs. I examine a person and, depending on the indications, refer them to blood and urine tests, endoscopic diagnostics, ultrasound, X-rays. All this is done in our train. If a person comes with ready-made test results, I can immediately prescribe treatment. But I don’t perform surgical manipulations - there are no conditions here. If the patient is "emergency", I call an ambulance to be taken to the nearest hospital. Such cases are not uncommon. In January, a 15-year-old boy came to me with ulcer bleeding. And the day before yesterday there was a 6-year-old girl with acute complicated appendicitis. Both were hospitalized (there was a knock on the door). Come in, come in.

Ekaterina Georgievna is waiting outside the door. We're going to the lab. “At the end of 2015, the equipment was updated here,” my companion says at the door of the spacious laboratory. Laboratory assistant Galina Laletina joins the conversation. “This device (she points to a white cabinet with a screen) determines the level of glucose in the blood. We also conduct detailed and biochemical blood tests, a general urine test. All studies take 1 hour and 20 minutes. At this time, the patient bypasses the necessary doctors, and when he is released, the results of the tests are already with the therapist. Some tests (gynecological smears, biopsy) take longer to prepare. Their results are sent to the district hospitals where the patient is attached. And the doctors of the Health Train interact with each other through the information system. All protocols in in electronic format, - explains Ekaterina Samsonyuk. “Thanks to this, the doctor, without leaving the office, can see the records of colleagues.”

A nurse peeks out from the optometrist's office:

Come check your eyesight!

- And I'm without a card, I'm a journalist.

Well then... Okay, come on while there are no patients.

The verdict of the ophthalmologist Oleg Fedchenko: - 1.0. “Pick up your glasses boldly,” he admonishes at parting. And again the door to the next car. It's time for an X-ray. “That's so giant!”, - I think, looking at the huge white apparatus. “This is our new digital x-ray machine. With it, you can take any pictures, not just fluorography, - explains Ekaterina Georgievna. - The device weighs more than a ton. To install it and prevent overweight in one direction, the engineers changed the design of the car, mounted special fasteners. Specialists check the serviceability of the equipment at the beginning of each business trip.”

Next to the X-ray machine is his "brother" - a digital mammograph. All equipment of the Health Train cannot be counted: endoscopes, ultrasound machines, electrocardiograph, equipment for functional diagnostics... There are all resources for telemedicine consultations with colleagues from regional and federal clinics. “Now we hold such consultations less often: there are fewer complex neglected cases. There were plenty of them when the train was just starting to work. And no wonder: in some villages there is not even a feldsher-midwife station. People have nowhere to turn for medical help,” says Kateryna Samsonyuk.

The realities of the Siberian hinterland stunned foreign journalists who visited the Health Train in the winter. “In January correspondents from Germany traveled with us. There was a business trip to the north, to Lesosibirsk. There were frosts at 45 degrees, - says my interlocutor. - The Germans were surprised how we endure such a cold (laughs). They were amazed that people even in a 40-degree cold go to the Health Train. Indeed, in Germany there are no problems with the availability of medicine and there are no such large territories like we have in the region.

In the cold, in the heat, on holidays and weekends, the train of health rushes to where the help of doctors is needed. Some villages do not telephone connection and no communication other than the railroad. “Sometimes local doctors twice my age come and ask: “What to do in such and such a situation? There is not always a connection to consult with colleagues, but the decision must be made now,” says the head of the Health Train. I know I know. Not without reason, in 2015, the staff of the mobile medical center became the laureate of the Sibmedportal "Vocation - Doctor" award in the nomination "For work in extreme conditions". By the way, about the conditions.

- Ekaterina Georgievna, how is the life of doctors on the Health Train arranged? How long are business trips?

We have a shift schedule: we work for 15 days and rest for the same amount. During a business trip, my colleagues and I are always together, like on a submarine (smiles). Medics and other employees of the train live in compartments in twos. In the "non-medical" cars there are showers and a dining room.

- From 8 a.m. to 6 p.m., doctors of the Health Train are receiving patients. And in free time what you are doing?

Reading, walking, playing sports. We have our own volleyball team on the train. In some areas we arrange friendly matches with local athletes. In Kansk and Lesosibirsk we go to the pool.

- In general, do not sit on the train for days. And all the same. Half a month on wheels… Not everyone can work like that.

Yes, but we have a permanent team. Some have been working since the very first trips of the Health Train. I first worked as a urologist. I quickly got used to traveling work. It's already a way of life. Before you have time to unpack your bags after a business trip, you are going to hit the road again (laughs).

It's time for Ekaterina Georgievna to go to her office - business. Am I still wandering around on the train next time I stop by here? There are queues in some carriages. Grandmothers perched on folding seats, children look at something through the train window. The younger girl hugged her mother. She reassures: "Don't be afraid, the doctor will just look." There are several people outside the therapist's office. They ask each other in a narrow corridor: “Have you already passed everyone?” “This is my first time on the Health Train. I visited a surgeon, a gynecologist, a urologist, an ENT doctor, an ophthalmologist. The doctors here are great. Attentive, friendly, - patient Tatyana shares her impressions. - We do not live in the outback, from Minino less than 30 km to Krasnoyarsk, but getting to the doctor is a problem. I have to go through Krasnoyarsk to the Emelyanovskaya district hospital. It is difficult to get to the surgeon there, and there is no laura at all. Fortunately, the health train is coming. Our community needs him." And many, many others too.

"Anastasia," Tatyana called as I made my way to the exit. - Please write in the article that we, the patients, congratulate the Health Train on its 10th anniversary. We wish the doctors health, patience and that they always work so well!”.

Anastasia Lemenkova

Moscow - St. Petersburg is the most popular railway line in Russia. Every year, 8.5 million passengers travel between the two capitals. Evgeniy Trofimchuk, director of recreation at the OneTwoTrip online travel service, decided to find out everything about the trains running along the route, and for two weeks he rode non-stop from Moscow to St. Petersburg and back ..

First aid kit will not be provided

Trains have special medical packs (first aid kits), but you will not find pills in them. The fact is that, according to the rules, conductors do not have the right to give passengers pills or medicines, since they do not have a medical education. Nevertheless, guides still undergo the minimum required training: everyone can provide first aid, stop bleeding, make bandages and even take birth.

If someone on the train becomes ill, it is necessary to call the conductor or the head of the train. He will announce over the speakerphone that they are looking for a doctor among the passengers to provide first aid. If there is no doctor, an ambulance is called to the nearest station, and the train will stop there, even if the stop is not scheduled according to the schedule.

Actors serve you

The conductors of some branded trains take compulsory acting courses. There they are taught to speak beautifully, move and even just stand on the platform, and they are also told how to always look good - including in difficult road conditions.

Anyone can become a conductor

Getting a job as a conductor is much easier than being a steward. To do this, you need to contact the nearest railway depot, from where you will be sent to a three-month course. Pass the exam after graduation - and you can get a job! The main thing is to be able to not sleep for 24 hours.

If you want to be promoted to the head of the train in the future, courses are not enough: you need to get a higher education and work in various sections of the railway.

There is a shower!

It's not a myth, it exists! Now there are showers in many branded trains between St. Petersburg and Moscow, and you can use it for a small fee. For example, in double-decker trains it will cost only 150 rubles, you can pay the conductor (in cash or by card if there is a terminal in the car). Most importantly, do not forget a towel and rubber slippers: they will not be given to you on the train. Splashing for a long time will not work either, only 16 liters of hot water are allocated per person.

studio games

Few people know, but the cost of your ticket includes the use of board games: dominoes, checkers and chess. They can be asked from the conductor, but, however, not all trains have games.

Take a seat closer to the conductor

Choose seats at the beginning of the car, closer to the conductor's compartment. There are several bonuses at once: firstly, tea will be brought faster. Secondly, if the neighbors make noise, more chances that the conductor will hear and come to reassure. Plus, there will be a couple of steps to sockets and titanium with boiling water. And you will be among the first to leave, as in the business class of an airplane.

See What You're Buying

Before buying a ticket, search the Internet for information about the cars of the train you are interested in. Prices for tickets in cars of different classes may differ by 100-200 rubles, but one will have air conditioning and a vacuum toilet, while the other will not.

Search in neighboring classes

There are times when higher-class tickets are cheaper than a reserved seat/coupe or only slightly more expensive. Therefore, when searching, do not limit yourself to only the cheapest reserved seat, see all the options.

How to buy the bottom two seats

... Or the top two. If you have ever bought tickets through the Russian Railways website, then you know that it is impossible to buy the top two shelves there: for some reason, the site offers to take two seats on one side of the table (top and bottom). The solution is simple: buy tickets on other sites.

Extend your trip for free

You can get off at any station and within 10 days continue your journey free of charge on the same ticket, you do not need to buy a new one. To do this, you need to find the head of the station at which you got off, and issue a "stopover" with him.

Do not slow down when issuing a ticket

The role plays every hour! The amount that will be returned if you decide to return the tickets is tied to the time, and the time depends on where you bought the ticket: in Russia, the CIS countries or abroad.

In Russia

Almost all the money spent can be returned only if more than 8 hours are left before the train departure: you will be charged a refund fee (192 rubles 70 kopecks as of September 2017), and the rest of the amount will be returned.

If before departure from 8 to 2 hours, the arithmetic becomes more complicated: you will be refunded 100% of the cost of the ticket and only 50% of the cost of the reserved seat. Here you need to clarify: the ticket consists of two parts - the cost of the ticket itself (fare) and the cost of the reserved seat (fee for a seat in the car, and it doesn’t matter if you are traveling in a SV, compartment or reserved seat).

If less than 2 hours are left before departure, you can return 100% of the ticket price, but the entire part of the reserved seat and the refund fee will be withheld. You can return the ticket even after the train has left, the main thing is that no more than 12 hours have passed from that moment.

What part of the ticket price falls on the reserved seat, you can see in the order information file. It will be sent to your email after purchasing the ticket.

If you are still late for the train, do not relax and still run to the ticket office (the return is usually processed there anyway). Ideally, be in time for an interval of no more than 3 hours after the departure of the train, then there will be no difficulties. If up to 12 hours have passed since the departure of the train, you will need to write a claim statement to return the money. And if the train left within a period of 12 hours to 5 days, the only way to return at least part of the money is to attach proof to the application that the delay was not your fault (a certificate from a doctor, for example, will do). If you just overslept, and then decided to postpone the trip to the station, you will not be able to get the money back.

To the CIS and the Baltic States

The full amount, minus the refund fee, can be received if the tickets are returned no later than 24 hours in advance. Less than a day is left before departure, but more than 6 hours - then you will be refunded 100% of the ticket price and 50% of the reserved seat (and withhold the fee). 1 hour before departure, you can get 100% of the ticket price, and the reserved seat cannot be returned. And if the train leaves in an hour, then tickets can no longer be returned, and you will lose money.

To foreign countries

The full amount will be refunded if you manage to return the ticket no later than 6 hours before the train departure, you will only have to pay a refund fee (for international destinations it is 10 euros). If the train leaves in less than 6 hours, the ticket cannot be returned.

The high-speed train "Lastochka" left on the afternoon of October 2 Nizhny Novgorod to Moscow. Here is what Alexander Sokolov told the Pravmir correspondent: the editor of the Anthropogenesis.ru portal who was riding this train: “The elderly man became ill, people shouted: “Doctor!”.

The conductor came running, the police came. They began to shout: “Who has a blood pressure monitor?”. The passengers found the device. But there was nothing on the train. If there was a first aid kit, they would have brought it. According to him, the conductor and one of the passengers took turns giving the victim a heart massage, but the impression was that they did not know how to provide first aid.

The Lastochka staff contacted the ambulance substation, but the train went 40 minutes to the nearest half-station. All this time, the victim was given first aid, but when the train stopped and the ambulance doctor entered, he pronounced him dead. The ambulance doctor refused to take the body, demanding to call the police, the policemen who were in the car argued with him. As a result, the body was carried to the platform on a soft stretcher, and the train left.

“I felt sorry for the conductor. It was clear that he was worried and tried to save this person as best he could, - the witness said, - it is not known if they could help the person if there was a first-aid kit. But she wasn't! Lastochka has neither first aid nor people who can provide it. But they sell wonderful souvenirs,” Alexander Sokolov told us.

Was there a first aid kit in that Lastochka?

When asked why Lastochka did not have a first-aid kit, the press service of the Federal Passenger Campaign (a structure of Russian Railways) answered:

– All Lastochka trains operated by JSC FPC are equipped with first aid kits in accordance with the current Sanitary Rules for organizing passenger traffic, approved by the Decree of the chief sanitary doctor Onishchenko G.G. dated March 4, 2012 No. 12.

– The train is coming non-stop, it turns out that a heart attack in the "Swallow" with a high probability can lead to death?

- The train can stop at any nearest station, even if it is not scheduled in the schedule, in order to provide assistance to the passenger as soon as possible. To do this, you need to contact the head of the train, who will call the doctors to the nearest station. Without waiting for the arrival of the doctors, the head of the train must also find out whether there are doctors among the rest of the passengers using the speakerphone or through the conductors. Train conductors long distance V without fail are trained to provide first aid to passengers.

The press service of JSC FPC reported that there was a first-aid kit in Lastochka, and following the results of an internal investigation of violations in the actions of employees railway transport was not identified.

Will the conductor's first aid kit help the passenger?

The press service of JSC FPC told us that all the cars passenger trains long-distance trains, including the Lastochka electric trains, are equipped with medical supplies for first aid in accordance with the order of the Ministry of Social Development of the Russian Federation No. 498n dated May 5, 2012.

The first-aid kit includes means for temporarily stopping bleeding and fixing fractures (tourniquet, bandages, splints, adhesive tape, etc.), a device for pulmonary resuscitation (breathing bag with masks for newborns and adults), there is even a kit for there are other medical devices to help you deliver, such as a frameless stretcher.

But can a first aid kit really save someone? Will it help a person with a heart attack survive? There are no anti-shock drugs in the railway first-aid kit, these are potent drugs that require special storage conditions. There are no defibrillators on trains. A defibrillator is an expensive and specific thing and is found only in intensive care units. Doctors or nurses are also not allowed on the train. As a rule, a medic can be found among the passengers. But for a physician, providing assistance in the field also often turns into a problem.

Cardiologist, candidate of medical sciencesAnton Rodionov previously told Pravmirabout how medical care is arranged on board an aircraft, and why a doctor should help an injured person on the street, but does not have the right to do so.

In addition, even if a doctor is found, he does not carry any medicines or equipment with him.

Perhaps, first-aid kits on trains and planes should be more specialized, discussions about this have long been ongoing in the relevant departments. There is another problem - an ambulance arriving at the nearest station cannot always deliver the victim to the hospital, the nearest specialized hospital may be too far away. The idea of ​​creating a special unit of transport medicine is being discussed, but the Ministry of Transport and the Ministry of Health have not yet reached an agreement on this issue.

Where to go, what to ask?

Where can the relatives of a deceased passenger go? What can they expect? Under the insurance, which is sold together with the train ticket, you can only receive compensation if the passenger's injury is related to the movement of the train, for example, in an accident.

But, according to the lawyerStalin Gurevich,the absence of a first-aid kit on the train may be a reason to go to court: “The absence of a first-aid kit on the train is a violation of the consumer protection law and the provision of services that do not meet safety requirements is a reason to bring criminal and civil liability. But there is an important question - was the lack of a first aid kit and first aid skills of the conductor the cause of death? Could this person have been saved?

If the relatives of the deceased passenger want to find out, they need to apply to the Investigative Committee, with a statement about initiating a criminal case and conducting a forensic medical examination. If the examination establishes causal relationships, then the perpetrators can be held accountable.”

What to do if a person becomes ill on the train

If a person next to you becomes ill, the first thing to do is to inform the guide about it. The conductor is obliged to contact the head of the train, if he does not do this - insist, go to the next car, contact another conductor.

The guide must have a first aid kit, all guides are trained in first aid. The guide must provide first aid using the first aid kit.

The head of the train should use the speakerphone to try to find a doctor among the passengers and call an ambulance to the nearest station, if necessary.

Remember that actions must be coordinated, ask the conductor how you can help (support the person, bring water, mark the time), do not panic and do not frighten other passengers. Remember what is happening in order to tell the doctor the necessary information at the station, to answer questions.

Do not get annoyed and do not resent what is happening - the train workers are doing everything they can. If you do not feel the strength to help, look at a person in serious condition, it is better to go out into the corridor of the train, into the vestibule, into the dining car and rest - do not interfere with those who are fighting for the life of the victim.