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The ongoing changes the system of emergency care (EC) in the Russian Federation (RF), especially its in-hospital component, require modifications of applicable laws. This paper analyzes past development and evaluates the current state of regulations pertinent to hospital-based EC in RF. We have reviewed and analyzed the regulatory statutes that governed hospital-based emergency care in Russia between 1735 and 2013. The study traces the development of past regulations (legal and normative acts) applicable to EC in RF. Main regulations currently in effect are characterized. At present, there already exists a body of laws supporting further modernization of hospital-based EC in Russia. Most recently, the legal foundation has been laid for previously novel concepts such as short-term observation, and for the creation of hospitalbased centers of EC. Work in progress involves active steps towards clinical recommendations and protocols for the envisioned new structure of EC in the RF. The paper will be of interest to professionals studying global emergency medicine development. It will help researchers and clinical practitioners in the fields of emergency medical care and healthcare management by understanding the link between regulatory deficiencies and barriers to improving emergency department operations. [ABSTRACT FROM AUTHOR]

Russia's national healthcare system is undergoing significant changes. Those changes which affect healthcare financing are particularly vital. As has often been the case in other nations, the emergency care field is at the forefront of such reforms. The ongoing challenges constitute the environment in which the hospital-based specialty of emergency medicine needs to develop as part of a larger system. Emergency care has to evolve in order to match true needs of the population existing today. New federal regulations recently adopted have recognized emergency departments as the new in-hospital component of emergency care, providing the long-needed legal foundation upon which the new specialty can advance. General knowledge of Western-style emergency departments in terms of their basic setup and function has been widespread among Russia's medical professionals for some time. Several emergency departments are functioning in select regions as pilots. Preliminary data stemming from their operation have supported a positive effect on efficiency of hospital bed utilization and on appropriate use of specialists and specialized hospital departments. In the pre-hospital domain, there has been a reduction of specialized ambulance types and of the number of physicians staffing all ambulances in favor of midlevel providers. Still, a debate continues at all levels of the medical hierarchy regarding the correct future path for emergency care in Russia with regard to adaptation and sustainability of any foreign models in the context of the country's unique national features. [ABSTRACT FROM AUTHOR]