The article suggests some ways of solving the problem of optimizing the ambulance services in a single city with large population more then 1 million of peoples. The roots of these problems are social and territorial. The nature of its appiarence related to the fact that development of emergency medical services usually lagging behind transformation of the city.

This article describes pre-hospital diagnostics and anticoagulant therapy in according to actual Russian, European and American guidelines. It makes diagnostic criteria for saphenous thrombosis, deep vein thrombosis, pulmonary embolism and insufficiency of laboratory and instrumental methods as well as the choice and dosing regimen for basic anticoagulants in pre-hospital.

Pulmonary embolism (PE) — an acute occlusion of the trunk or branches of the pulmonary arterial system then thrombus formed in the veins of the systemic circulation or in the right part of the heart. Pulmonary embolism in 95 % of cases is result of deep vein thrombosis (DVT). According to the modern literature, the term «pulmonary embolism» often replaces the term «venous thromboembolism». PE is the third most common form of cardiovascular disease after coronary heart disease and stroke. It causes the annual death of 300 500 thousand people. Thrombophlebitis is the most frequent source of thrombus formation during PE. The article describes diagnostic techniques in this type of pathology useful in practice of emergency doctors during initial examination.

The article says about possibilities of telemedicine’s use for modern diagnostics of acute coronary syndrome on the pre-hospital stage and differentiated approach to the assignment of thrombolytic therapy.

This article unified the general principles of the differential diagnosis of clinical symptoms of illnesses that cause a syndrome of «acute abdomen» in childhood. The authors conclude that the differential diagnosis of acute surgical abdominal diseases in children should be stratified between the inflammatory, mechanical and traumatic processes, as well as within them. In the initial stages of development of acute surgical abdominal diseases, depending on the etiological factor, adaptation reactions have nosological configuration. Evolution of end-stage acute abdominal processes and primary traumatic collapse do not have nosological configuration.

Injuries of the musculoskeletal system are one of the most common injuries during industrial and traffic accidents, as well as natural disasters. According to WHO statistics, the heavy mechanical trauma is a leading cause of death, the second one only are tumors and cardiovascular diseases, especially in patients younger than 45 years.

Over 5 million central venous catheters (CVC) are inserted annually in the United States for hemodynamic monitoring or medication administration. CVC are associated with significant infectious, mechanical, and thrombotic complications and should be discontinued when they are no longer needed for patient monitoring or resuscitation. Proper insertion technique is essential in order to prevent CVC-related complications from occurring.

The article described in detail changes of ECG mimesis myocardial infarction on the electrocardiogram in various diseases. Clinical examples were provided which allowing higher quality differential diagnosis of ECG changes to do.

The problem of differential diagnosis of paroxysmal states is one of the most difficult tasks. It is given the serious prognosis of epilepsy and syncope. The correct and early diagnosis influence often not only on health but also the life prognosis for the patient. Diagnosis of epileptic seizures and syncope require a comprehensive approach and includes not only the clinical examination and careful history collection, but neuropsychological, neuroimaging and laboratory research methods as well, and involvement of other medical professionals into the clinical exams.

The article raised problems of normal functioning of the ambulance service in Chelyabinsk, as well as the etiology of conflicts during ambulance service staff arrival on scene. Every third resident of the city call for emergency medical care, on average, for the year. The purpose of the investigation was spread of our report among the city's population and recognition of factors which slow down the working activity of the emergency services and we attempt to inculcate a culture of our citizens who call an ambulance. The main method of investigation was a statistical analysis of the material previously published by staff and statisticians of ambulance stations.