The organization and content of surgical care in wartime. The organization of surgical care in the army during medical evacuation. 

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               The organization and content of surgical care in wartime. The organization of surgical care in the army during medical evacuation. 

 An objective assessment of the severity of surgical trauma of combat. Assessment of the wounded. Primary and secondary survey. Evaluation of the main functions of vital organs and systems.                                                                                                      Principles of medical Sort affected in terms of peace and war. The concept of medical sorting victims. Definitions and urgency of providing surgical medical assistance to victims.

 

1. Law of Ukraine “On urgent medicare” and his role in perfection of technology of grant of medicare at mass cases.

In August, 2012 was passed an act Ukraine “On urgent medicare”. A law became fundamental in reformation of service of urgent medicare. He determines organizationally – legal principles of providing of citizens of Ukraine and other persons, that are on her territory, by urgent medicare, including during the origin of emergencies and liquidation of their consequences, and principles of creation, functioning and development of the system of urgent medicare.

In this Law the brought list over of terms that is used in interpretation of urgent medicare :

1) brigade of urgent(ambulance) medicare – morphon of the station of urgent(ambulance) medicare or center of urgent medicare and medicine of catastrophes, the task of that is a grant of urgent medicare to the man in the urgent state directly in place of event and during transportation of such man to establishment of health protection under this Law;

2) calls of urgent medicare are a report about the urgent state of man and place of event та/або appeal about the necessity of grant of urgent medicare after the only telephone number of urgent medicare 103 or after the only telephone number of the system of urgent help to the population 112;

 

There are several ways to approach the victims, but they all require knowledge-The provision of legal mental stress and physical effort. Facilitate the task prior training and gained combat experience.

Main methods of approximation:

– Climb to the provisions poplastunsky on hand napivrachkuyuchy;

– A quick walk or run pryhynayuchys; short dashes;

– By ambulances.

 

Algorithm review and first aid to the victim. On examination of the victim is necessary to determine its condition and decide what assistance should be provided first. Therefore, one who provides first aid, should know the basic signs of the vital functions of the human body, the general principles of first aid and its methods in the presence of the victim’s injuries. General principles are feasibility, accuracy and speed simultaneously with reasonableness and determination and the preservation of peace (do not panic). It is recommended to keep this algorithm:

♦ restore airway: an audit of the oral cavity and upper respiratory tract while removing foreign bodies (broken teeth, blood clots, land), removal of water from the lungs, throwing the head, lifting the lower jaw;

♦ check for breathing and in his absence to conduct CPR;

♦ for the assessment of the cardiovascular system to determine the pulse (periodic oscillations of the walls of the arteries caused by the ejection of blood from the heart into the arterial system and change it pressure during systole or diastole). Its presence on the carotid artery suggests that blood pressure above 60 mm Hg. Art., the radiation – above 80 mm Hg. Art. Absence of pulse requires appropriate measures medical emergency. If necessary, held closed (indirect) cardiac massage brushes pressing hands on the chest;

♦ ensure no bleeding, if any stop external bleeding first – blood;

♦ assess the condition of the senses, especially sight, often the severity of lesions can be determined by how the victim opens his eyes: the command or only to pain stimuli, or do not react to external stimuli;

♦ substantial assistance in emergency diagnosis provides installation verbal contact with the victim, and to assess its ability to actively move the limbs.

Primarily require first aid injured (affected):

– With burning clothes;

– The presence of external or internal arterial bleeding;

– In a state of shock; with asphyxia (cessation of breathing) seizures;

– In a state of collapse (drop in blood pressure);

– Fainting;

– Distance from traumatic limb;

– With vypavshymy loops of intestines through the wound of the abdominal cavity;

– With permeable wounds of the chest; with involuntary release of urine and feces;

– With dramatically altered the color of the skin and mucous membranes; with severe asthma and more.

 

In the second stage (ie deferred for a short period of time) first aid to the wounded (affected) is given when the failure of timely because of the circumstances, the chance that the victim’s condition, but does not create a direct threat to his life. For example, continuing an impressive impact factor: smoldering clothing; the presence of agents on the exposed parts of the body; high content of carbon monoxide in ambient air; body parts stay in engineering structures or buildings destroyed and more.

The third stage include the rest of the wounded (damaged) .Pid the review should be quickly and accurately determine which of the most dangerous injuries to life, respectively, first performed the necessary health care measure, and then others. For example, the victim emerged or developed asphyxia because the mouth and nose clogged with earth, in addition, it has a closed fracture of limbs and burn it; then you first need to clear the land of the upper airways, to the artificial respiration to restore independent, then enter analgesic substance apply to burnt place aseptic bandage and hold immobilization of the limb.

When providing first aid is very important to treat the wounded, including the right to be able to take off his clothes in the presence of fractures, bleeding, with loss of consciousness, with thermal and chemical burns. When bleeding mostly clothes are not removed, and cut above the location of bleeding. Burns when clothing or even prypiksya stuck to the skin tissue around the place you want to cut the burn – in any case it caot be separated. The bandage is applied over the burnt skin. If the damage of the upper extremity wear first shoot with healthy hands, and then with damaged hands tightening sleeve, maintaining the whole hand below. Just remove the lower extremities pants. Often, to avoid further injury to the victim, his clothes rips at the seams, this handbag is a nurse than a garden. Removing the victim of shoes and clothing is usually done with the participation of two people.

 

Procrastination is usually conducted on small (10-20 m) distance on a single person or using both improvised and attendance products. On the battlefield, often delayed for a position in the side or back, depending on the nature of the injury. Thus, wounded in the head, upper limbs, thorax and abdomen better delay on the side, and with injuries of the spine, the back surface of the body and lower extremities – on the back. Taken into account when choosing a method of delaying and terrain conditions and specific combat situation.

For delaying the side nurse falls to the side behind the wounded, then puts his head on his chest and body – to fit and leg bent at the knee. The victim may lie on the techs face down on the side or back (depending on the nature of the damage). With his free hand holding wounded nurse, and the second hand and free foot pushes off the ground and crawling sideways, arms (own and affected) forearm held in hands lying on the ground

Delaying the wounded on the side

 

For procrastination on the back Medical has put man on the healthy side and go back close to his chest, then gently slip your foot, lying on the ground and slightly bent at the knee, feet of the victim. If the nurse is on the right side, he took his right hand left hand hurt-tion, and left – on the back of his pants in the area of ​​the buttocks. If it is on the left side, while the left hand is the right hand of the victim, and his right hand behind his back gets injured and also takes on pants in the area of ​​the buttocks. So strong, but not abruptly nurse, holding the victim at his back, turned on his stomach, legs should be staggered between his legs. Moves nurse, pushing off the ground with only one leg until it tired, then pushes the other leg. This avoids stalling and rolling out the wounded from the back while driving. Weapons (and their victim) nurse keeps on forearm free hand

Delaying the man on the back

 

  These methods available for delaying physically strong orderlies, so that will require significant effort. For procrastination can be used henchmen (rope, coat, cloak-tent sufficient size piece of canvas, tied together branches of trees, skiing and other improvised scraper) and Personnel (straps, boat-scraper, health burden established skiing) means. His weapons and the victim nurse holds on the right forearm or left hand

Pulling wounded in cloak-tent using webbing health

 

Visual estimation of the state of victim

3) separations of urgent(urgent) medicare – structural subdivision of multi-field hospital, in that the grant of urgent medicare is provided in the twenty-four-hour mode;

4) premedical help is urgent actions and organizational measures sent to the rescue and maintenance of life of man in the urgent state and minimization of consequences of influence of such state on her health, that come true in place of event by persons that does not have medical education, but after the official duties must own basic practical skills from saving and maintenance of life of man that is in the urgent state, and under the law be under an obligation to carry out such actions and measures;

5) urgent medicare is medicare, that consists in realization of the system of urgent medicare workers under this Law of the urgent organizational, diagnostic and curative measures sent to the rescue and maintenance of life of man in the urgent state and minimization of consequences of influence of such state on her health;

6) place of event is territory, apartment or any other location of man in the urgent state in the moment of realization of call of urgent medicare;

7) the urgent state of man is the sudden worsening of physical or psychical health, that presents a line and inevitable threat to life and health of man or surrounding her people and it arises up as a result of illness, trauma, poisoning or other internal or external reasons;

8) system of urgent medicare is totality of certain by this Law establishments of health protection and them morphons that provide organization and grant of urgent medicare, including during the origin of emergencies and liquidations of their consequences;

9) a sanitary transport is specialized – the transport vehicle intended for transportation of man in the urgent state and equipped for the grant of urgent medicare in accordance with national standards in relation to such type of transport is equipped by the special light and voice alarm devices.

The system of urgent medicare is in Autonomous Republic of Crimea, areas, cities Kyiv and Sevastopol consists of centers of urgent medicare and medicine of catastrophes, stations of urgent(ambulance) medicare, brigades of urgent(ambulance) medicare, separations of urgent(urgent) medicare.

 

Medical (prehospital) medicare – given by medical brigades, that have in the order a necessary apparatus, tool, medications, and others like that, and provided with theoretical knowledge and practical skills from the grant of skilled urgent prehospital of medicare. Typical composition of medical brigade: doctor, medical assistant, medical sister, driver.

Early hospital the skilled is specialized specialized medicare – urgent measures, to the victims(to the patients), delivered by the coach of UM, that is conducted in the separations of the urgent states by forces of her workers.

At the same time, there is international classification in obedience to that urgent medicare is divided into next groups:

 

BLS( Basic of life support) is base support of vital functions, namely grant of urgent medicare on the prehospital stage by not physicians(by volunteers, policemen, firemen, rescuers), or the same physicians that by chance appeared in place of event;

ILS (Immidiate of life support) is urgent support of vital functions, that can come true in a policlinic, permanent establishment, in a private cabinet, and others like that, by medical workers to arrival of the specialized rescue medical brigade);

ALS (Advance of life support) – the extended is skilled medical including reanimation help, that is given by physicians and paraphysicians with bringing in of corresponding apparatus, medications, tool on prehospital and to the early hospital the stages;

ATLS (Advance of trauma life support) is a professional grant of the first medical aid at various traumas both on preclinic and on early hospital periods(mainly executed by doctors, rarer by medical sisters, paraphysicians);

ACLS (Advance of cardiac life support) is a grant of professional urgent medicare at cardiovascular pathology(conducted by doctors, medical sisters, paraphysicians);

PALS (Pediatric of advance life support) is a grant of professional urgent medicare for children(comes true by doctors, medical sisters, paraphysicians).

 

Operatively-controller’s service of center of urgent medicare and medicine of catastrophes

1. Operatively-controller’s service of center of urgent medicare and medicine of catastrophes is structural subdivision of center of urgent medicare and medicine of catastrophes, that with the use of telecommunicatioetworks, programmatic, technical and other equipments provides in the twenty-four-hour mode:

acceptance, forming and information transfer about the calls of urgent medicare;

informative support and co-ordination of actions of brigades of urgent(ambulance) medicare and establishments of health protection in relation to the grant of urgent medicare.

2. Operatively-controller’s service of center of urgent medicare and medicine of catastrophes is under an obligation :

to accept challenge urgent medicare, provide his treatment and operative reacting on such call;

during treatment of call of urgent medicare to form information about the place of event, character and features of the urgent state of man, type of help, necessary for the removal of negative consequences of such state for the health of man, and to report about it to the subscriber that carried out the call of urgent medical

to pass to the station of urgent(ambulance) medicare and corresponding brigade of urgent(ambulance) medicare information about the call of urgent medicare, character and features of the urgent state of man;

to define establishment of health protection, to that the brigade of urgent(ambulance) medicare will carry out transportation of patient in the urgent state, pass to this information the brigade of urgent(ambulance) medicare and such establishment;

to carry out informative accompaniment of grant of urgent medicare and accept information about the result of her grant in place of event, during transportation and arrival of patient to establishment of health protection;

to carry out first-line informatively-consultative support of appeals of population after medicare;

operatively to provide departure consultative medicare after the appeals of establishments of health protection.

3. The use, collection, treatment, accumulation, storage, transmission, distribution, elimination, grant to access, to information about the calls of urgent medicare come true in the order set by a law.

4. Information about the call of urgent medicare, subscriber that carried out him, and audio recording of such call and reacting on him subject operatively-controller’s service to storage during three years. Elimination of such information comes true under the law.

5. Routing of calls of urgent medicare comes true in the order set by a central executive that provides body forming and will realize a public policy in the field of connection, after the giving of central executive that provides forming and will realize a public policy in the field of a health protection body.

6. Norms of loading and qualifying requirements to the controllers of operatively-controller’s service of center of urgent medicare and medicine of catastrophes, and also the tables of rigging of operatively-controller’s service of center of urgent medicare and medicine of catastrophes become firmly established a central executive that provides forming and will realize a public policy in the field of a health protection body.

7. Order of informing of brigades of urgent(ambulance) medicare about the call of urgent medicare and order of their direction into place of event determined by Cabinet of Ministers of Ukraine taking into account the requirements of law on the protection of the personal data.

Station of urgent(ambulance) medicare

1. The station of urgent(ambulance) medicare is establishment of health protection, a basic task of that is providing of permanent readiness of brigades of urgent(ambulance) medicare to the grant of urgent medicare in accordance with the this Law provisions in the twenty-four-hour mode and co-ordination of their activity with operatively-controller’s service of center of urgent medicare and medicine of catastrophes on territory of corresponding administrative unit.

2. The station of urgent(ambulance) medicare can have status of legal entity or separated subdivision of center of urgent medicare and medicine of catastrophes.

3. Typical position about the station of urgent(ambulance) medicare and brigade of urgent(ambulance) medicare becomes firmly established Cabinet of Ministers of Ukraine.

4. About formation and stopping of the station of urgent(ambulance) medicare made decision in the order and within the limits of plenary powers that is certain a law, by the organs of local self-government taking into account the this Law provisions.

5. The material and technical base of the station of urgent(ambulance) medicare includes building, building, medical equipment, wares of the medical setting, communication means, transport vehicles and other material values passed by organs, by the authorized agents to manage general property of territorial communities of corresponding administrative-territorial unit, in the order certain a law.

6. Property of the station of urgent(ambulance) medicare, that is a legal entity, is fastened after her on a right for an operative management and used exceptionally for implementation of the tasks envisaged by this Law.

Separation of urgent(urgent) medicare

 1. A separation of urgent(urgent) medicare is structural subdivision of multi-field hospital, in that the grant of urgent medicare to the patients delivered is provided in the twenty-four-hour mode by the brigades of urgent(ambulance) medicare or other persons, and to the patients that appealed after the grant of such help or other first medical aid personally.

2. About organization of separation of urgent(urgent) medicare and his functioning made decision government of Autonomous Republic of Crimea bodies regional, by Kyiv and Sevastopol town councils, by other organs of local self-government in the order and within the limits of plenary powers that is certain a law.

3. Only requirements to the material and technical rigging of separations of urgent(urgent) medicare and qualification of their workers are determined by a central executive that provides forming and will realize a public policy in the field of a health protection body, in accordance with the requirements of this Law.

4. Typical position about the separation of urgent(urgent) medicare becomes firmly established a central executive that provides forming and will realize a public policy in the field of a health protection body.

Workers of the system of urgent medicare

1. The workers of the system of urgent medicare under this Law are:

medical workers of centers of urgent medicare and medicine of catastrophes, stations of urgent(ambulance) medicare, brigades of urgent(ambulance) medicare, separations of urgent(urgent) medicare, that directly render urgent medicare та/або provide her grant by law by it;

unmedical workers of centers of urgent medicare and medicine of catastrophes, stations of urgent(ambulance) medicare, brigades of urgent(ambulance) medicare, separations of urgent(urgent) medicare, that carry out the organizationally – technological providing of grant of urgent medicare the medical workers of the system of urgent medicare.

2. Qualifying and other requirements to the medical and other workers of the system of urgent medicare are determined by a central executive that provides forming and will realize a public policy in the field of a health protection body.

3. Preparation, retraining and in-plant training of medical workers, after a government order for the necessities of the system of urgent medicare is provided under the law by a central executive that provides forming and will realize a public policy in the field of a health protection body, jointly with a central executive that provides forming and will realize a public policy in the field of education and science body

4. The medical workers of the system of urgent medicare have a right on:

increase post salaries, raises for the special character of labour, for the special terms of labour, additional charge for a scientific degree, for the honoured ranks, and also for a time-in-service depending on experience of work in state and communal establishments health protection, other raises and additional charges, bonuses and rewards, size and order of establishment of that, are determined by Cabinet of Ministers of Ukraine;

material help for making healthy during the grant of annual vacation in size of one post salary and material help for the decision of socially – domestic questions in size of one post salary, that is set in the order certain Cabinet of Ministers of Ukraine;

social privileges and guarantees envisaged by a legislation about under abnormal condition – rescue services, in cases, Ministers of Ukraine set by Cabinet;

obligatory insurance, that is provided in the order certain a law;

the free of charge providing of only standard a working wear is in the order certain a central executive that provides forming and will realize a public policy in the field of a health protection body.

5. Worker of the system of urgent medicare, that enters in the complement of brigade of urgent(ambulance) medicare, during implementation of official duties has a right of defence from the untillegal trenching upon the life and health, that is provided in accordance with a legislation.

Persons that are under an obligation to render a premedical help

1. Persons that are under an obligation to render a premedical help to the man in the urgent state are: rescuers of under abnormal condition – rescue services, workers of state fire prevention, workers of organs and subdivisions of militia, pharmaceutical workers, explorers of passenger carriages, air stewards and other persons that does not have medical education, but after the official duties must own practical skills of grant of premedical help.

2. The order of preparation and in-plant training from the grant of premedical help of persons that are under an obligation to give her is determined by Cabinet of Ministers of Ukraine.

Scientific providing of activity of the system of urgent medicare

1. Central executive that provides forming and will realize a public policy in the field of a health protection body, jointly with a central executive that provides forming and will realize a public policy in the field of education and science body, assist to development of scientific researches after directions “Medicine of the urgent states” and “Medicine of catastrophes”, including by ordering of concrete fundamental and/ore applied scientific researches from the aim of introduction of their results in activity of the system of urgent medicare.

2. Researches, that is conducted by scientific establishments, educational establishments, are financed in the order set by a legislation.

Financial and material and technical providing of the system of urgent medicare

1. The financial providing of the system of urgent medicare due to budgetary facilities comes true in accordance with a budgetary legislation.

2. For development and improvement of material and technical base of the system of urgent medicare it can be attracted facilities of enterprises, establishments and organizations regardless of pattern of ownership and menage, and also voluntarily offering of physical and legal persons, eleemosynary organizations and associations of citizens, other sources not forbidden by a legislation.

{Text of the article 14 in the release of Law № 333 – VII from 18.06.2013}

Responsibility is for violation of legislation in the field of the grant of urgent medicare

1. Persons guilty in violation of the this Law provisions in the order set by a law bear the disciplinary, administrative, criminal or civil legal responsibility after:

ungrant without good reasons in place of event of premedical help or groundless refuse in her grant;

ungrant without good reasons in place of event of necessary medicare or groundless refuse in her grant;

an ungrant is without good reasons of present transport vehicle for free of charge transportation of man that is in the urgent state, to the nearest to the place of event separation of urgent(urgent) medicare or groundless refuse in realization of such transportation;

an ill-timed grant of urgent medicare or creation of obstacles is in her grant;

non-fulfillment is without good reasons of orders of operatively-controller’s service of center of urgent medicare and medicine of catastrophes or brigade of urgent(ambulance) medicare in relation to the grant of the necessary first medical aid to the patient, that is in the urgent state that threatens to life of such patient;

groundless refuse in a transmission and accepting challenge of urgent medicare.

2. Compensation of moral and material harm, corresponding help or improper implementation of the professional duties caused as a result of ungrant by medical workers or other persons, in the cases envisaged by this Law, comes true under the law.

Final positions

1. This Law enter into force from January, 1, 2013, except a point 4 the real article, that is entered into by a day, following by a day publication of this Law.

2. Laws and other normatively-legal acts to bringing to conformity with this Law are used in part, that does not conflict with this Law.

3. To make alteration to such legislative acts of Ukraine :

1) in the Budgetary code of Ukraine (Lists of Verkhovna Rada of Ukraine, in 2010, № 50-51, century 572) :

а) in the subitem of “а” point to eliminate 3 parts of the first article of a 89 word of the “station of ambulance and first medical aid”;

b) subitem of “а” point to complement 3 parts of the first article 90 words “centers of urgent medicare and medicine of catastrophes, station of urgent(ambulance) medicare”;

2) points 24 parts of the first article of a 10 Law of Ukraine “About a militia” (Lists of Verkhovna Rada of UKRAINE, in 1991, № 4, century 20) to expound in such release:

“24) to give within the limits of present possibilities to the persons that suffered from offences and accidents or are in helpless or dangerous for life and health the state, including minor that remained without guardianship, premedical help and other help, and also in case of necessity to use envisaged Law of Ukraine “On urgent medicare” of measures for providing of grant to the marked persons of urgent medicare”;

3) in Bases of legislation of Ukraine about a health protection (Lists of Verkhovna Rada of Ukraine, in 1993, № 4, century 19 with next changes) :

а) in part to the first article 3 :

after an indention sixth to complement two new indentions of such maintenance :

the “urgent state of man is the sudden worsening of physical or psychical health, that presents a line and inevitable threat to life and health of man or surrounding her people and it arises up as a result of illness, trauma, poisoning or other internal or external reasons;

a health protection is the system of measures that come true by public authorities and organs of local self-government, them by public servants, establishments of health protection, medical and pharmaceutical workers and citizens with the aim of maintenance and proceeding in physiology and psychological functions, optimal capacity and social activity of man at maximal biologically possible individual duration of her life”.

In this connection an indention is seventh to consider an indentiointh;

to complement an indention tenth of such maintenance :

b) premedical help is urgent actions and organizational measures sent to the rescue and maintenance of life of man in the urgent state and minimization of consequences of influence of such state on her health, that come true in place of event by persons that does not have medical education, but after the official duties must own basic practical skills from saving and maintenance of life of man that is in the urgent state, and under the law be under an obligation to carry out such actions and measures”;

to expound the б) point of the “в” article 10 in such release:

“в) to use envisaged Law of Ukraine “On urgent medicare” of measures for providing of grant of urgent medicare to other persons that are in the urgent state”;

c) in the article 33 :

to expound part first in such release:

“Medicare is given in accordance with medical testimonies by the professionally prepared medical workers that are in labour relationships with establishments of health protection, that provide the grant of medical

help according to the license, and physical persons – businessmen that is registered and got a corresponding license in the order set by a law and can be with these establishments in civil legal relations”, got under the law;

to complement part third words “if other is not statutory”;

d) part first to the article 35 to expound in such release:

“Urgent medicare is medicare, that consists in realization medical workers under the law of the urgent organizational, diagnostic and curative measures sent to the rescue and maintenance of life of man in the urgent state and minimization of consequences of influence of such state on her health”;

to expound г) text of the article 37 in such release:

“Medical workers are under an obligation without delay to render necessary medicare in case of origin of the urgent state of man.

Organization and providing of grant of urgent medicare to the citizens and other persons come true under the Law of Ukraine “On urgent medicare”.

Citizens that during an urgent or extreme situation participated in saving of people and assisted the grant of medicare, avouched for in case of necessity in the order set by a legislation, free of charge treatment and compensation of the moral and property harm caused to their health and property.

For the ill-timed and off-grade providing necessary medicare, that resulted in heavy consequences, winy persons bear the responsibility under the law”;

e) part second to the article 43 to expound in such release:

“Consent of patient or him legal representative on medical interference not need only in case of presence of signs of direct threat to life of patient on condition of impossibility of receipt on objective reasons of consent to such interference from a patient or him legal representatives”;

f) in the point of “н” part of the first article of a 77 word “doctors(head physicians) and middle medical personnel of departure brigades of the stations and separations of ambulance and first medical aid, stations of sanitary aviation and separations of planility and urgent consultative help” to replace words “medical workers of brigades of urgent(ambulance) medicare of centers of urgent medicare and medicine of catastrophes, medical workers of brigades of urgent(ambulance) medicare of the stations of urgent(ambulance) medicare, medical workers of operatively-controller’s services of centers of urgent medicare and medicine of catastrophes, medical workers of separations of urgent(urgent) medicare”;

g) in the point of “б” part of the first article to replace a 78 word “first” a word “corresponding”;

 

 

The basic tasks of the system of urgent medicare are organization and providing :

 

-it is a grant of accessible, without payment, timely and quality urgent medicare under this Law, including during the origin of emergencies and liquidation of their consequences;

– medicine- sanitary accompaniment of mass measures and measures with participation of persons, in relation to that a state guard comes true;

– co-operating with accident – rescue subdivisions of ministries, other central and local executive bodies during the origin of emergencies and liquidation of their consequences.

Basic principles of functioning of the system of urgent medicare are:

-it is permanent readiness to the grant of urgent medicare;

-it is the operative and twenty-four-hour reacting on the calls of urgent medicare;

-it is availability and безоплатність of urgent medicare, her timeliness, quality and priority;

-it is a sequence and continuity of grant of urgent medicare and her accordance to the only requirements;

-it is regional exterritoriality.

 

 

     For providing of timely grant of urgent medicare injured from the emergencies of technogenic and natural character to the citizens, rescuers and persons that participate in liquidation of emergencies of technogenic and natural character, in Autonomous Republic of Crimea, areas, cities Kyiv and Sevastopol the centers of urgent medicare and medicine of catastrophes services of medicine of catastrophes as special type of accident -rescue services operate in composition that are created. Co-ordination of activity of centers of urgent medicare and medicine of catastrophes in case of emergencies of technogenic and natural character is carried out by the special commissions of national (regional, local, objective) level, that appear by law by it. The Organizationally-methodical providing of activity of centers of urgent medicare and medicine of catastrophes comes true by a central executive that provides forming and will realize a public policy in the field of a health protection body.

 

Approach the injured, if possible, from the side of his/her head. First of all, visually assess patient’s general condition (age, sex, morphology of the body, language, skin colour, posture, availability of the movements (thorax, limbs), mimicry, eyes condition, visible injury made by traumatizing factor). Make initial resolution of its degree and further algorithm of help. Figure out the condition of consciousness according to the algorithm AVPU:

A – Alert (conscious, gives adequate answers to the questions, is able to perform conscious actions when asked by the medical rescuer);

V – Responds to Verbal stimuli (to a loud sound near the ear);

P– Responds to Pain (responds to pinch in the area of left thoracic muscle at the turn of 180 degrees);

U – Unresponsive. If there is a suspicion of simulation of unconsciousness, open patient’s eyelids, using 1st and 2nd fingers. The conscious patient will strain his/her eyelids muscles and they will open with tension.

 

Let’s make a priori assumption that cerebral trauma occurs at transport accidents, sports accidents, falling from high places, traumas in water and children’s traumas.

Fix with your hands a neck part of the spine in the position which you found the injured in. (medical assistant 1) If that position does not promote breathing, carefully turn the injured on his/her back or to the position, which is close to a stable (on his/her side) (medical assistant 1 + medical assistant 2). Start initial examination according to the A, B, C technique (optimal term of performance – 10 sec) (doctor).

Step A Provide patency of airways support (medical assistant 1):

Evaluate if there is a need to examine oral cavity. In case of secretion available (blood, vomitive mass, outside objects (depending on the mechanism of an injury), it is necessary to open oral cavity (between molar teeth you should put a spreader to prevent accidental pressing of fingers), take out outside objects with a clutch and tampon, provide the cleaning of oral cavity and pharynx, clean them from secretion (if there are several injured, the priority is to arrange them, according to the relief of the area, head down); throw the patient’s head back and raise his/her chin; in case of suspicion of cerebral trauma, it is prohibited to throw patient’s head back, you should raise only his/her chin.

Provide patency of airways support, find out if there are signs of life:

•         Patient’s response

•         Provide patency of airways support

•         Check respiration and pulse (not more than 10 sec)

 

…to confirm or oppose the circulatory arrest.

 

    The cabinet of Ministers of Ukraine provides realization of public policy in the field of the grant of urgent medicare, organization and functioning of the system of urgent medicare including asserts an order co-operations of establishments of health protection, that included in the system of urgent medicare, with accident -rescue services and subdivisions of central and other executive, government of Autonomous Republic of Crimea, organs of local self-government bodies bodies during the origin of emergencies and liquidation of their consequences.

    Council of ministers of Autonomous Republic of Crimea, regional, Kyiv and Sevastopol municipal state administrations determine the list of establishments of health protection, that provide the grant of medicare on territory of corresponding administrative-territorial units in case of origin of emergencies and liquidation of their consequences.

     The center of urgent medicare and medicine of catastrophes provides bringing in in case of necessity of establishments of health protection, that is not included in the system of urgent medicare, and their workers and technical resources to the grant of medicare in case of origin of emergencies and liquidation of their consequences.

 

 

 

 

2. Position is about the single system of grant of urgent medicare.

                                        

 

 

 

 

 

                                         

 

By the order of Мinistry of health of Ukraine from 01.06.2009 р № 379 Statute is ratified about the single system of grant of urgent medicare.

The single system of grant of urgent medicare (farther is System) is created with the aim of realization of politics of the state in relation to providing of timely and quality medicare to every person that is in the urgent state.

The system functions after principles:

– to availability and without payment of medicare to every physical person that is in the urgent state;

– to the timeliness and quality of grant of medicare;

it is a grant of medicare both in everyday terms and in the conditions of emergency;

– to unity of medical science, education and practice that provides dynamic development and improvement of System.

The system envisages the use of the newest standardized medical technologies, optimization of network of curative establishments, their reorganization on the basis of only scientifically reasonable organizational principles and international standards of grant of urgent medicare with a corresponding materially – hardware, professional preparation of medical workers on questions the grant of urgent medicare, and also rescuers and other specialists, that participate in liquidation of consequences of emergencies and does not have medical education, workers, the professional duties of that are related to motor-car, railway, water and air transport.

      A management System consists in control after implementation of protocols of grant of urgent medicare injured on prehospital and to the hospital stages, ratified by Ministry of health Ukraine, and providing of terms for the timeliness of grant of this help.

A management System comes true at central level – by the Ukrainian research and practice center of urgent medicare and medicine of catastrophes; at territorial level – by the territorial center of urgent medicare and medicine of catastrophes.

 

 

Prehospital  stage of the system includes:

– service of urgent medicare, functional unit of that is a brigade of emergency medicare.

– an unmedical personnel of the system is specialists that does not have medical education(workers of MES, rescuers et al), the functional duties of that envisage the grant of the first aid.

The hospital stage includes:

-are multi-field hospitals with twenty-four-hour office hours, including that have a medical emergency department in the composition;

-are hospitals of medical first-aid;

-are centers of trauma of three levels;

-are consultative toxicological centers.

The specialists of System are:

-it is an unmedical personnel(render a premedical help);

-medical assistants, medical sisters of emergency medicare

 (speciality is “Medicine of the urgent states”);

-doctors from speciality “Medicine of the urgent states”.

At emergencies urgent medicare is rendered:

-brigades of permanent readiness of the first turn(brigades of medical first-aid);

– the specialized brigades of the second turn;

– the mobile field brigades;

-mobile detachments;

– mobile hospitals;

– medical establishments.

 

3. A concept is about Center of urgent medicare and medicine of catastrophes and Separation of urgent medicare of multi-field hospital.

A center of urgent medicare and medicine of catastrophes(farther is a center) is establishment of health protection, that provides on territory of corresponding administrative-territorial unit(Autonomous Republic of Crimea, area, mm, is Kyiv and Sevastopol) organization and grant of urgent medicare to the patients and injured that are in the urgent state(farther are patients and injured), in everyday terms, special period and during liquidation of consequences of emergency situation.

Basic tasks to Center are:

1) providing of organization and grant :

urgent medicare on territory of corresponding administrative-territorial unit to the patients and injured in everyday terms, special period and during liquidation of consequences of emergency;

consultative medicare with departure into place;

2) organizations:

implementation of norm of arrival of brigades of urgent(ambulance) medicare(farther are brigades) is to the place of event;

medicine – sanitary providing during realization of mass measures and measures with participation of persons, in relation to that a state guard comes true;

co-operating is with accident -rescue services and subdivisions of ministries and other executive, government of Autonomous Republic of Crimea, organs of local self-government bodies bodies during the origin of emergency and liquidation of her consequences;

3) organizations and realization :

transporting of patients and injured, that need medical accompaniment, and also medical evacuation of the consequences of emergency injured during liquidation;

organizationally-methodical help to Ministry of health Autonomous Republic of Crimea, to structural subdivisions on questions a health protection, regional, Kyiv and Sevastopol municipal state administrations during development of plan of the medicine – sanitary providing of population in case of origin or threat of origin of emergency;

research and information providing of the Governmental research and information system on questions emergencies;

to control after a timeliness, plenitude and quality of grant of urgent medicare by brigades.

 

Step B. Make sure if the patient is breathing. Count the frequency of respiration during 10 sec.

Indications for carrying out trachea intubation apnoea;

risk of aspiration;

danger or presence of respiratory disorder (damage of respiratory tracts, maxillary-facial trauma);

closed craniocerebral injury;

hypoxemia, in spite of carrying out oxygen therapy;

frequency of respiration less than 10 or more than 30 per minute (for adults) danger of respiratory standstill (sepsis, major burns).

 

If the breathing is pathological but not agonal (deep and noisy), and also in case of shallow breathing, a patient should be given oxygen therapy (10-15 liters per minute).

Objective criteria is the data of pulsoximetria:

saturation <92 % – indication to oxygenotherapy;

saturation <90 % – indication to intubation.

Simultaneously with making decision concerning necessity of artificial ventilation and providing oxygen, put a neck collar (a doctor, medical assistant or a driver can do it) and continue initial examination.

Step C.

At the same time find out if there is pulse in the carotid (during 10 sec) (in case the patient is unconscious) (doctor). If there is not – start doing closed chest-cardiac massage (doctor, while medical assistant 2 is preparing cardiomonitor and defibrillator) with frequency of 100 times per minute – 30 pressures on the chest and 2 ventilations (medical assistant 1). Simultaneously, connect electrodes of cardiomonitor, link it up and find out the reason of cardiac arrest (medical assistant 2).

 

“Quick evaluation ”
Taking  electrodes,  classic, self-adhesive electrodes.

 

 

Examine if there is any external haemorrhage (doctor). In case of its availability stop the haemorrhage – press the wound with your hand using sterile tissue. If the haemorrhage stops, put the clutch, bandage. If you found a patient with an amputated limb, stop hemorrhage while  evaluating the breathing and pulse condition. Pay attention to the skin temperature (using the back of your hand), skin colour, time of colour return after pressure on the nail, skin moisture (doctor). This information will indicate the development of the shock. Paleness, skin moisture, skin cooling and also increase of the time of nail skin colour renewal after pressing for more than 2 sec indicates a development of a shock. In case of shock development, external hemorrhage, suspicion of internal hemorrhage, organize transfusion of the blood substitutes (medical assistant 2).

Check if the patient has trinkets, bracelets, or badges – medical markers, which may hold information about patient’s condition, allergy, need for certain medication (for example, when a patient suffers from diabetes, epilepsy, etc), especially, when the patient is unconscious. While examining the patient give priority to:

dangerous mechanism of the trauma;

decrease in the level of consciousness;

respiratory failure;

abnormalities at initial examination;

considerable aberrations at general examination (it is possible to make immediate conclusion of patient’s condition, his/her viability, tactics of examination and medical treatment);

 

 

 

Category “Load and Go“after primary examination

This category includes patients, who have very serious mechanism of the trauma (fall from the top, severe sports injury, car accident, etc) or negative impression of  the patient at initial examination (amputation of the limb, severe defects, etc);

at initial examination decrease in the level of consciousness is found;

malfunction of respiratory tracts or respiratory failure;

malfunction of cardiovascular activity (shock or uncontrolled hemorrhage);

injured children and pregnant women.

 

 

 

 

 

 

 

 

 

 

In accordance with the tasks fixed on him center:

1) provides:

taking is over the population of the calls in relation to the grant of urgent medicare, sent by means of all communication means;

a grant of urgent medicare is in accordance with ratified Мinistry of health of protocols and standards;

co-operate from:

– by the induction centres(by the separations of urgent(urgent) medicare) of multi-field hospitals with the aim of providing of continuity and sequence of grant of urgent medicare by brigades and establishments of health protection;

– by public authorities, government of Autonomous Republic of Crimea bodies, organs of local self-government, establishments, enterprises, establishments and organizations;

– by the State commission on questions technogenic – ecological safety and emergencies;

– by establishments of health protection corresponding administrative-territorial unit in relation to the accumulation of regional reserves of medicinal facilities and wares of the medical setting;

grant of consultative medicare;

studies and practical preparation of unmedical workers on questions the grant of premedical help;

development of plans of measures is in relation to development of the system of urgent medicare;

a conduct of statistical account and accounting is in relation to the grant of urgent and departure consultative medicare;

fuel – lubricating materials and technical service are specialize the sanitary transport vehicles of center;

connection with brigades;

prognostication of origin of consequences of emergency and development of recommendations is in relation to their liquidation;

realization of collection, analysis and information transfer about the consequences of emergency with the use of the Governmental research and information system on questions emergencies;

A medical emergency of hospital (farther is Separation) department (urgent) is structural subdivision of multi-field hospital(farther is Hospital), that in the twenty-four-hour mode renders urgent medicare.

Task of separation :

-it is the Twenty-four-hour reception of patients and grant to them of urgent(urgent) medicare according to the protocols of grant of medicare, ratified by Ministry of health Ukraine(farther are Protocols).

– To Separation persons that is delivered by the brigades of medical first-aid are accepted, directionally on hospitalization of medical and preventive establishments doctors or that appealed independently.

-it is Sorting of patients at a mass receipt to Hospital and early hospital stage.

-it is Inspection and sanitization of patients and direction of them to the profile separation of Hospital according to the set diagnosis for further stationary treatment.

-it is Presentation of information to the corresponding organs, services and establishments in the cases envisaged by the current legislation of Ukraine.

Structure of separation :

A separation must have three private entrances:

а) entrance is for the acceptance of the patients delivered by the sanitary transport of medical first-aid or helicopter;

b) entrance is for patients that apply independently or hospitalized in the plan order;

c) entrance is for patients with infectious diseases and contamination persons (before the isolated apartment that equiping in case of absence in Hospital of infectious separation).

In accordance with tasks and power of Hospital of Separation consists of such medical apartments:

а) apartment for expectation of patients and them accompanying;

b) apartment for registration and dispatching office;

c) apartment of sorting of patients;

d) apartment for realization of intensive therapy, where enter:

-it is a reanimation chamber;

-it is the specialized apartment for the grant of help at the united damages for realization of operating interferences, manipulations and inspections after vital testimonies;

-it is a doctors- nurses post on a limit between an apartment for realization of intensive therapy and chambers with possibility of the permanent visual watching these zones(equipped by communication and monitoring of the state of patients means).

To flame for patients formed as a general hall that is divided by partitions into places of beds. To every bed place a standard panel(oxygen; medical gases; press air; electricity; connecting is to the local computer network; additional illumination; call of medical personnel button and others like that) rises for realization in case of necessity of reanimation measures and monitoring of congratulatory functions of patient with the term of his stay to 24 hours.

The percent of places of beds for the stay of patients in Separation(from 3 to 7 % general beds fund of Hospital) is determined by the decision of the Territorial organs of management of health protection.

In case of possibility the isolated chambers equip for persons with inadequate behavior.

 

4. A concept is about the points of the permanent and temporal basing of brigades of UM.

A point of the permanent basing of brigade of urgent(ambulance) medicare is a place of location of brigade of urgent(ambulance) medicare and specialized sanitary transport, adjusted and it is equipped for her work in the twenty-four-hour mode;

A point of the temporal basing of brigade of urgent(ambulance) medicare is a place of sojourn of brigade of urgent(ambulance) medicare for providing of timely grant of urgent medicare, including during realization of mass measures and measures with participation of persons, in relation to that a state guard comes true;

Created for providing of timely of coming brigade of UM to the place of call.

 

 

 

5. Order of actions of medical personnel of urgent medicare at liquidation of medical consequences of emergencies(mass defeat of people) in accordance with Order of МОЗ of Ukraine from 01.06.2009 № 370.

1. A senior attendant is a medical worker of the station(separation) of medical first-aid :

1.1. Sends to the place of emergency depending on character of event, brigade of the first turn(farther is Brigade 1) and specialized brigades of the second turn(farther is Brigade 2) of territorial service of medicine of catastrophes(farther is Service), and in case of their absence – brigade of medical first-aid(farther is Brigade), defining a chief from them for organization of liquidation of medical consequences.

1.2. About an emergency that arose up, and taken measure reports main doctor of the station of medical first-aid, operative attendants : Ministries of health Autonomous Republic of Crimea, managements of health protection regional, Sevastopol municipal state administrations and Main administration of health protection and medical providing of Kyiv municipal state administration(farther -Territory health authorities), territorial organs of Ministry of internal affairs of Ukraine, Ministry of Ukraine on questions mergencies and in matters of protecting of population from the consequences of the Chornobyl’ catastrophe, staff of the Civil defensive, and in case of necessity – main state health-officer of territory there was an emergency on that.

    1.3. In case of presence of plenty of victim directs the operatively-staff brigade of territorial subdivision of service of medical first-aid to the place of event, and in a night-time, week, festive and non-working ends – operative group of the local Territorial organ of health protection for providing of operative management the resources of medical first-aid and co-operating with accident -rescue

services, representatives of law enforcement authorities and local state administrations of territory, where an emergency happened. In case of necessity directs additional brigades.

1.4. Informs guidance or duty medical personnel of medical and preventive establishments of reference amount of victim and medical consequences with the aim of preparation of medical and preventive establishments to the reception of patients.

1.5. At the receipt of new information about the change of situation in place of emergency in good time informs the public servants marked in a point 1.2 this Order.

1.6. Provides delivery to the place of event of necessary emergency stock of medications, bandaging material, tool, medical apparatus and others like that.

1.7. Gives to the Territorial organs the management of health protection current and final information about the volumes of sanitary losses, data about the hospitalized persons, amount of the attracted Brigades 1, Brigades 2, Brigades and medical and preventive establishments.

2. A controller is on accepting challenge

2.1. Obtaining information from a subscriber in relation to the case of mass defeat of people, registers in the map of call reference reason, reference amount of victim, address of place of emergency, telephone, last name(on possibility – position) of person, that causes, and personally gives her to the senior controller and reports about it to the manager of operative department, and in case of їого absence – duty medical worker of operative department.

2.2. Directs the necessary amount of Brigades of a 1 Service to the place of event.

2.3. Provides operative connection with the directed Brigades 1 and by Brigades.

2.4. Immediately reports got from Brigades 1, Brigades 2 and Brigades information about the course of performance of call of senior attendant of medical worker of the station(separation) of medical first-aid.

3. Leader of Brigade that the first arrives by to the place of event :

3.1. Immediately reports to the senior attendant of medical worker of subdivision of medical first-aid in relation to description of event, reference amount and state of victim, conducts the medical sorting.

3.2. Provides information to the controller in relation to the necessity of direction of additional Brigades 1, Brigades 2, Brigades, organizes the grant of urgent medicare to the patients to arriving on the place of event of senior official of the station of medical first-aid from organization of liquidation of medical consequences of emergency.

3.3. Informs the senior official of the station of medical first-aid or leader of operative group of the local Territorial organ of health protection, that arrived on the place of emergency, about the amount of victim, their state, character of defeats, accepted measures and passes to him guidance and acts further works on his pointin

 

 

6. A concept is about the territorial plans of reacting on emergencies.

The plans of the medicine – sanitary providing of population in extreme situations at state level are developed to Ministry of health of Ukraine, preliminary examined by the Central co-ordinating commission and become firmly established Cabinet of Ministers of Ukraine.

The plan of the medicine – sanitary providing of population in extreme situations at territorial level is developed to Ministry of health of Autonomous Republic of Crimea, by the managements of health protection, Kyiv and Sevastopol municipal state administration regional, preliminary examined by territorial co-ordinating commissions and become firmly established accordingly Council of ministers of Autonomous Republic of Crimea, regional, by Kyiv and Sevastopol municipal state administrations.

The plan of the medicine – sanitary providing of population of administrative territory(Autonomous Republic of Crimea, area, cities of Kyiv and Sevastopol) at the terms of emergency situations represents maintenance and volume of measures in relation to minimization and liquidation of medicine – sanitary consequences of forecast emergency situations in the scale of all territory, separate cities and districts and is an initial document for determination of necessities

financing, medical supply, logistical and transport support of the planned measures.

 

 

 

1. Analysis of the real state of all links of the system of health protection administrative territory and their readiness to functioning at the terms of emergency situations :

–it is the state of providing and level of training of medical personnels and possibility of his bringing in to work in the zone of emergency situations and on the stages of medical evacuation;

–it is the state of bed fund of medical establishments and possibility of his profiling and development of additional bed fund;

–it is the state of logistical support of medical establishments, medical forming created on their base of mobile;

–it is a presence of backlogs of sanitary-hygenic, medical and special property in case of emergency situations;

–it is a presence and state of sanitary and auxiliary motor transport for development of forces of medicine of catastrophes and evacuation of victim, population and medical establishments

–it is the state of operative communicatioetwork and possibility of equipment of forming of medicine of catastrophes modern connection;

 

 

 

2. Calculations of possible sanitary losses are among a population, exit of line-up of medical establishments and medical personnel at emergency situations.

3. Calculations of necessary amount of the medical forming, medical shots, additional bed fund, supplies of sanitary-hygenic, medical and special property, transport and other material and technical facilities for liquidation of medicine – sanitary consequences of emergency situations.

4. On the basis of comparison of potential of the system of health protection and the expected necessities of determining the amount of forming, medical shots, material and technical facilities, sanitary-hygenic, medical and special property, that it is necessary to bring over to forming of medicine of catastrophes at emergency situations from other departments, enterprises of different pattern of ownership, public organizations.

 5. Planning of accumulation and support in readiness of operative backlogs of forming and establishments of medicine of catastrophes.

6. Planning of training of personnels and forming is to participating in liquidation of medicine – sanitary consequences of emergency situations, their certification and licensing.

Task on planning of the medicine – sanitary

 

 

 

 

providing of population in emergencies:

–it is a normative document, that determines minimum requirements obligatory for implementation at planning, namely:

–it is a prognosis of medicine–tactic situation within the limits of administrative territory;

– basic tasks of the medicine – sanitary providing populations that follows from the forecast situation at possible emergency situations;

–it is composition(profile) and quantity of the medical forming of state and territorial level ;

–it is an amount and profile of beds in the medical and preventive establishments intended for the reception of the consequences of emergency situations staggered and sick at liquidation;

–terms of bringing to readiness of the medical forming and bed fund network to the reception of staggered and sick;

–it is an order of providing with medical, sanitary-economic and special property of the formed medical forming and beds intended for the acceptance of staggered and sick;

–it is an order of logistical and transport support of forming and establishments of medicine of catastrophes;

–it is composition, terms of bringing them over in readiness and setting of forces —-facilities that is distinguished in order of co-operation different departments, by private enterprises and public organizations that participate in liquidation of medicine – sanitary consequences;

–it is a location of points of management liquidation of medicine – sanitary consequences of emergency situations and order of presentation of reports.

 

The plan of the medicine – sanitary providing of population in emergencies includes a map and explanatory message.

On a map inflicted:

-the Administrative limits of territory and name of administrative territories, that to her fit closely

-the Names of settlements, distribution of the most essential potentially-dangerous objects of economy

– the Basic motor-car and railway highways with pointing of accepted their numeration, key stations

-Zones of possible infection as a result of accidents on radiation – and chemically dangerous

objects

-Zones of possible flood, seismo dangerous zones with pointing of the last year of their activity and power and others like that

-it is Distribution of naturally-nidal infections with pointing of closing date of registration of infection and amount of cases of disease

-it is Distribution of forming of medicine of catastrophes

-it is Distribution of establishments of sanepydemic supervision, service of blood, pharmacy and others like that

-it is Distribution of points of management and communication means

 

 

 

 

 

 

 

In an explanatory message represented:

-conclusions from the forecast medicine – tactic situation, the sanitary losses of population are possible, their structure, death medical establishments, loss of medical personnel, influence of consequences of emergency situations on organization of the medicine – sanitary providing of population;

-it is the compressed description of organs and establishments of health protection territorial and department submission that is the base of formation of service of medicine of catastrophes;

-it is a task of territorial level taking into account the forecast situation and present possibilities in relation to creation of her forces and facilities;

– forces(forming, establishments, subdivisions) of territorial health, private and public patterns of ownership, department submission authorities with pointing of terms of bringing them over in readiness to work at emergency situations;

-it is organization of supply of the created forming and medical establishments(bed network) by medical, sanitary-economic and special property, blood and her preparations;

-it is organization of a transport providing of forming and establishments of ДСМК, accordingly with the measures conducted by service;

-it is organization of defence of personnel of service of medicine of catastrophes from influence of striking factors in case of occurring of emergency situations;

-it is organization of, food material-supply of forming and establishments of ДСМК at liquidation of medicine – sanitary consequences of emergency situations (including order of technical maintenance of transport, providing fuel – by lubricating materials, food stuffs and water, communication means, material and other property);

-it is organization and maintenance of measures on introduction of the modes of an increase readiness and emergency taking into account the forecast medicine – tactic

 situation and features of the territorial and department system of health protection.

 

 

 

 

 

7. General description of mass case.

A mass case is characterized by good few of victim, that require a help after urgent testimonies, considerable material losses and disparity between the amount of persons that need help and by ability to help them.

For a guard healthyʼI is disparity between the amount of victim, that require medicare and the amount of medical workers that can give her working as in everyday terms.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

8. Concept about the medical sorting: introductory, primary, secondary

but evacuation.

1) Introductory sorting – the workers of MEM MEASURES and Ministry of  internal forcesexecute, giving priority in taking(leadingout ) away of поранених from the zone of defeat;

2) the Primary medical sorting is distribution of victim on groups depending on weight of the state and mark them by separate colors;

3) the Secondary medical sorting is determination of priority in the grant of medicare injured red group.

4) the Evacuation sorting is determination of order of evacuation, position of body in space, to accompaniment, type of transport and place

9. Description of victim is in accordance with the coloured marks at the primary sorting.

In accordance with Conception of the medical providing during preparation and realization in Ukraine of final part of championship of Europe of 2012 from football(in future Conception), approved by the order of Cabinet of Ministers of Ukraine from May, 7 in 2009 № 563-р, persons that need medicare are divided after categories, each of that a certain color answers:

 

 

 

 

10. Conditional distribution of part of the injured different sorting groups is depending on general to the amount of victim.

 

11. Criteria of the primary sorting of adults are by system of START.

The criteria of the medical sorting must contain the signs of primary inspection(АВСD). Most widespread for adults(from 8) is the system START.

Whether walks, if so” – “green”.

If no, or breathes, if “no” – provide communicating, if so” – “red”, if “no” – “black”. If breathes, find out breathing frequency. If in adult she anymore after 30 and less than after 10 min– 1 – “red”. If breathing frequency in a norm estimate the state of perfusion : capillary filling or pulse on a radial artery. If capillary filling more than two seconds or a pulse on a radial artery is absent – carry out control of the external bleeding(at a necessity stoped her) is a patient “red”. If the state of перфузії is stable(capillary filling less than two seconds or a pulse on a radial artery is present) – estimate the state of consciousness – ask to execute a simple commission. If so is a patient “yellow”, if “no” – “red”.

 

 

 

 

 

 

 

 

 

 

12. Criteria of the secondary sorting.

With an aim realizations of the secondary sorting are used the modified criteria of the revised scale of traumas(RTS), that includes the sum of points after a scale GLASO, and also after a scale frequency of breathing and systole arteriotony.

 

Scale	Number	Score	Sum
Scale com Glasgow, score	13-15	4	=     +     +
	9-12	3
	6-8	2
	4-5	1
	3	0
Breathing frequency, bpm	10-29	4
	30 and more	3
	6-9	2
	1-5	1
	0	0
BP (syst)	90 and more	4
	76-89	3
	50-75	2
	1-49	1
	0	0

 

 

12 = priority 3

11 = priority 2

10 and less than = піроритет 1

If in a patient in a sum 10 and less points is the first turn, 11 points – second turn, 12 points – third turn.

 

 

13. Development of zone of sorting, zone of grant of medicare and zone of transport, requirement is to them.

 

14. Distribution of functions of members of brigade of UM, that arrives the first on the place of event with a mass case.

In case of mass defeat priority are organizational principles in the grant of urgent medicare. Main organizers the crew of the first brigade of UM, that arrives on a call, becomes.

A doctor performs the duty of co-ordinator, medical assistant – assortman, a medical sister(second medical assistant) organizes the first-aid station, driver – accountable for a transport.

 

 

 

15. Algorithm of actions of brigade of UM, that arrives the first on the place of event in a dangerous hearth that does not require decontamination.

Step 1. First of all a co-ordinator determines the leader of rescue operation, knows for him a медико-тактичну situation:

– that did happen?

– how many injured?

– where a safe place is for organization of zone of sorting, zone of grant of medicare and zone of transport.

Step 2. In future a co-ordinator confirms the presence of numerous case to the controller, marks the potential necessity of bringing in of additional amount of brigades from the own zone of service from a calculation 2 brigades on 3 injured, 3 brigades on a 5 victim, 5 brigades on a 10 victim. At presence of 50 injured and anymore the amount of brigades must present the not less than 20 ід numbers of victim.

Main principle consists in aspiration of providing one brigade of ambulance one red injured, that is why eventual amount of brigades will be determined the during realization of rescue operation.

If the expected or real number of victim the territorial station of first-aid can distinguish more than, the last informs the nearest Territorial center of UM and МC with the aim of bringing in of additional brigades of permanent readiness of the first turn regional, and at a necessity and state level, in accordance with the plan of reacting in case of emergencies. Quality of such plan and him careful inhibition all performers is by main organizational principle of liquidation of medical consequences of emergencies.

Step 3. From a number the workers of brigade of first-aid a co-ordinator determines a medical assistant for realization of the medical sorting, medical sister for organization of the first-aid station and grant of medicare(“red” and “yellow”) and driver – for the reception of other brigades of first-aid. In this situation organizational principles have a decision value, than direct grant of medical by a help, as, only due to them it is possible to save most of victim.

A medical assistant targets at realization of sorting. He puts a waistcoat on with inscription “Сортувальник”(“Triage”). A leader of rescue operation of проінформовується is about the necessity of taking away of all victim to сортувальника that executes the primary medical sorting with determination of “red”, truly “yellow” and “black” injured.

A medical sister organizes the first-aid station – assembly of “red ” point and “yellow” injured, disposes with the help of driver medical property from the coach of ШМД for the grant of the first medical aid and executes her within the limits of the competense – BLS AED in the group of red. The first-aid station is designated corresponding color(red or yellow) by small flags on a pole. Appropriate is development of dense material on earth of corresponding color. At a necessity(winter season, bad weather) for organization of the first-aid station adherent apartments are attracted, transport vehicles(bus) or opened out by the workers of MEM MEASURES tents.

A driver disposes the coach of ambulance in the zone of transport, provides meeting of other coaches of ambulance, their parking and directs the brigades of ambulance in the first-aid station.

Step 4. On completion of the primary medical sorting a co-ordinator finally informs the controller of character of event “numerous” or “mass”, that will allow to amend in character of organization of liquidation of medical consequences of incident and prepare permanent establishments for the reception of victim.

Before arrival of other brigades of first-aid he brings over the not busy in a rescue operation workers of MEM MEASURES to the grant of medicare “red” injured within the framework of their competense.

Organizes a supervision and guardianship after a victim “green” and “yellow ” groups, as an in course of time victim that can move own forces can through the inflicted traumas or state of health, to behave to the “yellow” or “red” groups.

Practical principle of guardianship above a victim from a “green” group consists on their to grouping in sitting position(at possibility, warming blankets, thermo foil, improvised facilities) thus, that a rescuer(employee of Мinistry of internal affairs or any is brought over to it person) had the opportunity constantly to see their faces. It should be noted that a victim from a “green” group as a result of psychical stress can behave irrationally, and terms of estimation of the state of health caot be unambigiuous during a mass event and does not eliminate internal traumas. For maintenance of order in a group “green” and avoidance of complaints inalienable the help of psychological services, workers of the “Red cross” can become and law-enforcement organs.

At guardianship above “yellow” optimal is control of indexes of their vital functions (uninvolved in rescue operations by the representative of MEM MEASURES, МIA (Мinistry of internal affairs) , other rescue services certificated from the first aid), of grouping of them in a warm apartment(tent) for expectation of turn for the grant of medicare and evacuation.

Step 5. On arrival of other brigades of first-aid a co-ordinator directs them first of all to “red”.

 

 

At presence of two and more injured from a group “red”, doctor of the second brigade first-aid, as well as every following, conducts the secondary medical sorting with the purpose of to define a priority victim from this group in relation to the grant of prompt medical assistance. The secondary medical sorting in case of possibility can execute and co-ordinator, or other medical worker of the first brigade that arrives on a call, and to direct a next brigade to the priority victim.

Step 6. From the moment of arrival of the second and next brigades a co-ordinator is under an obligation to obtain information from a controller or worker of Center of medicine of catastrophes in relation to the places of hospitalization of victim and to pass to this structure the driver accountable for a transport, or personally to inform other brigades where to conduct a victim “red” group.

A co-ordinator conducts the permanent account of amount of victim from the hearth of defeat of different sorting groups in a corresponding map, marks a number them sorting coupon and curative establishment evacuation comes in that true, and also change of sorting group injured.

There can be a situation, wheext arriving brigades yet expect taking away of victim from the dangerous hearth of defeat. In this situation a co-ordinator provides the transmission of транспортувальних boards, neck neckwears and other necessary facilities to the rescuers of MEM MEASURES from the arriving brigades of first-aid for optimization of grant of the first aid and them transport from the hearth of defeat.

After realization of corresponding for a “red” group treatments, and to beginning of final transportation doctor of arriving brigades firat-aid execute the evacuation sorting(multiple declaration of indexes of vital functions, type of transport and permanent establishment). Some injured as a result of quality treatment, attribute to the “yellow” group, some, not having regard to application of intensive medical actions, perish in place of event, then a brigade is attracted for the grant of help other “red”.

After evacuation of “red”, given assistance by “yellow” and in future “green”.

Depending on the construction of transport vehicle, traumas injured and possibilities of hospital it is possible to decide a question in relation to transportation more than one injured. Consultation between doctors under the direction of co-ordinator the real chance allows maximally rationally to define on the survival of separate victim.

 

 

16. Algorithm of actions of brigade of UM, that arrives the first on the place of event in a safe hearth.

Steps 1 and 2 is identical.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Step 3. A co-ordinator determines realization of the medical sorting priority in the hearth of defeat(for example the Скнилівська tragedy). A sector on territory, in that they must distinguish “red”, “yellow” and “black”, is distinguished all medical workers of brigade. The members of brigade embrace all territory a zigzag route, marking a victim corresponding sorting coupons.

It should be remembered that in this situation there can be the problem related to the wilful substitution of sorting coupon “yellow” injured with “red” with the aim of near-term of grant of medicare.

Step 4 is identical. Except it all representatives of rescue services(uninvolved employees of MIA) are attracted for the grant of the first aid within the framework of the competense.

At presence of boards for transporting of “red” victim take in the first-aid station. The newly arrived brigades work first of all from already taken away “red” in the first-aid station and with untaken away in the safe hearth of defeat. A co-ordinator on the basis of the secondary medical sorting can specify on “red”, that require a grant prompt medical assistance in the first turn. If adequate facilities are absent for the grant of the first aid and transporting in the first-aid station priority is remained by the grant of medicare in place of defeat.

It should be noted that the arriving coaches of first-aid must take place in the zone of transport. There is not a single ground to get in a coach into place of grant of medicare even in the safe hearth of defeat.

General for both situations is circumstance that expectant mothers and children that were the subjected actions of injury factors have unambigiuous priority in the grant of medicare(group “red”) and transporting in force of the anatomy – physiology features.

Unpromising persons that after the grant of the first aid continue to remain living caot be considered lost. Through limitation of attempts of help in the conditions of mass event, these people get a secondary medical-transport priority with obligatory evacuation in curative establishment.

With the aim of the maximally effective use of forces and facilities in case of death of victim during transportation to the hospital the brigade of first-aid must return into place of event, pass the dead into place warehousing of bodies and again connected to the rescue measures.

Possible are cases of emotional and psychical disorders among the rescuers of MEM MEASURES(employees of MIA) and physicians, that require urgent interference that consists on the removal of them from measures. It follows to perceive such case as physical trauma that does impossible the further participating in these measures, not except the fitness of rescuer to service.

In case of traumas to the rescuers of MEM MEASURES(to the employees of МВС) it is needed near-term to render medicare, and those that work in a protective clothing and equipment, it follows without delay to exclude from rescue actions.

When transporting from the place of event to the hospital, where it is possible to give to the victim, occupies more than 30 min, it is necessary to use an air liner. Thus a doctor-co-ordinator has a right for his call or guidance of service of ambulance (Territorial center of UM and МC), an incident happened on territory of that.

On public all persons injured as a result of events must be hospitalized, where they finally will be inspected, will expose to treatment or will release. However in practice it maybe to deprive a person from a “green” or even “yellow” group in a kind in general lines bodily and psychical condition, without visible traumas, possibility freely to move, not to abandon the place of event. In such cases the special value corresponding documentation that certifies the decision of suffering participant collects accident.

 

 

17. Algorithm of actions of brigade of UM, that arrives the first on the place of event in a dangerous hearth with the necessity of decontamination.

Introductory sorting. The feature of realization of the introductory sorting is realization of him exceptionally by rescuers in isolating protective suits. It is thus possible to distinguish the group of walking victim that destroy in the first turn. In the second turn take away a victim there are visual signs of vital functions(talks, moans, cries, coughs, breathes, that is set by sight) in that. In the third turn take away other injured.

Introductory medical sorting. Before a tent for a disinfestation the introductory medical sorting is executed by a medical worker that has status of rescuer, dressed in a corresponding protective suit. Aim of the introductory medical sorting to distinguish a victim black sorting group among children and adults(does not breathe after providing of communicating of standard) and those, to the proper person to conduct certain medical rescue actions during procedure of disinfestation.

 

Primary medical sorting. It takes place in a safe place after decontamination of victim. He is conducted by all walking and not walking injured. For a walking victim add an additional criterion: presence of specific signs of poisoning. If so” – injured yellow. For not walking after the estimation of breathing, find out the presence of specific signs of poisoning. If so” – injured red.

The secondary medical and evacuation sorting takes place in the ordinary mode.

 

 

18. Rules of the use of sorting bangles and coupons.

1. Registration form of medical documentation № 109-2/oh “Card of the medical sorting”(farther is a card of the medical sorting) is the medical registration document intended for collection of information about a victim and sick because of emergencies during preparation and realization in Ukraine of final part of championship of Europe of 2012 from football(farther – injured) during realization of the medical sorting. On the basis of the collected information of victim divide after categories, each a certain color answers of that, and attribute to the certain sorting group in accordance with certain

 

2. The card of the medical sorting is filled on the prehospital stage by the medical workers of brigades of medical first-aid, brigades territorial centers of urgent medicare and medicine of catastrophes, by medical workers in the induction centres(medical emergency departments) of establishments of health protection.

3. During hospitalization of the health injured to establishment of guard the card of the medical sorting is glued up to the medical map of in-patient. In the case when a victim does not need hospitalization establishment of health protection, the card of the medical sorting is glued up to corresponding registration documentation of the station rapid of  first-aid.

4. The card of the medical sorting contains information for filling on facial and reverse parties. The card of the medical sorting needs to be filled by a clear and legible hand without errors and corrections.

5. The sizes of card of the medical sorting(together with that can be torn off parts) present: a width is a 12 cm, length is a 24 cm. From above in the middle there is the through opening ponderable for a ribbon long a not less than 80 cm, by means of that the card of the medical sorting will get dressed on a neck injured or fastened on a clothing. The card of the medical sorting is printed to the heavyweight paper in coloured kind.

 

ІІ. Order of filling

On a right side the cards of the medical sorting distinguish basic part(1) and that can be torn off parts(2, 3), as brought around to a chart:

 

  

 

 

 

 

1. In upperleft куті cards of the medical sorting the name of establishment of health protection, the workers of that conduct the medical sorting is inscribed.

2. On the right, under inscription there is “Card of the medical sorting”, inscribe the series of card of the medical sorting in accordance with an administrative-territorial device on such chart:

A number of card of the medical sorting is a sequence number that is filled in during making.

3. On the right side of card of the medical sorting in upperleft to куті mark a date and time of review injured.

4. In a block “Data of review” are in upperleft to куті sex and age register injured. In the case when age injured – 8 to, a medical worker that conducts the medical sorting puts a mark in a square opposite inscription “Child”.

5. The schematic outlines of man are below represented, between them there is a table with the list of damages : wound, penetrating wound, dull trauma, burn, break closed, open, amputation, coalface. At filling of this area medical worker that conducts the medical sorting, the type of damage marks from the list offered in a table and specifies a pointer on the schematic outlines of man the place of his localization. Under the schematic image of man the placed inscription “Other”. In this column specified present damages, symptoms or displays, are illnesses present in a victim, and also given, that can influence on the volume of grant of medicare, for example, pregnant, allergy and other, as shown on a chart:

 

6. On the right of schematic image of man and below inscription “Child” the coloured marks that answer the contamination agents of radiation, bacteriological, chemical character, and inscription, are placed it “unknown”. Below every sign and inscription it “unknown” the placed squares, where after realization of decontamination injured a medical worker that conducts medical sorting puts a corresponding mark:

 

 

7. On the left from the card of the medical sorting on all her length there is the that can be torn off part divided into two equal in size parts. On a red background by capital letters apeak in relation to all card of the medical sorting contained inscription “Contaminated” and series and number of card of the medical sorting.

In the case when контамінації of victim was not, this part of card of the medical sorting unstucked fully.               

 

If the specialists of the special subdivisions, that set the fact of presence of biological pathogenic agents, hazardous chemical and radioactive substances, are confirm their presence and conducted decontamination(sanitization) of victim, a medical worker that conducts medical sorting tears away an underbody that remains on a sorting ground, overhead part remains fastened on the card of the medical sorting.

. Under a block “Data of review” the placed table in that mark vital indexes injured : breathing, capillary pulse, state of consciousness.

Depending on indexes a medical worker that conducts the medical sorting puts a mark in a corresponding square that determines a category injured after a sorting group(And, ІІ, ІІІ, IV). Vital indexes on a blue background touch the injured children under age 8.

9. After determination of sorting group, the medical worker, that conducts the medical sorting, marks series and number of card of the medical sorting on her corresponding that can be torn off element, injured, belongs to that.

That can be torn off part of the lower field means a sorting category to that a victim is attributed. Thus that can be torn off elements from a right side, that answer a sorting category injured, remain for a medical worker that conducts the medical sorting, and that can be torn off elements on the left remain on the card of the medical sorting.

The lower field of that can be torn off part must answer information of basic part of card of the medical sorting, where a sorting category is determined injured depending on the state of his health and data of review medical workers.

Standard of the filled card of the medical sorting (right side) :

 

10. On reverse side of card of the medical sorting under the through opening a table takes place “Parameters of vital functions” that consists of six columns. In a table marked: time, consciousness(scale of commas of GLASGOW), breathing frequency for 1 minute, pulse for 1 minute, arteriotony, capillary pulse. This table is filled by medical workers(doctors, medical assistants, medical sisters) that conduct the second stage of the medical sorting on sorting grounds and during evacuation of the health injured to establishment of guard. It is necessary to conduct inspection injured at once after a receipt on a sorting ground and not rarer once every 30 min.

Below tables the placed scale of commas of GLASGOW and interpretation of her data.

11. Under data that touch the scale of commas of GLASGOW, placed table “Conducted treatment, to manipulation” that consists of five vertical and six horizontal columns. In a table such data register: number after an order, time of realization of manipulation or introduction of medicinal facilities preparation/is manipulation, dose(a dose and volume of medicinal means are specified), place of introduction(specified where exactly there was the executed manipulation and entered medicinal means, for example, “sorting ground”, “medical first-aid”).

12. The below placed table is the “Change of sorting category”, up-diffused on five parts sorting categories mark in that, : “СК And”, “СК ІІ”, “СК ІІІ”, “СК IV”. In the case when during realization of the second stage of the medical sorting or worsening or improvement of the state of health injured took place on the stage of evacuation, a medical worker notes in a column in accordance with the state of health, that is certain preliminary, and changes the coloured bangle.

13. Under a table mark data about the brigade of medical first-aid or territorial center of urgent medicine and medicine of catastrophes, that conducts the medical sorting or evacuation.

14. Block “Personal data fill a victim” such data: the last name, name, patronymic injured; location, telephone. In the case when a victim is unknown, information about it registers in the column of “Name and Surname”.

15. The back of that can be torn off underbody contains the coloured fields that take place like to facial part and consist of two identical parts. On the that can be torn off element of black the placed inscription “time of death, by hours хв”., where time of establishment of biological death is written down injured. On other coloured that can be torn off elements the placed inscriptions that mark sorting groups : “СК And”, “СК ІІ”, “СК ІІІ”.

 

 

 

 

 

 

 

Sources of information:

1.               American Heart Association in collaboration with the International Liaison Committee on Resuscitation (ILCOR)/ International Guidelines 2000 for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. A Consensus on Science // Resuscitation. – 2000. – 46. – P. 103 – 252.

2.               European Resuscitation Council. Immediate life support. 1- st Edition. Published by European Resuscitation Council Secretariat VZW, 2006.

3.               Lattore F., Nolan J., Robertson C. et al. The ALS working group of the European Resuscitation Council. The European Resuscitation Council Guidelines 2000 for Adult Advanced Life Support Resuscitation. 2000. – 48. – P. 211 – 212.

4.               Safar P, Bircher NG. Cardiopulmonary and cerebral resuscitation. 3rd ed. London: WB Saunders, 1988.

5.                John Campbell. International Trauma Life Support. USA. New Jersey 2008. P. 289.

 

6.               www.erc.edu

7.               www.resus.org.uk

8.               www.c2005.org

9.               www.americanheart.org

10.          www.bcs.com

11.          www.escardio.org

12.          www.ics.ac.uk

13.          www.aagbi.org

14.          www.bestbets.org

15.          www.euroanesthesia.org

16.          www.eusem.org

17.           http://zakon2.rada.gov.ua/laws/show/5081-17

18.            http://pidruchniki.ws/17540906/bzhd/samodopomoga_vzayemodopomoga_nadzvichaynih_

19.           http://www.bibliofond.ru/view.aspx?id=492657.