The stage of medical evacuation means. The main stages of medical evacuation of the wounded

The stage of medical evacuation is the formation or establishment of a disaster medicine service, any other medical institution deployed on the evacuation routes of the injured (sick) and providing them with reception, medical triage, provision of regulated medical care, treatment and preparation (if necessary) for further evacuation. Stages of medical evacuation in the BCMK system can be deployed by: medical units and medical institutions of the Ministry of Health of Russia, the medical service of the Ministry of Defense and the Ministry of Internal Affairs of Russia, the medical and sanitary service of the Russian Ministry of Railways, the medical service of the civil defense troops and other ministries and departments. Each stage of medical evacuation has its own characteristics in the organization of work, depending on the place of this stage in the general system of medical evacuation support and the conditions in which it solves its tasks. However, despite the variety of conditions that determine the activities of the stages of medical evacuation, the organization of their work is based on general principles, according to which, as part of the stage of medical evacuation, functional units are usually deployed to ensure the following main tasks:

Reception, registration and sorting of the injured arriving at this stage of medical evacuation;

Special treatment of the affected, decontamination, degassing and disinfection of their clothes and equipment;

Provision of medical assistance (treatment) to the injured;

Accommodation of the injured, subject to further evacuation

Isolation of infectious patients;

Isolation of persons with severe mental disorders.

Depending on the tasks assigned to the stage of medical evacuation and the conditions of its work, the list of functional indicators intended to perform these tasks may be different.

Each stage of medical evacuation also includes: management, pharmacy, business units, etc. (Scheme No. 5.1 is demonstrated.).

The first stage of medical evacuation in peacetime emergencies, intended mainly for the provision of pre-medical and first medical aid, is the medical institutions that have survived in the disaster zone, emergency medical aid points (deployed by ambulance teams, medical assistants and medical nursing teams who arrived at the disaster site) and medical stations of military units involved in rescue operations.

The second stage of medical evacuation in peacetime emergencies is functioning outside the outbreak, as well as additionally deployed medical institutions designed for comprehensive types of qualified and specialized medical care, united in the category of hospital types of medical care and for the treatment of those affected to the final outcome. These can be emergency medical care centers, specialized medical care centers (neurosurgical, burn and others).

The two-stage system is justified only in cases where there are not enough forces in the disaster area to provide comprehensive medical assistance, as was the case in Armenia and Bashkiria.

If such facilities exist, there is no need to set up intermediate health posts and facilities. Thus, in Arzamas and Sverdlovsk, after receiving medical assistance in the disaster area, the victims were evacuated to institutions where they were treated until the final outcome. In Armenia and Bashkiria, a two-stage LEO system has been successfully used. At the first stage, first medical aid was provided directly in the disaster area or near it in the order of self-help and mutual assistance, rescuers and first medical aid, at the second stage, qualified and specialized assistance, followed by treatment of the victims until the final outcome. Of course, continuity and consistency in the provision of medical care is envisaged. In some areas, during the earthquake in Armenia, the victims were given first aid, and they were immediately evacuated to the central regional hospitals (ie, according to a one-stage scheme).

Depending on the type and scale of emergencies, the number of people affected and the nature of their injuries, the availability of forces and means of the disaster medicine service, the state of healthcare, the distance from the emergency area of hospital-type medical institutions capable of performing the full scope of qualified and specialized medical care and their capabilities, there may be adopted (for the entire emergency zone, its individual sectors and directions) various options for organizing medical and evacuation measures (schemes No. 5.2 and No. 5.3 are demonstrated).

Prior to the evacuation of the injured to hospital-type medical institutions, they can be provided with:

Only first medical or first aid;

First medical, pre-medical medical aid and first medical aid.

First medical, pre-medical, first medical aid and qualified honey. help.

In the course of liquidation of the consequences of disasters, three periods are clearly distinguished:

1 - the period of isolation, which lasted from the moment the disaster occurred until the start of organized work;

2. - the period of rescue, which lasted from the beginning of rescue operations until the completion of the evacuation of the victims outside the outbreak. During this period, the victims are provided with all types of assistance for health reasons;

3 - the recovery period, which from a medical point of view is characterized by the planned treatment and rehabilitation of the affected until the final outcome.

The duration of the rescue period, depending on the nature and scale of the disaster, ranged from 2 hours to 5 days, the recovery period from several days to 2 months or more. With this in mind, an increase in medical forces and means was carried out.

During the rescue period immediately after the disaster, the stage of relative isolation of the affected area begins. Its duration is determined by the timing of the arrival of rescue and medical forces from outside the disaster zones and can range from several minutes to several hours. During catastrophes in Sverdlovsk, Arzamas, Bashkiria, relative isolation lasted from 30 minutes to 2 hours, during an earthquake in Armenia 6-8 hours. At this stage, only the forces that were on site and remained operational can be involved in rescue operations, while the solution to the problem of the survival of the victims largely depends on self-help and mutual assistance.

2.2. Types and scope of medical care.

In the system of staged treatment of the injured and sick with their evacuation according to their destination, the following types of medical care are distinguished: first medical aid, first aid, first medical aid, qualified medical aid, specialized medical aid.

In general, the first 4 types of medical care (first aid, first aid, first aid, qualified) solve similar problems, namely:

Elimination of phenomena that threaten the life of the affected or sick person at the moment;

Carrying out measures that eliminate and reduce the possibility of serious complications;

Implementation of measures to ensure the evacuation of the injured and sick without a significant deterioration in their condition.

However, differences in the qualifications of the personnel providing these types of medical care, the equipment used and working conditions determine significant differences in the list of activities performed.

Under the guise of medical care understand the established list of therapeutic and preventive measures carried out by the injured personnel of the formations and medical institutions in the centers of mass sanitary losses and at the stages of medical evacuation.

First aid It turns out directly in the lesions by the population itself in the order of self-help and mutual assistance, by rescuers, as well as by medical personnel who are allocated from the remaining medical and preventive institutions of the city. Timely and correctly provided first aid saves the life of the affected person and prevents the development of such serious complications as shock, asphyxia, bleeding, wound infection, etc. In the list of first aid measures, stopping external bleeding, administering painkillers, eliminating asphyxia, artificial lung ventilation, indirect heart massage to restore cardiac activity, immobilization of fractures of limb bones, etc., is of particular importance.

First aid is most effective when given immediately or within the first 15 minutes after an injury. It is possible to analyze the effectiveness of first aid in various disasters. In the railway accident at the Arzamas station, 744 people were injured, the estimated potential mortality was up to 6%, the actual was 7%. Efficiency of first aid 0.8. An explosion at a product pipeline in Bashkiria injured 1,284 people, potential mortality -13%, actual -21%, efficiency of first aid -0.6. Up to 40,000 people were affected in Armenia. Potential mortality -15%, actual - 62%, effectiveness of first aid - 0.25. The very low rate of effectiveness in the latter case is explained by the long time spent by the wounded in the rubble. During the elimination of the consequences of the earthquake in Armenia, the most effective option was when, after receiving first aid, the victims were evacuated from the outbreaks immediately to medical institutions in nearby cities.

Thanks to this, it was possible to start helping the victims much faster in hospitals.

In the disaster area, during periods of isolation and rescue, first aid should be provided. If first medical aid is provided for the first time 30 minutes after the injury, even if first medical aid is delayed up to a day, the probability of death is reduced by 3 times. A significant part of those affected die from untimely medical care, although the injury may not be fatal. There is evidence that for this reason, 30% die an hour after a severe injury, and after 3 hours, 60% of those who had a chance to survive, such persons in need of emergency medical care, in the structure of sanitary losses, there are 25% - 30 % of the total number of affected.

First aid it turns out to be ambulance teams (paramedical), first aid teams (which are organized in medical institutions on the instructions of the headquarters of the City Disaster Medicine Service).

The first aid team consists of 4 people: a senior nurse, a nurse, a driver, and an orderly. The brigade is equipped with medical, sanitary and special equipment. The medical property of the first aid team is designed to provide medical assistance to 50 injured.

The optimal period for providing first aid to a significant part of the affected is the first 1-2 hours after the lesion.

In addition to first aid, first aid includes:

Elimination of asphyxia (toilet of the oral cavity, nasopharynx, if necessary, the introduction of an air duct, oxygen inhalation, artificial ventilation of the lungs with a manual breathing apparatus);

Control over the correctness and expediency of applying a tourniquet with continued bleeding;

Imposition and correction of incorrectly applied bandages;

The introduction of painkillers;

Re-introduction of antidotes as directed; additional degassing of open areas of the skin and adjacent areas of clothing;

Heating affected at low air temperature, hot drink (in the absence of a wound in the stomach) in the winter;

According to the indications, the introduction of symptomatic cardiovascular drugs and respiratory analgesics.

First aid turns out to be at the 1st stage of medical evacuation (pre-hospital stage) in order to eliminate the consequences of a lesion that threaten life in the first hours and days after the lesion, prevent infectious complications in the wound and prepare the injured for evacuation. In the CMK system, in emergency situations in peacetime, the provision of first aid is provided for by: medical and nursing teams, medical teams (MO), and medical institutions that have survived in the outbreak or on the periphery of the outbreak, medical institutions of the Ministry of Defense of the Russian Federation (omedoSpN, MPP, etc. .).

First medical aid should be provided within 4-6 hours from the moment of injury. This is achieved by the rapid advancement of BEMP and MO to the focus of mass destruction and their deployment in a short time on the territory of the focus, as well as the restoration of the health of the medical institutions that have survived in the focus. Medical and nursing teams in the areas of accidents and natural disasters can be involved in the provision of first aid, pre-medical and first medical aid, and the preparation of victims for sending to the nearest medical and preventive institutions.

When providing first aid to those affected by SDYAV, the introduction of antidotes, the implementation of measures to maintain the functional usefulness of the cardiovascular and respiratory systems, the removal of a convulsive state, etc. are of particular importance. Along with this, measures are taken to stop further action on the affected damaging factor, partial sanitation, degassing or replacement of clothes and shoes of the affected, isolation of the affected with a sharp psychomotor agitation and relief of the reactive state with drugs. We will consider in more detail about the activities included in the volume of first medical aid in a practical lesson.

Qualified medical care - a complex of surgical and therapeutic measures carried out by doctors of the appropriate profile in medical institutions (divisions) aimed at eliminating the consequences of a lesion, primarily life-threatening, preventing possible complications, and combating those already developing, planned treatment of the affected until the final outcome. The optimal period for the provision of qualified medical care is the first 8-12 hours from the moment of injury.

Specialized medical care - this is a complex of therapeutic and preventive measures carried out by specialists in specialized institutions (departments) using special equipment and equipment in order to maximize the restoration of lost functions and systems, treatment of the affected to the final outcome (including rehabilitation).

These types of assistance are interrelated and it is difficult to draw a clear line between them.

Qualified and specialized medical care is provided in emergency medical centers, clinics of medical universities, regional and regional clinical hospitals.

The optimal term for the provision of specialized medical care is the first day after the injury.

The totality of therapeutic and preventive measures performed by the injured and sick at each stage of medical evacuation is the volume of his medical care. concept "amount of medical care" characterizes the content, the list of those measures that must and can be carried out in relation to certain contingents of the affected, taking into account their condition and conditions of the situation, i.e. gives an idea of the quality side of the work. The quantitative side of the work of the stage is revealed by the concept of "volume of work", which, in the conditions of the occurrence of massive sanitary losses, can significantly exceed the capabilities of this stage of medical evacuation.

Depending on the conditions of the situation, the volume of medical care may change: expand or decrease (due to the refusal to perform more labor-intensive and complex measures). However, in the subsequent stage, it always expands compared to the previous one. The activities previously performed at the first stage of medical evacuation at the second stage of evacuation are not duplicated in the absence of medical indications for this, but are consistently expanded.

The main requirement for each stage of medical evacuation is that medical care must be provided in full. The reduction in the volume of medical care comes with an indication of the superior head of the disaster medicine service. The head of the medical evacuation stage can independently decide to reduce the volume of medical care, but at the same time he must notify the superior head of the disaster medicine service.

The third educational question "Features of the organization of medical care for children in emergency situations" - 10 minutes

The experience of eliminating the medical and sanitary consequences of emergencies shows that in the structure of sanitary losses, children can make up 12-25%. In man-made disasters with dynamic damaging factors, injuries to the head (52.8%), upper (18.6%) and lower (13.7%) extremities predominate in the structure of injuries in children. Injuries to the chest, spine, abdomen and pelvis are recorded in 9.8%, 2.2%, 1.1% and 1.8% of cases, respectively. By the nature of injuries in children, soft tissue injuries, bruises and abrasions (51.6%), craniocerebral injuries, bruises and concussions of the spinal cord (26.0%) are more often noted. There are also traumatic otitis media (2.4%), penetrating eye injuries (1.4%) , traumatic asphyxia (1.5%), closed injuries of the chest and abdomen (20.0%) and other injuries (0.5%). The need for inpatient treatment of affected children with mechanical injuries reaches 44.7%. In adults, this figure averages 32.4% (Ryabochkin V M ., 1991)

The provision of medical care to children should be carried out taking into account the anatomical and physiological characteristics of the child's body, causing differences in the clinical manifestations and course of post-traumatic disease compared with adults.

With the same degree of severity of the lesion, children have an advantage over adults in receiving medical care both in the lesion and beyond.

When organizing first aid, it must be taken into account that the element of self-help and mutual assistance is excluded in children, therefore, special attention should be paid to the timely release of affected children from under the rubble of buildings. destroyed shelters, extinguishing burning (smoldering) clothing and eliminating other damaging factors that continue to act

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 force and frequency of pressing on the lower sternum so as not to cause additional trauma to the affected chest. In the places of loading of the injured on transport, all opportunities are used to shelter children from adverse climatic and weather conditions, care and the provision of necessary medical care are organized.

Removal and removal of children from the outbreak should be carried out in the first place and be accompanied by relatives, easily affected adults, personnel of rescue teams, etc. Children under the age of five are taken out (taken out) from the hearth to the place of first aid, if possible, on their hands, and not on a stretcher, in order to avoid them falling off the stretcher.

For the evacuation of affected children, the most gentle modes of transport, accompanied by medical personnel, are used whenever possible. It is desirable that children be evacuated immediately to medical facilities capable of providing specialized medical care and treatment.

When organizing medical evacuation support, it is necessary to provide for strengthening the stages of medical evacuation, at which qualified and specialized medical care is provided by specialized pediatric teams

If possible, qualified and specialized medical care for children affected by emergencies should be provided in children's medical institutions, children's departments (wards) of hospitals. In the absence of such an opportunity in medical institutions for the adult population, it is necessary to profile for children up to 20% of the bed capacity.

III. Conclusion - 5 minutes

In this lecture, we examined the LEO system in emergency situations, the main meaning of which is to ensure the correct actions of medical personnel in disaster conditions in order to successfully complete the main task of the service - maintaining health for as many affected people as possible, reducing disability. The way to this lies in increasing the social and professional competence of specialists, in bringing practical skills to automatism, in ensuring the confidence of each medical worker in the validity of their actions and high responsibility for them in emergencies, the readiness of the population to provide self- and mutual assistance to victims of disasters.

ORGANIZATION OF ASSISTANCE TO THE WOUNDED

IN THE MAXILLO-FACIAL REGION

AT THE STAGES OF MEDICAL EVACUATION

Plan

1. Stages of medical evacuation.

2. First aid.

3. First aid.

4. First medical aid.

5. Qualified medical care.

6. Specialized medical care and follow-up care.

7. Military medical examination for injuries in the maxillofacial region.

1. Stages of medical evacuation

Staged treatment with evacuation as directed - medical support for the wounded in the maxillofacial region, which is carried out in the system of medical and evacuation measures, and provides for the implementation of the principle of unity of the treatment and evacuation process.

Stages of medical evacuation - medical centers and medical institutions located at different distances from the battlefield and from each other, which the wounded sequentially pass during evacuation from the battlefield or from the focus of mass sanitary losses.

The volume of medical care at this stage is a set of medical and evacuation measures that can be performed at a particular stage of medical evacuation. The amount of assistance is not constant and may vary depending on the conditions of the combat and medical situation. In the event of massive sanitary losses and a significant overload of the stages of medical evacuation, the volume of medical care will be reduced. Under favorable conditions, the scope of medical care can be expanded.

The effectiveness of medical care depends on the following factors:

observance of the principle of continuity of medical and evacuation measures;
unified understanding of the pathology of combat trauma;
unified principles of medical care and treatment;
well established medical records.

The medical records must include:

location and type of injury or damage;
the nature of therapeutic measures performed at a particular stage;
the approximate period of treatment of the wounded and his further evacuation destination.

The modern system of staged treatment with evacuation by appointment provides for the provision of the following types of medical care.

First aid is provided on the battlefield or in the focus of mass sanitary losses.
First aid is provided at the battalion's medical station (MPB).
First medical aid is provided at the medical center of the regiment (MPP) or brigade.
Qualified assistance is provided in a separate medical battalion of the brigade (OMedB) and a separate medical company (OMedR).
Specialized medical care is provided in specialized hospitals of the hospital base.

The sequence of providing the listed types of medical care may not always be observed. It will depend entirely on the conditions of the combat and medical situation, as well as the availability of means of evacuation.

2. First aid

First aid to the wounded in the maxillofacial region is provided on the battlefield or in the focus of mass sanitary losses by orderlies and sanitary instructors. In some cases, it can be provided by the wounded themselves (self-help).

It is very important that the personnel not only know the features of injuries and injuries of the maxillofacial region, but also be able, if necessary, to correctly provide effective first aid.

First aid measures:

Prevention and fight against developed asphyxia;

With dislocation asphyxia - piercing the tongue with a pin, which is available in an individual dressing bag. The tongue should be pulled up to the level of the remaining front teeth and in this position, fix it with a bandage to the clothes.

With obstructive asphyxia, which develops most often as a result of blockage of the upper respiratory tract with blood clots and foreign bodies, you should clean the oral cavity and pharynx with your fingers and gauze.

In case of valvular asphyxia (with this type of asphyxia, as a rule, difficulty or absence of inspiration is noted), it is necessary to examine the oral cavity and, having found the valve, fix it with a pin to the surrounding tissues.

For all other types of asphyxia, including after fixing the tongue with a pin, the wounded person should be placed on his side with his head turned in the direction of the wound.

Temporary stop of bleeding:

Stopping bleeding from wounds of the maxillofacial region is carried out by applying a pressure bandage. With severe arterial bleeding, which is most often observed with injuries to the external or common carotid arteries, the most effective method is to press the common carotid artery against the transverse process of the sixth cervical vertebra.

Immobilization for fractures of the jaws. A sling bandage is used.
Applying a primary bandage to the wound;
The introduction of painkillers from a syringe tube available in an individual first-aid kit;
Reception of tableted antibiotics;
Putting on a gas mask when in an infected area;
Conclusion (removal) of the wounded from the battlefield or from the lesion.

3. First aid

First aid is provided by a paramedic or sanitary instructor and pursues the same goals as first aid, but the paramedic's ability to provide assistance is much broader.

First aid includes the following activities:

fight against asphyxia;
temporary stop of bleeding;
control and correction (if necessary) of previously applied dressings;
administration of cardiac and pain medications, taking
inside antibiotics;
ingestion or subcutaneous administration of antiemetics (according to indications);
heating the wounded who are in a state of shock;
quenching thirst;
preparation for evacuation.

The nature and scope of medical care for asphyxia and bleeding is the same as for first aid. The dressing is replaced only in those cases when it does not fully correspond to its purpose (bleeding continues, the wound is exposed). In other cases, only an inspection of the bandage or bandaging is performed (loose bandages, soaked in blood and saliva). Thirst is quenched with a piece of bandage, one end of which is placed in a flask, and the other - on the root of the wounded tongue so that water gradually enters the wounded man's mouth through gauze.

4. First aid

First aid to the wounded in the maxillofacial area is provided at the medical station of the regiment (MPP), the brigade with the direct participation of the dentist of the MPP brigade and includes the following activities:

elimination of asphyxia of all kinds;
stop bleeding;
implementation of transport immobilization for fractures of the jaws and patchwork lacerations of the soft tissues of the face;
correction of incorrectly applied and heavily soaked bandages;
the introduction of antibiotics, heart and painkillers;
carrying out novocaine blockades for gunshot fractures of the jaws;
carrying out anti-shock measures;
the introduction of tetanus toxoid for open injuries of the maxillofacial region (0.5 ml);
relief of the primary radiation reaction (with combined radiation injuries);
quenching thirst;
filling out the primary medical card;
preparation for evacuation.

If the use of pins to prevent dislocation asphyxia is ineffective, the tongue is stitched. The scope of care for obstructive asphyxia is the same as in the previous stages of medical evacuation. With valve asphyxia, the flaps are either fixed with sutures to the adjacent tissues, or cut off if they are not viable. Primary surgical treatment of the wound is not carried out.

If necessary, carry out the following operations:

tracheostomy;
ligation of blood vessels in the wound.

Transport immobilization is carried out using a standard transport bandage, which consists of a standard support cap and a standard chin sling by D. A. Entin.

For all the wounded, primary medical cards are filled out, which indicate passport data, information about the nature and location of the injury or damage, information about the amount of medical care, and also indicate the type and method of evacuation.

The provision of first medical aid to the wounded with injuries to the face and jaws in the conditions of the use of poisonous substances and other types of weapons by the enemy, mass destruction is carried out in accordance with the requirements set forth in the Directives on Military Field Surgery and Therapy.

5. Qualified medical care

Qualified medical assistance to the wounded in the maxillofacial area is provided in a separate medical battalion of the brigade (OMedB) or a separate medical company (OMedR) by a dentist and includes the following activities:

elimination of asphyxia;
final stop of bleeding;
prevention and control of traumatic shock;
medical triage;
surgical treatment of wounds of the face and jaws and treatment of lightly wounded (treatment period up to 10 days);
surgical treatment of torn patchwork and heavily soiled facial wounds and facial burns;
temporary fixation of fragments of the jaws (transport immobilization);
feeding the wounded;
preparation for further evacuation.

Depending on the conditions of the combat and medical situation, the volume and nature of medical care at this stage of medical evacuation can vary significantly. Under favorable conditions and the arrival of a small number of wounded, the volume of medical care can be complete. In the event of a massive influx of the wounded, the volume of medical care can be reduced by excluding measures, the delay in which does not entail the development of serious complications, and include only measures aimed at eliminating violations that threaten the life of the wounded.

Qualified medical surgical care for wounds and injuries of the maxillofacial region includes three groups of activities.

Group 1 - urgent surgical measures (interventions for vital indications):

operations undertaken to eliminate asphyxia or severe disorders of external respiration;
operations, the main purpose of which is to stop bleeding;
complex therapy of shock and acute anemia.

Group 2 - surgical measures, the implementation of which can be delayed only if absolutely necessary:

primary surgical treatment of infected wounds with significant destruction of the soft and bone tissues of the face, with obvious contamination of the wounds with earth;
primary surgical treatment of infected thermal burns of the face, heavily contaminated with earth.

Group 3 - activities, the delay of which does not necessarily lead to the development of severe complications:

primary surgical treatment of lightly wounded, the terms of treatment of which do not exceed 10 days;
temporary fixation of fragments of the jaws in violation of external respiration.

When providing a full scope of qualified medical care, a dentist must examine each wounded person with injuries to the maxillofacial region, regardless of his general condition, with the obligatory removal of the bandage. This must be done because at this stage the wounded must receive a further evacuation destination, the type and method of further evacuation must be determined.

With a mass admission of the wounded and a forced reduction in the volume of qualified medical care to the activities of the first group (according to vital indications), the diagnosis is established without removing the bandage.

With asphyxia at this stage, assistance is provided in full. The treatment of shock and the fight against severe anemia are carried out in accordance with the requirements of military field surgery.

With ongoing or emerging bleeding at this stage, it is stopped by all known methods, up to ligation of the external or common carotid arteries.

In case of fractures of the jaws with displacement of fragments, in which there are violations of external respiration, temporary fixation of fragments of the jaws is shown using ligature binding of teeth with bronze-aluminum wire.

All the wounded are given antibiotics, tetanus toxoid, if this has not been done before.

Groups of the wounded, subject to further evacuation.

The evacuation of the wounded to the maxillofacial area after the provision of qualified medical care, clarification of the nature, localization and severity of the injury is carried out as follows:

The first group - the wounded with leading injuries of the maxillofacial region. This group includes all the wounded with isolated injuries of soft and bone tissues of the maxillofacial region. Among the wounded in this group, those with minor injuries to the face and jaws are subject to evacuation to hospitals for the treatment of lightly wounded. The rest, who have wounds of the face and jaws of moderate and severe degree, are subject to evacuation to the maxillofacial departments of specialized hospitals for the treatment of those wounded in the head, neck and spine.

The second group - the affected, in which injuries and injuries of the maxillofacial region are combined with more severe, leading injuries (lesions) of other areas of the body, burns and radiation sickness.

Depending on the nature and location of the leading injury (lesion), the victims of this group are subject to evacuation to specialized hospitals for those injured in the head, neck and spine, traumatological, general surgical, multidisciplinary and therapeutic hospitals.

The wounded are not subject to further evacuation due to the ease of injury:

having superficial isolated injuries of soft tissues;
fractures and dislocations of individual teeth.

These wounded, after providing them with the necessary assistance, are subject to return to the unit or are temporarily hospitalized (up to 10 days).

6. Specialized medical care and beyond

treatment

Specialized medical care for those affected with injuries and injuries of the maxillofacial region is provided by:

in the maxillofacial departments of specialized hospitals for those wounded in the head, neck and spine;
in hospitals for the treatment of lightly wounded;
in the maxillofacial departments of other hospitals, in which the wounded with injuries of the maxillofacial region are being treated for a leading wound.

The maxillofacial department of a specialized hospital for the wounded in the head, neck and spine is deployed on the basis of one of the medical departments of the military field surgical hospital as part of the operating room, preoperative room and hospital. It is deployed, as a rule, in tents or adapted buildings and cellars.

Peculiarities of the deployment of the hospital of the maxillofacial department:

placement of the wounded on the beds with the head ends to the aisle, which facilitates the observation and care of them;
equipment in tent places for oral irrigation.

Therapeutic measures in the departments of specialized hospitals:

comprehensive care for bleeding, asphyxia and shock;
surgical treatment of wounds of soft and bone tissues;
therapeutic immobilization for fractures of the jaws;
prevention and treatment of complications;
carrying out simple plastic and reconstructive-restorative operations;
providing those in need with dental and complex maxillofacial prostheses;
food and special care for the wounded.

Sorting of the maxillofacial wounded entering a specialized hospital is carried out by the surgeon, therefore, knowledge of the characteristics of the injuries of the maxillofacial region is extremely necessary for him. Among the maxillofacial wounded, he should distinguish the following groups:

The wounded with ongoing bleeding and in a state of asphyxia, who are immediately sent to the operating room of the maxillofacial department, the wounded who need surgical treatment in the first place are also sent here.
The wounded in a state of shock and with signs of severe blood loss are sent to the intensive care tent, where anesthesiologists will conduct appropriate therapy.
The wounded, who do not currently need surgical care, are sent to the hospital of the maxillofacial department.

7. Military medical examination for wounds in the maxillofacial

region

The organization of work is carried out in accordance with the Order of the Ministry of Defense of the Republic of Belarus No. 461 dated 4.10. 1998 "On the procedure for conducting a military medical examination in the armed forces of the Republic of Belarus":

Tasks solved by military medical expertise;

determination of fitness for military service;
determination of the causal relationship of illness, injury, injury or injury to a serviceman with the conditions of military service.

A medical expert opinion on the presence or absence of such a connection serves as the basis for resolving the issue of pension provision upon dismissal of a serviceman from the Armed Forces due to illness.

The performance of these tasks is carried out by regular and non-staff bodies of military medical expertise.

Established bodies of military medical expertise: Central military medical commission, garrison and hospital military medical commissions.

The garrison military medical commission is appointed by order of the head of the garrison with the permission of the head of the medical service of the Main Staff of the Armed Forces of the Republic of Belarus. The commission consists of at least three doctors. To participate in the work of the garrison VVK may be involved by appointment of the head of the medical service of the garrison and other medical specialists, and by the decision of the head of the garrison - a representative of the unit in which the witness serves.

The commission will certify:

military personnel of the garrison, members of their families;
military personnel who are in the garrison on sick leave;
persons entering military educational institutions;
workers and employees of the Armed Forces.

The garrison VVK also monitors the state of medical and preventive work in the garrison units.

A hospital military medical commission is organized at a military hospital (infirmary, military sanatorium) by an annual order of the head of the hospital (infirmary, military sanatorium). The deputy head of the hospital for medical affairs is appointed as the chairman of the hospital VVK.

In addition to medical and expert work, the hospital VVK is entrusted with monitoring the state of medical diagnostic, preventive and expert work in serviced units, as well as providing practical assistance to military commissariats and health authorities in medical and recreational work among recruits and medical examination of those called up for military service.

Medical examination of the military personnel of the Airborne Forces units is carried out by the military medical commission of the formation of the Airborne Forces.

Temporary military medical commissions are created to examine persons entering military educational institutions, arriving reinforcements when they are distributed among training formations, units and subunits, as well as for medical selection and regular examination of military personnel, workers and employees of the Armed Forces entering work and working in special conditions.

Temporary VVKs decide only on the suitability of military personnel for training and work in the relevant military specialties, for service in special conditions. The decision on the suitability of testified for military service, on the need for sick leave is made by the hospital VVK after their inpatient examination and treatment. With the fulfillment of the tasks assigned to them, the temporary VVK cease their functions.

Military units do not have expert bodies. However, the doctors of the unit must know the main provisions of the current orders and instructions for military medical examination, the procedure for medical examination of young soldiers. The doctors of the unit also participate in the selection and send for examination of military personnel assigned to work with sources of ionizing radiation, rocket fuel components, generators of electromagnetic radiation of ultra-high frequency and other harmful factors of military labor.

Temporary disability of military personnel. When a soldier falls ill, the doctor of the unit gives an opinion on the need for him to be fully or partially relieved of duty for a period of up to three days. If necessary, a similar conclusion may be issued again, but in total for no more than 6 days. Soldiers and sergeants of military service who need to be released from work and work for a longer period are sent to the garrison (hospital) military medical commission, which may decide to grant them rest at the military unit for up to 15 days. By a second decision of the VVK, rest can be extended, however, its total duration should not exceed 30 days. In relation to officers, warrant officers and long-term servicemen, the VVK may decide on the need for release from duty for up to 10 days and subsequently, if necessary, extend the release up to 30 days.

In cases where it is necessary to resolve the issue of granting sick leave, fitness for military service, for service in special units, for training in a military educational institution, military personnel are also sent to the garrison (hospital) VVK. At the same time, the head of the medical service of the unit is obliged to ensure thorough training of persons sent for examination. To this end, he organizes their comprehensive medical examination with the necessary X-ray, laboratory and functional studies, consultations of medical specialists.

The head of the medical service of the unit takes an active part in the implementation of the decisions of the military medical commissions.

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 emergency situations is basically a two-stage system of medical care and treatment of the injured with their evacuation as directed.

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 primarily 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 institutions designed to provide comprehensive types of medical care - qualified and specialized, and for the treatment of those affected 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 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. To provide the 1st medical and first aid at the place where the injury was received or near it, as well as certain 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 service of emergency medical care in emergencies, two directions are objectively identified in the system of providing medical care. 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, 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 on 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, with 30% of those affected dying within 1 hour, 60% after 3 hours and if assistance 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, 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 change (expand or narrow) depending on the conditions of the situation, the number of the 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 found themselves 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 health 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- a method for distributing 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 first aid at the site (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 providing victims with all types of medical care. 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 (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 injured in the process of medical triage 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 by 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 triage 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, assistance to whom 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, removal 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 full medical care and final treatment. 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 “on oneself” (ambulances of medical institutions, emergency medical centers, etc.) and “away from oneself” (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 transport, 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 the 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.

31081 0

The wounded taken from the battlefield are delivered to medical units, units and medical institutions, which are called stages of medical evacuation. The stage of medical evacuation is understood as the forces and means of the medical service deployed along the evacuation routes with the task of receiving, sorting the wounded, providing them with medical care, preparing for further evacuation of those in need and treatment.

The stages of medical evacuation are: a medical post of a battalion (if it is deployed to assist the wounded), a medical post of a regiment (a medical company of a brigade, a regiment), a separate medical battalion of a division (a separate medical detachment, a separate medical detachment of special purpose), military medical institutions - military field hospitals of hospital bases, rear hospitals of the Ministry of Health and Social Development of Russia. Each stage of medical evacuation corresponds to a certain type of medical care (Fig. 1).

Rice. 1. Scheme of the modern system of medical and evacuation support for troops

Since the evacuation is carried out according to the principle “on oneself - (from the nests of the wounded - by the forces of the medical center of the battalion, from the battalion - by the transport of the medical center of the regiment, etc.), in a large-scale war, the wounded, as a rule, sequentially go through all stages of medical evacuation. However, whenever possible should strive to reduce multi-stage in helping the wounded, as this significantly improves the outcome of treatment.

Taking into account the probability of entering the stages of medical evacuation of the wounded in an amount exceeding their capacity, various volumes of medical care. For example, first aid may be provided in full(i.e. all the wounded who need it) or according to urgent indications, i.e. only to those wounded who need it to save their lives).

Not only volume, but even the type of medical care provided at a particular stage of evacuation can be changed depending on the specific conditions of the combat situation, the magnitude of sanitary losses, the provision of the medical service with forces and means, the possibility of further unhindered evacuation of the wounded (maneuvering the volume and type of medical care). So, upon admission to a separate medical battalion (the stage of providing qualified medical care) up to 1000 wounded per day, he can switch to providing only first medical aid.

An increase in the throughput of the stages of medical evacuation in the conditions of a mass influx of the wounded is achieved by using standard schemes for the provision of medical care and a clear organization of the brigade-line method of work personnel of all functional departments. The activities performed by the wounded at each stage of medical evacuation are standardized, namely: reception and accommodation, medical triage, provision of appropriate medical care to all those in need in order of priority, preparation for further evacuation.

The most important element in the organization of medical care and treatment of the wounded in the war is triage- distribution of the wounded into groups according to the signs of need for homogeneous medical evacuation and preventive measures in accordance with medical indications, the volume of medical care provided and the accepted evacuation procedure. Medical sorting (intrapoint and evacuation) contributes to the most efficient use of the forces and means of the medical service. Intra-item sorting - this is the distribution of the wounded into groups in accordance with the need for homogeneous therapeutic and preventive measures with the determination of the order and place of assistance at this stage of evacuation. Evacuation sorting provides for the distribution of the wounded into groups in accordance with the direction of further evacuation, the order of evacuation, the type of transport and the position of the wounded during transportation. The results of medical sorting are recorded using sorting marks, as well as in the primary medical card (form 100), the medical history.

On the way from the front to the rear, at each subsequent stage of medical evacuation, assistance to the wounded is always provided by other doctors. To ensure continuity and consistency in the provision of medical care all measures and methods of treating the wounded are strictly regulated by the "Instructions on military field surgery" and other governing documents. It also contributes military medical documentation accompanying the wounded throughout their evacuation: when providing first medical aid, a primary medical card (form 100) is filled out for each wounded person, during hospitalization - a medical history (form 102), when evacuating from the stage of providing qualified or specialized medical care, an evacuation envelope is formed ( form 104).

Gumanenko E.K.

Military field surgery

Fundamentals of medical and evacuation support of the affected population in emergency situations.