Medical evacuation stages. First stage of medical evacuation

For the existing LEO system, the general principle is a two-stage system of providing medical care and treatment of the affected with their evacuation as directed. On-site medical personnel and medical and preventive healthcare institutions in and near the outbreak are, as a rule, not enough for this purpose. Move to short time It is almost impossible to enter disaster zones of large medical healthcare institutions from the outside, since they do not have the mobility necessary for this. The capabilities of emergency medical care, as the most mobile formation of healthcare, in large outbreaks are also limited and are quickly exhausted. To strengthen them, medical and preventive institutions must allocate part of their medical personnel from their composition, creating from them mobile, highly mobile medical units varying degrees readiness to move in the source of a disaster (emergency medical teams, teams of emergency specialized medical care, medical teams, mobile hospitals, etc.), as well as to use medical and preventive institutions stored in or near the site. In addition, medical units of military units of civil defense, military medical service Ministry of Defense, medical and sanitary service of the Ministry of Transport of Ukraine and other departments. The complex of these activities is first (prehospital) stage medical evacuation in the struggle for the lives of those affected along the way of their evacuation to inpatient medical institutions (territorial, regional, and sometimes centers), that is, to second(hospital) stage of medical evacuation, where the full scope of medical care and treatment to the final result is provided.

Consequently, medical units and medical institutions of health care, the military medical service of the Ministry of Defense, the medical and sanitary service of the Ministry of Transport of Ukraine, medical centers of military units of the Civil Defense and other departments deployed along the route of evacuation of those affected from the disaster zone for mass admission, medical triage, provision of medical care, preparation for evacuation and treatment are called medical evacuation stage. For each stage, a certain amount of medical care is established.

As a rule, in the event of an emergency, first medical and first aid is provided at the first stage. But under some circumstances, elements of qualified medical care can be applied directly to the outbreak. At the second stage of medical evacuation, the provision of qualified and specialized medical care is ensured in full, treatment until recovery and medical rehabilitation.

Carrying out treatment and preventive measures with the maximum possible number of affected people at the prehospital (first) stage of medical evacuation increases their chances of survival. Not without reason, it can be considered as First stage intensive care available means with its continuation in a hospital setting.

The need to organize the first stage of medical evacuation is objectively determined by the fact that the distance between the source of the disaster and inpatient medical institutions can be large. A significant number of those affected will not withstand long-term evacuation directly from the source of the disaster after first aid has been provided to them in the outbreak or on its borders.

At the second (hospital) stage of medical evacuation(inpatient medical institutions of departmental, territorial, regional subordination of health care) the provision of the full volume of emergency qualified and specialized medical care to those affected and their treatment until recovery is ensured. For 65 – 70% of victims with mechanical injury and for 80% of victims of a therapeutic profile, qualified medical care is final.

The dispersal and echeloning of medical care by type of terrain and time is due to the objective need for a step-by-step struggle to preserve the lives of victims along the way of their evacuation to inpatient medical institutions of the second stage of medical evacuation.

However, this does not mean that options for providing a full range of medical care to victims and their treatment until recovery in inpatient facilities closest to the site of the disaster are excluded. For example, with a small number of victims and the presence of a hospital hospital of the appropriate profile near the outbreak and sufficient quantity beds, which can also be reinforced by teams of emergency specialized medical care, in the absence of seriously injured people in need of medical care and treatment in specialized medical institutions outside the territorial health care institutions. In such conditions, for the majority of victims, it is fair to use a one-stage system of LEO for the affected (on-site treatment). Only individual affected people may need highly specialized medical care in the appropriate medical institutions (departments) of the region or center.

The principle of phasing in the provision of medical care is to some extent determined by the time of arrival of the forces and means of rescue units at the source of the disaster. In the first hours after the disaster, rescue efforts involve forces located in the disaster zone and remaining operational, as well as rapid reaction forces arriving from nearby cities and regions. Large-scale disasters require the involvement of forces from other regions of the country.

MEDICAL TRITAGE.

In the event of an emergency, as a rule, there are massive sanitary losses and a lack of medical forces and resources to promptly organize assistance to all those affected. We have to use priority in providing medical care and evacuation. Medical triage required.

Medical triage is a method of dividing victims and patients into groups, which is based on the need for uniform treatment, preventive and evacuation measures, depending on medical indications and the specific circumstances of the emergency.

Medical triage is carried out starting from the moment of first aid at the injury site and continues during the provision of all pre-hospital and hospital types of medical care.

Depending on the tasks being solved, there are two types of medical triage:

1. Intra-point sorting determines the order of passage of the victim inside the medical institution (point of medical care);

2. Evacuation transport sorting is carried out with the aim of distributing victims into homogeneous groups according to evacuation order, types of evacuation transport, position of the victim (sitting, lying down) and evacuation destination (destination).

During the provision of first aid in the process of medical triage, the following groups are distinguished:

1) Victims who need medical attention first (presence of flaming clothing; external or internal arterial bleeding; shock; asphyxia; convulsions; collapse; loss of consciousness; traumatic amputation of limbs; prolapse of intestinal loops; open pneumothorax; involuntary release of urine and feces; a sharp change in the color of the skin and mucous membranes; severe shortness of breath, etc.);

2) Affected people, for whom assistance can be provided in the second place, that is, delayed for the near future (continuation of the influence of the damaging factor that aggravates damage to the body - smoldering clothing, the presence of SDYAV on open parts of the body, increased content carbon monoxide in the environment atmospheric air; finding body parts under the structures of a destroyed building, etc.). Delay in providing them with help may aggravate the condition, but does not create an immediate threat to life.

3 ) All other victims;

4) Victims who need to be removed or transported to the nearest medical and preventive institution in the first place (victims who received medical care in the first place) and in the second place (all other victims);

5) Slightly affected (ambulatory) patients who can, independently or with assistance, outside help get to a medical facility.

The following basic principles are taken as the basis for sorting: sorting criteria:

Danger to others determines the degree of need of those affected for sanitary or special treatment, isolation. Depending on this, those affected are divided into groups:

Those in need of special (sanitary) treatment (partial or complete);

Subject to temporary isolation (in an infectious disease or psychoneurological isolation ward);

Not requiring special (sanitary) treatment.

Curative sign– the degree of need of victims for medical care, the priority and place (medical unit) of its provision.

According to the degree of need for medical care in the relevant units of the evacuation stage, those affected are distinguished:

Those in need of emergency medical care;

Not in need of medical care (care may be delayed);

Those affected with an injury incompatible with life, in need of symptomatic help, that is, relief of suffering.

Evacuation sign– necessity, order of evacuation, type of transport and position of the injured person in transport. Based on these signs, those affected are divided into groups:

Those subject to evacuation outside the outbreak (affected area) to other territorial, regional medical institutions or centers of the country, taking into account the evacuation purpose, priority, method of evacuation (lying, sitting), type of transport;

Not subject to evacuation outside the outbreak (must be left in this medical institution due to the severity of the condition, non-transportability, temporarily or until recovery);

Subject to return to place of residence (resettlement) or short-term delay at the medical stage for medical observation.

IN emergency departments In medical and preventive institutions (MHIs), triage teams are formed to carry out medical triage. Optimal composition medical triage team is as follows: doctor, paramedic ( nurse), a nurse, two registrars, a line of porters (four people). Sorting is usually based on data from an external examination of victims, their interview, familiarization with medical documentation(if it exists), without using labor-intensive examination methods. The medical staff of the triage team first carries out selective triage in order to identify those affected, those who are dangerous to others, and those who primarily need medical care (the presence of external bleeding, asphyxia, women in labor, children, etc.). After the selective sorting method, the brigade personnel proceed to the “conveyor” inspection of the victims. Two people are examined at the same time: near one of them there is a doctor, a nurse and a registrar; near the other there is a paramedic (nurse) and a receptionist. Having made a triage decision on the first victim, the doctor moves on to the second, receives information from the paramedic, and, if necessary, additionally examines the victim. Then, having made a triage decision on the second victim, the doctor moves on to the third, receives information from the nurse about his condition, if necessary, supplements it with a personal examination, and makes a decision. The paramedic and the receptionist are currently examining the fourth victim, and thus the triage process continues.

If necessary, the victims are provided with medical assistance. The results of sorting are recorded with sorting marks, on the basis of which porters carry out the doctor’s sorting decisions. Given the uneven flow of victims, if there are a significant number of them, additional triage teams are formed from other departments of the hospital.

One triage team in 1 hour of work can sort from 20 to 40 trauma victims or those affected by SDYV with the provision of emergency medical care.

Currently attention modern medicine focused on finding methods for accelerating diagnostics and prognosis for grouping affected people with the goal of a differentiated approach based on the urgency of providing assistance and the order of evacuation. Various directions for this work have been identified. One of them is based on mathematical modeling using mathematical formulas, algorithms, a scoring system for multifactorial assessment of the severity of injury, symptoms of its detection and some complications. Tables of assessment scores, values ​​of trauma-logical indices, parametric scoring scales, as well as nomograms for calculating indices and prognosis of damage to the adult and child population are recommended.

Another direction to speed up the sorting of the affected is the use of differential diagnostic assessment tables possible prognosis in those affected by the number of identified most informative signs about the severity of the condition in the case of burn injury, trauma to the peritoneum and chest, acute radiation sickness, purulent-septic complications.

However, as the experience of exercises and the practice of medical personnel during the admission period shows large quantity conditionally injured during exercises and actually injured (during tornadoes, hurricanes, earthquakes, disasters and accidents), medical staff does not use any nomograms or mathematical formulas, nor indexes. But they can be used to clarify the degree of damage and determine the prognosis in subsequent periods of medical evacuation stages.

In addition, with appropriate training, triage nursing staff can collect data on visible anatomy and accessible functional disorders in the affected persons, taking into account the score to inform the triage team doctor about the condition of the affected person, and the doctor, specifying additional information if necessary clinical symptoms lesions, makes the final triage decision. These techniques with positive results can be used in the hospital and surgical dressing department to determine treatment tactics for each seriously affected patient (operative, conservative, symptomatic and other treatments).

Unconditional practical significance for medical triage they have tabular methods for determining the severity of radiation injury (acute radiation sickness), prognosis of thermal injury, as well as indicators of the volume of bleeding and some others.

An important element in the organization of emergency medical care to the population in case of mass casualties is medical evacuation.

Medical evacuation is a system of measures to remove those affected from the disaster zone who need medical care and treatment outside it. It begins with the organized removal, withdrawal and removal of victims from the disaster zone and ends with their delivery to medical institutions that provide the full scope of medical care and ensure treatment until the final result. Rapid delivery of the injured to the first and final stages of medical evacuation is one of the main means of achieving timely provision of medical care to the injured.

In disaster situations, sanitary and unsuitable vehicles, as a rule, are one of the main means of evacuating those affected in the link - the disaster zone - the nearest medical institution where the full scope of medical care is provided. If it is necessary to evacuate those affected by specialized centers The region usually uses air transport.

During evacuation, it is important to correctly place the injured in the bus or the back of the car. Severely wounded, in need of careful conditions transportation, are placed on stretchers mainly in the front sections and not higher than the second tier. Struck on stretchers with transport tires, plaster casts located on the upper tiers of the cabin. The head end of the stretcher should face the cabin and be 10–15 cm above the foot end in order to reduce the longitudinal movement of the affected persons during transport. Slightly affected (sedentary) patients are placed in buses last on folding seats, and in trucks on wooden planks (boards) that are secured between the side walls. The speed of vehicles is determined by the condition of the road surface, visibility on the roads, time of year, time of day, etc. and is usually set within 30 - 40 km/h.

Some advantages over by car, together with railway, also has river (sea) transport (commodity and passenger ships, barges, speed boats, fishing and cargo ships).

Among the air means for evacuating the injured, various types of civil and military transport aircraft, as well as specially equipped An-2, Yak-40, etc. can be used. Devices for stretchers, placement of sanitary equipment, and medical equipment are installed in aircraft cabins. The most convenient are the An-26M and “Spasatel” resuscitation and operating aircraft with an operating room, intensive care ward, etc.

As the experience of services in disaster zones has shown, the most difficult thing to implement organizationally and technically is the evacuation (removal, removal) of those affected from rubble, fires, etc. If it is not possible to vehicles to the location of the affected people, they are carried out on stretchers, improvised means (boards) to the place of possible loading onto transport (using a relay race).

During mass evacuation of victims by rail (water) transport (evacuation and sanitary trains, railway flights), access roads are equipped at loading points, using the simplest devices to ensure loading (unloading) of victims (ladders, bridges, shields). Platforms, gangways, and piers are also used for this purpose. When bad weather conditions measures are taken to protect those affected from rain, snow, cold, etc.

Evacuation is carried out on the principle of “on your own” (ambulances, medical institutions, regional, territorial emergency medical care centers, etc.) and “on your own” (by transport of the affected facility, rescue teams, etc.). General rule when transporting the affected persons on a stretcher, the stretchers are irreplaceable, with their replacement from the exchange fund.

It is very important to organize evacuation management in order to uniformly and simultaneously load medical units (hospitals) with treatment and preventive measures, as well as ensure the referral of victims to medical institutions of the appropriate profile (departments of medical institutions), reducing to a minimum the movement of those affected by destination between medical institutions of the region (city) ).

TYPES AND AmountS OF MEDICAL CARE. First medical aid, its content and scope.

Type of medical care- this is a list of therapeutic and preventive measures provided for injuries and diseases of people through self- and mutual assistance or medical workers in the affected area and at the stages of medical evacuation. The type of medical care is determined by the place of provision, the training of the persons who provide it, and the availability of appropriate equipment.

The medical care system in emergency situations defines 5 types of medical care:

First aid;

First aid;

First medical aid;

Qualified medical care;

Specialized medical care.

The first three types of medical care are provided directly at or near disaster sites and belong to prehospital types of care.

Hospital types of care– qualified and specialized medical care is provided outside the outbreak in medical institutions where victims are evacuated. In some cases, elements of skilled medical care may be provided during the prehospital period.

Each type of medical care is characterized by the volume of medical care.

Scope of medical care- this is a set of treatment and preventive measures provided to the injured and sick at this stage of medical evacuation. The scope of medical care, depending on the situation that arises at the stages, can be full or reduced.

The full scope of medical care includes urgent measures and activities that may be forced to be postponed.

The reduced volume of medical care provides for only urgent measures, that is, for life-saving reasons.

In certain situations, a reduction in the volume of assistance is carried out at the expense of activities of another group. The fact is that in the event of mass sanitary losses, as a rule, circumstances arise when the number of victims in need of one or another medical assistance significantly exceeds the ability to provide it with the available forces and means. Therefore, the modern LEO system provides for the grouping of first medical and qualified medical care measures according to the urgency of their provision. Its change can be influenced by many reasons (factors): the scale of the disaster itself, the size and structure of sanitary losses, the nature of the pathology, the availability of medical and other medical staff in a specific LPZ (stage of medical evacuation), the availability of specific complete medical equipment, the current working conditions of the LPZ, the ability of the senior medical commander to strengthen the LPZ with a variety of forces and means, and many other reasons.

The nature of the provision of one or another type of medical care depends on the medical and sanitary situation in the outbreak emergency and from the phase of its elimination.

1. Isolation phase lasts from the moment the emergency occurs until the start of organized rescue operations.

2. Rescue phase lasts from the beginning of rescue operations to the completion of the evacuation of victims outside the source of the disaster.

3. Recovery phase characterized by carrying out planned treatment of those affected until the final results and their rehabilitation in a hospital outside the outbreak. Regarding this, the medical service operates in a possible mode of medical care.

To provide medical assistance and treatment of victims in accordance with the modern system of medical and evacuation measures are put forward the following basic requirements:

1. Continuity in the provision of medical care and treatment of victims achieved:

A common understanding among all medical professionals involved in the provision of medical care, pathological processes, occurring in the human body as a result of the influence of known factors of damage during a disaster;

Knowledge of common methods of prevention and treatment of various lesions.

2. Consistency in the provision of medical care and treatment of victims is achieved by high-quality completion of documentation.

3. Timely medical care for victims provides for the provision various types medical assistance in the optimal time to save the lives of victims and restore their health.

Administration of antidotes and antibotulinum serum;

Complex therapy for acute cardiovascular failure, disorders heart rate, acute respiratory failure, comatose states;

Dehydration therapy for cerebral edema;

Correction of gross violations of the acid-base state and electrolyte balance;

A set of measures in case of ingestion of hazardous substances;

Administration of analgesic, desensitizing, anticonvulsant, antiemetic and bronchodilator drugs;

The use of tranquilizers and neuroleptics in acute reactive conditions.

The optimal period for providing qualified medical care is the first 8-12 hours after the injury, but delayed measures of the first stage (the optimal period of provision is up to 24 hours from the moment of the injury), delayed measures of the second stage (the optimal period of provision is up to 36 hours from the moment of the injury).

Specialized medical care– the final form of medical care, is exhaustive. It is provided by highly specialized doctors (neurosurgery, otolaryngologists, ophthalmologists, etc.) who have special diagnostic and treatment equipment in specialized medical institutions. The profiling of medical institutions can be carried out by assigning them teams of specialized medical care with appropriate medical equipment. The optimal period for providing specialized medical care is 24-48 hours from the moment of injury. There are surgical and therapeutic specialized medical care.

Depending on the type and scale of the emergency, the number of people affected and the nature of the damage, the availability of forces and means, the state of territorial and departmental healthcare, the distance from the emergency area of ​​hospital-type medical institutions capable of performing the full scope of qualified assistance and events specialized assistance their capabilities can be accepted various options providing medical care to those affected by emergencies, namely:

Providing assistance to the injured before their evacuation to hospital-type medical institutions only first or until medical care;

Providing the injured before their evacuation to hospital-type medical institutions, in addition to first or pre-medical aid, and first medical aid;

Providing qualified medical care to the injured before their evacuation to hospital-type medical institutions, in addition to first, pre-medical, first aid and emergency measures.

Before evacuating those affected to hospital-type medical institutions, in all cases they must take measures to eliminate current life-threatening conditions and prevent various severe complications and ensuring transportation without significant deterioration of their condition.

3.3 Organization of work at the stages of medical evacuation during liquidation of medical consequences of an emergency

Modern system medical evacuation measures provide for the deployment of medical evacuation stages by all medical units and health care facilities, regardless of their departmental affiliation.

Under medical evacuation stage understand medical units and institutions deployed along the evacuation routes for the affected (patients) and providing their reception, medical triage, provision of regulated medical care, treatment and preparation (if necessary) for further evacuation.

Stages of medical evacuation in the VSMC system:

· formation and establishment of a disaster medicine service;

· medical formations and medical institutions of the Ministry of Health and Social Development of Russia;

· formation and establishment 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 Civil Defense and other ministries and departments deployed along the evacuation routes of those affected from the emergency area for their mass reception, medical triage, provision of medical care, preparation for evacuation and treatment.

Each stage of medical evacuation carries out certain treatment and preventive measures, which together constitute the volume of medical care characteristic of this stage. The organization of medical evacuation stages is based on general principles, according to which, as part of the medical evacuation stage, functional units are deployed to ensure the implementation of the following main tasks:

Reception, registration and medical triage of injured (patients) arriving at this stage of medical evacuation - reception and sorting department;

Sanitary treatment of the affected, decontamination, degassing and disinfection of their uniforms and equipment - special processing department (site);

Providing medical care to the affected (patients) – dressing room, operating and dressing department, procedural, anti-shock, intensive care wards;

Hospitalization and treatment of affected (patients) – hospital department;

Accommodation of the injured and sick who are subject to further evacuation - evacuation department;

Accommodation of infectious patients with mental disorders – insulator.

Schematic diagram of the deployment of the medical evacuation stage

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The medical evacuation stage also includes management, pharmacy, laboratory, and business units.

The medical evacuation stage, intended to provide first medical aid, can be:

Medical aid points (MAP), deployed by medical and nursing teams;

Surviving (in whole or in part) clinics, outpatient clinics, local hospitals in the affected area;

Medical centers of the medical service of the Russian Ministry of Defense, Ministry of Internal Affairs, Civil Defense troops, etc.

Qualified and specialized medical care and treatment are carried out at subsequent stages of medical evacuation, which can be:

· hospitals of the disaster medicine service, multidisciplinary, profiled, specialized hospitals, clinical centers of the Ministry of Health and Social Development of Russia, medical forces of the Ministry of Defense of Russia (medical squads special purpose, medical and sanitary battalions, hospitals, etc.);

Given the poor development of muscles, for children under three years of age, in order to temporarily stop external bleeding from the distal parts of the extremities, in most cases it is enough to apply a pressure bandage to the injured limb (without resorting to a hemostatic tourniquet or twisting).

When carrying out to children closed massage heart, it is necessary to calculate the force and frequency of pressing the lower section sternum, so as not to cause additional injury chest stricken.

The removal and removal of children and the hearth should be carried out first and be accompanied by relatives, easily injured adults, rescue personnel, etc. When organizing medical evacuation support, it is necessary to provide for the strengthening of the stages of medical evacuation, at which qualified and specialized medical care is provided by specialized pediatric teams.

Study questions:

4.1. Measures to improve the sustainability of the functioning of medical institutions in emergency situations.

4.2. Measures to prevent and eliminate the consequences of emergency situations in medical institutions.

4.3. Organization of work of medical institutions in emergency situations.

4.4. Evacuation of medical institutions.

4.1. Measures to improve the sustainability of the functioning of medical institutions in emergency situations

An important role in solving the problems of medical and sanitary provision of the population in emergencies belongs to healthcare facilities:

· therapeutic and preventive (hospitals, clinics, dispensaries, etc.);

· sanitary-hygienic and anti-epidemiological institutions (state sanitary and epidemiological surveillance centers, anti-plague stations and institutes, research institutes, etc.);

· medical supply institutions (pharmacies, pharmaceutical warehouses, bases, stations and blood transfusion institutes);

· educational research institutions of medical profile.

Some of them serve as the basis for the creation of institutions and units of the disaster medicine service and participate in the implementation of medical evacuation, sanitary and hygienic and anti-epidemic measures, others provide healthcare facilities and the disaster medicine service with means of providing medical care and treatment. The solution to problems of health care provision for the population in emergencies largely depends on the degree of readiness and sustainability of the functioning of healthcare facilities and the organization of interaction between them.

Health care authorities and institutions are entrusted with the task of providing health care in emergencies, which confronts health care institutions with the need to operate sustainably in any extreme situation.

Sustainability of functioning of healthcare facilities– advance targeted preparation of the facility for work in emergency situations, peaceful and in war time, including administrative and organizational, engineering and technical, material and economic, sanitary and anti-epidemic, security, educational (personnel training) measures, as a result of which the risk of hitting the target is reduced and the fulfillment of wartime tasks and the occurrence of peacetime emergencies 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-technical requirements refer to requirements specific to healthcare facilities and implemented in all projects.

Common issues on which health care facilities are assessed for sustainability in extreme conditions peacetime and wartime include:

· analysis of initial data on the characteristics of the object, which determine the state of stability of its operation;

· forecasting the possible impact of damaging factors on objects in the event of peacetime disasters and modern means defeats in wartime;

· assessment of the facility’s readiness to operate in extreme conditions in peacetime and wartime, taking into account the characteristics of the region, city and the predicted situation in the event of disasters in peacetime and wartime;

· determination of a list of measures that increase the sustainability of the facility and the timing of their implementation;

· determination of criteria for restoration and resumption of operation of an object exposed to damaging factors.

TO special include requirements that depend on natural factors (seismicity, permafrost, low groundwater, etc.), on the region of development (proximity to nuclear power plants 17

Stages of medical evacuation

The stage of medical evacuation refers to the formations and institutions of disaster medicine services, as well as medical institutions deployed (functioning) along the routes of medical evacuation of the injured and providing their reception, medical triage, provision of a regulated type of medical care and preparation (if necessary) of the injured for further medical evacuation .

The stages of medical evacuation in the healthcare system are: medical detachment, field hospitals of the disaster medicine service, municipal, regional and federal medical institutions deployed (located) along the routes of medical evacuation of those affected from the emergency zone (district) for their reception, medical triage, and assistance to them. medical care, preparation, if necessary, for medical evacuation. Each stage of medical evacuation has its own characteristics in the organization of work, depending on the location of this stage in common system medical and evacuation support, as well as the type of emergency and health situation. As part of the medical evacuation stage, the following should be deployed:

Sorting post;

Sorting area;

Area sanitization;

Reception and sorting;

Evacuation;

Insulator;

Helipad.

If this is not possible, then they should be “marked in the mind” and used in the work of EME.

Functional divisions of EME, ensuring the implementation of the following main tasks:

Reception, registration and medical triage of victims arriving at this stage of medical evacuation - reception and triage department;

Sanitary treatment of victims, decontamination, degassing and disinfection of their clothing and equipment (if necessary) - special treatment department (site);

Providing medical care to victims - dressing room, operating room, treatment room, etc.;

Hospitalization and treatment of victims - hospital department;

Accommodation of victims subject to further medical evacuation - evacuation department;

Accommodation of infectious patients - isolation ward.

Medical triage and evacuation

In the system of organizing medical care for victims of emergency situations, medical triage is an important organizational event. Its importance increases with the simultaneous occurrence of multiple casualties and their arrival at the stage of medical evacuation (field hospital, mobile medical unit, medical institution etc.).

Medical triage involves the distribution of victims into groups based on their need for homogeneous treatment, evacuation and preventive measures in accordance with medical indications, established by the volume of assistance at this stage of medical evacuation and the accepted procedure for medical evacuation.

When carrying out medical triage, the following requirements must be observed: it must be continuous, consistent and specific.

The continuity of triage lies in the fact that it should begin directly at the collection points for victims (in the emergency zone or near it) and then be carried out at all stages of medical evacuation and in all functional units through which the victims pass.

Continuity lies in the fact that in a given medical institution, triage is carried out taking into account the next institution (medical evacuation stage) where the victim should be evacuated.

The specificity of medical triage means that at each specific moment the grouping of victims must correspond to the operating conditions of the medical evacuation stage and ensure the successful solution of problems in the current situation.

Medical triage is based on determining the diagnosis of the lesion or disease and its prognosis, and therefore is always diagnostic and prognostic in nature.

When conducting medical triage of victims, the leading signs on the basis of which they are divided into groups are:

The need for victims to be isolated or sanitized, i.e. this group of victims is dangerous to others;

The need for medical care, the place and priority of its provision to victims admitted to a specific stage of medical evacuation;

The feasibility and possibility of further medical evacuation.

Depending on the tasks solved in the process of medical triage, there are two types:

· Intrapoint.

Intra-point medical triage is carried out to determine the nature and priority of medical care, as well as the functional unit in which it should be provided.

· Evacuation transport.

The sorting is based on the basic Pirogov sorting characteristics. During medical triage, it is necessary to distinguish two streams of victims: lightly injured and moderately and severely injured. The flow of victims must be divided. It is especially necessary to separate the lightly injured from the general flow of victims because they interfere with work (they constantly require attention, while we miss those who are heavy, in shock, unconscious, etc.)

Lightly injured (Persons who have received mechanical, thermal, radiation or other trauma, who have temporarily lost their ability to work, but have retained the ability to move independently, whose treatment can be completed within 60 days. They should not have penetrating injuries to cavities, including eyeball And large joints, damage great vessels and nerve trunks, fractures of long tubular bones, I-II degree burns of more than 10% of the body surface, deep thermal burns, exposure to ionizing radiation more than 150 rad.

When triaging victims, there are three things to consider:

1. Dangerous to others;

2. Medicinal;

3. Evacuation.

1. Dangerous to others - determines the degree to which victims need sanitary treatment and isolation. This group includes victims who have:

Infectious diseases;

Infestation of clothing and skin hazardous substances and radioactive substances;

Reactive states.

2. Therapeutic sign - the degree of need of victims for medical care, the priority and place of its provision (in an ambulance car, health care facility, department).

3. Evacuation sign - need, order of evacuation, type of transport, position of the victim in transport, need to be accompanied by medical personnel.

When conducting medical triage of victims at the stages of medical evacuation, the following requirements must be observed:

· allocate independent functional units with sufficient room capacity to accommodate victims, with good passages and approaches to them;

· organize auxiliary functional units for medical triage - distribution posts, sorting sites, etc.;

· create sorting teams and equip them with the necessary simple diagnostic tools (dosimetric devices, etc.) and recording of sorting results (sorting marks, primary medical cards, etc.);

· assign a nurse dispatcher to regulate the placement of incoming victims and their further movement.

The triage teams include the most experienced doctors who are able to quickly assess the condition of the victims, determine the diagnosis (leading lesion) and prognosis without removing the bandages and without using labor-intensive research methods, establish the nature of the necessary medical care and the procedure for evacuation.

The optimal composition of a triage team for stretchers is: a doctor, a paramedic (nurse), a nurse, two receptionists and a section of stretchers. For walking victims, a triage team is created consisting of a doctor, a nurse and a registrar.

Subsequence practical implementation medical triage: a nurse, paramedic, doctor first identify those affected who are dangerous to others. Then, an initial quick examination (questioning) identifies victims in need of emergency medical care. Priority remains with children and pregnant women. After this, the medical personnel proceeds to a sequential examination of the victims, trying, as quickly as possible, to distribute them among the functional units of this stage of medical evacuation.

Evacuation-transport triage aims to determine: where, in what queue, by what type of transport, and in what position (lying, sitting) each specific victim should be evacuated.

MEDICAL EVACUATION STAGE - forces and means of the medical service deployed along the routes of movement of the injured and sick, for reception, medical triage, sanitization, isolation, providing them with medical care, treatment and preparation for further evacuation.

31) Type of medical care, definition, place and timing of provision, forces and means involved. A type of medical care is a complex of treatment and preventive measures carried out by wounded and sick medical personnel of certain qualifications who have the appropriate medical equipment.

PMP: Place of delivery: directly at the site of injury (disease), in the focus of the enemy’s use of weapons of mass destruction. Time frame: first 30 minutes from the moment of injury (defeat). Who turns out to be: turns out to be at sanitary posts (SP), sanitary squads (SD), as well as the wounded and sick themselves (self-help) or in the form of mutual assistance. Equipment: Individual dressing packages (IPP); Individual anti-chemical packages (IPP-11); Individual first aid kits AI-2; Nurse's bag; Military medical bag.

First aid: Place and by whom it is provided: it turns out to be a paramedic medical center to combat life-threatening disorders. Timing: first 2 hours from the moment of injury (defeat).

First medical aid: Place and by whom: provided by doctors general profile in first aid units (FAM); Timing: for urgent indications 3-4 hours; in full 5-6 hours from the moment of injury.

Qualified medical care: Place and by whom it is provided: surgeons and therapists in medical units (KhPG, TTPG, IPG) and BB institutions. Timing: for urgent indications 8-15 hours; delayed 24-48 hours after injury.

Specialized medical care: Place and by whom it is provided: by medical specialists in medical institutions of the hospital base (HB) with special equipment. Time frame: up to 72 hours from the moment of injury.

32) Scope of medical care and content of activities

A set of treatment and preventive measures appropriate a certain type medical care and performed at the stages of medical evacuation depending on the general and medical situation, called volume of medical care.

MP volume can be full and abbreviated.

Full scope of medical care refers to the implementation of all therapeutic and preventive measures that are indicated for the wounded, sick or affected.

Reduced volume of medical care refers to the implementation of only part of the treatment and preventive measures for urgent indications.

The modern treatment system for the affected population provides the following: types of medical care:

First aid;

First aid;

First aid;

Qualified medical care (QMC);

Specialized medical care (SMP).

FIRST AID

Target: temporary elimination of causes that threaten the life of the wounded (patient) in this moment, preventing the development of severe complications.

Place of delivery: directly at the site of injury (disease), in the focus of the enemy’s use of weapons of mass destruction.

Who turns out to be: turns out to be at sanitary posts (SP), sanitary squads (SD), as well as the wounded and sick themselves (self-help) or in the form of mutual aid.

Optimal timing first aid- the first 30 minutes from the moment of injury (defeat).

FIRST CARE

Target: combating life-threatening consequences of injuries (diseases) and preventing severe complications.

Place and who it turns out to be: turns out to be a paramedic at a medical station in order to combat life-threatening disorders.

Delivery time: the first 2 hours from the moment of injury (defeat).

FIRST AID

Target: eliminating the consequences of a lesion (disease) that threatens the life of a wounded or sick person, preventing the development of life-threatening complications (shock, wound infection) and preparing the wounded and sick for further evacuation.

Place and who it turns out to be: provided by general practitioners in first aid units (FAM);

Delivery time:

For urgent indications – 3-4 hours;

In full – 5-6 hours from the moment of injury.

QUALIFIED MEDICAL CARE

A set of therapeutic and preventive measures performed by qualified doctors (surgeons and therapists) in order to preserve the life of the affected person, eliminating the consequences of the lesion.

Target: eliminating or mitigating the consequences of injuries, preventing the development of complications or reducing their severity, as well as preparing those in need for further evacuation.

Place and who it turns out to be: surgeons and therapists in medical units (KhPG, TTPG, IPG) and BB institutions.

Terms of provision:

Urgent measures- within 8-12 hours;

Postponed events – within 24-48 hours after

SPECIALIZED MEDICAL CARE

Target: final, comprehensive treatment aimed at restoring the working capacity of the population.

Who turns out to be: medical specialists in medical institutions of a hospital base (BB) with special equipment.

Terms of provision: up to 72 hours from the moment of injury.

33) Medical triage, definition, types of principles, organization of implementation.Medical triage – this is the distribution of those affected into groups depending on their need for homogeneous treatment, preventive and evacuation measures. Medical triage is based on certain N.I. Pirogov sorting characteristics: - danger of the affected person to others; - therapeutic; - evacuation. Depending on degree of danger of those affected to others When sorting, the following groups of affected people are distinguished: - those in need of isolation; - those in need of partial or complete sanitary treatment; - affected people who do not pose a danger to others. During medical triage By therapeutic indication those affected are divided into groups: 1. those in need of emergency medical care; 2. those affected, whose assistance may currently be delayed; 3. those who are mildly injured, those in need of outpatient treatment or those who are able to independently follow the next stage of medical evacuation; 4. those in agony, those in need of care and relief of suffering. According to evacuation criteria those affected are divided into groups: -those in need of evacuation to the next stage; -those remaining at this stage temporarily or until the final outcome; -subject to return to their place of residence for outpatient treatment. Distinguish 2 types of medical triage: Intrapoint triage - distribution of the wounded into groups for referral to departments at this stage of medical evacuation and determination of the priority and nature of medical care provided to them. Evacuation and transport- distribution of the wounded into groups depending on the priority, type of transport and position in which it is necessary to evacuate the injured person. Organization of medical triage . 1) Medical triage is carried out in the reception and triage department of the medical evacuation stage. 2) To conduct medical triage, triage teams are created (1-2 most experienced doctor, nurse registrar, orderlies).3) Medical documentation is filled out: - primary Medical Card(f. 100); - all wounded and injured are registered in the book of registration of the received wounded, sick and injured. 4) Sorting stamps are used, attached to the clothing of the wounded or injured, indicating where and in what order he should be sent.

An integral part of medical evacuation support, which is inextricably linked with the process of providing medical care to victims (patients) and their treatment, is medical evacuation.

Under medical evacuation stage understand the forces and means of the medical service (preserved healthcare institutions, medical formations of civil defense troops, etc.) deployed along evacuation routes and intended for receiving, medical triage of the injured, providing them with medical care, treatment and preparation for further evacuation.

The first stages of medical evacuation (in a 2-stage LEM system) may include healthcare institutions that remain on the border of the source of mass sanitary losses, medical units (units) of civil defense troops, etc.

The first stages of medical evacuation are intended to provide first medical aid, qualified emergency measures and prepare victims for evacuation to the second stages.

The second stages of medical evacuation are medical institutions (headquarters, specialized, multidisciplinary and other hospitals) of MSGOs deployed as part of a hospital base in a suburban area.

The second stages complete the provision of qualified and specialized medical care, as well as rehabilitation.

Stages of medical evacuation Regardless of the features, they deploy and equip functional units identical in purpose:

1. for receiving victims, their registration, sorting and placement;

2. for sanitary treatment;

3. for temporary isolation;

4. to provide various types of assistance (surgery, therapy, etc.);

5. for temporary and final hospitalization;

6. evacuation;

7. support and maintenance units.

At each stage of medical evacuation, a certain type and amount of medical care is provided. Taking this into account, the stages of medical evacuation are staffed with medical personnel (including doctors of certain qualifications) and medical equipment.

Requirements for the deployment site of the medical evacuation phase

To deploy the stages of medical evacuation, places (areas) are selected taking into account:

1. the nature of the hostilities;

2. provision organizations;

3. radiation and chemical conditions;

4. protective properties of the area;

5. availability of sources of good quality water;

6. near transport and evacuation routes;

7. on terrain with good camouflage and protective properties against weapons of mass destruction;

8. far from objects attracting the attention of enemy artillery and aviation;

9. away from the likely direction of the enemy’s main attack;

10. inaccessible (inaccessible) for tanks;

11. The area in the area where the medical evacuation stage is located should not be contaminated with toxic substances or bacterial agents, the level of radioactive contamination should not exceed 0.5 r/hour.

The route along which the affected (patients) are removed and transported is called medical evacuation route, and the distance from the point of departure of the affected person to the destination is considered to be medical evacuation shoulder. The set of evacuation routes located at the stages of medical evacuation and working ambulance and other vehicles is called evacuation directions eat.

Various vehicles are used to evacuate the injured and sick.

Medical evacuation begins with the organized removal, withdrawal and removal of victims and ends with their delivery to medical institutions that provide a full range of medical care and provide final treatment. Rapid delivery of the injured to the first and final stages of medical evacuation is one of the main means of achieving timely provision of medical care to the injured.

In war conditions, sanitary and unsuitable vehicles, as a rule, are one of the main means of evacuating those injured in the link - the disaster zone is the nearest medical institution where the full scope of medical care is provided. If it is necessary to evacuate those affected to specialized centers in a region or country, air transport is usually used. Due to the fact that sanitary and adapted evacuation transport will always be insufficient, and for the evacuation of especially seriously injured people it is necessary to use unsuitable transport, it is necessary to strictly comply with the requirements of evacuation and transport triage.

Among the air means for evacuating the injured (sick), various types of civil and military transport aircraft and, in particular, specially equipped ones can be used. Adaptations for stretchers, sanitary equipment, and medical equipment are installed in aircraft cabins.

In war zones, the most difficult thing to implement organizationally and technically is the evacuation (removal, removal) of those affected through rubble and fires. If it is impossible to move to the location of the affected vehicles, the affected vehicles are carried out on stretchers, using improvised means (boards, etc.) to the place of possible loading onto the transport.

Evacuation from damaged objects usually begins with the arriving vehicles of medical institutions, transport attracted by the state road safety inspection, as well as transport of regional disaster medicine centers, transport of economic facilities and motor depots. Personnel from rescue units, the local population, and military personnel are involved in carrying out and loading victims.

Places for loading victims onto transport are chosen as close as possible to the affected areas, outside the zone of infection and fires. To care for the injured in places where they are concentrated, medical personnel from emergency medical services and rescue squads are allocated until emergency medical teams and other units arrive there. In these places, emergency medical care is provided, evacuation sorting is carried out and a loading area is organized.

Evacuation is carried out on a “self-guided” basis.(vehicles of medical institutions, regional, territorial disaster medicine centers) and "Push"(transport of the damaged object, rescue teams).

Medical evacuation is an integral part of medical evacuation measures and is continuously associated with the provision of assistance to victims and their treatment. Medical evacuation is a forced event because It is impossible (there are no conditions) to organize comprehensive assistance and treatment in the area of ​​massive sanitary losses.

Thus, medical evacuation is understood as a set of measures to deliver victims from the area of ​​sanitary losses to the medical evacuation stage for the purpose of timely provision of medical care and treatment. The head of the MSDF plans and organizes medical evacuation (mainly on a “self-directed” basis). From the area of ​​mass sanitary losses to the emergency response center or to the main hospital, victims are evacuated (by direction) in one direction, then to their destination in accordance with the type of damage. For this purpose, sanitary transport units of the MSCD are used, as well as vehicles allocated by the chiefs of the civil defense. To temporarily accommodate affected people waiting for transport, evacuation centers are deployed at railway stations, airfields, ports, etc.