Stages of evacuation of the wounded. Stage of medical evacuation. Qualified medical care

A set of measures for the delivery of sick and wounded to the stages of medical evacuation for the provision of medical care and treatment.

1) the fastest delivery of the wounded to the stages of medical evacuation to provide medical care and treatment.

2) the release of advanced stages of medical evacuation to receive newcomers.

The route along which removal and transportation is carried out is the path of medical evacuation. And the distance from the point of departure to the destination is the shoulder of the medical evacuation. The set of evacuation routes is the evacuation direction.

Medical evacuation begins with the removal, removal and removal of victims from the lesion and ends with their delivery to the hospital, providing a full amount of medical care and full treatment. If it is necessary to evacuate the affected to special centers of the region or country, air transport is used. Sanitary and prepared transport is needed, but it is not enough. In war zones, the most difficult is evacuation through rubble, fires. If it is impossible to get to the places of location of the affected, they are carried out on stretchers, boards to the place of their possible loading onto transport (relay method). From the affected objects, evacuation is carried out by ambulance vehicles, transport of medical institutions, it is possible to attract an empty empty car along the way and individual transport. The military, local population and rescuers are involved in the removal and loading. Places of loading should be near the affected areas, outside the zone of contamination and fires. To care for the injured, medical personnel are allocated from the ambulance medical staff, dignity of squads, and rescue units.

Evacuation can occur according to two principles:

1) “on oneself” (cars of medical institutions, regional centers for disaster medicine)

2) "on my own" (transportation of the affected object, transport rescued by the detachment).

Evacuation from a medical point of view is not a positive factor for the wounded and is a forced measure and is only a means of achieving the best results in providing medical care to treatment.

Stage of medical evacuation: purpose and definition.

The stage of medical evacuation is understood as the forces and means of the MSGO deployed along the evacuation routes and designed to receive and sort the injured, provide them with medical care, treatment, and prepare for further evacuation. The stages are healthcare institutions, medical institutions and civil defense formations deployed in advance.

Functional institutions - Tasks: 1) reception and sorting of incoming (sorting) 2) sanitation (washing) 3) medical care (operating, dressing, anti-shock) 4) hospitalization and treatment of the wounded (hospital department) 5) accommodation of the wounded and sick, prepared for further evacuation 6) ISOLATION OF INFECTIOUS PATIENTS 7) subdivision and maintenance of patients

At each stage, a certain type and amount of medical care is provided; for this, doctors of a certain specialization and medical property are needed. Must be ready to work in any conditions and change of location.

Medical means of anti-radiation protection: classification. Radioprotectors: mechanisms of protective action, application procedure. Means of long-term maintenance of increased radioresistance. Means of prevention and relief of the primary reaction to radiation

Medical means of anti-radiation protection are divided depending on the “place” of their application: use for prophylactic purposes or for first aid:

1. Preventive agents.

1.1. Radioprotectors are drugs intended to prevent the damaging effects of a single external exposure.

Radioprotectors of emergency action - fast ultrashort action: the time of protective action occurs 5-10 minutes after application, lasts 40-60 minutes. (Mexamine Naphthyzin Indralin)

1.1.1. Radioprotectors with a standard duration of action: the time of protective action occurs 30-40 minutes after administration, lasts 4-6 hours (mercaptoethylamine, its cystamine disulfide, as well as derivatives of these compounds - cystafos, gammaphos, etc.)

Means of long-term maintenance of radioresistance - means intended for the prevention of the damaging effect of II under conditions of prolonged exposure (the protective effect occurs 24-48 hours after the start of the drug, lasts up to 7-10 days). (Amitetravit Riboxin, diethylstilbestrol,

propolis, eleutherococcus extract and ginseng tincture.)

1.2. Means that prevent the accumulation of RV in the body - preparations of the corresponding stable isotopes (iodine, potassium, calcium).

1.3. Means that prevent the adhesion of RV on the skin - protective pastes.

2. Means for rendering first aid to the injured:

2.1. Means for the prevention and relief of the primary reaction to radiation.

2.2. Means that prevent the entry of RV from the gastrointestinal tract - sorbents.

(Barium Sulfate, Vocacite, Ferrocine, Polysurmin, Prussian Blue, Calcium Alginate)

2.3. Means of prevention of early transient incapacity.

Radioprotectors - pharmacological preparations or formulations that, when used prophylactically, are able to minimize radiation damage with possible exposure to a dose of more than 1 Gy.

The use of radioprotectors for irradiation at doses less than 1 Gy is impractical due to the absence of a practically significant anti-radiation effect.

The mechanism of action of long-acting radioprotectors is associated with the ability of these drugs to cause an increase in the overall resistance of the organism, including radioresistance. In addition, the processes of post-radiation repopulation of the bone marrow are activated, which restores the blood system. The most effective drugs from this group are hormonal preparations of steroid structure and their analogs and immunomodulators.

diethylstilbestrol (DES) hormonal

vaccine preparations from bacteria of the enteric-typhoid group, as well as preparations of polysaccharide, lipopolysaccharide and protein-lipopolysaccharide components of these microorganisms (typhoid vaccine with sextaanatoxin, BCG vaccine, anti-influenza, typhoid paratyphoid and other vaccines from live or killed microorganisms)

Riboxin (able to reduce the formation of chromosomal aberrations)

Amitetravit is a drug consisting of ascorbic acid, rutin, thiamine, pyridoxine, as well as the amino acids tryptophan and histidine.

Adaptogens of natural origin(phyto- and zoopreparations), the basis of the pharmacological action of which is their ability to increase the nonspecific resistance of the organism

Propolis, eleutherococcus extract and ginseng tincture.

As a result of total exposure to a dose of more than 1 Gy, a symptom complex develops quite quickly, denoted as primary response to radiation. The main manifestations are acute dyspepsia (vomiting) and decreased motor activity.

Etaperazine - the mechanism of antiemetic action is associated with inhibition of dopamine receptors in the trigger zone of the vomiting center

Metoclopramide (cerucal, raglan) - an antiemetic drug with a specific B 2 -dopaminolytic effect

Dimetkarb - antiemetic + stimulant (prevention of asthenia)

dixafen relieves vomiting and weakness, when antiemetic ineffectiveness is usually

Metoclopramide. repeatedly with already developed vomiting parenterally

Dimetpramide is an analogue of metoclopramide.

Latran (zofran) - antiemetic drug

other drugs acting on the central nervous system (psychotropic drugs): phenazepam, metacin, droperidol, haloperidol, chlorpromazine, etc.

The name “stage of medical evacuation” has been attached to medical institutions since, in the evacuation system, they stood at a distance of one daily passage of horse-drawn ambulance transport from each other and really were the place where one stage of the long-term transportation of the wounded and sick ended and the beginning of another.

Vladimir Alekseevich Oppel was the first to formulate the main provisions of the system of medical and evacuation measures, which were called staged treatment. “By staged treatment, I mean a treatment that is not disturbed by evacuation, and in which it is included as an indispensable component.”

The exhaustive wording of the concept - the stage of medical evacuation - is as follows: The stage of medical evacuation means - the forces and means of the medical service deployed on the evacuation routes with the tasks of receiving, medical sorting, providing assistance, treatment and preparation for further evacuation of the wounded and sick. Each stage of medical evacuation is characterized by a certain type of medical care. As an example of the evacuation phase, a schematic diagram of the deployment of a first aid team is given (diagram 5).

Scheme 5. Principal diagram of the deployment of the OPM for reception from the outbreak

defeat of nuclear weapons.

At the same time, as part of each stage of medical evacuation, a number of typical functional units are usually deployed to perform the corresponding tasks.

For the reception and sorting of the incoming wounded and sick, a sorting and evacuation or receiving and sorting department is intended. If, in accordance with the established volume of medical care, some of the wounded and sick are evacuated further to the rear immediately after sorting, without sending them to other functional units of the medical facility, they are placed and prepared for evacuation in the evacuation tents of the sorting and evacuation department. From medical institutions, the evacuation of the wounded and sick is carried out, as a rule, directly from the medical departments.

Partial or complete sanitization of the wounded and sick, as well as special treatment of ambulances and stretchers, is carried out in the department (on the site) of special treatment.

The provision of medical care to the wounded and sick in the amount characteristic of this stage of medical evacuation is carried out in the dressing room, surgical dressing room and hospital departments. The hospital department is intended for hospitalization and treatment of the wounded and sick. An isolation room is deployed to isolate infectious patients.

As part of the stages of medical evacuation, subdivisions are provided that manage their work and provide logistics - management (headquarters), a pharmacy, a laboratory, a kitchen, warehouses, etc.

Requirements for the stage deployment site:

Places (regions) for the deployment of medical centers and medical institutions are selected taking into account specific conditions (organization of the rear, road markings, radiation and chemical conditions, the availability of sources of good-quality water, the sanitary and epidemic state of the area, the possibility of using local means for protection and camouflage).

However, in all cases, one should strive to deploy medical posts and medical institutions close to the supply and evacuation routes, if possible away from objects that could attract the attention of the enemy, in areas where convenient deployment of functional units is ensured, their good protection and camouflage, as well as the possibility of organizing reliable protection and defense.

At the same time, the deployment site should be as close as possible to the areas of greatest losses in order to ensure the provision of medical care to the wounded and sick as soon as possible (first aid - in the first 4-5 hours, qualified - 8-12 hours from the moment of injury, and in case of damage to FOV - first medical aid - within 2-4 hours, qualified therapeutic assistance - 6-8 hours from the moment signs of intoxication appear).

Stages of medical evacuation must be constantly ready to work in various, often unfavorable conditions, to quickly change their location and to simultaneously receive a large number of wounded and sick, including directly from the centers of mass destruction.

The options for the operation of the evacuation stage in various medical settings are given in detail using the example of the OPM:

With the systematic implementation of the measures of the civil defense OPM, it acts in accordance with the procedure for introducing civil defense formations into the lesion site and the plan for conducting rescue operations.

In the event of a sudden attack by the enemy, first aid units of rural areas and cities that have not been subjected to nuclear strikes, as well as those that have survived in the affected cities, are included in the groupings of civil defense forces.

When setting the task of advancing, deploying and organizing the work of the detachment, the head of the OPM brings the situation to the personnel briefly - in the medical and evacuation direction and in detail - on the advance route, indicating the route of advancement of the detachment to the lesion, the tasks of the medical intelligence group (non-standard), the order of construction the column of the detachment, the time of arrival of the OPM to the focus of destruction, the place of meeting with the medical intelligence group, the time and place of deployment of the detachment.

The Medical Intelligence Unit provides:

Conducting medical reconnaissance on the routes of the detachment's advance to the focus of destruction and in the places of its deployment;

Identification of premises suitable for the deployment of a detachment in a given area;

Conducting medical reconnaissance in the area of operation of the OPM and on the routes of removal of the affected to the place of deployment of the detachment.

Upon completion of medical reconnaissance, the group arrives at the PKO, and its personnel begin to perform functional duties in their units.

With the arrival of the OPM at the nuclear lesion site, the deputy head of the detachment for mass formations, in accordance with the data of medical intelligence, organizes communication with the commanders of the sanitary teams providing first aid at the facilities, determines the routes for evacuating the injured from the objects of rescue operations by the OPM transport.

The first aid squad is deployed in preserved buildings and protective structures with sufficient area to accommodate functional units. OPM can also be deployed in railway cars, on sea and river vessels.

When choosing a place for deploying a detachment, take into account:

Availability of uncontaminated territory and evacuation routes for those affected in the PKO from the objects of rescue operations and from the PKO to the suburban area;

Presence of uncontaminated water sources;

The possibility of using the remaining protective structures in case of radioactive and chemical contamination of the territory or in case of repeated use of weapons of mass destruction by the enemy.

During the work of the detachment in the area contaminated with RS, the total radiation dose of personnel is taken into account, which should not exceed 50 R during the time of advancement and work in the focus (up to 4 days).

The detachment must be fully prepared to receive the injured 2 hours after arriving at the lesion site. Reception of the injured begins simultaneously with the deployment of the sorting and evacuation department and the department for partial sanitization and decontamination of clothes and shoes.

With the mass admission of the injured and sick, in order to organize the most effective work of medical personnel in the functional units of the detachment, medical and nursing teams are created.

During the deployment and work of the detachment, the head of the OPM organizes communication with the health authority of the district (city), reports to him on arrival at the place of deployment, the readiness of the detachment to receive the injured, the beginning of the arrival of the injured, then - in accordance with the timesheet of urgent reports. In this case, radio communications and mobile communications are used.

Administration of antidotes and anti-botulinum serum;

Complex therapy for acute cardiovascular insufficiency, cardiac arrhythmias, acute respiratory failure, coma;

Dehydration therapy for cerebral edema;

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

A set of measures in case of ingestion of AOHV;

The introduction of painkillers, desensitizing, anticonvulsant, antiemetic and bronchodilator drugs;

The use of tranquilizers and neuroleptics in acute reactive conditions.

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

Specialized medical care- the final form of medical care, is exhaustive. It is provided by narrow-profile doctors (neurosurgery, otolaryngologists, ophthalmologists, etc.) who have special medical and diagnostic equipment in specialized medical institutions. The profiling of medical institutions can be carried out by giving them teams of specialized medical care with appropriate medical equipment. The optimal term for the provision of specialized medical care is 24-48 hours from the moment of injury. Distinguish between surgical and therapeutic specialized medical care.

Depending on the type and scale of emergencies, the number of people affected and the nature of the injuries they have, 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 specialized assistance activities of their capabilities, there may be various options for providing medical care to those affected in emergencies have been adopted, namely:

Rendering to the injured before their evacuation to hospital-type medical institutions only first or first aid;

Rendering the injured before their evacuation to hospital-type medical institutions, except for first or first aid, and first medical aid;

Rendering to the injured before their evacuation to hospital-type medical institutions, except for the first, pre-medical, first medical aid and urgent measures, qualified medical care.

Prior to the evacuation of the injured to hospital-type medical institutions, in all cases, they must take measures to eliminate life-threatening conditions at the moment, prevent various serious complications and ensure transportation without a significant deterioration in their condition.

3.3 Organization of the work of stages of medical evacuation in the liquidation of medical consequences of emergencies

The modern system of medical evacuation measures provides for the deployment of stages of medical evacuation by all medical units and healthcare facilities, regardless of their departmental affiliation.

Under stage of medical evacuation understand the medical formations and institutions deployed on the evacuation routes of the injured (sick) and ensuring their reception, medical triage, the provision of regulated medical care, treatment and preparation (if necessary) for further evacuation.

Stages of medical evacuation in the VSMK system:

Formation and establishment of a disaster medicine service;

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

formations and institutions of the medical service of the Ministry of Defense of Russia, the medical service of the Ministry of Internal Affairs of Russia, the medical service of the Civil Defense and other ministries and departments deployed on the evacuation routes of the affected from the emergency area for their mass reception, medical sorting, medical care, preparation for evacuation and treatment.

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

Reception, registration and medical sorting of the injured (sick) arriving at this stage of medical evacuation, - receiving and sorting department;

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

Providing injured (sick) medical care - dressing room, operating and dressing department, procedural, antishock, intensive care wards;

Hospitalization and treatment of the affected (sick) - hospital department;

Placement of the injured and sick, subject to further evacuation - evacuation department;

Placement of infectious patients with mental disorders - insulator.

Schematic diagram of the deployment of the medical evacuation stage

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

Stage of medical evacuation, intended for the provision of first aid, can be:

Points of medical care (PMP), deployed by medical and nursing teams;

Surviving (in whole or in part) polyclinics, outpatient clinics, district hospitals in the lesion;

Medical posts of the medical service of the Ministry of Defense of Russia, the Ministry of Internal Affairs, the Civil Defense Troops, etc.

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

Disaster medicine hospitals, multidisciplinary, profiled, specialized hospitals, clinical centers of the Ministry of Health and Social Development of Russia, medical forces of the Russian Ministry of Defense (special medical teams, medical battalions, hospitals, etc.);

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

When conducting closed heart massage for children, it is necessary to calculate the strength and frequency of pressing on the lower sternum so as not to cause additional trauma to the chest of the affected person.

The removal and removal of children and the outbreak should be carried out in the first place and carried out accompanied by relatives, easily injured adults, personnel of rescue teams, etc. pediatric teams.

Topic No. 4. Preparation of medical institutions (HCF) for work in emergency situations

Study questions:

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

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

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

4.4. Evacuation of medical institutions.

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

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

Treatment and prevention (hospitals, clinics, dispensaries, etc.);

Institutions of sanitary-hygienic and anti-epidemiological profile (centers of state sanitary epidemiological surveillance, anti-plague stations and institutes, research institutes, etc.);

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

· educational research institutions of medical profile.

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

Health authorities and institutions are entrusted with the task of providing health care in emergencies, which puts health institutions in front of the need for sustainable work in any extreme situation.

Sustainability of functioning of healthcare facilities- advance targeted preparation of the object for work in emergency situations of peacetime and wartime, including administrative, organizational, engineering, material and economic, sanitary and anti-epidemic, regime, educational (training) measures, as a result of which the risk of damage to the object is reduced and the fulfillment of wartime tasks and the occurrence of emergency situations in peacetime is ensured.

For these purposes, general and special medical and technical requirements are imposed on existing or planned for construction medical and preventive healthcare institutions.

To general Medical and technical requirements include requirements specific to healthcare facilities and implemented in all projects.

General questions on which health care institutions are assessed for resilience under extreme peacetime and wartime conditions include:

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

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

· assessment of readiness of the object to work in extreme conditions of peacetime and wartime, taking into account the peculiarities of the region, city and the predicted situation in the event of disasters in peacetime and wartime;

determination of the list of measures that increase the stability of the facility and the timing of their implementation;

· determination of criteria for recoverability and resumption of operation of an object that has been exposed to damaging factors.

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

Stages of medical evacuation

The stage of medical evacuation is understood as the formations and institutions of the disaster medicine service, as well as medical institutions deployed (functioning) on the routes of medical evacuation of the injured and ensuring their reception, medical triage, provision of a regulated type of medical care and preparation (if necessary) of victims for further medical evacuation .

The stages of medical evacuation in the healthcare system are: a medical detachment, field hospitals of the disaster medicine service, municipal, regional and federal medical institutions deployed (located) on the routes of medical evacuation of the injured from the emergency zone (district) for their reception, medical sorting, providing 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 place of this stage in the general system of medical evacuation support, as well as on the type of emergency and medical situation. As part of the medical evacuation stage, the following should be deployed:

sorting post;

Sorting area;

Sanitization site;

Primno-sorting;

Evacuation;

Insulator;

Helipad.

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

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

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

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

Provision of medical care to the injured - dressing room, surgical dressing department, treatment room, etc.;

Hospitalization and treatment of victims - hospital department;

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

Accommodation of infectious patients - insulator.

Medical triage and evacuation

In the system of organizing the provision of medical care to victims of emergency situations, triage is an important organizational measure. Its significance increases with the simultaneous occurrence of multiple casualties and their admission to the stage of medical evacuation (field hospital, mobile medical detachment, medical institution, etc.).

Medical sorting provides for the distribution of victims into groups according to the signs of need for homogeneous medical evacuation and preventive measures in accordance with medical indications, the established amount of assistance at this stage of medical evacuation and the accepted procedure for medical evacuation.

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

The continuity of triage lies in the fact that it should begin directly at the collection points for victims (in or near the emergency zone) 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 this medical institution, sorting is carried out taking into account the next institution (stage of medical evacuation), where the victim should be evacuated.

The specificity of medical triage means that at each specific moment the grouping of victims must comply with the conditions of work of the medical evacuation stage and ensure the successful solution of tasks in the current situation.

Triage is carried out on the basis of determining the diagnosis of a lesion or disease and its prognosis, therefore, it is always diagnostic and prognostic.

When carrying out medical sorting of victims, the leading signs on the basis of which their distribution into groups is carried out 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 sequence of its provision to victims admitted to a specific stage of medical evacuation;

Feasibility and possibility of further medical evacuation.

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

· Intra-point.

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

· Evacuation transport.

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

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

There are three things to keep in mind when sorting casualties:

1. Dangerous for others;

2. Medical;

3. Evacuation.

1. Dangerous to others - determines the degree of need for victims in sanitization and isolation. This group includes victims with:

Infectious diseases;

Infection of clothes and skin with AHOV and radioactive substances;

reactive states.

2. Medical sign - the degree of need of the victims in medical care, the order and place of its provision (in the ambulance car, medical facility, department).

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

When carrying out medical sorting of victims at the stages of medical evacuation, the following requirements must be observed:

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

· to organize auxiliary functional subdivisions for medical sorting - distribution posts, sorting yards, etc.;

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

· allocate 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 using labor-intensive research methods, and establish the nature of the necessary medical care and the evacuation procedure.

The optimal composition of the triage team for stretchers: a doctor, a paramedic (nurse), a nurse, two registrars and a link of porters. For walking victims, a sorting team is created consisting of a doctor, a nurse and a registrar.

The sequence of practical medical sorting: a nurse, a paramedic, a doctor first identify the affected, dangerous to others. Then, with an initial quick examination (survey), victims in need of emergency medical care are identified. Priority is given to children and pregnant women. After that, the medical staff proceeds to sequential examination of the victims, trying to distribute them as quickly as possible among the functional units of this stage of medical evacuation.

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

ORGANIZATION OF ASSISTANCE TO THE WOUNDED

TO THE MAXILLO-FACIAL REGION

AT THE STAGES OF MEDICAL EVACUATION

Plan

1. Stages of medical evacuation.

2. First aid.

3. First aid.

4. First medical aid.

5. Qualified medical care.

6. Specialized medical care and follow-up care.

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

1. Stages of medical evacuation

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

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

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

The effectiveness of medical care depends on the following factors:

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

The medical records must include:

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

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

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

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

2. First aid

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

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

First aid measures:

Prevention and fight against developed asphyxia;

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

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

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

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

Temporary stop of bleeding:

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

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

3. First aid

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

First aid includes the following activities:

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

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

4. First aid

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

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

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

If necessary, carry out the following operations:

tracheostomy;
ligation of blood vessels in the wound.

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

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

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

5. Qualified medical care

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Groups of the wounded, subject to further evacuation.

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

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

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

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

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

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

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

6. Specialized medical care and beyond

treatment

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

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

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

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

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

Therapeutic measures in the departments of specialized hospitals:

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

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

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

7. Military medical examination for wounds in the maxillofacial

region

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

Tasks solved by military medical expertise;

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

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

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

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

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

The commission will certify:

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

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

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

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

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

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

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

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

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

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

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