Stages of evacuation of the wounded. Medical triage and evacuation. Measures to improve the sustainability of the functioning of medical institutions in emergency situations

The medical evacuation stage is understood as forces and means of the medical service (MSGO, preserved healthcare institutions, medical formations of civil defense troops, etc.) deployed along the evacuation routes.

The LEO is based on a system of staged treatment with evacuation as directed. Currently, the Civil Defense Ministry has adopted a two-stage system of treatment and evacuation support for the injured.

Rice. Schematic diagram of a two-stage system of treatment and evacuation support for the affected

As the first stages of medical evacuation there may be medical detachments of MSGO (OPM), health care institutions preserved on the border of the source of mass sanitary losses, medical units (units) of civil defense troops, etc.

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

The second stages of medical evacuation are medical institutions (headquarters, specialized, multidisciplinary and other hospitals) MSGO deployed as part of medical evacuation areas (B.B.) in the suburban area.

At the second stages, the provision of qualified medical care is completed, specialized treatment and rehabilitation are provided.

Regardless of their place in the overall LEO system, all stages of medical evacuation are inherent general tasks:

reception, registration, medical triage of incoming casualties;

carrying out, according to indications, sanitary treatment of the affected, disinfection, decontamination and decontamination of their clothing;

provision of medical care;

hospitalization and inpatient treatment of the affected;

preparation for the evacuation of persons subject to treatment at subsequent stages;

isolation of infectious patients and persons with disorders of neuropsychic activity.

The stages of medical evacuation, regardless of their features, are deployed and equipped identical in purpose functional units :

for receiving victims, registering them, sorting and placing them;

for sanitary treatment;

for temporary isolation;

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

for temporary and final hospitalization;

evacuation;

support and service divisions.

Rice. Schematic diagram of the deployment and operation of the medical evacuation stage

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

Requirements for the deployment site of the medical evacuation stage.

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

nature of hostilities

provision organizations;

radiation and chemical conditions;

availability of sources of good quality water.

availability of transport and evacuation routes;

the presence of masking and protective properties of the terrain;

the absence of objects attracting the attention of enemy artillery and aviation;

probable direction of the enemy's main attack (to the side);

inaccessibility (inaccessibility) for tanks;

3. TYPES OF MEDICAL CARE – DEFINITION, PLACE OF PROVISION, OPTIMAL DATES OF PROVIDING DIFFERENT TYPES, EMPLOYEES AND MEANS ATTRACTED. VOLUME OF MEDICAL CARE, CONTENT OF THE EVENT, ITS DEPENDENCE ON THE CURRENT CIRCUMSTANCES

Type of medical care - this is a certain list of treatment and preventive measures carried out by the affected (wounded, sick) at the source of the lesion and at the stages of medical evacuation.

Currently, the system of medical evacuation measures provides for the following types of medical care:

First aid;

Pre-medical (paramedic) care;

First medical aid;

Qualified medical care;

Specialized medical care;

Medical rehabilitation.

First aid turns out (no later than 15-20 minutes from the moment of injury) directly at the place where the injury was received or the disease occurred, in the order of self-help, mutual assistance, by sanitary vigilantes, and by the staff of medical posts. In this case, first of all, the contents of an individual first aid kit, an individual sterile dressing package (PPI), and an individual anti-chemical package (IPP) are used. Use the property of the sanitary squad's bag.

Purpose of first aid elimination of life-threatening phenomena of the wounded (patient) and prevention of dangerous complications.

Pre-medical (paramedic) care turns out (no later than 2-3 hours from the moment of defeat) by paramedical personnel (paramedics, nurses) of the medical units of the civil defense forces and the medical institutions remaining in the outbreak in order to elimination of disorders that pose a threat to the life of the affected person through the use of standard medications, equipment for artificial ventilation of the lungs, etc. The need for its implementation arises in case of asphyxia, acute cardiovascular failure, shock, convulsions, and uncontrollable vomiting.

First aid turns out (no later than 4-5 hours from the moment of injury or defeat) by a general practitioner in the first aid unit, with the aim of eliminating the consequences of a lesion (disease) that directly threatens the life of the wounded and sick, preventing the development of complications (shock, wound infection), preparing the wounded and sick for further evacuation.

To provide first aid, the standard equipment of the first aid squad is used.

Qualified medical care is provided by surgeons (qualified surgical care) and therapists (qualified therapeutic care) in multidisciplinary medical institutions of the city or hospital base no later than 8-12 hours from the moment of injury or defeat. She has her own purpose preserving the life of the affected person, eliminating the consequences of the lesion, preventing the development of complications and combating already developed complications.

Specialized medical care This is a complex of treatment and preventive measures performed by medical specialists using special equipment and equipment. This is the highest type of medical care, which is comprehensive. Delivery time is within 24 hours from the moment of injury.

Qualified and specialized medical care for the affected population is provided in the medical institutions of the hospital base of the MS GO in the suburban area, where the affected people are treated until their final outcome and rehabilitation measures are carried out.

Medical rehabilitation - this is a set of consistent and continuous treatment and preventive measures, hygienic training and education, promotion of a healthy lifestyle, aimed at restoring health and ability to work, impaired or lost by the population due to illness or injury. Medical rehabilitation is carried out in combination with psychological, physical and professional rehabilitation.

The set of treatment and preventive measures corresponding to a certain type of medical care that can be provided at the stages of medical evacuation depending on the situation is called volume of medical care .

Depending on the general and medical-tactical situation, the scope of medical care can be full, reduced or expanded.

The decision to reduce or expand the volume of medical care during medical evacuation measures is made by the relevant head of the Civil Defense Ministry. For example, for the OPM, this is the head of the Civil Defense MS of the city (district), on the territory of which rescue operations are being carried out, for medical institutions (hospital base) of the Civil Defense MS of a suburban area - the head of the Civil Defense MS of the region (region, republic) within the Russian Federation.

Extracting victims from under rubble, hard-to-reach places, and fires.

Applying an aseptic dressing to the wound or burn surface, and in case of open pneumothorax - an occlusive dressing using the rubberized shell of an individual dressing package.

Extinguishing burning clothing and incendiary mixture that got on the body.

Immobilization of the damaged surface in the simplest ways using standard and improvised means.

Wearing a gas mask when in a contaminated area.

Partial sanitary treatment of exposed skin areas and degassing of adjacent clothing IPP - 8 (10).

Temporary stop of external bleeding.

Taking antibiotics, antiemetics and other medications.

Administration (reception) of antidotes.

Elimination of asphyxia by freeing the upper respiratory tract from mucus, blood and possible foreign bodies, fixing the tongue when it is retracted, introducing an air duct.

First aid includes:

Elimination of asphyxia (introduction of an air duct, artificial ventilation of the lungs using portable devices, oxygen inhalation, etc.).

Improving transport immobilization using standard and improvised means.

Monitoring the correctness and appropriateness of applying a tourniquet and applying it if bleeding continues.

Administration of cardiovascular and other medications as indicated.

Applying and correcting incorrectly applied dressings.

Carrying out infusion therapy.

Repeated administration of painkillers, antidotes according to indications, giving antibiotics.

Repeated partial sanitization of exposed skin areas and decontamination of clothing adjacent to them.

Warming victims, providing hot drinks (except for those wounded in the stomach).

The full scope of the first medical assistance consists of activities that must be carried out urgently and activities that can be delayed.

Urgent measures indicated for life-threatening conditions. These include:

Elimination of asphyxia (suction of mucus and blood from the upper respiratory tract, insertion of an air duct, suturing of the tongue, cutting off or suturing hanging flaps of the soft palate and lateral parts of the pharynx, tracheostomy according to indications, artificial ventilation, application of an occlusive dressing, with open and pneumothorax, puncture of the pleural cavity or thoracentesis for tension).

Stopping abnormal bleeding (suturing or ligating a vessel in the wound, applying a hemostatic clamp or tight tamponade of the wound, controlling the tourniquet and, if necessary, applying it again.

Cutting off a limb (its segments) hanging on a flap.

Carrying out anti-shock measures (blood transfusions and blood substitutes, novocaine blockades, administration of painkillers, cardiovascular drugs).

Catheterization or capillary puncture of the bladder in case of damage to the urethra.

Partial sanitization and change of uniform.

Administration of antibiotics, anticonvulsants, bronchodilators and antiemetics.

Gastric lavage using a tube in case of substances entering the stomach.

Degassing of a wound when it becomes infected with persistent agents.

The use of antitoxic serum in case of poisoning with bacterial toxins and nonspecific prophylaxis in case of infection with bacterial toxins, etc.

To the group of first aid measures that may be delayed relate:

Elimination of deficiencies in first medical and first aid (correction of bandages, immobilization).

Administration of tetanus toxoid and antibiotics.

Novocaine blockades for limb injuries without signs of shock.

Prescription of various symptomatic remedies for conditions that do not pose a threat to the life of the victim.

The volume of first medical care is reduced by refusing to carry out activities of the 2nd group.

Qualified medical events assistance is divided:

Qualified surgical care;

Qualified therapeutic assistance.

Qualified surgical care includes:

1) Urgent measures:

Final stop of bleeding of any location;

Elimination of asphyxia and establishment of stable breathing.

Complex therapy of acute blood loss, shock, traumatic toxicosis.

Treatment of anaerobic infection.

Surgical treatment and suturing of wounds for open pneumothorax, thoracentesis for valve pneumothorax.

Laporotomy for penetrating wounds and closed abdominal trauma with damage to internal organs, for closed damage to the bladder and rectum.

Amputation due to avulsions and massive destruction of limbs.

Decompressive craniotomy for injuries and injuries accompanied by compression of the brain.

Surgical treatment of fractures of long tubular bones with extensive destruction of soft tissues.

Necrotomy for circular burns of the chest and limbs accompanied by respiratory and circulatory disorders.

2) Measures that, if not carried out in a timely manner, can lead to serious complications:

Application of a suprapubic fistula in case of damage to the urethra and an unnatural anus in case of intra-abdominal damage to the rectum.

Surgical treatment of wounds for fractures of long tubular bones (without extensive destruction of soft tissue).

Necrotomy for circular burns of the chest and limbs that do not cause respiratory or circulatory disorders.

Amputation for ischemic necrosis of the limb.

Primary H.O. wounds contaminated with radioactive substances and agents.

Restoring the patency of the main arteries.

3) Measures (operations), the delay of which, subject to the use of antibiotics, does not necessarily lead to complications:

Primary H.O. soft tissue wounds.

Primary H.O. burns.

Application of plate sutures for patch wounds of the face.

Ligature binding of teeth for fractures of the lower jaw, etc.

Qualified therapeutic assistance includes:

1) Urgent measures:

Administration of antidotes and antibotulinum serum.

Complex therapy of cardiovascular failure, heart rhythm disturbances, acute respiratory failure.

Treatment of toxic pulmonary edema.

Administration of analgesics, desensitizing, anticonvulsants, antiemetics and bronchodilators.

Complex therapy of acute renal failure.

The use of tranquilizers and neuroleptics in acute reactive states, etc.

2) Activities that can be abandoned under unfavorable conditions:

Administration of antibiotics and sulfonamides for prophylactic purposes.

Vitamin therapy.

Blood transfusions for replacement purposes.

Use of symptomatic drugs.

Physiotherapeutic procedures, etc.

The following types are found in specialized medical institutions of hospital bases: specialized medical care:

1) Specialized surgical care:

neurosurgical (ophthalmological, otorhinolaryngological, dental) for those wounded in the head, neck, spine;

thoracoabdominal;

urological;

orthopedic - for wounded with damage to long tubular bones and large joints (except for the hand, foot, forearm);

burned;

lightly wounded;

2) Specialized therapeutic medical care:

general somatic;

psychoneurological;

toxicological;

radiological;

dermatovenerological;

infectious patients;

easily sick;

tuberculosis patients;

3) Specialized medical care for women;

4) Nephrological specialized medical care;

5) Specialized medical care for those affected by damage to large main vessels.

Medical evacuation stage called the formation or establishment of a disaster medicine service, any other medical institution deployed along the evacuation routes of the affected (patients) and providing their reception, medical triage, provision of regulated medical care, treatment and preparation (if necessary) for further evacuation.

In turn, such an organization of medical care increases the need for disaster medicine services in manpower and resources. Therefore, when organizing medical evacuation measures, it is necessary to minimize the number of stages of medical evacuation through which the injured and sick must “pass.” The optimal option is to evacuate those affected to a specialized medical institution after first medical aid in the source (zone) of an emergency.

The stages of medical evacuation in the VSMC system can be deployed:

medical units and medical institutions of the Russian Ministry of Health;

medical service of the Ministry of Defense and Ministry of Internal Affairs of Russia;

medical and sanitary service of the Ministry of Railways of Russia;

medical service of the civil defense troops and other ministries and departments.

Each stage of medical evacuation has its own characteristics in the organization of work, depending on the place of this stage in the overall system of medical evacuation support and the conditions in which it solves the assigned tasks. However, despite the variety of conditions that determine the activities of the medical evacuation stages, the organization of their work is based on general principles, according to which functional units are usually deployed as part of the medical evacuation stage, ensuring the following main tasks:

reception, registration and triage of casualties arriving at this stage of medical evacuation;

special treatment of the affected, decontamination, degassing and disinfection of their clothing and equipment;

Providing medical care (treatment) to those affected;

placement of the affected, subject to further evacuation;

isolation of infectious patients;

isolation of persons with severe mental disorders.

Depending on the tasks assigned to the medical evacuation stage and its operating conditions, the list of functional units designed to perform these tasks may be different.

Each stage of medical evacuation includes:

control;

receiving and sorting units;

Special Processing Division;

units for providing medical care;

hospital departments;

evacuation units;

insulators;

diagnostic departments (X-ray room, laboratory);

room for medical staff;

area for aircraft (helicopters) and vehicles;

pharmacy; economic divisions.

A schematic diagram of the deployment of the medical evacuation stage is presented in Figure No. 1.

The medical evacuation stages must be constantly prepared to work in any, even the most difficult, conditions, to quickly change the location of deployment and to simultaneously receive a large number of casualties.

Fundamentals of organizing medical and evacuation support.

The VSMC is responsible for carrying out the following medical and evacuation measures:

participation (together with emergency rescue and other RSChS units) in providing first aid to the affected (patients) and their evacuation from the source of damage;

organization and provision of pre-medical and first aid;

organization and provision of qualified and specialized medical care to the affected (patients), creation of favorable conditions for their subsequent treatment and rehabilitation;

organization of medical evacuation of the injured (patients) between the stages of medical evacuation;

organizing and conducting (if necessary) a forensic medical examination of the dead and a forensic medical examination of the injured (patients).

The organization of medical and evacuation support largely depends on the conditions prevailing in an emergency.

If it is possible for medical units to work in the outbreak, then after removing the injured from the rubble and providing them with first aid, they are delivered by emergency rescue personnel to collection points organized in the immediate vicinity. Here, additional first aid measures are carried out and, if possible, first aid is provided, evacuation and transport triage is carried out (distribution of those affected by evacuation order, types of vehicles and places in them), loading onto vehicles.

If it is impossible for medical units to work in the outbreak (chemical, radiation contamination, etc.), after carrying out vital first aid measures on the spot, the affected (sick) personnel are delivered by personnel of rescue units to collection points organized on the border of the outbreak in a safe zone. Here, first medical and pre-hospital aid is provided, evacuation and transport triage, loading onto vehicles for dispatch to the medical evacuation stage.

If there is a doctor working at the collection point or he is in the vehicle in which the injured are evacuated, then he can perform certain first aid measures (resuscitation measures, oxygen therapy, etc.).

The stages of medical evacuation intended to provide first medical aid can be: a surviving (in whole or in part) hospital in the affected area; a hospital located in close proximity to the lesion; hospital (detachment) of the territorial center for disaster medicine; medical aid stations deployed by medical and nursing teams (including emergency medical care); medical centers of the medical service of the Russian Ministry of Defense, civil defense troops and others.

Qualified and specialized medical care and treatment are provided at the following stages of medical evacuation. Such stages for the affected (patients) may be: hospitals and hospitals (bed stock), disaster medicine services, multidisciplinary, profiled, specialized hospitals, clinics and centers of the Russian Ministry of Health, special-purpose medical units, medical battalions and hospitals of the Russian Ministry of Defense; medical institutions of MGTS, Ministry of Internal Affairs, border troops, FSB of Russia, medical service of the Civil Defense and others.

Rice. 2. Schematic diagram of medical and evacuation support during the elimination of health consequences of minor emergencies.

Depending on the medical and tactical situation, the nature of the lesion and the capabilities of the specialized medical institution, the injured person admitted to it may be left until final treatment or evacuated to another medical institution (the next stage of medical evacuation). From the VCMK formations intended to provide qualified medical care with elements of specialized medical care, all those affected, after providing medical care and being removed from a non-transportable state, are evacuated to the next stage of medical care as directed. The outlined scheme for organizing medical and evacuation measures is not strictly mandatory.

Depending on the type and scale of the emergency, the number of people affected and the nature of the damage, the availability of forces and means of the Higher Medical Medical Center, the state of health care at the territorial and local levels, the distance from the zone (district) of the emergency of hospital-type medical institutions capable of performing the full scope of qualified and specialized medical activities assistance, and their capabilities, various options for providing medical care to those affected by an emergency can be adopted (for the entire emergency area, its individual sectors and areas):

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

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

Providing the injured, before their evacuation to hospital-type medical institutions, in addition to first medical, pre-medical, first aid, also qualified medical care in varying amounts.

From the above, it is obvious that when eliminating the health consequences of small-scale emergencies, it is quite possible to use the system of providing medical care to the affected (patients) that exists under normal conditions (the first of these options), that is, the system "on-site treatment"

When planning (organizing) medical and evacuation support during emergency response, depending on the nature, scale, location of occurrence, availability and possibility of using disaster medicine service units and local medical institutions, features of the road (transport) network and other factors, it is necessary to develop (apply) various organizing the provision of medical care to the affected (patients).

An integral part of medical evacuation support, which is inextricably linked with the organization of medical care for the injured (patients) and their treatment, is medical evacuation.

Under medical evacuation understand the removal (removal) of those affected from the source, area (zone) of an emergency and their transportation to the stages of medical evacuation in order to provide the necessary medical care in a timely manner and possibly early delivery to medical institutions, where comprehensive medical care and treatment can be provided.

Medical evacuation is a complex set of organizational, medical and technical measures carried out at all levels of the system of medical evacuation support for the injured.

It should be noted that medical evacuation, in addition to the specified purpose, ensures the timely release of medical evacuation stages and the possibility of their reuse.

Evacuation from a medical point of view cannot be considered a positive factor for those affected by an emergency and is usually a forced event due to the current situation and the inability to organize the provision of comprehensive medical care and full treatment of those affected in the immediate vicinity of the emergency zone (district). Therefore, evacuation is not an end in itself, but only a means to help achieve the best results in fulfilling one of the main tasks of the QMS - the fastest restoration of the health of those affected by emergencies, and the maximum reduction in fatalities. Obviously, the most gentle and fast means of transport should be used for evacuation.

The route along which the removal (removal) and transportation of the injured from the source of the lesion to the stages of medical evacuation is carried out is called by medical evacuation, and the distance from the point of departure of the affected person to the destination is considered to be medical evacuation shoulder .

The set of evacuation routes located in a strip (part) of the administrative territory of a constituent entity of the Russian Federation, functionally integrated stages of medical evacuation deployed on them and working sanitary and other vehicles is called evacuation direction.

In case of a large-scale emergency, several evacuation directions can be created in the system of medical and evacuation support for those affected, as was the case during the liquidation of the consequences of earthquakes in Ashgabat, Armenia and other natural disasters and catastrophes.

Medical evacuation begins with the organized removal, withdrawal and removal of the affected (sick) from the disaster zone and ends with their delivery to medical institutions that provide final treatment.

As a rule, the main means of evacuating those affected from the disaster zone to the nearest medical facility is road transport (sanitary and general purpose).

Places for loading affected persons onto transport are chosen as close as possible to the source of injury outside the zone of contamination (infection) and fires. To provide medical assistance and care for the injured in places where they are concentrated until the arrival of emergency medical care teams (medical, nursing, paramedic teams) and other units, medical personnel from emergency medical services, rescue squads, and sanitary squads are allocated. At these places (collection points), a loading area is prepared, medical care is provided to the affected people, and they are sorted.

In some cases, aviation, in particular helicopters, is used for medical evacuation from emergency zones.

Due to the fact that sanitary and adapted transport for evacuating the injured is, as a rule, not enough, it is necessary to use passenger and cargo vehicles. At the same time, it is necessary to provide in advance for measures to adapt them for this purpose.

The characteristics and evacuation capabilities of vehicles that can be used to evacuate those affected by emergencies are presented in Table 1.

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

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

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

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

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

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

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

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

2. for sanitary treatment;

3. for temporary isolation;

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

5. for temporary and final hospitalization;

6. evacuation;

7. support and maintenance units.

Requirements for the deployment site of the medical evacuation phase

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

1. the nature of the hostilities;

2. provision organizations;

3. radiation and chemical conditions;

4. protective properties of the area;

5. availability of sources of good quality water;

6. near transport and evacuation routes;

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

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

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

10. inaccessible (inaccessible) for tanks;

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

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

Various vehicles are used to evacuate the injured and sick.

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

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

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

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

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

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

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

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

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

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

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

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

Since evacuation is carried out according to the principle “on your own” (from the nests of the wounded - by the forces of the battalion medical point, from the battalion - by the transport of the regiment medical point, etc.), in a large-scale war, the wounded, as a rule, sequentially go through all stages of medical evacuation. However, whenever possible one should strive to reduce the multi-stage nature in providing assistance to the wounded, as this significantly improves treatment outcomes.

Considering the likelihood of wounded arriving at the stages of medical evacuation in numbers exceeding their carrying capacity, various volumes of medical care. For example, first aid may be provided in full(i.e. to all wounded who need it) or for urgent indications, i.e. only to those wounded who need it to save their lives).

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

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

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

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

Gumanenko E.K.

Military field surgery

The system of medical and evacuation support for the population in emergency situations includes a set of scientifically based principles of organizational and practical measures to provide medical care and treatment to the affected population associated with its evacuation outside the disaster zone (source) and the forces and means of the disaster medicine service intended for this .

The organization of the medical evacuation support system is influenced by the following basic conditions:

Type of disaster;

Size of the lesion;

Number of people affected;

The nature of the pathology, the degree of failure of health care forces and means in the disaster zone;

The state of the material and technical equipment of the QMS;

Level of personnel training;

Presence of dangerous damaging factors in the area (RV, SDYAV, fires), etc.

The general principle of medical and evacuation support in emergency situations there is basically a two-stage system of providing medical care and treating the injured with their evacuation to their destination.

Medical formations and medical institutions deployed along the evacuation routes of those affected in their zone (region) of the disaster and intended for mass reception, medical triage, provision of medical care to the affected, preparing them for evacuation and treatment were named "Medical evacuation phase."

The first stage of medical evacuation, intended primarily for the provision of first medical and first aid, are the medical institutions preserved in the emergency zone, collection points for those affected, deployed by ambulance teams and medical and nursing teams that arrived in the emergency zone from nearby medical institutions. The second stage of medical evacuation consists of existing and operating outside the emergency zone, as well as additionally deployed medical institutions, designed to provide comprehensive types of medical care - qualified and specialized, and to treat those affected until the final outcome. Each stage of medical evacuation is assigned a certain amount of medical care (list of treatment and preventive measures).

The main types of assistance in the outbreak or at its border are First Medical, First Aid and First Medical Aid. Depending on the situation, certain categories of victims may receive elements of qualified medical care here.

At the 2nd stage of medical evacuation the provision of qualified and specialized medical care in full, treatment until the final outcome and rehabilitation are ensured.

The LEO system offers the following types of medical care:

First aid;

First medical aid;

Qualified medical care;

Specialized medical care.

A characteristic feature of providing medical care to those affected is:

dismemberment,

Dispersal (echeloning) of its provision in time and location as those affected are evacuated from the source of the disaster to inpatient medical institutions.

The degree of division (echelon) of medical care varies depending on the medical situation in the disaster zone. Based on it, the volume of medical care can change - expand or narrow. However, measures should always be taken to save the life of the affected person and reduce (prevent) the development of dangerous complications.

Each stage of medical evacuation has its own characteristics in the organization of work. However, in its composition it is necessary to create conditions for reception, accommodation and medical care. triage of the affected, premises for medical care, temporary isolation, san. processing, temporary or definitive hospitalization, awaiting evacuation, and service units. To provide first medical and first aid at the place where the injury occurred or close to it, as well as individual measures of first medical aid, the deployment of functional departments on the ground is not required. The need to organize the 1st stage of medical evacuation is due to the fact that the distance between the disaster area and inpatient medical institutions can be significant. A certain part of the affected people will not withstand a long evacuation directly from the source of the disaster after providing them with only the first medical care received in the source or on its border. In the emergency medical service in emergencies, two directions in the medical provision system are objectively identified. assistance to the affected and their treatment in extreme conditions:
when providing medical assistance to those affected in full can be provided by the forces of facility and local territorial healthcare
when to eliminate honey. consequences of a major disaster, it is necessary to deploy mobile forces and assets from other areas and regions. Due to the fact that with a two-stage system of epidemiological surveillance of the population in emergency situations, honey.

Assistance is divided into two basic requirements:

Continuity in consistently carried out treatment and preventive measures;

Timeliness of their implementation.

Continuity in the provision of medical care and treatment is ensured by:

The presence of a unified understanding of the origin and development of the pathological process, as well as uniform, pre-regulated and mandatory principles for medical personnel for the provision of medical care and treatment;

The presence of clear documentation accompanying the affected person.

Such documentation is:

Primary medical card of the Civil Defense (for wartime);

Primary medical record of the affected (patient) in an emergency situation (in peacetime);

Hospitalization voucher;

Disease history.

Primary medical card GO(the primary medical record of the person affected by the emergency) is drawn up for all those affected when they are provided with the first medical aid, if they are subject to further evacuation, and if they are delayed for treatment for more than one day, it is used as a medical history (or is included in the latter). When evacuating a casualty, these documents accompany him. Timeliness in providing medical care. assistance is achieved by good organization of the search, removal and removal (evacuation) of those affected from the outbreak to the stages of medical evacuation, the maximum proximity of the 1st stage to the areas where losses occur, the correct organization of work and the correct organization of medical triage.

Types of medical care

3.2.1. First aid aims to prevent further exposure to the damaging factor on the victim, prevent the development of severe complications and thereby save the life of the affected person. The effectiveness of this type of medical care is maximum when it is provided immediately, or as soon as possible from the moment of injury. According to WHO, every 20 out of 100 people killed in a peacetime accident could have been saved if medical attention had been provided to them at the scene.

With the increase in the period of provision of 1st medical care, the frequency of complications in those affected quickly increases.

First aid- this is a set of simple medical measures performed at the site of injury, mainly in the form of self- and mutual assistance, as well as by participants in rescue operations, using standard and improvised means in order to eliminate the ongoing impact of the damaging factor, save the life of the victim, reduce and prevent the development of severe complications . The optimal period is up to 30 minutes after injury.

First medical aid for those affected is provided syndromously, based on the nature, severity and location of the injuries.

The organization of emergency medical care for those affected is closely related to the phasic development of processes in the disaster area.

Thus, during the isolation phase, which lasts from several minutes to several hours, First medical aid can only be provided by the victims themselves in the order of self- and mutual assistance, and the degree of training of the population and the ability to use improvised means to provide assistance are of great importance. It should be borne in mind that the use of service equipment to provide first aid begins only when rescue forces arrive at the outbreak.

Scope of first aid:

1 - in case of disasters with a predominance of mechanical (dynamic) damaging factors:

Removing victims from under the rubble (before releasing the limb from compression, a tourniquet is applied to its base, which is removed only after the limb has been tightly bandaged from the periphery to the tourniquet);

Bringing the blinded out of the fireplace;

Extinguishing burning clothing or burning mixtures that have come into contact with the body;

Combating asphyxia by clearing the airways of mucus, blood and possible foreign bodies. If the tongue sinks, vomiting, or profuse nosebleeds occur, the victim is placed on his side; when the tongue sinks, it is pierced with a pin, which is fixed from the outer arch with a bandage to the neck or chin;

Artificial ventilation using the mouth-to-mouth or mouth-to-nose method, as well as using an S-shaped tube;

Giving a physiologically advantageous position to the victim;

Closed heart massage o temporary stop of bleeding by all available means: pressure bandage, finger pressure, tourniquet, etc.;

Immobilization of the damaged area using the simplest means;

Applying an aseptic dressing to the wound and burn surface;l

Administration using a syringe - a tube of an anesthetic or antidote;

Giving water-salt (1/2 teaspoon of soda and salt per 1 liter of liquid) or tonic hot drinks (tea, coffee, alcohol) - in the absence of vomiting and evidence of injury to the abdominal organs;

Prevention of hypothermia or overheating o gentle early removal (removal) of victims from the outbreak and their concentration in designated shelters;

Preparation and control of the evacuation of victims to the nearest medical center or to places where the injured are loaded onto transport.

2. In areas where thermal injury predominates, in addition to the listed measures, the following is carried out:

Extinguishing burning clothing;

Wrap the victim in a clean sheet.

3. In case of disasters with the release of highly toxic substances into the environment:

Respiratory, eye and skin protection;

Partial sanitary treatment of exposed parts of the body (running water, 2% soda solution, etc.) and, if possible, decontamination of clothing adjacent to them;

Giving sorbents for oral poisoning, milk, drinking plenty of fluids, gastric lavage using the “restaurant” method”;

Removal of the affected person from the poisoning zone as quickly as possible.

4. In case of accidents with the release of radioactive substances:

Iodine prophylaxis and the use of radioprotectors by the population whenever possible;

Partial decontamination of clothing and shoes;

Providing first aid to the population in the listed volume during their evacuation from radioactive contamination zones.

5. In case of mass infectious diseases in foci of bacteriological (biological) infection:

Use of improvised and (or) standard personal protective equipment;

Active identification and isolation of feverish patients suspected of an infectious disease;

Use of emergency preventive measures;

Carrying out partial or complete sanitization.

3.2.2. First aid- a set of medical procedures performed by medical personnel (nurse, paramedic) using standard medical equipment. It is aimed at saving the lives of those affected and preventing the development of complications. The optimal period for providing first aid is 1 hour after injury.

In addition to first aid measures, the scope of first aid includes:

Insertion of an air duct, mechanical ventilation using an “Ambu” type device;

Putting a gas mask (cotton-gauze bandage, respirator) on the affected person when he is in a contaminated area;

Monitoring cardiovascular activity (measurement of blood pressure, pulse pattern) and respiratory function (frequency and depth of breathing) in the affected person;

Infusion of infusion agents;

Administration of painkillers and cardiovascular drugs;

Administration and administration of antibiotics and anti-inflammatory drugs;

Administration and administration of sedatives, anticonvulsants and antiemetics

Supply of sorbents, antidotes, etc.;

Monitoring the correct application of tourniquets, bandages, splints, and, if necessary, correcting them and supplementing them with standard medical supplies;

Application of aseptic and occlusive dressings.

3.2.3. First aid- a set of treatment and preventive measures performed by doctors at the first (prehospital) stage of medical evacuation in order to eliminate the consequences of a lesion that directly threatens the life of the affected person, prevent the further development of infectious complications in the wound and prepare victims for evacuation.

First medical aid should be provided within the first 4-6 hours from the moment of injury. First medical aid for emergency life-saving conditions will require an average of 25% of all sanitary losses. The leading causes of mortality on days 1 and 2 are severe mechanical trauma, shock, bleeding and respiratory dysfunction, with 30% of these victims dying within 1 hour, 60% after 3 hours and if help is delayed for 6 hours , then 90% of those seriously affected already die. Among the dead, about 10% received injuries incompatible with life, and death was inevitable, regardless of how quickly medical assistance was provided to them. Considering the nature of the pathology and the severity of injury in disasters, first medical aid should be provided as early as possible. It has been established that shock one hour after injury may be irreversible. When carrying out anti-shock measures in the first 6 hours, mortality is reduced by 25-30%.

Scope of first aid:

Final stop of external bleeding;

Fighting shock (administration of painkillers and cardiovascular drugs - novocaine blockades, transport immobilization, transfusion of anti-shock and blood replacement fluids, etc.);

Restoration of airway patency (tracheotomy, tracheal intubation, tongue fixation, etc.);

Application of an occlusive dressing for open pneumothorax, etc.;

Artificial respiration by manual and hardware methods);

Closed heart massage;

Bandaging bandages, correcting immobilization, carrying out transport amputation (cutting off a limb hanging on a skin flap);

Catheterization or puncture of the bladder for urinary retention;

Administration of antibiotics, tetanus toxoid, antitetanus and antigangrenosis serums and other agents that delay and prevent the development of infection in the wound;

Obstetric and gynecological care (hemostasis, wound care, preterm birth, measures to maintain pregnancy, etc.) o emergency therapeutic care (relief of the primary reaction to external radiation, administration of antidotes, etc.).

Preparing the injured for medical evacuation.

The scope of first medical aid may change (expand or narrow) depending on the conditions of the situation, the number of injured people admitted, the time of their delivery, the distance to the nearest medical institutions, and the availability of transport for evacuating the injured.

Providing first medical aid is the task of emergency medical teams, medical and nursing teams that have not stopped their work at medical facilities that find themselves in places where the affected people are concentrated.

In addition, medical centers and medical evacuation points are being deployed in areas where the affected people are concentrated. It should be remembered that transportation of seriously injured people over a distance of more than 45-60 km (1.5-2 hours) is possible only after stabilization of vital functions, accompanied by medical workers while carrying out the necessary intensive care measures. It should be remembered that, other things being equal, priority in the order of emergency medical care at the prehospital stage and evacuation belongs to pregnant women and children.

In case of disasters, 20% enter the Second Stage of medical evacuation in a state of shock. For 65-70% of victims with mechanical trauma and burns and up to 80% of the therapeutic profile, qualified medical care is the final type.

In the second stage of evacuation, 25-30% of those affected will need qualified and specialized medical care for life-saving treatment and preventive measures. The need for hospitalization for those affected by mechanical trauma will be up to 35%, and with burn injuries - up to 97%.

After providing the victims with first medical and first aid at the pre-hospital stage, they are sent to hospitals located outside the disaster areas, where they should be provided with qualified and specialized medical care and where they will be treated until the final outcome.

These types of medical care provide for the fullest use of the latest advances in medicine. Their implementation completes the provision of the full scope of medical care; they are exhaustive.

3.2.4. Qualified medical care- a set of surgical and therapeutic measures performed by doctors of the appropriate profile in hospitals of medical institutions and aimed at:

Elimination of the consequences of damage, primarily life-threatening, prevention of possible complications and fight against developed ones,

Also providing planned treatment of those affected until the final outcome and creating conditions for the restoration of impaired functions of organs and systems.

It should be provided as early as possible, but no later than 2 days. It turns out that medical specialists working in hospitals in suburban areas:

Surgeons - qualified surgical care,

Therapists provide qualified therapeutic assistance.

In some cases, if the situation is favorable (the mass arrival of victims has ceased and first medical aid has been provided to everyone who needs it), qualified assistance can be provided in the OPM.

According to the urgency of providing qualified surgical care, measures are divided into three groups:

The first group: urgent measures for life-saving reasons, failure to carry out which threatens the death of the affected person in the coming hours;

Second group: interventions, untimely implementation of which can lead to severe complications;

Third group: operations, the delay of which, provided antibiotics are used, will not necessarily lead to dangerous complications.

Under favorable conditions, qualified surgical care should be provided in full (operations of all three groups are performed). The reduction in the volume of qualified surgical care is carried out by refusing to carry out the activities of the third group, and in extremely unfavorable conditions - also due to the activities of the 2nd group.

Qualified therapeutic assistancehas as its goal the elimination of severe, life-threatening consequences of the lesion (asphyxia, convulsions, collapse, pulmonary edema, acute renal failure), the prevention of possible complications and the fight against them to ensure further evacuation of the affected.

According to the urgency of its provision, measures of qualified therapeutic assistance are divided into two groups:

Measures (emergency) in conditions that threaten the life of the affected person or are accompanied by severe psychomotor agitation, intolerable skin itching in case of mustard gas lesions or threatening severe disability (damage to the eye, etc.);

Activities that may be delayed.

In unfavorable conditions, the volume of qualified therapeutic assistance may be reduced to the implementation of group 1 activities.

3.2.4. Specialized medical care- a set of treatment and preventive measures performed by medical specialists in specialized medical institutions (departments) using special apparatus and equipment in order to maximize the restoration of lost functions of organs and systems, treatment of victims until the final outcome, including rehabilitation. Should be provided as early as possible, but no later than 3 days.

To organize specialized assistance, the following factors are necessary:

Availability of specialists;

Availability of equipment;

Availability of appropriate conditions (hospitals in a suburban area) 70% of all those affected will need specialized medical care:

With damage to the head, neck, spine, large vessels;

Thoraco - abdominal group;

Burn victims;

Affected with ARS;

Affected by poisonous substances or highly toxic substances;

Infectious patients;

Affected with mental disorders;

Chronic somatic diseases in exacerbation.

If massive losses occur simultaneously among the population and there is a lack of medical forces and resources, it is impossible to provide timely assistance to all those affected. In emergency situations, there is always a discrepancy between the need for medical care and the ability to provide it. Medical triage is one of the means to achieve timely provision of medical care to victims.

3.3. Medical triage- a method of dividing victims into groups based on the principle of need for homogeneous treatment, preventive and evacuation measures, depending on medical indications and specific conditions of the situation.

It is carried out starting from the moment of provision of first medical aid at the scene (in the zone) of an emergency and in the pre-hospital period outside the affected area, as well as upon admission of those affected to medical institutions to receive the full scope of medical care and treatment until the final outcome.

Medical triage is based on diagnosis and prognosis. It determines the volume and type of medical care. Medical triage is a specific, continuous (emergency categories can change quickly), repetitive and consistent process in providing victims of all types of medical care. It is carried out on the basis of diagnosis and prognosis. It determines the volume and type of medical care. At the source of the injury, at the site where the injury occurred, the simplest elements of medical triage are performed in the interests of providing first aid. As medical personnel (ambulance teams, medical and nursing teams, emergency medical teams) arrive in the disaster area, triage continues, becomes more specific and deepens.

The specific grouping of those affected during the medical triage process varies depending on the type and volume of medical care provided, while the volume of medical care is determined not only by medical indications and the qualifications of medical personnel, but mainly by the conditions of the situation.

Depending on the tasks solved during the triage process, it is customary to distinguish two types of medical triage:

Intra-point - distribution of those affected by units of a given stage of medical evacuation (i.e. where, in what queue and to what extent assistance will be provided at this stage):

Evacuation and transport - distribution by evacuation purpose, means, methods and order of further evacuation (i.e. in what order, by what transport, in what position and where).

At the heart of sorting, the three main sorting criteria developed by Pirogov still retain their effectiveness.

Sign I - danger to others. Depending on the danger to others, the degree of need of victims for sanitary or special treatment, isolation is determined and they are divided into groups:

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

Subject to temporary isolation;

Not requiring special (sanitary) treatment.

II sign – therapeutic- the degree of need of victims for medical care, the priority and place (medical unit) of its provision. According to the degree of need for medical care, three groups of affected people are distinguished:

Those in need of emergency medical care;

Those who do not need medical assistance at this stage (help may be delayed);

Those affected in terminal conditions, in need of symptomatic care, with an injury incompatible with life.

III sign- uh vacuation sign- necessity, priority of evacuation, type of transport and position of the victim in transport, evacuation purpose. Based on this sign, those affected are divided into groups:

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

Subject to stay in a given medical institution (depending on the severity of the condition) temporarily or until the final outcome;

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

To successfully conduct medical triage, it is necessary to create appropriate conditions at the stages of medical evacuation:

It is necessary to allocate the required amount of medical personnel, creating triage teams from them,

Provided with appropriate instruments, apparatus, means of recording sorting results, etc.

The triage teams should include experienced doctors of relevant specialties who can quickly assess the condition of the affected person, establish a diagnosis, determine the prognosis and the nature of the necessary medical care.

To calculate the need for sorting teams, you can use the following formula:

Ps. br = K x Tt, where:

K - number of affected patients admitted per day;

T t - time spent on sorting one victim (1.5-2 minutes);

T - duration of work of the sorting team (840 min - 14 hours).

Medical personnel of any level of training and professional competence must first perform selective triage:

Identify those affected who are dangerous to others

Through a quick review of those affected, identify those most in need of medical care (presence of external bleeding, asphyxia, convulsive condition, women in labor, children, etc.). Priority remains for those in need of emergency medical care.

After the selective triage method, the triage team proceeds to sequential examination of the affected individuals. The team simultaneously examines two affected people: one has a doctor, a nurse and a receptionist, and the second has a paramedic (nurse and receptionist). The doctor, having made a triage decision on the 1st affected person, moves on to the 2nd one and receives information about it from the paramedic. Having made a decision, he moves on to the 3rd affected person, receiving information from the nurse. At this time, the paramedic examines the 4th injured person, etc. The porter unit implements the doctor’s decision in accordance with the sorting mark. With this “conveyor” method of work, one triage team can sort up to 30-40 stretchers affected by trauma or those affected by SDYA (with emergency care) in an hour.

During the triage process, all victims, based on an assessment of their general condition, the nature of the injuries and the complications that have arisen, taking into account the prognosis, are divided into 5 triage groups:

- I sorting group - victims with extremely severe injuries incompatible with life, as well as those in a terminal state (agonal), who require only symptomatic treatment. The prognosis is unfavorable.

- II sorting group- victims with severe injuries, accompanied by rapidly increasing life-threatening disorders of the main vital functions of the body, the elimination of which requires urgent treatment and preventive measures. The prognosis may be favorable if they receive prompt medical attention. Patients in this group need help for urgent life reasons.

- III sorting group - victims with severe and moderate injuries that do not pose an immediate threat to life, whose assistance is provided in the 2nd priority or it can be delayed until they arrive at the next stage of medical evacuation;

- IV sorting group - victims with moderate injuries with mild or absent functional disorders;

- V sorting group- victims with minor injuries requiring outpatient treatment.

3.4. Medical evacuation - This is a system of measures to remove those affected from the disaster zone who need medical care and treatment outside it.

It begins with the organized removal, removal and removal of victims from the disaster zone, where they are provided with first medical aid and ends with their delivery to medical institutions of the second stage of medical evacuation, which ensures the provision of a full volume of medical care and final treatment. The rapid delivery of those affected to the first and final stages of medical evacuation is one of the main means of achieving timeliness in the provision of medical care and combining medical evacuation measures dispersed locally and over time into one whole.

Ultimate goal of evacuation- hospitalization of the victim of the appropriate profile in a medical institution, where the victim will be provided with the full scope of medical care and final treatment (evacuation as prescribed).

Evacuation is carried out according to the principle “on your own” (ambulance vehicles from medical institutions, emergency medical care centers, etc.) and “on your own” (by transporting the affected object, rescue teams, etc.).

The general rule when transporting injured people on stretchers is:

The irreplaceability of stretchers, and their replacement from the exchange fund

Loading transport, whenever possible, with single-profile nature (surgical, therapeutic, etc. profile) and localization of the lesion significantly facilitates evacuation not only in direction, but also in destination, reducing inter-hospital transportation to a minimum.

When evacuating victims in a state of mental agitation, measures are taken to prevent the possibility of them falling from transport (fixing them to a stretcher with straps, administering sedatives, monitoring those who are easily affected, and sometimes assigning accompanying persons).

The evacuation of those affected from the outbreaks of SDYV is organized in accordance with general principles, although it has some peculiarities. Evacuation of patients from areas of particularly dangerous infectious diseases, as a rule, is not carried out or is sharply limited.

If necessary, its implementation must be ensured that the requirements of the anti-epidemic regime are met in order to prevent the spread of infection along evacuation routes:

Identification of special evacuation routes;

Non-stop movement through populated areas and along city streets;

Availability of disinfection means in vehicles and collection of secretions from patients;

Escort of transport by medical staff;

Organization of sanitary control points when leaving outbreaks, etc.