vestimИзвестия Национальной академии наук Беларуси. Серия медицинских наукProceedings of the National Academy of Sciences of Belarus, Medical series1814-60232524-2350The Republican Unitary Enterprise Publishing House "Belaruskaya Navuka"10.29235/1814-6023-2026-23-3-251-264vestim-1107Research ArticleКЛИНИЧЕСКАЯ И ЭКСПЕРИМЕНТАЛЬНАЯ МЕДИЦИНАCLINICAL AND EXPERIMENTAL MEDICINEУнифицированный алгоритм первичного осмотра пациента при оказании скорой медицинской помощи на догоспитальном этапеStandardized algorithm for the primary assessment of patients during the prehospital phase of emergency medical carehttps://orcid.org/0009-0001-8266-952XСтанишевскийА. Л.StanishevskyA. L.

Станишевский Александр Леонидович – ст. преподаватель 

ул. П. Бровки, 3/3, 220013, г. Минск 

Alexander L. Stanishevsky – Senior Lecturer. Institute for Advanced Training and Retraining of Healthcare Personnel

3/3, P. Brovki Str., 220013, Minsk 

als.74@mail.ruhttps://orcid.org/0009-0003-9682-7909СоколовЮ. А.SokolovYu. A.

Соколов Юрий Анатольевич – канд. мед. наук, доцент, проректор по учебной работе

пр. Дзержинского, 83, 220083, г. Минск 

Yuriy A. Sokolov – Ph. D. (Med.), Associate Professor, Vice-Rector for Academic Affairs

83, Dzerzhinsky Ave., 220083, Minsk 

uchprorector@bsmu.byАльховикД. В.AlkhovikD. V.

Альховик Дмитрий Васильевич – гл. врач 

ул. Мясникова, 39, 220030, г. Минск

Dmitry V. Alkhovik – Chief Physician 

39, Myasnikova Str., 220030, Minsk

alkhovik@comr.byhttps://orcid.org/0000-0001-7849-6497БогданВ. Г.BogdanV. G.

Богдан Василий Генрихович – д-р мед. наук, профессор, академик-секретарь

пр. Независимости, 66, 220072, г. Минск

Vasiliy G. Bogdan – D. Sc. (Med.), Professor, Academician Secretary

66, Nezavisimosti Ave., 220072, Minsk

medic@presidium.bas-net.byСуковатыхА. Л.SoukovatykhA. L.

Суковатых Андрей Леонидович – ст. преподаватель. Институт повышения квалификации и переподготовки кадров здравоохранения

ул. П. Бровки, 3/3, 220013, г. Минск 

Andrey L. Soukovatykh – Senior Lecturer. Institute for Advan­ ced Training and Retraining of Healthcare Personnel 

3/3, P. Brovki Str., 220013, Minsk

sandleon@mail.ruНовиковаН. П.NovikovaN. P.

Новикова Наталья Петровна – канд. мед. наук, доцент, заведующий кафедрой. Институт повышения квалификации и переподготовки кадров здравоохранения

ул. П. Бровки, 3/3, 220013, г. Минск

Natal’ya P. Novikova – Ph. D. (Med.), Associate Professor, Head of the Department

3/3, P. Brovki Str., 220013, Minsk

emergency@bsmu.byЖинкоА. Е.ZhinkoA. E.

Жинко Александр Евгеньевич – гл. врач. Главный внештатный специалист по скорой медицинской помощи Министерства здравоохранения Рес­публики Беларусь

ул. Захарова 52/1, 220088, г. Минск 

Alexander E. Zhinko – Chief Physician 

52, building 1, Zakharova Str., 220088, Minsk

smp_minsk@minsk-smp.byБелорусский государственный медицинский университетБеларусьBelarusian State Medical UniversityBelarusРеспубликанский центр организации медицинского реагированияБеларусьRepublican Center for Organization of Medical ResponseBelarusОтделение медицинских наук Национальной академии наук БеларусиБеларусьDepartment of Medical Sciences of the National Academy of Sciences of BelarusBelarusГородская станция скорой медицинской помощиБеларусьCity Emergency Medical Care StationBelarus202630082026233251254Copyright © Станишевский А.Л., Соколов Ю.А., Альховик Д.В., Богдан В.Г., Суковатых А.Л., Новикова Н.П., Жинко А.Е., 20262026Станишевский А.Л., Соколов Ю.А., Альховик Д.В., Богдан В.Г., Суковатых А.Л., Новикова Н.П., Жинко А.Е.Stanishevsky A.L., Sokolov Y.A., Alkhovik D.V., Bogdan V.G., Soukovatykh A.L., Novikova N.P., Zhinko A.E.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://vestimed.belnauka.by/jour/article/view/1107

Качество оказания скорой медицинской помощи на догоспитальном этапе детерминировано степенью стандартизации алгоритмов первичного осмотра (ПО). В условиях жесткого лимита времени и высокой степени неопределенности унифицированные протоколы минимизируют субъективизм диагностического поиска и оптимизируют тактику ведения пациента. Цель исследования – разработать и научно обосновать унифицированный алгоритм ПО пациента. Проведен анализ нормативных правовых актов, отечественных и зарубежных научных публикаций, экспертных оценок качества оказания медицинской помощи. Установлено, что игнорирование биомеханики травмы и несистемное проведение ПО формируют феномен «диагностической слепоты» и «маскированного» клинического профиля, при котором частота пропущенных скрытых повреждений при политравме достигает 20–30 %. Доказано, что дефекты сбора информации предопределяют ошибки постановки первичного диагноза и выбора лечебной тактики, что в последующем приводит к нарушению преемственности между этапами оказания помощи. Разработан унифицированный алгоритм, который системно интегрирует анализ биомеханики травмы и поэтапный протокол DRSABCDE. Алгоритм реализует принцип «максимум информации за минимум времени» и приоритетное исключение жизнеугрожающих состояний. Его внедрение позволит минимизировать влияние субъективного фактора, стандартизировать тактику ведения пациентов с критическими состояниями, сократить время принятия решений и повысить юридическую защищенность свидетелей первого контакта и медицинских работников.

The quality of emergency medical care provided in the prehospital setting is directly dependent on the standardization of the algorithms used during the initial assessment. In situations of acute time constraints and significant clinical uncertainty, the use of standardized protocols helps reduce subjectivity in the diagnostic process and streamline patient management strategies. The aim of this study was to develop and scientifically substantiate a standardized algorithm for the initial patient examination. The study involved an analysis of legislative and regulatory documents, domestic and international scientific sources, as well as expert opinions on the quality of medical care. It was found that neglecting the biomechanical characteristics of the injury and the absence of a strict sequence during the initial examination contribute to the development of “diagnostic blindness” and an “obfuscated” clinical picture, in which the proportion of undetected hidden injuries in cases of multiple trauma ranges from 20 to 30 %. It has been established that errors made during the collection of medical history and objective data lead to an incorrect initial diagnosis and the selection of a suboptimal treatment strategy, which subsequently results in a break in continuity between the various stages of care. A standardized algorithm has been developed that combines an analysis of the biomechanics of the injury with the sequential application of the DRSABCDE protocol. This algorithm is based on the principles of obtaining the most comprehensive information possible in the shortest possible time and prioritizing the exclusion of pathological conditions that pose an immediate threat to life. The practical implementation of the proposed approach will reduce the influence of subjective factors, ensure consistency in tactical decisions when treating critically ill patients, shorten the decision-making phase, and strengthen the legal protection of first responders and healthcare professionals.

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The authors declare that there are no conflicts of interest present.