RUSSIA'S EMERGENCY SERVICES IN CRISIS : POOR RESPONSE, CONDITIONS PREVAIL.

Byline: Dave Carpenter Associated Press 

Weapons extracted from patients are displayed like trophies in a doctors' lounge at Russia's biggest emergency hospital. Bullets, nails, a carving knife and a switchblade that once was embedded in a neck gleam from a makeshift showcase.

``We used to have a better collection, but policemen drop by from time to time and take them away,'' Dr. Sergei Polyakov tells a visitor at the huge Sklifosovsky hospital.

Russia's steep rise in violent crime since the Soviet era often evokes comparisons to the wild days of Chicago in the 1920s. But less noticed is the extra strain it has put on Russia's crumbling emergency medical services - a victim of the deterioration in the nation's health care system.

Dialing the 03 emergency telephone number is an unhappy gamble for many Russians, who must rely on a system often alarmingly lacking in equipment, medicine and personnel.

The last line of defense is emergency room doctors - badly paid, overworked and often required to do heroic work under trying conditions.

``I can't say if Russian doctors are the best, but we're forced to work more with our eyes, ears and hands,'' says Dr. Ryurik Noyevich, who also works at Sklifosovsky.

Asked about the handicaps they work under, he shrugs: ``Our conditions reflect our country's condition.''

Troubles in the emergency medical care system are evident from the moment someone calls for help.

Unlike President Boris Yeltsin, who is whisked off to elite Kremlin clinics when his heart acts up, ordinary people dialing 03 know the ambulance service or ``skoraya pomoshch'' - literally, fast help - often doesn't live up to its name.

Even the director of Moscow's main ambulance service, Dr. Igor Elkis, concedes the response rate - ambulances arrive within 20 minutes 86 percent of the time - could be better.

He blames traffic jams, authorities' failure to punish motorists who impede ambulances and a lack of computers, which are just now being installed.

In the spartan dispatch center, 100 pink-uniformed women field emergency calls at bare desks, their scribbled notes then conveyed to co-workers who walk them across the long room to dispatchers.

White ambulance vans with red stripes ply the streets cautiously and often without sounding their sirens, their drivers seemingly resigned to a lack of the respect that emergency vehicles merit abroad.

The Russian press is full of horror stories about patients who suffer or die while ambulances are stuck in traffic and of ambulance crews that take cigarette breaks before responding to urgent calls.

The situation is no better when victims arrive at hospitals in provincial Russia. Patients there often must supply their own medicine, sleep in corridors and pay bribes for surgery - or maybe just to have sheets and bedpans changed.

Those who are fortunate are taken to Sklifosovsky, which bills itself as the country's leading emergency care center.

Dingy and gloomy, there is no chance it could be confused with the setting of the TV hit ``ER.''

A walk through Sklifosovsky's dimly lit labyrinth reveals run-down conditions and a shortage of staff - patients outnumber them 3-to-1. Linoleum is faded and cracked; paint on the walls is chipped. Electronic equipment badly lags the West. And patients are often crowded together with no privacy.