Organization of Emergency Medical Care: The Soviet Experience

Hospital emergency departments play an increasingly important role in serving emergency and non-emergency medical needs of the public. Reports on how foreign medical services solve the numerous problems of delivery of emergency care might provide a welcome source of fresh and useful ideas in this field. Unfortunately, Organization of Emergency Medical Care: The Soviet Experience does not fulfill such expectations. The small text, translated and published under a National Science Foundation grant, is peppered with polemics against medicine as practiced in "western capitalist nations." In reporting statistics of trauma (Russian newspapers are the reference sources cited), actual numbers of injuries in western countries are presented, while percentages only are given for eastern nations. Organization of Emergency Medical Care is a translation of the Russian text published in 1969, carrying references no later than 1965. At that time, at least, soviet treatment of emergencies in major cities was based on the principle of Skoraya, i.e., transport of expert care to the patient-not the reverse as practiced in western countries. According to the text, many hours might be spent administering to patient needs prior to transport to hospital. In my opinion this would place an enormous strain on medical staff capacity, no matter how broad. All readers would readily agree. with the author's conclusion that ". . . progress depends upon quality and amount of treatment administered on the spot and enroute... ." However, nowhere in the book is there documentation of the efficacy of Skoraya compared to the alternative system of rapid transport with simultaneous stabilization, cardiopulmonary resuscitation, etc., as required. The text also contains chapters describing treatment of trauma, cardiovascular disease, cerebrovascular disease and poisoning. These reviews are seven to ten years old and thus are of little more than historical interest. In addition, drug nomenclature is of a foreign variety and recourse to foreign drug indexes is necessary for product identification. SAUL LANDE Department of Emergency Medicine Hospital of St. Raphael New Haven, CT. and Department of Dermatology Yale University School of Medicine