Medical evacuation is part of the primary pre-medical. Medical evacuation: definition, purpose. Stage of medical evacuation: definition, tasks, functional units. evacuation methods. The concept of transportability. Medical evacuation stage

Administration of antidotes and anti-botulinum serum;

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

Dehydration therapy for cerebral edema;

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

A set of measures in case of ingestion of AOHV;

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

The use of tranquilizers and neuroleptics in acute reactive conditions.

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

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

Depending on the type and scale of emergencies, the number of people affected and the nature of the injuries, the availability of forces and means, the state of territorial and departmental health care, the distance from the emergency area of hospital-type medical institutions capable of performing the full scope of qualified assistance and specialized assistance activities of their capabilities, there may be various options for providing medical care to those affected in emergencies have been adopted, namely:

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

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

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

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

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

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

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

Stages of medical evacuation in the VSMK system:

Formation and establishment of a disaster medicine service;

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

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

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

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

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

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

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

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

Placement of infectious patients with mental disorders - insulator.

Schematic diagram of the deployment of the medical evacuation stage

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

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

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

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

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

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

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

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

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

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

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

Study questions:

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

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

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

4.4. Evacuation of medical institutions.

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

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

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

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

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

· educational research institutions of medical profile.

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

Health authorities and institutions are entrusted with the task of providing 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

The stage of medical evacuation is understood as medical units and institutions deployed on the evacuation routes of the injured (sick) and providing them with reception, medical triage, provision of regulated medical care, treatment and preparation (if necessary) for further evacuation.

Stages of medical evacuation in the system of the All-Russian Disaster Medicine Service:

Formation and establishment of a disaster medicine service;

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

Formation and establishment of the medical service of the Ministry of Defense of Russia, the medical service of the Ministry of Internal Affairs of Russia, the medical service of the Civil Defense Troops and other ministries and departments deployed on the evacuation routes of the injured 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 volume of these activities at the stages of medical evacuation is not constant and may vary depending on the situation. 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 measures, as well as on the type of emergency and the medical situation. However, despite the variety of conditions that determine the activities of individual stages of medical evacuation, their organization is based on general principles, according to which functional units are deployed as part of the stage of medical evacuation (Fig. 3.1), which ensure the implementation of the following main tasks:

deployment of the stage of medical care: SP - sorting post (+ - designation of the Red Cross flag) reception, registration and medical sorting of the injured (sick) arriving at this stage

medical evacuation, - reception and sorting department;

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

Provision of medical care to the injured (sick) - dressing room, surgical dressing department, procedural, anti-shock, intensive care wards;

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

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

Accommodation of infectious patients - insulator.

The medical evacuation stage also includes administration, a pharmacy, a laboratory, business units, etc. Stages of medical evacuation must be constantly ready to work in any, even the most difficult conditions, to quickly change location and simultaneously receive a large number of victims.

The stage of medical evacuation, intended for the provision of first medical aid, may be the following structures:

Points of medical care (PMP) deployed by medical 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 of those affected

carried out at subsequent stages of medical evacuation. Such stages of medical evacuation can be the following institutions:

Medical institutions of the Ministry of Internal Affairs of Russia, the Federal Security Service of Russia, the troops and the medical service of the Civil Defense, etc.

More on the topic MEDICAL EVACUATION STAGE:

8.4. Fundamentals of medical triage of the affected (sick) in an emergency
8.5. Organization of work of stages of medical evacuation in the zone (district) of an emergency
8.5.1. Deployment and organization of the work of the stage of medical evacuation, designed to provide first aid in an emergency
8.5.2. Deployment and organization of the work of the medical evacuation stage, designed to provide qualified medical care in an emergency

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 injury.

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 types;
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 carried out by the surgeon, therefore, knowledge of the characteristics of the injuries of the maxillofacial region is extremely necessary for him. Among the maxillofacial wounded, he should distinguish the following groups:

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

7. Military medical examination for wounds in the maxillofacial

region

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

Tasks solved by military medical expertise;

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

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

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

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

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

The commission will certify:

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

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

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

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

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

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

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

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

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

Stages of medical evacuation in the system of the All-Russian Service for Disaster Medicine:

Formation and establishment of a disaster medicine service;

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

Each stage of medical evacuation carries out certain medical and preventive measures, which together constitute the volume of medical care characteristic of this stage.

Rice. 3.1. Scheme of deployment of the stage of medical care: SP - sorting post (+ - designation of the Red Cross flag)

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;

Provision of medical care to the injured (sick) - dressing room, surgical dressing department, procedural, anti-shock, intensive care wards;

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

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

Accommodation of infectious patients - insulator.

The stage of medical evacuation, intended for the provision of first aid, may have the following structures:

Points of medical care (PMP) deployed by medical 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 the injured are carried out at subsequent stages of medical evacuation. Such stages of medical evacuation can be the following institutions:

Medical institutions of the Ministry of Internal Affairs of Russia, the Federal Security Service of Russia, the troops and the medical service of the Civil Defense, etc.

3.4. MEDICAL TRIGGING IN EMERGENCIES

The most important organizational event that ensures the smooth implementation of the system of medical and evacuation support is triage. Its foundations were developed by the Russian military field surgeon and scientist N.I. Pirogov more than 150 years ago. For the first time, medical triage was used on a large scale during the Crimean War in 1853-1856. Its special significance was proved in the case of simultaneous admission to the stages of medical evacuation of a significant number of the affected.

medical triage- the distribution of the affected (sick) into groups based on the need for homogeneous treatment and prevention and evacuation measures, depending on medical indications and specific conditions of the situation.

It serves as one of the most important methods of organizing the provision of medical care to those affected in case of their mass admission and allows the most efficient use of the forces and means available at this stage of medical evacuation for the successful implementation of medical evacuation measures.

Purpose of sorting its main purpose is to provide the injured with timely medical care in the optimal amount and rational evacuation.

Medical sorting begins directly at the collection points of the injured, is carried out at the stage of medical evacuation and is carried out in all its functional divisions. Its content depends on the tasks assigned to a particular functional unit and the stage of medical evacuation as a whole, as well as on the conditions of the situation.

Sorting types. Depending on the tasks solved in the process of medical sorting at the stages of medical evacuation, there are two types of triage: intra-point and evacuation-transport medical triage.

Intra-item sorting are carried out in order to distribute the injured (patients) into groups (depending on the degree of their danger to others, the nature and severity of the lesion) for referral to the appropriate functional units of this stage of medical evacuation and establishing the order in these units.

Evacuation and transport sorting carried out in order to distribute the affected (sick) into homogeneous groups in accordance with the direction (evacuation destination), priority, methods and means of their evacuation.

The solution of these issues in the process of sorting is carried out on the basis of the diagnosis, prognosis and condition of the affected person. For this reason, triage is always entrusted to the most experienced professionals who are able to accurately determine the amount and type of medical care. “Without a diagnosis,” writes N.I. Pirogov, "correct sorting of the wounded is unthinkable." In the conditions of mass admission of the injured to the stages of medical evacuation and the reduction in the volume of medical care provided to them, the intra-point and evacuation-transport sorting of the majority of the injured should be carried out simultaneously in the interests of maximizing savings in manpower and resources.

In the process of intra-point sorting, along with resolving questions about the need for medical care for the wounded and sick, the nature, urgency and place of its provision, the evacuation destination, sequence, method and means of further evacuation of those injured (sick) who do not need medical care should be determined at this stage of medical evacuation.

To carry out medical sorting of the injured and sick, a medical and nursing sorting team is formed. Its composition: a doctor, one or two nurses (paramedic), one

or two registrars. The brigade must have the necessary equipment to carry out emergency medical procedures (injections of emergency medicines, apply a bandage, splint, tourniquet) as prescribed by a doctor and register the injured.

Diagnosis of the severity of the condition of the victims is carried out by the doctors of the teams according to the simplest clinical signs. It includes an assessment of the degree of impaired consciousness, breathing, changes in pulse, pupillary reactions, a statement of the presence and localization of fractures and bleeding.

To fix the results of medical sorting at the stages of medical evacuation, colored figured sorting marks are used and entries are made in the primary medical record (card) and other medical documents.

When carrying out medical sorting, sorting features proposed by N.I. Pirogov:

Danger to others;

medical sign;

evacuation sign.

At each stage of medical evacuation, five main groups (streams) of the injured and sick are distinguished:

Dangerous for others (infectious patients, infected with AHOV, contaminated with RV, patients with reactive conditions);

Those in need of medical care at this stage (an important task is to identify those affected who require timely medical care for urgent indications);

The injured and sick, who can be assisted at the next stage of medical evacuation (this group of victims needs delayed medical care);

Slightly affected and sick;

The agonizing ones, for whom no complex interventions can save their lives (they need relief from suffering).

Careful organization of triage at each stage of medical evacuation is essential for successful medical triage. This requires the following:

Allocation of independent functional units with sufficient capacity of premises to accommodate the injured and providing convenient approaches to the injured;

Organization of auxiliary functional divisions for sorting - sorting posts and sorting yards;

Creation of medical and nursing sorting teams and their equipment with the necessary simple diagnostic tools;

Mandatory recording of sorting results (sorting stamps, primary medical cards, etc.) at the time of sorting.

3.5. MEDICAL EVACUATION OF THE INJURED IN EMERGENCIES

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

Medical evacuation is understood as the removal (removal) of the injured (sick) from the focus of the emergency and transportation to the stages of medical evacuation or to medical institutions in order to timely provide the injured (sick) with the necessary medical care and effective treatment and rehabilitation.

The route along which the affected (sick) are carried out and transported is called medical evacuation route and the distance from the point of departure of the affected to the destination is considered to be shoulder medical evacuation. The set of evacuation routes, the stages of medical evacuation located on them and the working ambulance and other vehicles are called evacuation direction.

Medical evacuation begins with the organized removal, withdrawal and removal of the injured (sick) from the disaster zone and ends with their delivery to medical institutions that provide a full range of medical care and provide final treatment. The rapid delivery of the injured (sick) to the first and final stages of medical evacuation is one of the main means of achieving timeliness in the provision of medical care to the injured.

In the conditions of disasters, sanitary and unsuitable vehicles, as a rule, serve as one of the main means of evacuating the injured in the link "disaster zone - the nearest medical institution (where they provide a full range of medical care)". If it is necessary to evacuate the injured to specialized centers of the country, air transport is usually used.

Evacuation is carried out according to the principle "on oneself" (cars of "ambulance", medical institutions, regional, territorial centers of emergency medical care, etc.) and "on one's own" (transport of the injured object, rescue teams, etc.) . The general rule when transporting the injured on a stretcher is the irremovability of the stretcher in order to prevent the transfer of the seriously injured (from stretcher to stretcher) with their replacement from the exchange fund.

It is very important to organize evacuation management with the aim of uniform and simultaneous loading of the stages of medical evacuation and medical institutions, as well as the direction of the injured to medical institutions of the appropriate profile (departments of medical institutions), minimizing the transfer of the injured to their destination between medical institutions.

The loading of vehicles, if possible, single-profile in nature (surgical, therapeutic profile, etc.) and the localization of the lesion by the victims greatly facilitates the evacuation not only in the direction, but also according to the destination, minimizing inter-hospital transportation.

The above principles and provisions of medical and evacuation support for the population cannot be mandatory and unconditional for each type of emergency (earthquake, chemical and radiation accidents, etc.), which has its own characteristics, different magnitude and structure of sanitary losses. In this regard, when organizing medical and evacuation measures, one should focus on a specific situation, making the necessary adjustments to the basic scheme of medical and evacuation support for the population in emergencies.

test questions

1. Medical and evacuation support (LEO). The main directions of health care activities in the elimination of medical and sanitary consequences of emergencies.

2. Definition and procedure for carrying out measures for medical and evacuation support of the population during emergencies.

3. Rationale for staged treatment with the evacuation of the affected according to the destination.

4. Stage of medical evacuation. Definition and tasks.

5. Functional subdivisions of the medical evacuation stage and their purpose.

6. Types and scope of medical care. Definition and characteristics.

7. First medical aid. Characteristics of events.

8. Medical evacuation of those affected in emergency situations, its purpose and components.

9. Medical triage. Definition, purpose and types.

Medical evacuation is an integral part of medical evacuation support, which is inextricably linked with the process of providing medical care to the injured (sick) and their treatment.

Under the medical evacuation stage understand the forces and means of the medical service (surviving healthcare facilities, medical formations of the civil defense troops, etc.) deployed along the evacuation routes and intended for receiving, medical sorting of the injured, providing them with medical care, treating and preparing for further evacuation.

The first stages of medical evacuation (in the 2-stage LEM system) can be health care facilities that have survived on the border of the focus of mass sanitary losses, medical units (units) of the civil defense troops, etc.

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

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

At the second stages, the provision of qualified and specialized medical care, as well as rehabilitation, is completed.

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

1. for the reception of victims, their registration, sorting and placement;

2. for sanitization;

3. for temporary isolation;

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

5. for temporary and final hospitalization;

6. evacuation;

7. subdivisions of provision and maintenance.

At each stage of medical evacuation, a certain type and amount of medical care is provided. With this in mind, the stages of medical evacuation are staffed with medical staff (including doctors of a certain qualification) and medical equipment.

Requirements for the deployment site of the medical evacuation stage

For the deployment of medical evacuation stages, places (districts) are selected taking into account:

1. the nature of hostilities;

2. organization of support;

3. radiation and chemical environment;

4. protective properties of the terrain;

5. availability of sources of good quality water;

6. near the routes of supply and evacuation;

7. on the ground with good masking and protective properties against weapons of mass destruction;

8. away from objects that attract the attention of artillery and enemy aircraft;

9. away from the probable direction of the enemy's main attack;

10. inaccessible (inaccessible) for tanks;

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

The route along which the removal and transportation of the affected (sick) is carried out is called medical evacuation route, and the distance from the point of departure of the affected person to the destination is considered to be shoulder medical evacuation. The set of evacuation routes located at the stages of medical evacuation and operating ambulances and other vehicles is called evacuation direction eat.

Various vehicles are used to evacuate the injured and sick.

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

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

From air means for the evacuation of the injured (sick), various types of aircraft of civil and military transport aviation, and, in particular, specially equipped ones, can be used. In aircraft cabins, devices for stretchers are installed to accommodate sanitary equipment and medical equipment.

In war zones, the most difficult to implement in organizational and technical terms is the evacuation (removal, removal) of the affected through the rubble, fires. If it is impossible to advance to the locations of the affected vehicles, the removal of the affected vehicles on stretchers, improvised means (boards, etc.) to the place of possible loading on transport is organized.

The evacuation from the affected objects usually begins with the arriving vehicles of medical institutions, transport attracted by the state traffic safety inspectorate, as well as the transport of regional disaster medicine centers, transport of economic facilities and motor depots. For the removal and loading of the victims, personnel of rescue units, the local population, and military personnel are involved.

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

Evacuation is carried out on the principle of "on oneself"(cars of medical institutions, regional, territorial centers of disaster medicine) and "Push"(transport of the affected object, rescue teams).

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

Thus, medical evacuation is understood as a set of measures for the delivery of victims from the area of sanitary losses to the stage of medical evacuation in order to provide timely medical care and treatment. The head of MSGO plans and organizes medical evacuation (mainly on the principle of “on oneself”). From the area of mass sanitary losses to the OPM or to the head hospital, the victims are evacuated (in the direction) in one direction, then - according to the destination in accordance with the type of injury. For this purpose, MSGO sanitary and transport units are used, as well as vehicles allocated by the heads of civil defense. Evac stations are being deployed for temporary accommodation of affected people waiting for transport at railway stations, airfields, ports, etc.