Functional divisions of the medical evacuation stage. Medical evacuation stage, definition of the concept, tasks, deployment scheme
Administration of antidotes and antibotulinum serum;
Complex therapy for acute cardiovascular failure, heart rhythm disturbances, acute respiratory failure, coma;
Dehydration therapy for cerebral edema;
Correction of gross violations of the acid-base state and electrolyte balance;
A set of measures in case of ingestion of hazardous substances;
Administration of analgesic, desensitizing, anticonvulsant, antiemetic and bronchodilator drugs;
The use of tranquilizers and neuroleptics in acute reactive conditions.
The optimal period for providing qualified medical care is the first 8-12 hours after the injury, but delayed measures of the first stage (the optimal period of provision is up to 24 hours from the moment of the injury), delayed measures of the second stage (the optimal period of provision is up to 36 hours from the moment of the injury).
Specialized medical care– the final form of medical care, is exhaustive. It is provided by highly specialized doctors (neurosurgery, otolaryngologists, ophthalmologists, etc.) who have special diagnostic and treatment equipment in specialized medical institutions. The profiling of medical institutions can be carried out by assigning them teams of specialized medical care with appropriate medical equipment. The optimal period for providing specialized medical care is 24-48 hours from the moment of injury. There are surgical and therapeutic specialized medical care.
Depending on the type and scale of the emergency, the number of people affected and the nature of the damage, the availability of forces and means, the state of territorial and departmental health care, the distance from the emergency area of hospital-type medical institutions capable of providing the full scope of qualified care and specialized care activities of their capabilities, there may be Various options have been adopted for providing medical care to those affected by emergencies, namely:
Providing only first or pre-medical aid to the injured before their evacuation to hospital-type medical institutions;
Providing the injured before their evacuation to hospital-type medical institutions, in addition to first or pre-medical aid, and first medical aid;
Providing qualified medical care to the injured before their evacuation to hospital-type medical institutions, in addition to first, pre-medical, first aid and emergency measures.
Before evacuating those affected to hospital-type medical institutions, in all cases they must take measures to eliminate current life-threatening conditions, prevent various severe complications and ensure transportation without significant deterioration of their condition.
3.3 Organization of work at the stages of medical evacuation during liquidation of medical consequences of an emergency
The modern system of medical evacuation measures provides for the deployment of medical evacuation stages by all medical units and health care facilities, regardless of their departmental affiliation.
Under medical evacuation stage understand medical units and institutions deployed along the evacuation routes for the affected (patients) and providing their reception, medical triage, provision of regulated medical care, treatment and preparation (if necessary) for further evacuation.
Stages of medical evacuation in the VSMC system:
· formation and establishment of a disaster medicine service;
· medical formations and medical institutions of the Ministry of Health and Social Development of Russia;
· formations and establishments of the medical service of the Ministry of Defense of Russia, the medical service of the Ministry of Internal Affairs of Russia, the medical service of Civil Defense and other ministries and departments deployed along the evacuation routes of those affected from the emergency area for their mass reception, medical triage, provision of medical care, preparation for evacuation and treatment.
Each stage of medical evacuation carries out certain treatment and preventive measures, which together constitute the volume of medical care characteristic of this stage. The organization of medical evacuation stages is based on general principles, according to which, as part of the medical evacuation stage, functional units are deployed that ensure the implementation of the following main tasks:
Reception, registration and medical triage of injured (patients) arriving at this stage of medical evacuation - reception and sorting department;
Sanitary treatment of the affected, decontamination, degassing and disinfection of their uniforms and equipment - special processing department (site);
Providing medical care to the affected (patients) – dressing room, operating and dressing department, procedural, anti-shock, intensive care wards;
Hospitalization and treatment of affected (patients) - hospital department;
Accommodation of the injured and sick who are subject to further evacuation - evacuation department;
Accommodation of infectious patients with mental disorders – insulator.
Schematic diagram of the deployment of the medical evacuation stage
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The medical evacuation stage also includes management, pharmacy, laboratory, and business units.
The medical evacuation stage, intended to provide first medical aid, can be:
Medical aid points (MAP), deployed by medical and nursing teams;
Surviving (in whole or in part) clinics, outpatient clinics, local hospitals in the affected area;
Medical centers of the medical service of the Russian Ministry of Defense, Ministry of Internal Affairs, Civil Defense troops, etc.
Qualified and specialized medical care and treatment are carried out at subsequent stages of medical evacuation, which can be:
· hospitals of the disaster medicine service, multidisciplinary, profiled, specialized hospitals, clinical centers of the Russian Ministry of Health and Social Development, medical forces of the Russian Ministry of Defense (special-purpose medical units, medical battalions, hospitals, etc.);
Given the poor development of muscles, for children under three years of age, in order to temporarily stop external bleeding from the distal parts of the extremities, in most cases it is enough to apply a pressure bandage to the injured limb (without resorting to a hemostatic tourniquet or twisting).
When performing closed cardiac massage on children, it is necessary to calculate the strength and frequency of pressure on the lower part of the sternum, so as not to cause additional trauma to the chest of the affected person.
The removal and removal of children and the hearth should be carried out first and be accompanied by relatives, easily injured adults, rescue personnel, etc. When organizing medical evacuation support, it is necessary to provide for the strengthening of the stages of medical evacuation, at which qualified and specialized medical care is provided by specialized pediatric teams.
Topic No. 4. Preparation of medical and preventive institutions (HCI) for work in emergency situations
Study questions:
4.1. Measures to improve the sustainability of the functioning of medical institutions in emergency situations.
4.2. Measures to prevent and eliminate the consequences of emergency situations in medical institutions.
4.3. Organization of work of medical institutions in emergency situations.
4.4. Evacuation of medical institutions.
4.1. Measures to improve the sustainability of the functioning of medical institutions in emergency situations
An important role in solving the problems of medical and sanitary provision of the population in emergencies belongs to healthcare facilities:
· therapeutic and preventive (hospitals, clinics, dispensaries, etc.);
· sanitary-hygienic and anti-epidemiological institutions (state sanitary and epidemiological surveillance centers, anti-plague stations and institutes, research institutes, etc.);
· medical supply institutions (pharmacies, pharmaceutical warehouses, bases, stations and blood transfusion institutes);
· educational research institutions of medical profile.
Some of them serve as the basis for the creation of institutions and units of the disaster medicine service and participate in the implementation of medical evacuation, sanitary and hygienic and anti-epidemic measures, others provide healthcare facilities and the disaster medicine service with means of providing medical care and treatment. The solution to problems of health care provision for the population in emergencies largely depends on the degree of readiness and sustainability of the functioning of healthcare facilities and the organization of interaction between them.
Health care authorities and institutions are entrusted with the task of providing health care in emergencies, which confronts health care institutions with the need to operate sustainably in any extreme situation.
Sustainability of functioning of healthcare facilities– advance targeted preparation of the facility for work in emergency situations in peacetime and in wartime, including administrative, organizational, engineering, technical, material and economic, sanitary and anti-epidemic, security, educational (personnel training) measures, as a result of which the risk of damage to the facility is reduced and ensures the fulfillment of wartime tasks and the occurrence of peacetime emergencies.
For these purposes, general and special medical and technical requirements are imposed on existing or planned for construction medical and preventive healthcare institutions.
TO general Medical-technical requirements refer to requirements specific to healthcare facilities and implemented in all projects.
Common questions on which healthcare institutions are assessed for resilience in extreme conditions in peacetime and war include:
· analysis of initial data on the characteristics of the object, which determine the state of stability of its operation;
· forecasting the possible impact on objects of damaging factors in the event of disasters in peacetime and modern weapons in wartime;
· assessment of the facility’s readiness to operate in extreme conditions in peacetime and wartime, taking into account the characteristics of the region, city and the predicted situation in the event of disasters in peacetime and wartime;
· determination of a list of measures that increase the sustainability of the facility and the timing of their implementation;
· determination of criteria for restoration and resumption of operation of an object exposed to damaging factors.
TO special include requirements that depend on natural factors (seismicity, permafrost, low groundwater, etc.), on the region of development (proximity to nuclear power plants 17
Medical evacuation stage I
Medical evacuation stage
in military medicine - medical centers and medical institutions deployed along evacuation routes with the task of receiving, medical triage of the injured and sick, providing medical care, treatment and preparing them for further evacuation. in Civil Defense - definition of E. m. e. the same as in military medicine. However, the Civil Defense medical service system, as a rule, provides for the deployment of only two stages; the first - first aid units, the second - .
1. Small medical encyclopedia. - M.: Medical encyclopedia. 1991-96 2. First aid. - M.: Great Russian Encyclopedia. 1994 3. Encyclopedic Dictionary of Medical Terms. - M.: Soviet Encyclopedia. - 1982-1984.
See what the “medical evacuation stage” is in other dictionaries:
Stage of medical evacuation of the population- The stage of medical evacuation is the formations and institutions of the disaster medicine service, as well as other medical institutions deployed along the evacuation routes for the injured (patients) and providing their reception, medical triage, provision... ... Official terminology
Medical centers and medical institutions deployed along evacuation routes with the task of receiving, medical triage of the injured and sick, providing them with medical care, treatment and preparing them for further evacuation... Large medical dictionary
Definition of E. m. e. the same as in military medicine. However, the Civil Defense medical service system, as a rule, provides for the deployment of only two stages; the first first aid units, the second hospital base... Large medical dictionary
Formations and establishments of disaster medicine services, as well as other medical institutions deployed along the evacuation routes of the affected (patients) and providing their reception, medical triage, provision of regulated medical care,... ... Dictionary of emergency situations
I (OPM) is a mobile medical unit of the Civil Defense Ministry, designed to provide first aid to the injured and sick in areas affected by disasters, in areas of natural disasters, in case of major industrial accidents and to prepare them for evacuation.… … Medical encyclopedia
- (historical; PPM) stage of medical evacuation in the Red Army (1925-1941), deployed in battle by the medical unit of the regiment with the task of providing first medical aid to the wounded and sick and preparing them for further evacuation; predecessor... ... Large medical dictionary
Large medical dictionary
The stage of medical evacuation in the Air Force, deployed at the airfield by the medical service of the aviation technical unit to provide pre-medical care and evacuate the injured and sick to the medical center of the aviation technical unit ... Medical encyclopedia
- (omedb) 1) a special part of the division intended for its medical support; 2) the stage of medical evacuation, deployed in the military rear area to provide qualified medical care to the injured and sick, their treatment and... ... Medical encyclopedia
- (MPP) is the main unit of the regiment’s medical service, intended to provide medical support to its personnel in peacetime and wartime. In peacetime, MPP carries out medical, preventive, sanitary and hygienic and... ... Medical encyclopedia
The system of medical and evacuation support for the population in emergency situations includes a set of scientifically based principles of organizational and practical measures to provide medical care and treatment to the affected population associated with its evacuation outside the disaster zone (source) and the forces and means of the disaster medicine service intended for this .
The organization of the medical evacuation support system is influenced by the following basic conditions:
Type of disaster;
Size of the lesion;
Number of people affected;
The nature of the pathology, the degree of failure of health care forces and means in the disaster zone;
The state of the material and technical equipment of the QMS;
Level of personnel training;
Presence of dangerous damaging factors in the area (RV, SDYAV, fires), etc.
The general principle of medical and evacuation support in emergency situations there is basically a two-stage system of providing medical care and treating the injured with their evacuation to their destination.
Medical formations and medical institutions deployed along the evacuation routes of those affected in their zone (region) of the disaster and intended for mass reception, medical triage, provision of medical care to the affected, preparing them for evacuation and treatment were named "Medical evacuation phase."
The first stage of medical evacuation, intended primarily for the provision of first medical and first aid, are the medical institutions preserved in the emergency zone, collection points for those affected, deployed by ambulance teams and medical and nursing teams that arrived in the emergency zone from nearby medical institutions. The second stage of medical evacuation consists of existing and operating outside the emergency zone, as well as additionally deployed medical institutions, designed to provide comprehensive types of medical care - qualified and specialized, and to treat those affected until the final outcome. Each stage of medical evacuation is assigned a certain amount of medical care (list of treatment and preventive measures).
The main types of assistance in the outbreak or at its border are First Medical, First Aid and First Medical Aid. Depending on the situation, certain categories of victims may receive elements of qualified medical care here.
At the 2nd stage of medical evacuation the provision of qualified and specialized medical care in full, treatment until the final outcome and rehabilitation are ensured.
The LEO system offers the following types of medical care:
First aid;
First aid;
First medical aid;
Qualified medical care;
Specialized medical care.
A characteristic feature of providing medical care to those affected is:
dismemberment,
Dispersal (echeloning) of its provision in time and location as those affected are evacuated from the source of the disaster to inpatient medical institutions.
The degree of division (echelon) of medical care varies depending on the medical situation in the disaster zone. Based on it, the volume of medical care can also change - expand or contract. However, measures should always be taken to save the life of the affected person and reduce (prevent) the development of dangerous complications.
Each stage of medical evacuation has its own characteristics in the organization of work. However, in its composition it is necessary to create conditions for reception, accommodation and medical care. triage of the affected, premises for medical care, temporary isolation, san. processing, temporary or definitive hospitalization, awaiting evacuation, and service units. To provide first medical and first aid at the place where the injury occurred or close to it, as well as individual measures of first medical aid, the deployment of functional departments on the ground is not required. The need to organize the 1st stage of medical evacuation is due to the fact that the distance between the disaster area and inpatient medical institutions can be significant. A certain part of the affected people will not withstand a long evacuation directly from the source of the disaster after providing them with only the first medical care received in the source or on its border. In the emergency medical service in emergencies, two directions in the medical provision system are objectively identified. assistance to the affected and their treatment in extreme conditions:
when providing medical assistance to those affected in full can be provided by the forces of the facility and local territorial healthcare
when to eliminate honey. consequences of a major disaster, it is necessary to deploy mobile forces and assets from other areas and regions. Due to the fact that with a two-stage system of epidemiological surveillance of the population in emergency situations, honey.
Assistance is divided into two basic requirements:
Continuity in consistently carried out treatment and preventive measures;
Timeliness of their implementation.
Continuity in the provision of medical care and treatment is ensured by:
The presence of a unified understanding of the origin and development of the pathological process, as well as uniform, pre-regulated and mandatory principles for medical personnel for the provision of medical care and treatment;
The presence of clear documentation accompanying the affected person.
Such documentation is:
Primary medical card of the Civil Defense (for wartime);
Primary medical record of the affected (patient) in an emergency situation (in peacetime);
Hospitalization voucher;
Disease history.
Primary medical card GO(the primary medical record of the person affected by the emergency) is drawn up for all those affected when they are provided with the first medical aid, if they are subject to further evacuation, and if they are delayed for treatment for more than one day, it is used as a medical history (or is included in the latter). When evacuating a casualty, these documents accompany him. Timeliness in providing medical care. assistance is achieved by good organization of the search, removal and removal (evacuation) of those affected from the outbreak to the stages of medical evacuation, the maximum proximity of the 1st stage to the areas where losses occur, the correct organization of work and the correct organization of medical triage.
Types of medical care
3.2.1. First aid aims to prevent further exposure to the damaging factor on the victim, prevent the development of severe complications and thereby save the life of the affected person. The effectiveness of this type of medical care is maximum when it is provided immediately, or as soon as possible from the moment of injury. According to WHO, every 20 out of 100 people killed in a peacetime accident could have been saved if medical attention had been provided to them at the scene.
With the increase in the period of provision of 1st medical care, the frequency of complications in those affected quickly increases.
First aid- this is a set of simple medical measures performed at the site of injury, mainly in the form of self- and mutual assistance, as well as by participants in rescue operations, using standard and improvised means in order to eliminate the ongoing impact of the damaging factor, save the life of the victim, reduce and prevent the development of severe complications . The optimal period is up to 30 minutes after injury.
First medical aid for those affected is provided syndromously, based on the nature, severity and location of the injuries.
The organization of emergency medical care for those affected is closely related to the phasic development of processes in the disaster area.
Thus, during the isolation phase, which lasts from several minutes to several hours, First medical aid can only be provided by the victims themselves in the order of self- and mutual assistance, while the degree of training of the population and the ability to use improvised means to provide assistance are of great importance. It should be borne in mind that the use of service equipment to provide first aid begins only when rescue forces arrive at the outbreak.
Scope of first aid:
1 - in case of disasters with a predominance of mechanical (dynamic) damaging factors:
Removing victims from under the rubble (before releasing the limb from compression, a tourniquet is applied to its base, which is removed only after the limb has been tightly bandaged from the periphery to the tourniquet);
Bringing the blinded out of the fireplace;
Extinguishing burning clothing or burning mixtures that have come into contact with the body;
Combating asphyxia by clearing the airways of mucus, blood and possible foreign bodies. If the tongue sinks, vomiting, or profuse nosebleeds occur, the victim is placed on his side; when the tongue sinks, it is pierced with a pin, which is fixed from the outer arch with a bandage to the neck or chin;
Artificial ventilation using the mouth-to-mouth or mouth-to-nose method, as well as using an S-shaped tube;
Giving a physiologically advantageous position to the victim;
Closed heart massage o temporary stop of bleeding by all available means: pressure bandage, finger pressure, tourniquet, etc.;
Immobilization of the damaged area using the simplest means;
Applying an aseptic dressing to the wound and burn surface;l
Administration using a syringe - a tube of an anesthetic or antidote;
Giving water-salt (1/2 teaspoon of soda and salt per 1 liter of liquid) or tonic hot drinks (tea, coffee, alcohol) - in the absence of vomiting and evidence of injury to the abdominal organs;
Prevention of hypothermia or overheating o gentle early removal (removal) of victims from the outbreak and their concentration in designated shelters;
Preparation and control of the evacuation of victims to the nearest medical center or to places where the injured are loaded onto transport.
2. In areas where thermal injury predominates, in addition to the listed measures, the following is carried out:
Extinguishing burning clothing;
Wrap the victim in a clean sheet.
3. In case of disasters with the release of highly toxic substances into the environment:
Respiratory, eye and skin protection;
Partial sanitary treatment of exposed parts of the body (running water, 2% soda solution, etc.) and, if possible, decontamination of clothing adjacent to them;
Giving sorbents for oral poisoning, milk, drinking plenty of fluids, gastric lavage using the “restaurant” method”;
Removal of the affected person from the poisoning zone as quickly as possible.
4. In case of accidents with the release of radioactive substances:
Iodine prophylaxis and the use of radioprotectors by the population whenever possible;
Partial decontamination of clothing and shoes;
Providing first aid to the population in the listed volume during their evacuation from radioactive contamination zones.
5. In case of mass infectious diseases in foci of bacteriological (biological) infection:
Use of improvised and (or) standard personal protective equipment;
Active identification and isolation of feverish patients suspected of an infectious disease;
Use of emergency preventive measures;
Carrying out partial or complete sanitization.
3.2.2. First aid- a set of medical procedures performed by medical personnel (nurse, paramedic) using standard medical equipment. It is aimed at saving the lives of those affected and preventing the development of complications. The optimal period for providing first aid is 1 hour after injury.
In addition to first aid measures, the scope of first aid includes:
Insertion of an air duct, mechanical ventilation using an “Ambu” type device;
Putting a gas mask (cotton-gauze bandage, respirator) on the affected person when he is in a contaminated area;
Monitoring cardiovascular activity (measurement of blood pressure, pulse pattern) and respiratory function (frequency and depth of breathing) in the affected person;
Infusion of infusion agents;
Administration of painkillers and cardiovascular drugs;
Administration and administration of antibiotics and anti-inflammatory drugs;
Administration and administration of sedatives, anticonvulsants and antiemetics
Supply of sorbents, antidotes, etc.;
Monitoring the correct application of tourniquets, bandages, splints, and, if necessary, correcting them and supplementing them with standard medical supplies;
Application of aseptic and occlusive dressings.
3.2.3. First aid- a set of treatment and preventive measures performed by doctors at the first (prehospital) stage of medical evacuation in order to eliminate the consequences of a lesion that directly threatens the life of the affected person, prevent the further development of infectious complications in the wound and prepare victims for evacuation.
First medical aid should be provided within the first 4-6 hours from the moment of injury. First medical aid for emergency life-saving conditions will require an average of 25% of all sanitary losses. The leading causes of mortality on days 1 and 2 are severe mechanical trauma, shock, bleeding and respiratory dysfunction, with 30% of these victims dying within 1 hour, 60% after 3 hours and if help is delayed for 6 hours , then 90% of those seriously affected already die. Among the dead, about 10% received injuries incompatible with life, and death was inevitable, regardless of how quickly medical assistance was provided to them. Considering the nature of the pathology and the severity of injury in disasters, first medical aid should be provided as early as possible. It has been established that shock one hour after injury may be irreversible. When carrying out anti-shock measures in the first 6 hours, mortality is reduced by 25-30%.
Scope of first aid:
Final stop of external bleeding;
Fighting shock (administration of painkillers and cardiovascular drugs - novocaine blockades, transport immobilization, transfusion of anti-shock and blood replacement fluids, etc.);
Restoration of airway patency (tracheotomy, tracheal intubation, tongue fixation, etc.);
Application of an occlusive dressing for open pneumothorax, etc.;
Artificial respiration by manual and hardware methods);
Closed heart massage;
Bandaging bandages, correcting immobilization, carrying out transport amputation (cutting off a limb hanging on a skin flap);
Catheterization or puncture of the bladder for urinary retention;
Administration of antibiotics, tetanus toxoid, antitetanus and antigangrenosis serums and other agents that delay and prevent the development of infection in the wound;
Obstetric and gynecological care (hemostasis, wound care, preterm birth, measures to maintain pregnancy, etc.) o emergency therapeutic care (relief of the primary reaction to external radiation, administration of antidotes, etc.).
Preparing the injured for medical evacuation.
The scope of first medical aid may change (expand or narrow) depending on the conditions of the situation, the number of injured people admitted, the time of their delivery, the distance to the nearest medical institutions, and the availability of transport for evacuating the injured.
Providing first medical aid is the task of emergency medical teams, medical and nursing teams that have not stopped their work at medical facilities that find themselves in places where the affected people are concentrated.
In addition, medical centers and medical evacuation points are being deployed in areas where the affected people are concentrated. It should be remembered that transportation of seriously injured people over a distance of more than 45-60 km (1.5-2 hours) is possible only after stabilization of vital functions, accompanied by medical workers while carrying out the necessary intensive care measures. It should be remembered that, other things being equal, priority in the order of emergency medical care at the prehospital stage and evacuation belongs to pregnant women and children.
In case of disasters, 20% enter the Second Stage of medical evacuation in a state of shock. For 65-70% of victims with mechanical trauma and burns and up to 80% of the therapeutic profile, qualified medical care is the final type.
In the second stage of evacuation, 25-30% of those affected will need qualified and specialized medical care for life-saving treatment and preventive measures. The need for hospitalization for those affected by mechanical trauma will be up to 35%, and with burn injuries - up to 97%.
After providing the victims with first medical and first aid at the pre-hospital stage, they are sent to hospitals located outside the disaster areas, where they should be provided with qualified and specialized medical care and where they will be treated until the final outcome.
These types of medical care provide for the fullest use of the latest advances in medicine. Their implementation completes the provision of the full scope of medical care; they are exhaustive.
3.2.4. Qualified medical care- a set of surgical and therapeutic measures performed by doctors of the appropriate profile in hospitals of medical institutions and aimed at:
Elimination of the consequences of damage, primarily life-threatening, prevention of possible complications and fight against developed ones,
Also providing planned treatment of those affected until the final outcome and creating conditions for the restoration of impaired functions of organs and systems.
It should be provided as early as possible, but no later than 2 days. It turns out that medical specialists working in hospitals in suburban areas:
Surgeons - qualified surgical care,
Therapists provide qualified therapeutic assistance.
In some cases, if the situation is favorable (the mass arrival of victims has ceased and first medical aid has been provided to everyone who needs it), qualified assistance can be provided in the OPM.
According to the urgency of providing qualified surgical care, measures are divided into three groups:
The first group: urgent measures for life-saving reasons, failure to carry out which threatens the death of the affected person in the coming hours;
Second group: interventions, untimely implementation of which can lead to severe complications;
Third group: operations, the delay of which, provided antibiotics are used, will not necessarily lead to dangerous complications.
Under favorable conditions, qualified surgical care should be provided in full (operations of all three groups are performed). The reduction in the volume of qualified surgical care is carried out by refusing to carry out the activities of the third group, and in extremely unfavorable conditions - also due to the activities of the 2nd group.
Qualified therapeutic assistancehas as its goal the elimination of severe, life-threatening consequences of the lesion (asphyxia, convulsions, collapse, pulmonary edema, acute renal failure), the prevention of possible complications and the fight against them to ensure further evacuation of the affected.
According to the urgency of its provision, measures of qualified therapeutic assistance are divided into two groups:
Measures (emergency) in conditions that threaten the life of the affected person or are accompanied by severe psychomotor agitation, intolerable skin itching in case of mustard gas lesions or threatening severe disability (damage to the eye, etc.);
Activities that may be delayed.
In unfavorable conditions, the volume of qualified therapeutic assistance may be reduced to the implementation of group 1 activities.
3.2.4. Specialized medical care- a set of treatment and preventive measures performed by medical specialists in specialized medical institutions (departments) using special apparatus and equipment in order to maximize the restoration of lost functions of organs and systems, treatment of victims until the final outcome, including rehabilitation. Should be provided as early as possible, but no later than 3 days.
To organize specialized assistance, the following factors are necessary:
Availability of specialists;
Availability of equipment;
Availability of appropriate conditions (hospitals in a suburban area) 70% of all those affected will need specialized medical care:
With damage to the head, neck, spine, large vessels;
Thoraco - abdominal group;
Burn victims;
Affected with ARS;
Affected by poisonous substances or highly toxic substances;
Infectious patients;
Affected with mental disorders;
Chronic somatic diseases in exacerbation.
If massive losses occur simultaneously among the population and there is a lack of medical forces and resources, it is impossible to provide timely assistance to all those affected. In emergency situations, there is always a discrepancy between the need for medical care and the ability to provide it. Medical triage is one of the means to achieve timely provision of medical care to victims.
3.3. Medical triage- a method of dividing victims into groups based on the principle of need for homogeneous treatment, preventive and evacuation measures, depending on medical indications and specific conditions of the situation.
It is carried out starting from the moment of provision of first medical aid at the scene (in the zone) of an emergency and in the pre-hospital period outside the affected area, as well as upon admission of those affected to medical institutions to receive the full scope of medical care and treatment until the final outcome.
Medical triage is based on diagnosis and prognosis. It determines the volume and type of medical care. Medical triage is a specific, continuous (emergency categories can change quickly), repeating and consistent process in providing victims of all types of medical care. It is carried out on the basis of diagnosis and prognosis. It determines the volume and type of medical care. At the source of the injury, at the site where the injury occurred, the simplest elements of medical triage are performed in the interests of providing first aid. As medical personnel (ambulance teams, medical and nursing teams, emergency medical teams) arrive in the disaster area, triage continues, becomes more specific and deepens.
The specific grouping of those affected during the medical triage process varies depending on the type and volume of medical care provided, while the volume of medical care is determined not only by medical indications and the qualifications of medical personnel, but mainly by the conditions of the situation.
Depending on the tasks solved during the triage process, it is customary to distinguish two types of medical triage:
Intra-point - distribution of those affected by units of a given stage of medical evacuation (i.e. where, in what queue and to what extent assistance will be provided at this stage):
Evacuation and transport - distribution by evacuation purpose, means, methods and order of further evacuation (i.e. in what order, by what transport, in what position and where).
At the heart of sorting, the three main sorting criteria developed by Pirogov still retain their effectiveness.
Sign I - danger to others. Depending on the danger to others, the degree of need of victims for sanitary or special treatment, isolation is determined and they are divided into groups:
- those in need of special (sanitary) treatment (partial or complete);
Subject to temporary isolation;
Not requiring special (sanitary) treatment.
II sign – therapeutic- the degree of need of victims for medical care, the priority and place (medical unit) of its provision. According to the degree of need for medical care, three groups of affected people are distinguished:
Those in need of emergency medical care;
Those who do not need medical assistance at this stage (help may be delayed);
Those affected in terminal conditions, in need of symptomatic care, with an injury incompatible with life.
III sign- uh vacuation sign- necessity, priority of evacuation, type of transport and position of the victim in transport, evacuation purpose. Based on this sign, those affected are divided into groups:
Those subject to evacuation to other territorial, regional medical institutions or the center of the country, taking into account the evacuation purpose, priority, method of evacuation (lying or sitting), type of transport;
Subject to stay in a given medical institution (depending on the severity of the condition) temporarily or until the final outcome;
Those subject to return to the place of residence (settlement) of the population for outpatient treatment or medical observation.
To successfully conduct medical triage, it is necessary to create appropriate conditions at the stages of medical evacuation:
It is necessary to allocate the required amount of medical personnel, creating triage teams from them,
Provided with appropriate instruments, apparatus, means of recording sorting results, etc.
The triage teams should include experienced doctors of relevant specialties who can quickly assess the condition of the affected person, establish a diagnosis, determine the prognosis and the nature of the necessary medical care.
To calculate the need for sorting teams, you can use the following formula:
Ps. br = K x Tt, where:
K - number of affected patients admitted per day;
T t - time spent on sorting one victim (1.5-2 minutes);
T - duration of work of the sorting team (840 min - 14 hours).
Medical personnel of any level of training and professional competence must first perform selective triage:
Identify those affected who are dangerous to others
Through a quick review of those affected, identify those most in need of medical care (presence of external bleeding, asphyxia, convulsive condition, women in labor, children, etc.). Priority remains for those in need of emergency medical care.
After the selective triage method, the triage team proceeds to sequential examination of the affected individuals. The team simultaneously examines two affected people: one has a doctor, a nurse and a receptionist, and the second has a paramedic (nurse and receptionist). The doctor, having made a triage decision on the 1st affected person, moves on to the 2nd one and receives information about it from the paramedic. Having made a decision, he moves on to the 3rd affected person, receiving information from the nurse. At this time, the paramedic examines the 4th injured person, etc. The porter unit implements the doctor’s decision in accordance with the sorting mark. With this “conveyor” method of work, one triage team can sort up to 30-40 stretchers affected by trauma or those affected by SDYA (with emergency care) in an hour.
During the triage process, all victims, based on an assessment of their general condition, the nature of the injuries and the complications that have arisen, taking into account the prognosis, are divided into 5 triage groups:
- I sorting group - victims with extremely severe injuries incompatible with life, as well as those in a terminal state (agonal), who require only symptomatic treatment. The prognosis is unfavorable.
- II sorting group- victims with severe injuries, accompanied by rapidly increasing life-threatening disorders of the main vital functions of the body, the elimination of which requires urgent treatment and preventive measures. The prognosis may be favorable if they receive prompt medical attention. Patients in this group need help for urgent life reasons.
- III sorting group - victims with severe and moderate injuries that do not pose an immediate threat to life, whose assistance is provided in the 2nd priority or it can be delayed until they arrive at the next stage of medical evacuation;
- IV sorting group - victims with moderate injuries with mild or absent functional disorders;
- V sorting group- victims with minor injuries requiring outpatient treatment.
3.4. Medical evacuation - This is a system of measures to remove those affected from the disaster zone who need medical care and treatment outside it.
It begins with the organized removal, removal and removal of victims from the disaster zone, where they are provided with first medical aid and ends with their delivery to medical institutions of the second stage of medical evacuation, which ensures the provision of a full volume of medical care and final treatment. The rapid delivery of those affected to the first and final stages of medical evacuation is one of the main means of achieving timeliness in the provision of medical care and combining medical evacuation measures dispersed locally and over time into one whole.
Ultimate goal of evacuation- hospitalization of the victim of the appropriate profile in a medical institution, where the victim will be provided with the full scope of medical care and final treatment (evacuation as prescribed).
Evacuation is carried out according to the principle “on your own” (ambulance vehicles from medical institutions, emergency medical care centers, etc.) and “on your own” (by transporting the affected object, rescue teams, etc.).
The general rule when transporting injured people on stretchers is:
The irreplaceability of stretchers, and their replacement from the exchange fund
Loading transport, whenever possible, with single-profile nature (surgical, therapeutic, etc. profile) and localization of the lesion significantly facilitates evacuation not only in direction, but also in destination, reducing inter-hospital transportation to a minimum.
When evacuating victims in a state of mental agitation, measures are taken to prevent the possibility of them falling from transport (fixing them to a stretcher with straps, administering sedatives, monitoring those who are easily affected, and sometimes assigning accompanying persons).
The evacuation of those affected from the outbreaks of SDYV is organized in accordance with general principles, although it has some peculiarities. Evacuation of patients from areas of particularly dangerous infectious diseases, as a rule, is not carried out or is sharply limited.
If necessary, its implementation must be ensured that the requirements of the anti-epidemic regime are met in order to prevent the spread of infection along evacuation routes:
Identification of special evacuation routes;
Non-stop movement through populated areas and along city streets;
Availability of disinfection means in vehicles and collection of secretions from patients;
Escort of transport by medical staff;
Organization of sanitary control points when leaving outbreaks, etc.
Treatment and evacuation support in emergencies is carried out on the basis of a system of staged assistance with the evacuation of victims to their destination. The medical service of the Ministry of Emergency Situations is involved in the provision of first and pre-medical aid to the injured and their evacuation from the source of the emergency, in the provision of qualified and specialized medical care.
Formations and institutions of the disaster medicine service, as well as other medical institutions deployed along the evacuation routes for victims and providing their reception, medical triage, provision of medical care and preparation for further evacuation, are called stage of medical evacuation.
The route along which the exit and transportation of victims from the source of an emergency to the stage of medical evacuation is carried out is called by medical evacuation.
To most effectively provide assistance to victims at the source of an emergency, one-stage and two-stage evacuation systems are used. A one-stage evacuation system is possible; there are functioning educational institutions near the disaster site. Ambulance teams deliver those affected directly from the source of the emergency to them to provide qualified and specialized care.
11 In the absence of medical facilities at the site of the disaster, a two-stage evacuation system is used. The first stage is supplying medical care on site, at the source of the emergency. The second is the provision of qualified and specialized care in inpatient medical institutions, where victims according to the profile of the lesion are evacuated from the first place.
When providing medical care to those affected in the outbreak of multiple diseases, two circumstances are taken into account:
when the provision of medical care can be ensured by the preserved medical institutions of the post-finish territory;
when it is necessary to provide medical care, mobile medical units from other
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The two-stage system of treatment and evacuation measures provides for two main requirements - continuity, consistency in the implementation of treatment and preventive measures and the timeliness of their implementation.
Continuity in the provision of care is based on uniform principles of medical care and treatment that are mandatory for medical workers, as well as the availability of clear documentation accompanying the affected person.
The main documents are the primary medical record of the person affected by the emergency, a hospitalization certificate, and a medical history.
The primary medical record is filled out for all those affected when providing them with first medical aid, if they are subject to further evacuation, and if they remain in place for more than one day, it is used as a medical history. During evacuation, these documents accompany the affected person to the second stage.
Timely provision of assistance is achieved by clearly organizing the search, removal (removal) from the outbreak to the stages of medical evacuation, bringing the first stage as close as possible to the source of disasters, and proper organization of medical triage.
A first aid unit and mobile hospitals of the Ministry of Emergency Situations are deployed in the outbreak. The OPMP organizes the work of first-aid teams directly at the outbreak and the evacuation of victims “on their own” from the outbreak after they receive first aid and pre-medical aid. The OPMC provides first aid to eliminate life-threatening conditions. The purpose of such assistance is to stabilize the general condition of the victims to ensure their safe transportation to the second stage of medical evacuation. The experience of the emergency response services of the Ministry of Emergency Situations has shown that without preliminary preparation for evacuation, many victims cannot withstand long-term transportation.
First and pre-medical aid is provided directly at the outbreak.
Pervan medical care- These are measures carried out at the scene of injury by victims in the form of self-help, as well as by participants in emergency rescue operations, aimed at stopping the impact of the traumatic factor, eliminating life-threatening conditions, and ensuring safe transportation. First aid requirements:
Timeliness;
Correct execution of techniques;
Maintaining consistency of care and continuity.
First aid tasks:
Restoring the functions of vital organs and systems;
Relieving the general condition of the victims;
Protection from adverse environmental conditions.
Goals of first aid:
Saving the lives of victims;
Reducing the risk of severe consequences of injury;
Creation of favorable conditions for transportation.
First aid measures:
Elimination of the traumatic factor (removal, removal, extinguishing of clothing, removal of poisons from the skin, etc.);
Administration of painkillers;
Carrying out cardiopulmonary resuscitation;
Temporary stop of bleeding;
Applying aseptic dressings to wounds and burns;
Application of an occlusive dressing for open pneumothorax;
Providing transport immobilization;
Prevention of radiation injuries (giving cystamine, a splash of potassium, partial sanitation and decontamination of clothing, shoes);
Failure to take antidotes for poisoning;
Carrying out emergency nonspecific prophylaxis (and infectious diseases (giving sulfadimethoxine, IMntetracycline).
First aid carried out by pre-medical teams of the Ministry of Emergency Situations. The team consists of a head nurse (or paramedic), a nurse and one or two orderlies. Pre-hospital medical care is provided by medical workers with secondary education. Its goal is to eliminate and prevent disorders that threaten the lives of victims and prepare them for transportation to the first stage of evacuation.
Requirements, tasks and goals of first aid the same as when providing first aid.
TO first aid measures Similar first aid measures include:
Elimination of deficiencies in first aid (correction of bandages, improvement of transport immobilization);
Insertion of air ducts and artificial ventilation of the lungs using the Ambu apparatus;
Control of cardiac activity and respiration;
Infusion of plasma substitutes;
Administration of cardiovascular drugs;
Oxygen therapy using oxygen inhalers;
Administration of anticonvulsants, sedatives, antiemetics;
Administration of antibiotics.
Equipping the first-aid team allows for a wider range of measures to save the lives of victims. A nurse and paramedic work in an emergency situation without a doctor and are required to make independent decisions, know the symptoms of emergency conditions, and be able to correctly use assistance techniques and medications.
The stage of medical evacuation refers to the forces and means of the medical service (MSGO, surviving healthcare institutions, medical formations of civil defense troops, etc.) deployed along the evacuation routes and intended for receiving, medical triage of the injured, providing them with medical care, treatment and preparation for further evacuation.
The first stages of medical evacuation (in a 2-stage LEM system) may include medical units of MSGO (WMD), healthcare institutions remaining on the border of the source of mass sanitary losses, medical units (units) of civil defense troops, etc.
The first stages of medical evacuation are intended to provide first medical aid, qualified emergency measures and prepare victims for evacuation to the second stages.
The second stages of medical evacuation are medical institutions (headquarters, specialized, multidisciplinary and other hospitals) of the MSGO deployed as part of the L.E.N. (B.B.) in a suburban area.
At the second stages, the provision of qualified medical care is completed, specialized treatment and rehabilitation are provided.
2. The stages of medical evacuation, regardless of the specifics, deploy and equip functional units identical in purpose:
To receive victims, register them, triage and place them;
For sanitary treatment;
For temporary isolation;
To provide various types of assistance (surgery, therapy, etc.);
For temporary and final hospitalization;
Evacuation;
Support and service divisions.
At each stage of medical evacuation, a certain type and amount of medical care is provided. Taking this into account, the stages of medical evacuation are staffed with medical personnel (including doctors of certain qualifications) and medical equipment.
Stages of medical evacuation- these are medical centers or medical institutions (a group of medical institutions) deployed along the evacuation routes for the injured and sick to provide them with medical care, treatment and preparation for evacuation. The stages of medical evacuation include a regimental medical center (see), a medical battalion (see), a separate medical detachment (SMO), a hospital (see) and hospital bases of the front and the interior region.
The distance of medical evacuation stages from the front depends on many conditions, the most important of which are the time during which the injured can be delivered to this stage for timely provision of medical care, the combat and medical situation. The deployment site should be located near evacuation routes running from the front to the rear: away from objects that attract the enemy’s attention; if possible, near water sources.
Schematic diagram of the deployment of the medical evacuation stage.
The basic diagram of the deployment of the stages of medical evacuation provides for the presence of the following functional units (Fig.): a reception and triage department with a triage post, care and treatment departments (operating rooms, dressing rooms, hospital wards, etc.), an evacuation department, isolation wards and a special treatment department (or sanitary inspection room). In the event of a mass arrival of affected people, a sorting area is equipped in front of the reception and triage department. In addition to the listed functional units, diagnostic units (laboratory, X-ray room), utility units (kitchen, dining room, warehouses, power plant), pharmacy, management, personnel premises, etc. are also being developed. A landing site for helicopters and airplanes is also provided. The simplest scheme for deploying the stages of medical evacuation is the deployment of a primary care unit, the most complex is a triage hospital, a hospital for the lightly wounded and sick. The stages of medical evacuation are deployed in tents, in various types of buildings in populated areas, specially created earthen shelters, etc.
When deploying medical evacuation stages, provision is made for its security, fire safety measures, and ease of communication between functional units. In winter and in bad weather, measures are taken to increase the capacity of the reception and triage department and to heat all rooms, especially those where the injured and sick are housed.
The stage of medical evacuation refers to the forces and means of the medical service deployed along the medical evacuation routes to receive, triage the wounded and sick, provide them with medical care, treat them and prepare them according to indications for further evacuation.
The main stages of medical evacuation are MPP, OMEDB or OMO and GB medical institutions. The medical evacuation stage can also be considered a medical emergency unit if it is deployed to work on site.
Regardless of their role in the medical support system for troops, the stages of medical evacuation perform the following common to each of them: tasks:
1) reception, registration, medical triage of incoming wounded and sick;
2) carrying out, according to indications, sanitary treatment of the wounded and sick, disinfection, decontamination and decontamination of their uniforms and equipment;
3) providing medical care to the wounded and sick;
4) inpatient treatment of the wounded and sick (starting with OMEDB);
5) preparation for the evacuation of the wounded and sick who are subject to treatment in subsequent stages;
6) isolation of infectious patients.
To solve these problems, the deployment of appropriate functional units is provided at each stage of medical evacuation.
A triage and evacuation department is deployed in the MPP and OMEDB (OMO), where the reception and medical triage of the wounded and sick are carried out, and the wounded and sick are concentrated to be evacuated to the subsequent stages of medical evacuation. In hospitals, a reception and triage department is deployed to receive and triage incoming wounded and sick people. These departments include functional units in which sanitary treatment of the wounded and sick, decontamination and decontamination of their uniforms and equipment are carried out: a special treatment area for medical supplies and a special treatment area for OMEDB (OMO) and hospitals.
To provide medical care to the wounded and sick, a dressing room is deployed in the MPP, operating and dressing departments, resuscitation and intensive care units in the OMEDB (OMO), and hospitals. Inpatient treatment of the wounded and sick is carried out in the OMEDB (OMD) and military hospitals, for which various functional units are deployed (hospital department of the OMEDB, medical departments of hospitals, laboratories, dental offices, etc.). In addition, a pharmacy and isolation wards for the temporary accommodation of infectious patients are being deployed, and places are being equipped to accommodate personnel and business units.
Medical evacuation stages are deployed at such a distance from active troops and move behind them in such a way as to ensure timely provision of medical care to the wounded and sick. The optimal time for providing first aid is 4-5 hours, qualified 8-12 hours from the moment of injury.
Requirements for the deployment site of the medical evacuation stage. Schematic diagram of deployment
Areas for the placement of medical evacuation stages are selected taking into account the specific conditions of the situation. They should be deployed near supply and evacuation routes, as far as possible away from objects likely to be affected by enemy artillery, aviation, and nuclear missile weapons (troop command and control posts, areas where missile units, reserves are deployed, etc.), in areas where good conditions are provided. their camouflage, protection, security and defense. On the routes leading to the stages of medical evacuation, signs (picketage signs) visible day and night are installed, and, if necessary, control posts are set up. The location (area) of medical evacuation stages is promptly reported to the senior medical commander and lower levels of the medical service are informed.
Types of medical care at the stages of medical evacuation. The concept of the scope of medical care
At each stage of medical evacuation, a certain type of medical care is provided:
1) at the regiment medical station - first medical aid;
2) in a separate medical battalion (SMB) - qualified medical care;
3) in hospitals - specialized medical care.
The totality of treatment and preventive measures carried out at the stage of medical evacuation constitutes the scope of medical care. It is not permanent and may change depending on the situation. The scope of medical care for the stages of medical evacuation is established and modified by the senior medical commander. In urgent cases, the scope of medical care can be clarified for MPP by the head of the regiment's medical service, and for OMEDB - by the head of the formation's medical service. This is immediately reported to the senior medical supervisor. Changes in the volume of medical care can be either in the direction of its reduction or in the direction of expansion. The reduction is due to the discrepancy between the capabilities of the medical evacuation stage to provide medical care to the number of incoming wounded and sick.
Expansion of the scope of medical care at the stage of medical evacuation can occur when it is strengthened by the forces and resources of the senior medical commander, or when it is difficult to evacuate the wounded and sick to subsequent stages.
Continuity and consistency presuppose adherence to uniform principles of treatment and expansion of treatment and preventive measures at the stages of medical evacuation.
The work of the medical service in eliminating the consequences of the enemy’s use of weapons of mass destruction is based on the general principles of organizing treatment and evacuation measures with the direction of the wounded directly to specialized medical institutions, where they can be provided with comprehensive medical care and specialized treatment.
The most important requirement of the modern system of medical evacuation measures is the timeliness of medical care. Medical care should be provided on the battlefield and at the stages of medical evacuation in such a time frame that helps preserve the life of the wounded and sick, prevent the development of severe complications and thereby reduce the time of treatment and speedy return of the wounded and sick to duty. Of particular importance is the timely provision of first aid for fractures, the implementation of emergency first medical and qualified medical care, as well as the implementation of therapeutic and preventive procedures that ensure the possibility of providing medical care at a later date (deferred medical care).
The timeliness of medical care is due, first of all, to the precise organization of the search, collection and removal (removal) of the wounded and sick from the battlefield (from areas of mass casualties), good military medical training of all personnel, the approach of the stages of medical evacuation to the boundaries (regions) of sanitary losses and centers of mass sanitary losses and the fastest evacuation of the wounded and sick to them.
