Medical triage of those affected by an emergency. Civil defense and emergency protection

Depending on the tasks being solved, medical triage is divided into 2 types: intra-point and evacuation-transport.

In progress intra-point sorting victims are divided into groups depending on the following factors: - degree of danger to others;

the nature and severity of the lesion.

This establishes the need to provide medical care, its priority and volume, the functional division of the medical evacuation stage where it should be provided is determined.

Evacuation and transport sorting carried out to distribute the affected people into homogeneous groups. The following points are taken into account: evacuation order; kind of transport; location of the injured on means of evacuation (lying, sitting; on the first, second or third tier; a certain position); determination of the destination - evacuation destination; need to be accompanied by a medical professional.

Basic sorting characteristics:

Medicinal;

Evacuation.

Danger to others determines the degree of need of the victim for sanitary or special treatment, isolation:

1. Those in need of sanitary treatment (partial or complete).

2. Subject to temporary isolation.

3. Not requiring sanitary treatment (full or partial).

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

1. Affected in terminal states, with an injury incompatible with life, in need of symptomatic care.

2. Those in need of emergency medical care for life-saving reasons.

3. Not in need of medical assistance at this stage.

Division into these groups is appropriate when the disaster occurred far from the location of the main rescue forces and the number of victims significantly exceeds the number medical workers. When rescue operations are carried out in a large populated area or when the number of victims compared to the number of medical workers is small, 2 groups are distinguished:

1. Those in need of emergency medical care for life-saving reasons. This 1st group also includes terminal patients.

2. Not in need of medical assistance at this stage (or assistance may be delayed)

Evacuation sign determines the need for evacuation, its priority, type of transport, position of the injured person on transport.

1. Subject to evacuation to other territorial, regional health care facilities or health care facilities. located in the center of the country - taking into account the evacuation purpose, priority, position during transportation (lying, sitting), type of transport.

2. Those subject to return to the place of residence (resettlement) of the population for outpatient treatment or medical observation.

3. Non-transportable this moment victims.

First they carry out selective sorting - identify those who are affected and dangerous to others. Then, through a quick review of those affected, those most in need of medical care are identified (with the presence of external bleeding, asphyxia, convulsive condition, women in labor, children). Priority remains with those in need emergency care.

After selective triage, the nursing staff proceeds to sequential (“conveyor”) inspection of the affected people. The team simultaneously examines two affected people: one of them has a doctor, a nurse and a receptionist, and the other has a paramedic (nurse) and a receptionist. The doctor, having made a triage decision on the first affected person, moves on to the second, receives information from the paramedic about the condition of the affected person, supplementing it, if necessary, with information from personal examination and observation to determine the diagnosis and prognosis. Having made a triage decision on the second affected person, the doctor moves on to the third, receiving information about this affected person from the nurse, if necessary, personally clarifies the condition of the affected person and makes a triage decision. At this time, the paramedic with the registrar examines the fourth victim, etc. The porter section implements the doctor’s decision in accordance with the sorting mark. With this “conveyor” method of work, one sorting team can sort up to 30 - 40 stretchers affected by trauma or hazardous hazardous materials (with emergency care) in an hour of work, using 1.5 minutes per injured person.

During an external examination and interview of the victim, the following are determined:

Severity of the condition: consciousness, forms of its disturbance, reaction of the pupils to light, pulse, breathing patterns, presence of bleeding, convulsions, blood pressure level (according to indications and possibilities), complexion and skin;

Localization of injury;

Nature of injury: mechanical injury local, multiple, combined, severity of injury, presence of bone fractures, prolonged tissue crushing, burn injury, damage by combustion products, hazardous chemicals, radiation damage;

A leading lesion that currently threatens the life of the affected person;

Possibility of independent movement;

The nature of the necessary medical care, the time and place of its provision.

Medical triage on prehospital stage medical evacuation.

First aid is provided to the victims directly at the scene of the disaster or at collection points (concentration). If there are life-threatening factors in the area. The affected people are taken out or taken outside the contaminated areas and given assistance. When providing primary care, the following triage groups of affected people are distinguished:

1. Those who need this type of assistance first of all - in the presence of burning clothing, external arterial bleeding, shock, acute cardiac and respiratory failure, asphyxia, convulsions, collapse, loss of consciousness, extensive burns of more than 20% of the body surface, burns of the face and respiratory tract, traumatic amputation of a limb, open hip fracture, prolapsed intestinal loops, open and tension pneumothorax, sudden change in complexion and skin.

2. Victims who can be helped provided in the second place (postponed for the near future) - with further exposure to a damaging factor that aggravates the damage: smoldering clothing, the presence of hazardous chemicals on open parts of the body, carbon monoxide in the surrounding atmosphere, victims whose body parts are crushed by the rubble of a destroyed building, with open and closed fractures bones, extensive soft tissue damage, burns of less than 20% of the body surface, skull trauma. Delay in helping them may worsen their condition, but does not pose an immediate threat to life.

3. Those in need of removal or transportation to the nearest medical aid point ( medical institution). The injured who received medical assistance are evacuated first, and everyone else second. The position of the affected person in transport is determined (lying or sitting). Lightly affected people (walkers) leave the disaster area independently or with outside help(rescuers, relatives)

Medical triage at the hospital stage

medical evacuation.

LUs of this stage are the final stage of evacuation of the affected, if the profile of their lesion corresponds to the medical departments of the institution. In these institutions important intra-point triage is acquired in order to identify those dangerous to others, determine the functional unit (clinic) where assistance can be provided in full, taking into account the leading lesion, the order of its provision is established, the sequence of the affected persons passing through treatment departments (for combined and combined lesions).

At the entrance to territorial health care facilities, a distribution post (RP) is organized at a distance of visual and audio communication with the emergency department, appropriately equipped.

The RP is staffed by a paramedic (nurse) and a dosimetrist (in case of RV infection). They constantly monitor the environment, meet transport with victims, regulate the order of its delivery to the sorting site, and notify about the arrival of victims from the source of the lesion. RP personnel use individual means protection according to the situation.

From the RP, the transport is sent to the sorting area to the reception department for unloading the victims. During intra-point sorting of affected people, suspects are identified at the sorting site. infection or obviously sick, sending them to an infectious disease isolation ward, those affected in a state of psychomotor agitation - to a psychoneurological isolation ward. The affected people, who are not relevant for a given LU, are not removed from the vehicle, but are evacuated further to their destination in the corresponding LU.

Emergency(Emergency) occurs when significant destruction occurs, regardless of its cause, even in the absence of human casualties.
The incident is considered massive already with three victims.
The incident is considered "catastrophe", if the destruction led to the death of one person.

Highlight three phases of the care process in case of mass casualties.
First phase- isolation phase. This is the period from the moment an emergency occurs until the start of first aid by regular rescue units. First aid is provided in the form of self- and mutual assistance.
Second phase- rescue phase. The period from the arrival of rescuers until the evacuation of victims from the affected area. During the rescue phase, regular medical forces provide assistance to victims abroad.
Third phase- recovery phase. This is the period after the evacuation of victims and before the final outcome.

Each affected person is assigned an appropriate triage category.

Medical force leadership at the scene of mass incidents, the first person in charge of any emergency medical service team that first arrived at the scene of the incident assumes responsibility. The person in charge of the EMS paramedic team that was the first to arrive at the scene of the incident takes over the leadership of the medical forces and carries it out until the arrival of the first EMS medical team.

In 1st turnAffected children and pregnant women, who are a priority group, need help and removal from the outbreak.

Then those affected with external and internal bleeding, in a state of shock, asphyxia, convulsions, in unconscious, with penetrating wounds of the chest and abdomen, which are under the influence of damaging factors that aggravate the lesion (burning clothing, the presence of SDYAV, RV on open parts of the body).After the initial triage, the victims are sent to the central site for continued triage and periodic reassessment of the severity of the condition. Here, if necessary, they are redistributed into categories.

Once the issues of primary sorting and marking of victims are resolved, there is a need to distribute medical transport, depending on needs. Type must be provided vehicle and all available territorial resources. The triage physician must know the location and distance to local hospitals, as well as the capabilities of emergency departments and the location of specialized centers (trauma, toxicology, burns).

A certain number of teams are sent to the scene of the incident depending on the number of victims:
If there are 3 victims, it is advisable to send 2 emergency medical services teams, including one intensive care team, to the scene of the incident.
If there are 4-5 victims It is advisable to send 3 emergency medical services teams to the scene of the incident, including one intensive care team.
If there are 10 victims at the scene, it is advisable to send 3 emergency medical services teams for every 5 victims.
If there are 50 casualtiesIt is advisable to send 25 emergency medical services teams to the scene of the incident.

Additional

The most important condition for ensuring the clear implementation of stage-by-stage treatment of those affected (victims) in peacetime and wartime emergencies, and their subsequent evacuation to their intended destination is medical triage. Its foundations were developed by the outstanding Russian surgeon N.I. Pirogov. In other words, medical triage is an important organizational element in the system of medical evacuation support, mandatory when organizing it according to the type of staged treatment.

Medical triage is the distribution of affected(victims) into groups according to sign of need for homogeneous treatment-and-prophylactic and treatment-evacuation measures according with medical indications and the amount of medical care provided at this stage of medical evacuation in specific conditions of the situation .

Some authors replace the ending “in specific conditions of the situation” in the definition with the phrase “and the accepted evacuation procedure” (Komarov F.I.) or “the possibilities of providing it at this stage” (Musalatov Kh.A.). In these moments there is no fundamental contradiction, since the dependence of the evacuation order on the prevailing conditions of the situation is quite natural. Moreover, it is the conditions of the situation that determine the dynamism of medical triage, making its implementation either tougher or, on the contrary, softer. It is quite obvious that the ultimate goal of organizing and conducting medical triage at any stage of medical evacuation is to increase its throughput depending on the need for this, determined by the situation.

Purpose of medical triage – providing the wounded and sick (affected) with timely implementation of treatment and preventive measures in the optimal volume and rational evacuation. Pointing out the significance of his method, N.I. Pirogov wrote: “a well-organized sorting of the wounded... is the main means for providing correct assistance and for preventing helplessness and trouble that is harmful in its consequences.”

Medical triage of the injured is carried out at each stage of medical evacuation, in all its functional units.

This is an important task and a responsible task, the solution of which involves the most experienced doctors, guided by main sorting criteria , formulated by N.I. Pirogov and have not lost their significance today:

A sign of danger to others (a sign of the need for special treatment and isolation);

Treatment sign (sign of need for medical care);

Evacuation sign (sign of need for evacuation).

It is customary to distinguish two types of medical triage: intra-point and evacuation-transport.

Intra-point sorting aims to distribute incoming injured people into groups for referral to the appropriate functional units in a certain order (determining the need and the order of admission to the functional units of a given stage of medical evacuation.)

Evacuation and transport sorting determines the evacuation purpose (where?), the order of evacuation, the type of transport and the position on it.

This division into species is largely arbitrary, since often both of these types are combined, which has allowed some specialists to doubt the appropriateness of such a division (Sakhno I.I., Goncharov S.F., 2002).

Summarizing the above provisions, we can determine the basic requirements for medical triage:

Continuity (carried out at all stages and in all functional departments);

Continuity (triage is carried out taking into account the next stage of medical evacuation);

Specificity (means that at each specific moment the grouping of the wounded and affected must correspond to the operating conditions of the medical evacuation stage at the moment and ensure the successful solution of problems in the current situation).

At the stage of medical evacuation, medical triage is carried out by triage teams, whose main task is to quickly identify the following sorting groups:

Group 1 – dangerous to others : RV infection is higher acceptable standards and infection with persistent agents (need special treatment); persons in a state of psychomotor agitation, with signs of an infectious disease or with suspicion of it (subject to isolation). These wounded and affected people are immediately separated from the general flow and sent to the special treatment department (site) or to the appropriate isolation wards.

Group 2 – those in need of medical care at this stage of medical evacuation ( those in need of emergency assistance and assistance on a first-come, first-served basis). These affected people are sent to the appropriate functional units (dressing room, operating room, anti-shock department, etc.).

3rd group – subject to further evacuation (help will be provided at the next stage). They are sent to the evacuation department (unit) for preparation and evacuation to the next stage.

Group 4 – mildly affected . These affected people remain at this stage until recovery or can be immediately sent to outpatient treatment (after receiving help and a short rest).

Group 5 – those affected with extremely severe injuries incompatible with life and defeats (agonizing). Such victims are not subject to evacuation; they are given symptomatic therapy aimed at alleviating suffering.

Identifying such a category of affected individuals is both paramount (triage priority) and challenging. As in no other case, the allocation of those affected to this triage group is so independent of the prevailing situation. The more complex the situation, the sharper the disproportion between the number of people in need of medical care and the ability to provide it with the available forces and means, the stricter the medical triage is carried out, aimed at identifying groups of affected people who have prospects for survival and recovery, the more obvious it becomes that it is inevitable to single out a group of unpromising affected.

At the stage of medical evacuationsorting begins at the sorting (distribution) post, where those who pose a danger to others are separated from the general flow of those affected. They are sent for sanitary treatment and to isolation wards. Persons who do not pose a danger to others, depending on meteorological conditions, are sent from the distribution post to the sorting site or to the receiving and sorting room (sorting room). Persons who have undergone sanitary treatment, as a rule, are sent to the sorting area (reception and sorting room); in some cases, the seriously injured can be sorted immediately after special treatment in the clean half of the special treatment area (department).

At the sorting site and in the premises of the reception and sorting (triage and evacuation) department, medical triage is carried out by triage teams created at the expense of the personnel of the reception and sorting and other functional units of the medical evacuation stage. The triage team includes a doctor, a nurse or paramedic, a registrar and 1-2 levels of orderlies. In triage units, doctors continue to identify persons who are dangerous to others and send them for special treatment and to isolation wards. Doctors of the triage teams identify those affected who need medical care at this stage of medical evacuation. During selective triage, persons in need of emergency assistance at this stage are first identified and the functional unit where this assistance should be provided is determined. The rest of the affected people are placed in a fan or in rows with good passages to each of them (“Pirogov rows”). The triage team proceeds to a sequential (“conveyor”) inspection of the wounded and affected with the determination of a triage decision regarding them.

Medical triage is based on the diagnosis and prognosis of the lesion (medical triage is diagnostic and prognostic in nature).

The team method of work in the reception and triage (triage and evacuation) department provides for triage while simultaneously providing some emergency care. The doctor quickly, using physical methods, examines the affected person, formulates a diagnosis of the lesion with an assessment of severity and taking into account the leading syndrome, gives instructions to the nurse or paramedic to perform emergency measures, and makes a decision on the need for medical care at this stage. If the affected person needs medical care at this stage, the order of its provision and the functional unit where it should be provided are determined. If the affected person is subject to further evacuation, then the components of the evacuation and transport sorting solution are determined. Indications for evacuation are determined based on the condition of the injured, the urgency of the medical care they need, the type and availability of ambulance transport, the condition and length of evacuation routes, as well as its possible duration. Triage in relation to evacuation should take into account the available means of transport that are most appropriate for the duration of evacuation and the urgency of providing medical care. The following sorting options are possible:

Evacuation is possible and carried out quickly, the plan for its implementation is based on the possibility of choosing means of assistance, direction and means of evacuation;

Evacuation is long and difficult, which requires careful provision of medical care and precise selection of means of evacuation;

Evacuation is practically impossible in the near future; triage can be carried out in order to select those affected who can be treated on the spot and ensure their survival.

The speed of sending the affected person is determined by its condition and the availability of vehicles. This principle can only be violated in exceptional cases in a threatening combat situation. “Evacuation at any cost” violates triage principles and endangers the lives of the wounded and injured.

In one hour of work, the triage team sorts about 10 incoming patients, and in a day of work about 150-180 affected people. If the triage team is strengthened by a second nurse and a registrar, then using the “rolling” method - sequentially serving two wounded or affected people - the productivity of the team can be increased by 1.5 times.

The registrar issues the passport part medical document: primary medical card of the civil defense, primary medical card of the affected (patient) in an emergency (form No. 167/u-96), medical history. Records diagnosis and procedures performed therapeutic measures, and also registers the affected person in the book of affected (sick) people. Thus, these documents record the results of medical triage. The orderlies deliver the wounded and injured to the appropriate functional unit, guided by the sorting marks attached to their clothes on the chest. Colored triage marks allow orderlies to move the affected person to a functional department for medical care or for loading onto vehicles without additional instructions from a doctor. Sorting marks are replaced with others when sharp deterioration condition of the affected person or after medical care and are removed completely upon loading onto evacuation transport.

MEDICAL SORTING- distribution of the affected and sick in first-aid posts and treatment. institutions into groups, each of which includes persons in need of homogeneous treatment, preventive and evacuation measures, with the determination of the priority and place of providing them with medical care, as well as the direction, priority and method of evacuation. S. m. is an organizational event that allows the most effective use of available forces and means medical service, correctly organize the provision of medical care to the injured and sick, their treatment and evacuation, i.e., ensure successful implementation adopted system of medical and evacuation measures.

The need to use S. m. for the purpose of timely provision of medical care to those most in need arose from the time when fighting began to be accompanied by significant sanitary losses (see Sanitary losses). Theoretical provisions, S. m.’s technique was first substantiated and brilliantly put into practice by N. I. Pirogov. However, the distribution of the wounded and sick into groups was used in medical cases. providing troops in the pre-Pirogov period. With the emergence of organized medical care in the Russian army (see Military Medicine), the division of the wounded and sick into severe and mild received official recognition. So, in the wars of the 17th century. it was carried out mainly for the purpose of issuing, “depending on the wounds,” various amounts of money “for treatment.” In the wars of the 18th century. the wounded and sick were divided into those who were able to follow with the army, those who were to be left in “retrashements” and those who needed to be sent to hospitals. During Russian-Turkish war 1768-1774 persons to be treated in hospitals were also distributed according to the place of treatment; in a circular letter from Commander-in-Chief P.A. Rumyantsev, mildly ill patients were offered, giving hope for get well soon, send them to “nearby hospitals”, and send severe cases, “who are not reliable for a quick cure,” to “distant ones.” By the end of the 18th century. refers to the division of the wounded and sick “into three classes” - chronically ill, seriously ill and weak. The “Regulations on the procedure for establishing hospitals under the Foreign Army”, published in 1807, mentions the wounded and sick who are unable to “endure further transfer”, as well as “not tolerating the slightest delay.” The book by A. A. Charukovsky “Military Camping Medicine” (1836) speaks of the need to identify “at the regimental dressing” the wounded in need of immediate surgical care, and the composition of this group is given. Further development of evacuation trends in medical. provision of the army in the first half of the 19th century. required a more differentiated separation of the wounded and sick, based on possible outcomes and likely duration of treatment.

Consequently, long before N.I. Pirogov, there were separate elements of triage of the wounded and sick in medical care, but the genius of N.I. Pirogov, his enormous knowledge and clinical experience was needed to create a coherent and scientifically substantiated doctrine of S. m This was facilitated by the medical conditions. provisions prevailing in besieged Sevastopol. Significant sanitary losses among the city’s defenders and the relatively short distance from the main dressing points from the troops led to the arrival at these points of a large number of wounded within short periods of time. The discrepancy that was created between the significant number of wounded who needed medical care and the ability to provide it in the near future was the main reason for introducing triage as a mandatory organizational event that could, to some extent, eliminate this discrepancy. “The idea of ​​sorting the wounded,” wrote N. I. Pirogov, “came to me precisely when I had to deal with thousands of wounded...”. However for scientific justification It was not enough for S. to recognize its necessity; it was necessary to reconsider existing views on the organization of medical care for the wounded. And here the decisive role was played by the conviction of N.I. Pi-rogoEa that “the benefits brought to known cases early operations, does not compensate for the harm resulting from the uneven distribution of assistance for the majority of cases...” This provision formed the basis for the division of the wounded into 5 categories proposed by Pirogov: “hopeless and mortally wounded”; “severely and dangerously wounded, requiring immediate assistance”, “severely wounded, also requiring immediate, but more protective assistance”; “wounded for whom immediate surgical assistance is necessary only to make transport possible”; “slightly wounded or those whose first aid is limited to applying a light bandage or removing a superficially seated bullet.”

N.I. Pirogov began his activities in Sevastopol by improving the organization of work at dressing stations and, first of all, by introducing medical triage. He wrote: “Having realized soon after my arrival in Sevastopol that simple order and order at the dressing station is much more important than purely medical activity, I made a rule for myself: not to begin operations immediately when transferring the wounded to these points, not to waste time on long-term benefits. .. and immediately start sorting them.”

Subsequently, during the war of 1877-1878, N.I. Pirogov substantiates the role of medical triage in ensuring the evacuation of the wounded and sick. He believed that S. m. should be carried out in accordance with the ability of the wounded and sick to endure transportation over a certain distance (severely wounded who “cannot withstand distant and difficult transport”; lightly wounded and sick who are not subject to evacuation far to the rear, because “they soon recover and return to duty” and occupy “the middle between these categories”) and recommended the most appropriate methods of transportation.

And at present, many of N.I. Pirogov’s recommendations on the procedure for carrying out S. m. have fully retained their significance. These include, first of all, the following: S. m. is possible only on the basis of a “correct scientific diagnosis,” in connection with which “the most experienced doctors” should be involved in S. m.; to carry out S. m. you must have special place(“storage place”), where the wounded and sick “should be placed leaving passages allowing them to be approached from all sides”; S. m. should begin “at the first admission and analysis” of the wounded by specially designated medical personnel and be carried out “without touching” the original dressing; first of all, it is necessary to separate the lightly wounded from the “difficult and lying”; In order to carry out triage conclusions in a timely manner, it is necessary to have a sufficient number of “support personnel”, separate places for concentrating the wounded and sick of each category, etc.

After the works of N.I. Pirogov and up to Russo-Japanese War 1904-1905 practically nothing new was introduced into the doctrine of S. m. Moreover, the predominance of evacuation trends in medical support for troops during this war led to the oblivion of a number of provisions of N. I. Pirogov. True, the chief surgeon of the Manchurian army, R.R. Vreden, sought, through appropriate medical treatment, to to some extent combine the evacuation of the wounded and sick with their treatment. In particular, he proposed at the forward dressing station to allocate a group of wounded in need of emergency surgical interventions at the main dressing points. However, these proposals were not fully implemented.

During the First World War 1914-1918. S. m. was regulated mainly by two official documents- regulations on military sanitary institutions and military department institutions and instructions on the sanitary unit of the North-Western Front on the sorting and evacuation of the sick and wounded. According to the Regulations, all wounded and sick who arrived at the main dressing station were divided into 4 categories: those who were subject to return to duty, those who were able to go to a medical institution on foot, those who were subject to transportation to medical institutions, and, finally, those who were unable to withstand transportation without obvious harm to them. In accordance with the Instructions, the following groups of wounded and sick were to be distinguished: “those requiring... immediate operational assistance”, “not requiring immediate assistance”, who, after providing them with “initial assistance”, were subject to further evacuation, and those not subject to evacuation due to the severity of their condition. However, even during the First World War, especially in its first years, N.I. Pirogov’s teaching about S. m. in its significant part was not implemented in medical practice. provision of the Russian army. But at the same time, it received further theoretical development, which is associated primarily with the name of V. A. Oppel. The main role in the system of staged treatment (see) he proposed was given to S. m. “Whether we have stopped at studying the principles of staged treatment of the wounded,” he noted, “have we stopped at considering issues of surgical tactics, we involuntarily immediately encounter triage of the wounded as the main element of the organization of surgical care during the war." V. A. Oppel based the S. m. on “two signs: therapeutic and evacuation.” In their scientific works he was the first to connect them with each other within the framework of a single process of medical and evacuation support for troops and showed the role of S. m. in it. “Taking into consideration the whole army, going from regimental dressing stations to forward detachments, division hospitals, field mobile hospitals and head evacuation points , it is possible to develop whole plan triage of the wounded,” wrote V. A. Oppel.

Great October socialist revolution created favorable conditions for successful development based on the principles of socialist humanism, the theory and practice of military medicine. At the same time, it became possible to implement the provisions on S. m. N.I. Pirogov, V.A. Oppel, other prominent representatives of military medicine and their further development. B.K. Leonardov introduced the concept of “point” and “evacuation or transport” triage, substantiated the order of medical evacuation in various functional divisions of the stages of medical evacuation, and defined the role of medical evacuation in ensuring the evacuation of the wounded and sick to their destination. He revealed the essence of S. m. as a “group diagnosis”. “As important as an individual diagnosis is for the treatment of a particular patient,” said B.K. Leonardov, “this criterion is so insufficient for the “classification” of the mass of wounded and sick people in need of a wide variety of help.” Meanwhile, in war, the medical service has to deal with “a mass of wounded and sick.” In these conditions, “it is possible to properly organize the provision of medical care only if it is based not on individual, but on group diagnostics.” In turn, this is possible provided that the contingents of the wounded and sick are classified not according to descriptive or causal characteristics, but according to the need for certain measures, that is, not according to individual, but according to group characteristics.

Further improvement in the organization of medical support for military operations of troops has significantly enriched the teachings about S. m. This is a great merit of both the organizers of the medical service (E. I. Smirnov, N. I. Zavalishin, A. N. Grigoriev, etc.) and the military - field surgeons (M. N. Akhutin, S. I. Banaitis, F. F. Berezkin, M. M. Diterichs, P. A. Kupriyanov, etc.). In particular, A. N. Grigoriev showed the need to sort the wounded starting from the battlefield. N. I. Zavalishin developed the basics of S. m. in the head department of the field evacuation point. The recommendations of P. A. Kupriyanov, S. I. Banaitis and M. N. Akhutin about S. m. for regimental and divisional medical services were of great value. points based on a generalization of medical experience. ensuring combat operations on the lake. Hasan, b. Khalkhin Gol and during the Soviet-Finnish military conflict. The expediency of most of their proposals was confirmed during the Great Patriotic War 1941 -1945, when the doctrine of S. m. received further development and became one of the foundations of the entire system of medical and evacuation measures. S.'s practice followed from the provisions of the unified field military medical doctrine and ensured the successful implementation of staged treatment with evacuation as directed. Emphasizing the decisive role of S. m., E. I. Smirnov and S. S. Girgolav wrote: “There is no brilliance in our military sanitary business, but if at each stage of a given area there is no bustle, the queue surgical interventions is determined not by the groans and complaints of the wounded, but by the severity of the injuries and the actual capabilities of this stage and at this time, if calm and intense work is going on in the operating room and dressing room, if the reception and departure of the wounded are carried out in an organized manner, then you can be sure that three quarters of the wounded are already in they will be back in service in the next 2-6 months.”

During the Great Patriotic War, medical treatment, which was an integral part of the work of all medical units and institutions, was institutionalized: regular triage and evacuation hospitals (SEH) were created and their place in the system of medical and evacuation support was determined (see Triage hospital, Treatment and evacuation support system)", at the emergency medical service (see Medical battalion) and in hospitals, separate reception and triage departments were deployed for the seriously and lightly wounded, as well as for the sick; it was practiced to place stages of medical evacuation of the wounded and sick in evacuation departments among homogeneous groups as a measure to ensure clearer evacuation to destination, etc.

The experience of the past war convincingly showed that medical evacuation should be carried out at all stages of medical evacuation and in each functional unit of the stage. Moreover, it must be carried out continuously in strict accordance with the capabilities of the stage and the volume of medical care established for it in accordance with the purpose and the developing combat and medical situation. Elements of S. m. must be applied already on the battlefield. Middle and junior honey composition in the presence of several affected people, deciding on the order of assistance to them or the order of removal (removal), essentially produces S. m.

When carrying out S. m. at the stages of medical evacuation (see), first of all, from the general flow of those affected, those dangerous to others are identified: infected with radioactive substances and organic substances are subject to referral to a unit that carries out sanitary (special) treatment, and infectious patients and persons with suspected infectious disease - to the isolation ward. Two groups of affected people are established: a) those in need of medical care at this stage; b) affected, medical care in Crimea can be postponed until the next stage. In relation to the first group, in accordance with the nature and localization of the lesion (disease) and general condition the victim is determined what medical care (in terms of volume and nature) the injured person needs and in what order it should be provided to him. Depending on this, the functional unit of this stage is determined (operating room, anti-shock, dressing room, etc.), which will provide him with such assistance. Next, the advisability of leaving the affected (patients) at this stage is determined, depending on the severity of the lesion (disease): non-transportable - until the possibility of their further evacuation becomes possible; affected and sick, treatment of which can be completed on the spot - until recovery. For each person subject to further evacuation, it is established where he should be evacuated, on what transport, in what position (sitting, lying down) and in what order (first or second).

S. m. is carried out on the basis of the diagnosis and prognosis of the lesion (disease) with mandatory consideration of combat and medical conditions. situation. Depending on the diagnosis, the need and possibility of providing medical care to the injured (patient), the place and sequence of its provision are determined, indications and contraindications for evacuation, and its urgency are established. Particular care must be taken when identifying a group of affected people and patients with life-threatening injuries and diseases. Only persons who have undoubted signs of such injuries or diseases and therefore cannot be classified in other categories can be included in this group. Compliance with this condition is necessary in order to provide each affected person with the maximum and most effective assistance.

S. m. is usually divided into two types: intra-point, which determines the order in which the affected (patients) pass through the functional units of a given medical center (medical institution), the order and place of assistance to them at a given stage, and evacuation transport, which determines the order of sending the affected (patients) for the limits of this stage, sequence, method of evacuation and evacuation purpose. At the same time, in the process of S. m., carried out in SMEs (OMO). the type of medical institution must be determined to which the injured or patient should be sent for its intended purpose (“specialized surgical hospital for those wounded in the head, neck, spine”, “specialized surgical hospital for those wounded in the chest and abdomen”, “therapeutic hospital”, “ hospital for the treatment of lightly wounded”, etc.). When establishing a method of evacuation, the issue of the type of transport and the position of the evacuee in it (lying, sitting) is decided.

Certain conditions are created for the organization of S. m. At every stage honey. evacuation for these purposes, a special reception and sorting department (in SMEs and OMO, sorting and evacuation) department is deployed and equipped. Admission to PMP, SME and OMO in short time a large number of affected people forces the doctor conducting S. m. to carry it out, as a rule, without removing the bandage based on a brief* medical history, the results of an external examination of the affected (patient) and the use of simple diagnostic techniques. IN the power of This-C. m. should be assigned to the most* experienced doctors, capable under these conditions to deliver the most accurate diagnosis and make a decision that meets both the condition of the affected person and the situation, which often limits the capabilities of the stage in providing assistance. It is also very difficult to sort people with combined lesions and identification of the leading lesion, i.e. the one that poses the greatest threat to the life of the affected person at the moment and on which the degree of urgency of medical care at this stage of medical care depends. evacuation.

The receiving and sorting department includes a sorting post (SP), a sorting area and receiving and sorting premises (tents); In SMEs and OMOs, separate triage areas are usually allocated for the severely affected and mildly affected, and reception and triage rooms (tents) are allocated for the severely affected, mildly affected and sick. In hospitals, to clarify the diagnosis, diagnostic wards and a dressing room can also be deployed as part of this department.

The results of S. m. are recorded with appropriate colored marks (marking), which are attached to the clothes of the affected (patient) or to the handles of the stretcher. Marking allows orderlies, without additional instructions, guided only by sorting marks, to deliver the injured to the appropriate units or load them onto transport in strict accordance with the decision of the doctor who carried out the triage.

The importance of S. m. especially increases in a war with the use of weapons of mass destruction by the enemy, characterized by the simultaneous occurrence of mass sanitary losses (see) and in connection with this, the entry into the stages of medical evacuation in a short time of a large number of affected people. This determined the need for further development of S. m., clarification of its organization, justification of methods for its implementation in difficult conditions modern warfare. The works of A. N. Berkutov, A. A. Bocharov, A. A. Vishnevsky, E. V. Gembitsky, A. S. Georgievsky, I. I. Deryabin, N. G. Ivanov, F. were devoted to solving these problems. I. Komarova, I. P. Lidova, G. P. Lobanova, I. A. Yurova and others.

The problem of S. m. is relevant not only in the active army, but also in the conditions of Civil Defense, during various natural disasters and peacetime disasters with a large number injured. Earthquakes, accidents railway transport and other events accompanied by mass casualties among the population require similar actions in civilian medical institutions, the personnel of which must be prepared to carry out S. m. in these conditions. It should only be emphasized that, in addition to the diagnosis and prognosis, the medical staff performing S. m. in these conditions must be guided by certain social aspects. So, for example, women in labor, postpartum women, children should be provided preemptive right for priority evacuation.

Bibliography: Akhutin M. N. Military field surgery, M., 1941; Berez-k and N F. Basic principles of sorting the wounded according to the stages of evacuation of a military area, Military San. case, No. 6, p. 32, 1937; Georgievsky A. S. Organizational basis for sorting those injured in battle and sick, Voen.-med. zhurn., No. 1, p. 8, 1959; Zavalishin N.I. Head field evacuation point, M., 1942; Ivanov N. G. and Lobanov G. P. Organization of medical triage in a medical battalion (separate medical squad), Military Med. zhurn., No. 7, p. 6, 1965; Kupriyanov P. A. and Banaitis S. I. Short course military field surgery, M., 1942; Oppel V. A. The basis for sorting the wounded from a medical point of view at the theater of military operations, Voyen.-med. zhur., vol. 244, October, p. 151, 1915; Pirogov N.I. Collected works, vol. 5, part 1, M., 1961; Smirnov E.I. Ideas of N.I. Pirogov during the days of the Great Patriotic War, Military San. case, No. 1, p. 3, 1943; aka, Military Medicine and N.I. Pirogov, Military Med. journal, January-February, p. 6, March, p. 3, 1945; aka, War and military medicine, 1939-1945, M., 1979; encyclopedic Dictionary military medicine, vol. 3, art. 1002, M., 1948.

I. P. Lidov, G. P. Lobanov.

Medical triage is the distribution of the affected and sick during their mass arrival, depending on the nature and severity of the lesion (disease), into groups in need of homogeneous treatment and preventive or evacuation measures, determining the priority and place of care for each group or the priority and method of evacuation.

Since the conduct of hostilities began to be accompanied by significant sanitary losses (see), there has been a need to use medical triage in order to provide timely medical care to those most in need. N. I. Pirogov was the first to theoretically substantiate the doctrine and methodology of medical triage and brilliantly put them into practice. Arriving in besieged Sevastopol in 1854, he began his activities not with surgical aids, but with establishing order at dressing stations and, first of all, with conducting medical triage. N.I. Pirogov wrote: “Having realized soon after my arrival in Sevastopol that simple order and order at the dressing station is much more important than purely medical activity, I made a rule for myself: not to begin operations immediately when transferring the wounded to these points, not to waste time for long-term benefits and immediately start sorting them out.”

It is impossible to do without medical triage in all those cases when a large number of injured or sick people simultaneously enter a medical institution, even in peacetime. If, for example, you go to the hospital as a result natural disaster or a train accident, a large number of victims are delivered at the same time, doctors first of all face the task of conducting medical triage. In a combat situation, when mass arrivals of casualties are the rule, medical triage becomes especially important.

When carrying out medical triage at stages (see), first of all, from the general flow of those affected, those dangerous to others are identified (infected with radioactive substances, persistent agents, infectious or suspected patients) in order to prevent contact with them and to take possible measures to neutralize them (decontamination , etc.). Groups of affected people are identified who need medical care at this stage and for whom it can be postponed until the next one. In relation to the first group, in accordance with the nature and localization of the lesion (disease) and the general condition of the victim, it is established what medical care (in terms of volume, nature) he needs and in what order it should be provided. Depending on this, the functional unit of this stage (operating room, anti-shock, etc.) in which this assistance should be provided to him is determined. Next, questions are resolved about the indications for delaying the affected (patients) at this stage, depending on the severity of the lesion (disease). Thus, those who are not transportable are left until further evacuation becomes possible, and those who are easily injured are left until they recover. For each person subject to further evacuation, it is established where he should be evacuated, on what transport, in what position (sitting, lying down) and in what priority (first or second).

Medical triage is carried out only on the basis of diagnosis and prognosis. Depending on the diagnosis, questions are resolved about the need to provide assistance to the affected (patient) at a given stage, its nature and place, the order of provision of this assistance is determined, indications and contraindications for evacuation, the urgency and order of this evacuation are established. Depending on the prognosis, the question of the possibility of curing the injured or sick person at this stage with his subsequent return to duty or the need for his further evacuation to the rear (due to the length of the recovery period) is decided.

Medical triage is usually divided into two types: intra-point, which determines the order of passage of the affected (patients) inside the first-aid post, while establishing the order and place of care at this stage; and evacuation transport, which determines the order of sending the affected (patients) beyond this stage, while deciding the order and method of their evacuation, as well as where they should be evacuated (destination).

Certain conditions are created to organize medical triage. At each of them, a specially equipped receiving and sorting department, including a sorting area, is allocated for these purposes. Admission to the stage in a short time large quantity of the injured forces the doctor performing medical triage, as a rule, to carry it out without removing the bandage and carefully collecting an anamnesis, most often guided only by an external examination of the victim. Because of this, medical triage should be entrusted to the most experienced doctors.

The results of medical triage are recorded with appropriate colored marks (markings), which are attached to the clothes of the affected person (patient) or to the handles of the stretcher (Fig.). Marking allows junior medical staff, without additional instructions, guided only by sorting marks, to send to certain units or load the affected persons onto transport in strict accordance with the decision of the doctor who carried out the triage.

Elements of medical triage are already used on the battlefield. Middle and junior medical staff, in the presence of several affected people, deciding on the order of care for them or the order of removal (removal), essentially performs medical triage.

The importance of medical triage especially increases in a war with the use of nuclear weapons by the enemy, characterized by the simultaneous and massive occurrence of sanitary losses and arrival at stages medical evacuation in a short time, a large number of affected people.

The civil defense medical service must be ready to provide medical and evacuation services to large masses of the affected population. Due to this medical staff The person called upon to provide this support must know the principles and methods of medical triage. There are no significant differences in the conduct of medical triage in civil defense conditions. It should only be emphasized that, in addition to diagnosis and prognosis, medical personnel performing medical triage in these conditions are required to be guided by certain social aspects. For example, women in labor, postpartum women, and children should be given priority for priority evacuation.

Sorting marks: E - evacuation, SO - sanitization, (numbers indicate order).