Functional subdivisions of the medical evacuation stage. Stage of medical evacuation, definition of the concept, tasks, deployment scheme
Administration of antidotes and anti-botulinum serum;
Complex therapy for acute cardiovascular insufficiency, cardiac arrhythmias, 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 AOHV;
The introduction of painkillers, desensitizing, anticonvulsant, antiemetic and bronchodilator drugs;
The use of tranquilizers and neuroleptics in acute reactive conditions.
The optimal term for the provision of qualified medical care is the first 8-12 hours after the lesion, however, delayed measures of the first stage (the optimal period for rendering up to 24 hours from the moment of the lesion), delayed measures of the second stage (the optimal period for rendering up to 36 hours from the moment of the lesion).
Specialized medical care- the final form of medical care, is exhaustive. It is provided by narrow-profile doctors (neurosurgery, otolaryngologists, ophthalmologists, etc.) who have special medical and diagnostic equipment in specialized medical institutions. The profiling of medical institutions can be carried out by giving them teams of specialized medical care with appropriate medical equipment. The optimal term for the provision of specialized medical care is 24-48 hours from the moment of injury. Distinguish between surgical and therapeutic specialized medical care.
Depending on the type and scale of emergencies, the number of people affected and the nature of the injuries, 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 performing the full scope of qualified assistance and specialized assistance activities of their capabilities, there may be various options for providing medical care to those affected in emergencies have been adopted, namely:
Rendering to the injured before their evacuation to hospital-type medical institutions only first or first aid;
Rendering to the injured before their evacuation to hospital-type medical institutions, except for first or first aid, and first medical aid;
Rendering to the injured before their evacuation to hospital-type medical institutions, except for the first, pre-medical, first medical aid and urgent measures, qualified medical care.
Prior to the evacuation of the injured to hospital-type medical institutions, in all cases, they must take measures to eliminate life-threatening conditions at the moment, prevent various serious complications and ensure transportation without a significant deterioration in their condition.
3.3 Organization of the work of stages of medical evacuation in the liquidation of medical consequences of emergencies
The modern system of medical evacuation measures provides for the deployment of stages of medical evacuation by all medical units and healthcare facilities, regardless of their departmental affiliation.
Under stage of medical evacuation understand the medical formations and institutions deployed on the evacuation routes of the injured (sick) and ensuring their reception, medical triage, the provision of regulated medical care, treatment and preparation (if necessary) for further evacuation.
Stages of medical evacuation in the VSMK 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 institutions 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 the Civil Defense and other ministries and departments deployed on the evacuation routes of the affected from the emergency area for their mass reception, medical sorting, medical care, preparation for evacuation and treatment.
Each stage of medical evacuation carries out certain therapeutic and preventive measures, which together constitute the volume of medical care characteristic of this stage. The organization of the stages of medical evacuation is based on the general principles, according to which, as part of the stage of medical evacuation, functional units are deployed to ensure the implementation of the following main tasks:
Reception, registration and medical sorting of the injured (sick) arriving at this stage of medical evacuation, – receiving and sorting department;
Sanitary treatment of the affected, decontamination, degassing and disinfection of their uniforms and equipment - department (platforms) of special processing;
Providing injured (sick) medical care – dressing room, operating and dressing department, procedural, antishock, intensive care wards;
Hospitalization and treatment of the affected (sick) - hospital department;
Placement of the injured and sick, subject to further evacuation - evacuation department;
Placement 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, a pharmacy, a laboratory, and business units.
Stage of medical evacuation, intended for the provision of first aid, can be:
Points of medical care (PMP), deployed by medical and nursing teams;
Surviving (in whole or in part) polyclinics, outpatient clinics, district hospitals in the lesion;
Medical posts of the medical service of the Ministry of Defense of Russia, the Ministry of Internal Affairs, the Civil Defense Troops, etc.
Qualified and specialized medical care and treatment are carried out at the subsequent stages of medical evacuation, which can be:
Disaster medicine hospitals, multidisciplinary, profiled, specialized hospitals, clinical centers of the Ministry of Health and Social Development of Russia, medical forces of the Russian Ministry of Defense (special medical teams, medical battalions, hospitals, etc.);
Given the weak development of the muscles, in children under three years of age, to temporarily stop external bleeding from the distal extremities, in most cases it is enough to apply a pressure bandage to the injured limb (without resorting to a hemostatic tourniquet or twist).
When conducting closed heart massage for children, it is necessary to calculate the strength and frequency of pressing on the lower sternum so as not to cause additional trauma to the chest of the affected person.
The removal and removal of children and the outbreak should be carried out in the first place and carried out accompanied by relatives, easily injured adults, personnel of rescue teams, etc. pediatric teams.
Topic No. 4. Preparation of medical institutions (HCF) for work in emergency situations
Study questions:
4.1. Measures to improve the stability of the functioning of medical institutions in emergency situations.
4.2. Measures to prevent and eliminate the consequences of emergencies in medical institutions.
4.3. Organization of the 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:
Treatment and prevention (hospitals, clinics, dispensaries, etc.);
Institutions of sanitary-hygienic and anti-epidemiological profile (centers of state sanitary epidemiological surveillance, anti-plague stations and institutes, research institutes, etc.);
· institutions of medical supply (pharmacies, pharmacy warehouses, bases, stations and institutes of blood transfusion);
· 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 the means of providing medical care and treatment. The degree of readiness and sustainability of the functioning of healthcare facilities, the organization of interaction between them largely determines the solution of tasks for the medical and sanitary provision of the population in emergencies.
Health authorities and institutions are entrusted with the task of providing medical and sanitary assistance in emergencies, which puts health institutions in front of the need for sustainable work in any extreme situation.
Sustainability of functioning of healthcare facilities- advance targeted preparation of an object for work in emergency situations of peacetime and wartime, including administrative, organizational, engineering, material and economic, sanitary and anti-epidemic, regime, educational (training) measures, as a result of which the risk of damage to the object is reduced and the fulfillment of wartime tasks and the occurrence of emergency situations in peacetime is ensured.
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 and technical requirements include requirements specific to healthcare facilities and implemented in all projects.
General questions on which health care institutions are assessed for resilience under extreme peacetime and wartime conditions include:
analysis of the initial data on the characteristics of the object, which determine the state of stability of its work;
forecasting the possible impact on objects of damaging factors in the event of disasters in peacetime and modern means of destruction in wartime;
· assessment of readiness of the object to work in extreme conditions of peacetime and wartime, taking into account the peculiarities of the region, city and the predicted situation in the event of disasters in peacetime and wartime;
determination of the list of measures that increase the stability of the facility and the timing of their implementation;
· determination of criteria for recoverability and resumption of operation of an object that has been 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 NPP 17
Medical evacuation stage I
Stage of medical evacuation
in military medicine - medical posts and medical institutions deployed along evacuation routes with the task of receiving, medical sorting of the injured and sick, providing medical care, treating and preparing them for further evacuation. in Civil Defense - the definition of E. m. e. the same as in military medicine. However, in the system of the medical service of the Civil Defense, as a rule, the deployment of only two stages is envisaged; 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 "stage of medical evacuation" 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 on the evacuation routes of the injured (sick) and ensuring their reception, medical triage, rendering ... ... Official terminology
Medical posts and medical institutions deployed along evacuation routes with the task of receiving, medical sorting of the injured and sick, providing them with medical care, treating and preparing them for further evacuation ... Big Medical Dictionary
Definition of E. m. e. the same as in military medicine. However, in the system of the medical service of the Civil Defense, as a rule, the deployment of only two stages is envisaged; the first squads of first aid, the second hospital base ... Big Medical Dictionary
Formations and institutions of the disaster medicine service, as well as other medical institutions deployed on the evacuation routes of the injured (sick) and providing their reception, medical triage, the provision of regulated medical care, ... ... Emergencies Dictionary
I (OPM) is a mobile medical formation of the MS GO, designed to provide first aid to the injured and sick in the lesions, areas of natural disasters, in case of major industrial accidents and 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 aid to the wounded and sick and preparing them for further evacuation; predecessor ... ... Big Medical Dictionary
Big 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 first aid and evacuate the injured and sick to the medical post of the aviation technical unit ... Medical Encyclopedia
- (omedb) 1) a special unit 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) the main unit of the medical service of the regiment, designed to provide medical support to its personnel in peacetime and wartime. In peacetime, WFP carries out medical and preventive, sanitary and hygienic and ... ... Medical Encyclopedia
The system of medical and evacuation support of the population in emergency situations includes a set of scientifically based principles of organizational and practical measures to provide the affected population with medical care and treatment related to its evacuation outside the disaster zone (center) and the forces and means of the disaster medicine service intended for this .
The following main conditions influence the organization of the system of medical and evacuation support:
Type of disaster;
The size of the lesion;
The number of people affected;
The nature of the pathology, the degree of failure of the forces and means of healthcare in the disaster zone;
The state of the material and technical equipment of the QMS;
The level of personnel training;
The presence of dangerous damaging factors on the ground (RV, SDYAV, fires), etc.
The general principle of medical and evacuation support in emergencies is basically a two-stage system of medical care and treatment of the injured with their evacuation according to their destination.
Medical formations and medical institutions deployed on the evacuation routes of the affected zone (region) of the disaster and intended for mass reception, medical sorting, providing medical care to the injured, preparing them for evacuation and treatment received the name "Stage of medical evacuation".
The first stage of medical evacuation, intended mainly for the provision of first medical and first medical aid, are medical institutions that have survived in the emergency zone, collection points for the 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 is existing and functioning outside the emergency zone, as well as additionally deployed medical facilities designed to provide comprehensive types of medical care - qualified and specialized, and to treat the injured to the final outcome. Each stage of medical evacuation is assigned a certain amount of medical care (a list of medical and preventive measures).
The main types of assistance in the outbreak or on its border are the First Medical, Pre-medical and First Medical Aid. Depending on the situation, elements of qualified medical care can be performed here for some categories of the affected.
At the 2nd stage of medical evacuation the provision of qualified and specialized medical care in full, treatment to the final outcome and rehabilitation is ensured.
The LEO system has the following types of medical care:
First aid;
First aid;
First medical aid;
Qualified medical care;
Specialized medical care.
A characteristic feature of the provision of medical care to the affected is:
dismemberment,
Dispersion (separation) of its provision in time and on the ground as the injured are evacuated from the focus of the disaster to stationary medical institutions.
The degree of division (separation) of medical care varies depending on the medical situation in the disaster area. descending from it, the volume of medical care can also change - expand or narrow. 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 honey. sorting of the affected, rooms for medical care, temporary isolation, dignity. treatment, temporary or definitive hospitalization, waiting for evacuation and maintenance units. For the provision of the 1st medical and first aid at the place where the injury was received or near it, as well as individual measures of the 1st medical aid, 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 stationary medical institutions can be significant. A certain part of the injured will not survive a long evacuation directly from the source of the disaster after providing them with only the first medical assistance received in the source or at its border. In the emergency medical service in emergency situations, two directions are objectively identified in the system of medical provision. assistance to the injured and their treatment in extreme conditions:
when rendering honey. it is possible to provide assistance to the affected in full by the forces of the facility and local territorial health care
when to eliminate honey. consequences of a major catastrophe, it is necessary to put forward mobile forces and means from other areas and regions. Due to the fact that with a two-stage system of LEO of the population in emergency situations, honey.
Assistance is divided into two main requirements:
Continuity in consistently carried out medical and preventive measures;
timeliness of their implementation.
Continuity in the provision of medical care and treatment is ensured by:
The presence of a unity of understanding of the origin and development of the pathological process, as well as uniform, pre-regulated and mandatory for medical personnel principles for the provision of medical care and treatment;
The presence of clear documentation accompanying the affected person.
Such documentation is:
Primary medical card GO (for wartime);
Primary medical card of the injured (patient) in an emergency (for peacetime);
Hospitalization card;
Disease history.
Primary medical card GO(primary medical card of the injured in an emergency) is issued for all the injured when they are provided with the 1st medical assistance, 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 invested in the latter). When evacuating the injured, these documents follow with him. Timeliness in the provision of honey. help is achieved by a good organization of search, removal and removal (evacuation) of the affected from the focus to the stages of medical evacuation, the maximum approximation of the 1st stage to the areas of loss, 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 impact on the affected damaging factor, to prevent the development of severe complications and thereby save the life of the affected. The effectiveness of this type of medical care is maximum when it is provided immediately, or as soon as possible after the injury. According to the WHO, every 20 out of 100 people killed in an accident in peacetime could have been saved if medical assistance had been provided to them at the scene.
With the increase in the period of provision of the 1st medical care, the frequency of complications in the affected also increases rapidly.
First aid- this is a complex of simple medical measures performed at the site of injury, mainly in the order 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 lives of the victims, reduce and prevent the development of serious complications . The optimal time is up to 30 minutes after the injury.
First aid to the injured is provided syndromic, based on the nature, severity and localization of injuries.
The organization of emergency medical care for the injured is closely related to the phases of the 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-help and mutual assistance, while the degree of education of the population, the ability to use improvised means to provide assistance is of great importance. It should be borne in mind that the use of service equipment for first aid begins only upon arrival at the center of rescue units.
Scope of first aid:
1 - in disasters with a predominance of mechanical (dynamic) damaging factors:
Extraction of the victims from under the blockage (before releasing the limb from compression, a tourniquet is applied to its base, which is removed only after the limb is tightly bandaged from the periphery to the tourniquet);
Leading the blinded out of the hearth;
Extinguishing burning clothes or burning mixtures that have fallen on the body;
Fight asphyxia by freeing the airways from mucus, blood and possible foreign bodies. When the tongue falls, vomiting, profuse nosebleeds, the victim is laid on his side; when the tongue sinks, it is pierced with a pin, which is fixed from the side of the outer arch with a bandage to the neck or chin;
Artificial ventilation of the lungs 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 by the simplest means;
Applying an aseptic dressing to the wound and burn surface;l
Introduction using a syringe - a tube of anesthetic or antidote;
Giving water-salt (1/2 tsp soda and salt per 1 liter of liquid) or tonic hot drinks (tea, coffee, alcohol) - in the absence of vomiting and data for trauma to the abdominal organs;
Prevention of hypothermia or overheating o sparing early removal (export) of victims from the outbreak and their concentration in designated shelters;
Preparation and control over the evacuation of the injured to the nearest medical center or to the places of loading the injured onto transport.
2. In foci with a predominance of thermal injury, in addition to the above measures, the following is carried out:
Extinguishing burning clothes;
Wrap the victim in a clean sheet.
3. In case of catastrophes with release into the environment of highly active Poisonous Substances:
Respiratory, eye and skin protection;
Partial sanitization of exposed parts of the body (running water, 2% soda solution, etc.) and, if possible, degassing of clothing adjacent to them;
Giving sorbents for oral poisoning, milk, drinking plenty of water, gastric lavage in a “restaurant” way”;
The speedy removal of the affected from the zone of poisoning.
4. In case of accidents with the release of radioactive substances:
Iodine prophylaxis and the use of radioprotectors by the population, if possible;
Partial decontamination of clothing and footwear;
Providing first aid to the population in the listed volume during its evacuation from the zones of radioactive contamination.
5. In case of mass infectious diseases in the foci of bacteriological (biological) infection:
Use of improvised and (or) personal protective equipment;
Active identification and isolation of patients with fever, suspected of an infectious disease;
The use of means of emergency prevention;
Carrying out partial or complete sanitization.
3.2.2. First aid- a complex of medical manipulations carried out 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 time for first aid is 1 hour after the injury.
In addition to first aid measures, the scope of first aid includes:
Introduction of an air duct, IVL using an apparatus of the “Ambu” type;
Putting on a gas mask (cotton-gauze bandage, respirator) on the affected person when he is in an infected area;
Control of cardiovascular activity (measurement of blood pressure, the nature of the pulse) and the function of the respiratory organs (frequency and depth of breathing) in the affected person;
Infusion of infusion means;
The introduction of painkillers and cardiovascular drugs;
Introduction and oral administration of antibiotics, anti-inflammatory drugs;
Administration and administration of sedatives, anticonvulsants, and antiemetics
Giving sorbents, antidotes, etc.;
Control of the correct application of tourniquets, bandages, splints, if necessary - their correction and addition of standard medical equipment;
The imposition of aseptic and occlusive dressings.
3.2.3. First aid- a complex of therapeutic and preventive measures performed by doctors at the first (pre-hospital) stage of medical evacuation in order to eliminate the consequences of a lesion that directly threaten the life of the affected person, prevent the development of further infectious complications in the wound and prepare the victims for evacuation.
First medical aid should be provided in the first 4-6 hours after the injury. First medical aid for urgent vital indications 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 impaired respiratory function, and 30% of these affected die within 1 hour, 60% after 3 hours and if help is delayed for 6 hours , then 90% of those seriously affected die. Among the dead, about 10% receive injuries incompatible with life, and death was inevitable, regardless of how soon medical care was provided to them. Given the nature of the pathology and the severity of the injury in disasters, first medical aid should be provided as early as possible. It has been established that shock an 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;
The fight against shock (the introduction of painkillers and cardiovascular drugs - novocaine blockade, transport immobilization, transfusions of anti-shock and blood-substituting fluids, etc.);
Restoration of airway patency (tracheotomy, tracheal intubation, tongue fixation, etc.);
The imposition of an occlusive dressing with open pneumothorax, etc.;
Artificial respiration by manual and hardware methods);
Closed heart massage;
Bandaging of bandages, correction of immobilization, carrying out transport amputation (cutting off a limb hanging on a skin flap);
Catheterization or puncture of the bladder with urinary retention;
The introduction of antibiotics, tetanus toxoid, tetanus toxoid and anti-gangrenous sera, and other agents that delay and prevent the development of infection in the wound;
Obstetric and gynecological care (hemostasis, wound care, preterm delivery, pregnancy maintenance, etc.) o emergency therapeutic care (stopping the primary reaction to external radiation, the introduction of antidotes, etc.).
Preparing casualties for medical evacuation.
The volume of first medical aid may vary (expand or narrow) depending on the conditions of the situation, the number of injured, the time of their delivery, the distance to the nearest medical institutions, the availability of transport for the evacuation of the injured.
The provision of first medical aid is the task of ambulance teams, medical and nursing teams that have not stopped their work at health facilities that have ended up in places of concentration of the affected.
In addition, medical stations and medical evacuation points are being deployed in places where the injured are concentrated. It should be remembered that the transportation of seriously injured people over a distance of more than 45-60 km (1.5-2 hours) is possible only after the 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 catastrophes, 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 form.
In qualified and specialized medical care at the second stage of evacuation, 25-30% of the affected will need urgent medical and preventive measures for health reasons. The need for hospitalization of those affected with a mechanical injury will be up to 35%, and with a burn injury - up to 97%.
After providing the injured with first medical and first medical aid at the out-of-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 a full range of medical care, they are exhaustive.
3.2.4. Qualified medical care- a complex of surgical and therapeutic measures performed by doctors of the appropriate training profile in hospitals of medical institutions and aimed at:
Elimination of the consequences of the lesion, primarily life-threatening, prevention of possible complications and the fight against developed ones,
Also, the provision of planned treatment of the affected until the final outcome and the creation of 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 to be specialist doctors working in hospitals in the suburban area:
Surgeons - qualified surgical care,
Therapists - qualified therapeutic assistance.
In some cases, under a favorable situation (the cessation of the mass influx of victims and the first medical aid is provided to all those in need), qualified assistance can be provided in the PMO.
According to the urgency of providing qualified surgical care, the measures are divided into three groups:
The first group: urgent measures for health reasons, the refusal to perform which threatens the death of the affected person in the next few hours;
The second group: interventions, untimely implementation of which can lead to severe complications;
The third group: operations, the delay of which, subject to the use of antibiotics, will not necessarily lead to dangerous complications.
In a favorable environment, qualified surgical care should be provided in full (all three groups of operations 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 an extremely unfavorable situation - by the activities of the 2nd group.
Qualified therapeutic helpaims to eliminate the 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.
The measures of qualified therapeutic assistance are divided into two groups according to the urgency of its provision:
Measures (urgent) in conditions that threaten the life of the affected person or are accompanied by a sharp psychomotor agitation, intolerable skin itching in case of mustard gas lesions or threatening severe disability (damage to the OB of the eyes, etc.);
Activities that may be delayed.
In an unfavorable situation, the volume of qualified therapeutic assistance can be reduced to the activities of the 1st group.
3.2.4. Specialized medical care- a complex of therapeutic and preventive measures performed by specialist doctors in specialized medical institutions (departments) using special equipment and equipment in order to maximize the restoration of lost functions of organs and systems, treatment of victims to the final outcome, including rehabilitation. Should be provided as early as possible, but not 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 the 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 affected;
Those affected with ARS;
Affected by poisonous substances or potent poisonous substances;
infectious patients;
Affected with mental disorders;
Chronic somatic diseases in exacerbation.
With the simultaneous occurrence of mass losses among the population with a lack of medical forces and means, it is impossible to provide timely assistance to all the affected. In emergencies, there is always a mismatch between the need for medical care and the ability to provide it. Medical triage is one of the means to achieve timeliness in the provision of medical care to victims.
3.3. medical triage- the method of distribution of victims into groups according to the principle of need for homogeneous treatment-and-prophylactic and evacuation measures, depending on medical indications and specific conditions of the situation.
It is carried out starting from the moment of providing first medical aid at the place (in the zone) of the emergency and in the pre-hospital period outside the affected area, as well as when the injured are admitted to medical institutions to receive the full amount of medical care and treatment until the final outcome.
Triage is carried out on the basis of diagnosis and prognosis. It determines the scope and type of medical care. Triage is a concrete, continuous (categories of urgency can change rapidly), repetitive and successive process in the provision of all types of medical care to victims. Based on diagnosis and prognosis. It determines the scope and type of medical care. In the focus of the lesion, at the place where the injury was received, the simplest elements of medical triage are performed in the interests of first aid. As medical personnel (emergency medical 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 injured in the process of medical sorting 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 in the sorting process, it is customary to distinguish two types of medical sorting:
Intra-point - distribution of the injured by units of this stage of medical evacuation (i.e. where, in what queue and in what volume assistance will be provided at this stage):
Evacuation and transport - distribution according to the evacuation purpose, means, methods and sequence of further evacuation (i.e. in which queue, by what transport, in what position and where).
At the basis of sorting, the three main sorting features developed by Pirogov still retain their effectiveness.
I sign - danger to others. Depending on the danger to others, the degree of need for the victims in sanitary or special treatment, isolation is determined and they are divided into groups:
- requiring special (sanitary) treatment (partial or complete);
Subject to temporary isolation;
Not requiring special (sanitary) treatment.
II sign - curative- the degree of need of the victims in medical care, the order and place (medical unit) of its provision. According to the degree of need for medical care, three groups of the affected are distinguished:
Those in need of emergency medical care;
Not in need of medical attention at this stage (help may be delayed);
Affected in terminal conditions, in need of symptomatic care, with an injury incompatible with life.
III sign- uh vacuum sign- the need, the order of evacuation, the type of transport and the position of the victim in transport, the evacuation purpose. Based on this symptom, the affected are divided into groups:
Subject to evacuation to other territorial, regional medical institutions or the center of the country, taking into account the evacuation destination, priority, method of evacuation (lying or sitting), mode of transport;
To be left in this medical institution (according to the severity of the condition) temporarily or until the final outcome;
Subject to return to the place of residence (settlement) of the population for outpatient treatment or medical supervision.
For successful triage, it is necessary to create appropriate conditions at the stages of medical evacuation:
It is necessary to allocate the required amount of medical staff, creating sorting teams from it,
Provided with appropriate devices, apparatus, means of fixing the results of sorting, etc.
The triage teams should include experienced doctors of relevant specialties who are able to 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 \u003d K x Tt, where:
K - the number of affected admitted per day;
T t - time spent on sorting one victim (1.5-2min);
T - the duration of the sorting team (840 min - 14 hours).
Medical personnel of any level of training and professional competence must first selectively triage:
Identify the affected dangerous to others
By a cursory review of the affected, identify those most in need of medical care (the presence of external bleeding, asphyxia, convulsions, women in labor, children, etc.). Priority remains with those in need of emergency medical care.
After the selective sorting method, the sorting team proceeds to sequential examination of the affected. The team simultaneously examines two injured: one has a doctor, a nurse and a registrar, and the second has a paramedic (nurse and registrar). The doctor, having made a sorting decision on the 1st affected, goes to the 2nd and receives information about him from the paramedic. Having made a decision, he moves on to the 3rd affected, receiving information from the nurse. The paramedic at this time examines the 4th affected person, etc. The porter unit implements the doctor's decision in accordance with the sorting mark. With such a “conveyor” method of work, one sorting team can sort up to 30-40 stretchers affected by a traumatological profile or affected by SDYAV (with emergency care) per hour.
In the process of triage, all victims, based on an assessment of their general condition, the nature of injuries and complications that have arisen, taking into account the prognosis, are divided into 5 sorting groups:
- I sorting group - victims with extremely severe, incompatible with life injuries, as well as those in a terminal state (agonistic), who need only symptomatic treatment. The prognosis is unfavorable.
- II sorting group- victims with severe injuries, accompanied by rapidly growing life-threatening disorders of the main vital functions of the body, the elimination of which requires urgent therapeutic and preventive measures. The prognosis can be favorable if they receive timely medical care. Patients in this group need help for urgent vital signs.
- III sorting group - victims with severe and moderate injuries that do not pose an immediate threat to life, for whom assistance is provided in the 2nd stage or it can be delayed until they enter the next stage of medical evacuation;
- IV sorting group - victims with injuries of moderate severity with mild functional disorders or they are absent;
- V sorting group- Victims with minor injuries requiring outpatient treatment.
3.4. medical evacuation - this is a system of measures to remove from the disaster zone the affected, in need of medical care and treatment outside it.
It begins with the organized removal, withdrawal and removal of victims from the disaster zone, where they are provided with first aid, and ends with their delivery to medical institutions of the second stage of medical evacuation, which ensures the provision of a full range of medical care and final treatment. The rapid delivery of the injured 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 in the area and in time into a single whole.
The ultimate goal of evacuation- hospitalization of the victim of the appropriate profile in a medical institution, where the victim will be provided with a full amount of medical care and final treatment (evacuation as directed).
Evacuation is carried out according to the principle “to oneself” (ambulances of medical institutions, emergency medical care centers, etc.) and “away from oneself” (by transport of the injured object, rescue teams, etc.).
The general rule for transporting the injured on a stretcher is:
Irremovability of stretchers, and their replacement from the exchange fund
Loading vehicles, if possible, single-profile in nature (surgical, therapeutic, etc. profile) and localization of the lesion greatly facilitates evacuation not only in the direction, but also for the intended purpose, minimizing inter-hospital transportation.
When evacuating the injured in a state of mental arousal, measures are taken to exclude the possibility of their falling from the transport (fixation to the stretcher with straps, the introduction of sedative drugs, the observation of the lightly injured, and sometimes the allocation of accompanying persons).
The evacuation of the affected from the foci of SDYAV is organized in accordance with general principles, although it has some peculiarities. The evacuation of patients from the centers of especially dangerous infectious diseases, as a rule, is not carried out or is sharply limited.
If it is necessary to implement it, compliance with the requirements of the anti-epidemic regime should be ensured in order to prevent the spread of infection along evacuation routes:
Allocation of special evacuation routes;
Non-stop movement through settlements, along the streets of cities;
Availability of disinfectants in vehicles and collection of secretions from patients;
Transport escort by medical staff;
Organization of sanitary checkpoints when leaving the outbreaks, etc.
Medical and evacuation support in emergencies is carried out on the basis of a system of staged assistance with the evacuation of victims according to their destination. The medical service of the Ministry of Emergency Situations is involved in providing first and first aid to the injured and evacuating them from the focus of emergency situations, in providing qualified and specialized medical care.
Formations and institutions of the disaster medicine service, as well as other medical institutions deployed along the evacuation routes of victims and providing them with reception, medical triage, 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 emergency to the stage of medical evacuation is carried out is called by medical evacuation.
For the most effective assistance to victims in the focus of emergency situations, one-stage and two-stage evacuation systems are used. A one-stage evacuation system is possible, “and there are functioning medical institutions near the disaster site. In them, directly from the source of emergency situations, ambulances deliver the injured to provide qualified and specialized assistance.
11 If there are no medical institutions near the disaster site, a two-stage evacuation system is used. The first stage is the supply of medical care on the spot, in the focus of emergency situations. The second is the provision of qualified and specialized care in inpatient medical institutions, where from the first I1 n, the victims are evacuated according to the profile of the lesion.
When providing medical care to those affected in the focus of multiple trophies, two circumstances are taken into account:
when the provision of medical care can be ensured by the remaining medical institutions of the finish area;
when it is necessary to provide medical care, mobile medical units from other
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The two-stage system of therapeutic and evacuation measures provides for two main requirements - continuity, sequence in the implementation of therapeutic and preventive measures and the timeliness of their implementation.
Continuity in the provision of care is based on the 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 injured (patient) in an emergency, a hospitalization ticket, and a medical history.
The primary medical card is filled out for all the injured when providing them with first aid, if they are subject to further evacuation, and if they remain in place for more than 1 day, it is used as a medical history. During evacuation, these documents follow with the affected to the second stage.
The timeliness of assistance is achieved by a clear organization of the search, removal (export) from the focus to the stages of medical evacuation, the maximum approximation of the first stage to the focus of disasters, and the correct organization of medical triage.
A first aid detachment (OPMP) and mobile hospitals of the Ministry of Emergency Situations are being deployed in the outbreak. OPMP organizes the work of pre-medical teams directly in the outbreak and the evacuation of the victims "on themselves" from the outbreak after they receive first and pre-medical care. 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.
Directly in the hearth is the first and pre-medical care.
Pervan medical care- these are activities performed at the site of injury by victims in self-help, as well as participants in emergency rescue operations, aimed at stopping the impact of a traumatic factor, eliminating life-threatening conditions, and ensuring safe transportation. First aid requirements:
Timeliness;
The correctness of the implementation of techniques;
Compliance with the sequence of assistance and continuity.
Tasks of first aid:
Restoration of the functions of vital organs and systems;
Relief of the general condition of the victims;
Protection from adverse environmental conditions.
Goals of first aid:
Saving the lives of the victims;
Reducing the risk of severe consequences of the defeat;
Creation of favorable conditions for transportation.
First aid measures:
Elimination of the effect of the traumatic factor (extraction, removal, extinguishing of clothes, removal of poisons from the skin, etc.);
The introduction of painkillers;
Carrying out cardiopulmonary resuscitation;
Temporary stop of bleeding;
The imposition of aseptic dressings on wounds and burns;
The imposition of an occlusive dressing with an open pneumothorax;
Ensuring transport immobilization;
Prevention of radiation injuries (giving cystamine, Pshik of that potassium, partial sanitation and decontamination of pngzhdy, shoes);
The use of antidotes in case of poisoning with poisons;
Carrying out emergency non-specific prophylaxis (and infectious diseases (giving sulfadimethoxine, IM-tetracycline).
First aid carried out by pre-medical teams of the Ministry of Emergency Situations. The team consists of a senior nurse (or paramedic), a nurse and one or two orderlies. Pre-hospital medical care is provided by medical workers with secondary education. Its purpose is to eliminate and prevent life-threatening disorders of the victims and prepare them for transportation to the first stage of evacuation.
Requirements, tasks and goals of first aid the same as for first aid.
To first aid measures include similar first aid measures, as well as:
Elimination of shortcomings in first aid (correction of dressings, improvement of transport immobilization);
The introduction of air ducts and artificial ventilation of the lungs with the Ambu device;
Control of cardiac activity and respiration;
Infusion of plasma substitutes;
Introduction of cardiovascular agents;
Oxygen therapy with oxygen inhalers;
The introduction of anticonvulsants, sedatives, antiemetics;
Introduction of antibiotics.
The equipment of the pre-medical team allows for a wider range of life-saving measures for the victims. A nurse and a paramedic work in an emergency without a doctor and are required to make independent decisions, know the symptoms of emergency conditions, and be able to correctly apply assistance and medication.
The stage of medical evacuation is understood as the forces and means of the medical service (MSGO, surviving healthcare institutions, medical formations of the civil defense troops, etc.) deployed along the evacuation routes and intended for receiving, medical sorting of the injured, providing them with medical care, treatment and preparation for further evacuation.
As the first stages of medical evacuation (in the 2-stage LEM system), there may be MSGO medical units (OMP), preserved on the border of the focus of mass sanitary losses of health care institutions, medical units (units) of civil defense troops, etc.
The first stages of medical evacuation are designed to provide first aid, qualified emergency measures and prepare victims for evacuation to the second stages.
The second stages of medical evacuation are medical institutions (head, specialized, multidisciplinary and other hospitals) MSGO deployed as part of L.E.N. (B.B.) in the countryside.
At the second stages, the provision of qualified medical care is completed, specialized, treatment and rehabilitation are provided.
2. Stages of medical evacuation, regardless of the features, deploy and equip functional units identical in purpose:
For the reception of victims, their registration, sorting and placement;
For sanitary treatment;
For temporary isolation;
To provide various types of assistance (surgery, therapy, etc.);
For temporary and final hospitalization;
evacuation;
Provision and maintenance divisions.
At each stage of medical evacuation, a certain type and amount of medical care is provided. With this in mind, the stages of medical evacuation are staffed with medical staff (including doctors of a certain qualification) and medical equipment.
Stages of medical evacuation- these are medical centers or medical institutions (a group of medical institutions) deployed on the evacuation routes of 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 (OMO), a hospital (see) and hospital bases of the front and the interior.
The remoteness of the stages of medical evacuation 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 the timely provision of medical care, the combat and medical situation. The deployment site should be located near the evacuation routes leading from the front to the rear: away from objects that attract the attention of the enemy; if possible, near water sources.
Schematic diagram of the deployment of the medical evacuation stage.
The schematic diagram of the deployment of the stages of medical evacuation provides for the following functional units (Fig.): reception and sorting department with a sorting post, care and treatment departments (operating rooms, dressing rooms, hospital wards, etc.), evacuation department, isolation rooms and a special treatment department (or sanitary inspection room). In the event of a mass arrival of the affected, a sorting yard is equipped in front of the reception and sorting department. In addition to the listed functional units, diagnostic units (laboratory, X-ray room), utility units (kitchen, canteen, warehouses, power plant), pharmacy, administration, premises for personnel, etc. are being deployed. A landing site for helicopters and aircraft is also provided. The simplest scheme for deploying the stages of medical evacuation is the deployment of a PMP, the most complex is the deployment of a sorting hospital, a hospital for the lightly wounded and sick. Stages of medical evacuation are deployed in tents, in various buildings of settlements, specially created earthen shelters, etc.
When deploying stages of medical evacuation, it is provided for its protection, fire-fighting 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 sorting department and to heat all rooms, especially those where the injured and sick are placed.
The stage of medical evacuation is understood as the forces and means of the medical service deployed along the medical evacuation routes for receiving, sorting the wounded and sick, providing them with medical care, treating and preparing them, according to indications, for further evacuation.
The main stages of medical evacuation are WFP, OMEB or OMO and medical institutions of GB. BCH can also be considered a stage of medical evacuation if it is deployed to work on the spot.
Regardless of the role in the system of medical support for troops, the stages of medical evacuation perform the following common for each of them tasks:
1) reception, registration, medical sorting of incoming wounded and sick;
2) conducting, according to indications, sanitization of the wounded and sick, disinfection, decontamination and degassing of their uniforms and equipment;
3) provision of medical assistance to the wounded and sick;
4) inpatient treatment of the wounded and sick (starting with OMEB);
5) preparation for the evacuation of the wounded and sick to be treated at subsequent stages;
6) isolation of infectious patients.
To solve these problems at each stage of medical evacuation, the deployment of appropriate functional units is envisaged.
A sorting and evacuation department is being deployed at the WFP and OMEDB (OMO), where the wounded and sick are received and medically sorted, and the wounded and sick are concentrated, to be evacuated to the subsequent stages of medical evacuation. In hospitals for the reception and medical sorting of the incoming wounded and sick, a reception and sorting department is being deployed. As part of these departments, there are functional divisions in which the sanitary treatment of the wounded and sick, decontamination and degassing of their uniforms and equipment are carried out: a site for special processing of the MPP and a special treatment department for the OMEDB (OMO) and hospitals.
To provide medical care to the wounded and sick, a dressing room is being deployed at the MPP, operating and dressing departments, resuscitation and intensive care units at the OMEDB (OMO), and hospitals. Inpatient treatment of the wounded and sick is carried out in the OMEDB (OMO) and military hospitals, for which various functional units are deployed (the hospital department of the OMEDB, medical departments of hospitals, a laboratory, dental offices, etc.). In addition, a pharmacy, isolation wards for the temporary placement of infectious patients are being deployed, places are being equipped to accommodate personnel and economic units.
Stages of medical evacuation are deployed at such a distance from the active troops and move behind them in such a way as to ensure the timely provision of medical care to the wounded and sick. The optimal time for first aid is 4-5 hours, qualified 8-12 hours from the moment of injury.
Requirements for the place of deployment of the stage of medical evacuation. Deployment Concept
Areas for placement of stages of medical evacuation are selected taking into account the specific conditions of the situation. They should be deployed near the routes of supply and evacuation, if possible, away from the objects of probable impact of the enemy by artillery, aviation and nuclear missiles (troop command posts, areas for deploying missile units, reserves, etc.), in areas where good their disguise, protection, protection and defense. On the paths 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 place (area) of placement of the stages of medical evacuation is reported in a timely manner to the senior medical officer and informs the lower levels of the medical service.
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 medical center of the regiment - first medical aid;
2) in a separate medical battalion (OMO) - qualified medical care;
3) in hospitals - specialized medical care.
The totality of therapeutic and preventive measures carried out at the stage of medical evacuation is the volume 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 officer. In cases of urgency, the scope of medical care can be clarified for the MPP by the head of the medical service of the regiment, and for the OMEDB - by the head of the medical service of the unit. This is immediately reported to the senior medical officer. The change 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.
The expansion of the volume of medical care at the stage of medical evacuation can occur when it is strengthened by the forces and means of a senior medical officer, or when it becomes difficult to evacuate the wounded and sick to subsequent stages.
Continuity and consistency presuppose the observance of uniform principles of treatment and an increase in therapeutic and preventive measures at the stages of medical evacuation.
The work of the medical service in eliminating the consequences of the use of weapons of mass destruction by the enemy is based on the general principles of organizing medical 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 and evacuation measures is the timeliness of medical care. Medical assistance should be provided on the battlefield and at the stages of medical evacuation in such terms that help to save the life of the wounded and sick, prevent the development of serious complications and thereby reduce the time of treatment and the speedy return of the wounded and sick to duty. Of particular importance is the timely provision of first aid for fractures, the implementation of urgent 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 the provision of medical care is primarily due to the precise organization of the search, collection and removal (removal) of the wounded and sick from the battlefield (from the centers of mass casualties), good military medical training of all personnel, the approach of the stages of medical evacuation to the borders (areas) of sanitary losses and centers of mass sanitary losses and the fastest evacuation of the wounded and sick to them.
