MEDICAL SORT, ITS TYPES AND MAIN OBJECTIVES.
Medical sort - the distribution of the groups affected by the need for uniform
medical and evacuation measures in accordance with the medical evidence, the
volume of medical care provided at this stage and accepted medical evacuation order
evacuation.
The purpose of the medical sort - to ensure timely hit conducting medical and
evacuation.
Objective medical sort - to determine the nature of injury, set priority, the
place of the victims of medical care and treatment, to determine the order of
evacuation and medical facility where to evacuate, and sequencing, mode of
transport for evacuation, the evacuation of the affected position (sitting, lying).
The basis of the sort on the first stage of medical care are three main sorting
features:
- Treatment;
- Danger to others;
- Evacuation.
For medical grounds determine the extent necessary victims of medical care,
order and place of delivery. On this basis the victims are divided into three groups:
- Victims who need emergency care at this stage of medical care;
- Victims that do not require emergency care at this stage of medical care
(assistance may be delayed);
- Affected with terminal conditions and injuries incompatible with life
(ahonuyuchi).
On the basis of harm to others affected are divided into three groups:
- Those that require temporary isolation;
- Those that require special (health) treatment;
- Those that do not require isolation and special (health) treatment.
Evacuation sign - it is a necessity and priority evacuation mode of transport,
means of evacuation (lying, sitting). On this basis the victims are also divided into
three groups:
- Those that require further evacuation considering evacuation appointment,
prioritization method evacuation mode of transport;
- Those that may remain at this stage of medical care;
- Those that are to be returned to the place of settlement (accommodation) for
further treatment or medical care.
For a medical sort most appropriate creation marshalling teams. Their number
and composition are determined depending on the size and structure of sanitary
losses and the availability of medical capabilities.
The structure marshalling teams should include: a doctor, 2 nurses (nurses),
two recorders, link stretcher-bearer. Originally by external examination the doctor
performed selective sorting to identify victims who are dangerous to others and those
in need of medical care in the first place. Thus the initial review of doctor should
spend up to 40 seconds. for each victim.
After selective sorting doctor goes to a serial (conveyor-tion) given by the
victim diagnostic algorithms:
- Localization of lesions (head, chest, abdomen, pelvis, extremities, spine);
- Nature of damage: mechanical trauma - local, combined, multiple trauma,
the presence of bleeding, fractures, long-term compression of tissue, burn injury,
poisoning SDYAV, radiation damage, etc.;
- The culprit lesion that most threatens currently lives post-razhdaloho;
- The degree of severity: the presence (absence) of consciousness, pupillary
response to light, pulse, breathing, bleeding, blood pressure, skin color;
- The possibility of independent movement.
Health sorting is divided into two types: vnutrishnopunktove and evacuation
and transportation.
Vnutrishnopunktove medical sort - the distribution of victims into groups
depending on the nature and severity seems to set the priority of care and
determining the functional separation of this phase of medical care or medical
institution which should be helped.
Evacuation and transport sorting - the distribution of victims into
homogeneous groups in accordance with the direction, sequence, ways and means of
further evacuation and determine the destination of their evacuation.
When vnutrishnopunktovomu sort by:
- Nature of the lesion and the necessary amount of medical assistance;
- The need and place of care at this stage;
- Sequence (first or second stage).
When conducting evacuation and transport sort by:
- Evacuation destination (where to send);
- Mode of transport;
- A way of escape (lying, sitting);
- A place for evacuation vehicle (on the first or second tier);
- Order of evacuation.
Results sorting fixed sorting stamps on which stretcher-bearer implement
sorting decision doctor and marks in medical documents (primary medical card,
passport evacuation).
Medical card primary account is affected by tear-signal band. Having
detachable signal bands on the medical card will not only promote the successful
implementation of the results of sorting at this stage, but also provides information
next stage of medical evacuation, it defines victims, which should be paid attention
to.
Sorting affix stamps to clothes or nosh victim. Marks indicate where and
which part should be directed affected. Figures on the mark (1.2) indicate all medical
assistance or evacuation, and the letters O (operating) or E (evacuation) point at
which functional unit of stage medical evacuation stretcher-bearers to deliver victim.
Stamps are made of thick cardboard or plastic.
Emergency passport contains information about the profile of lesions in the
pos-trazhdalyh located in the vehicle, their amount and method of transportation,
time of departure and arrival, transport and others.
Medical sort conducted both pre-hospital and on hospitalization bc stage.
In hospitals prehospital medical evacuation carried vnutrishnopunktove and
evacuation and transport sorting. Sort by hospital stage mainly vnutrishnopunktove.
Medical sort in hospitals for hospital stage is diagnostic and prognostic
character. For the sort involved most qualified doctors. Just as in the prehospital
phase, are sorting brigade consisting doctor, two nurses, two registrars, nurses
carrier. Results sorting guardian medical records (history). Sort sorting performed on
site and the building of receiving and sorting compartment (cold season). At this
stage, primarily distinguished victims who are dangerous to others:
- Infection of the body or clothing SDYAV, toxic and radioactive substances.
They sent for a full sanitization to the office of special treatment;
- From mental disorders and infectious patients. They refer respectively to a
psychiatric and infectious jail.
All other victims are divided into 4 groups according to diagnosis, condition,
possibility of further complications and other indicators.
The first group includes victims of lesions that are incompatible with life
(ahonuyuchi).
The second group includes victims of severe lesions with significant
functional disorders.
The third group - with victims of severe and moderate lesions with minor
functional disorders or without them.
The fourth group includes patients with mild lesions.
Completion evacuation sorting is to implement measures for medical
evacuation.
Medical evacuation - a removal of the affected lesion to hospitals, where they
were provided with medical assistance and treatment to the final result.
The path that is medical evacuation is called the way of medical care.
Stages of medical care combined evacuation routes called medi-flaxevacuation direction.
Evacuation can be carried out medical transportation and other vehicles This
could be road, rail, water and air transport. Medical evacuation is carried out mainly
on the principle "assume," but it does not preclude evacuation on a "self."
Great value in the treatment and medical evacuation support becomes
intelligence that behaves in cells emergencies.
It is for the purpose of timely determination of objective data on the health
situation and must be active, be continuously and provide timely surgical receive the
information. Typically, it is all the medical units, divisions and operational groups of
health care management.
Medical intelligence is divided into tactical medical and sanitaryepidemiological.
The main objectives of medical and tactical intelligence are:
a) collecting data on the number and structure of pathology among the
victims, as well as places of accommodation, search terms, collection and removal of
catastrophes;
b) determine the state of health care capabilities that find themselves in the
disaster areas suitable for deployment stages of medical evacuation;
c) the identification of ways to promote medical units;
d) identify ways of evacuation to hospitals.
Sanitary-Epidemiological survey collects data on sanitary and epidemiological
situation.
The organization relies on intelligence, health authorities and anti-epidemic
institutions of the areas, and the practical implementation exercise territorial centers
of emergency medical care.
Almost in the event of any disaster can be roughly divided into three main
phases in the rescue of victims - isolation, rescue and recovery (treatment).
Phase insulation - lasts from the moment of the disaster to the orderly conduct
rescue operations.
Phase Rescue - covers the period from the beginning of the rescue until the
evacuation beyond catastrophes.
Phase recovery - from a medical point of view is determined from the start of
the planned treatment and rehabilitation of victims to their ultimate recovery.
Depending on the situation in the center of an emergency duration of each of
these phases can be different.
Phase insulation can last from 30 minutes to 6 hours. In this period of first aid
to the victims at the crash site is in the order of self-help and mutual aid, and
rescuers and medical workers who find themselves at the crash site.
Phase rescue may take from 6 to 12 hours. It starts from the moment of arrival
to cell rescue units, personnel which possesses skills in first aid and medical units
(brigades of ambulance, medical brigades of permanent readiness of the first stage,
medical and nursing teams, etc.). During this period, extended first aid (if necessary)
and provided the first medical aid and preparing victims for further medical care.
Phase recovery (treatment) can last from 0.5 - 2 to 90 days. During this period
the victims is qualified and specialized medical care, provides treatment to outcome
and rehabilitation.
Features of medical evacuation support at tech-nohennyh accidents.
With radiation accidents with the release of radionuclides into the
environment a range of measures to protect the population from external and internal
irradiation-tion. It includes measures for diagnosis, medical sorting, treatment and
rehabilitation of persons who fall into the area of the accident. There are three main
categories of the population, about the need for health protection:
One - the population needs emergency countermeasures to reduce the promo
nevyh loads and prevent radiogenic effects;
- Second - people with symptoms of reactive mental disorders that require
psychological treatment and psychological care;
third - outpatient and in-patient population, which is subject to evacuation, and
requires constant medical care as during the evacuation and resettlement in places.
There are three phases of flow accident
Early phase begins with the start of the uncontrolled release of radioactive
material and the forming of radioactive trace. The duration of this phase can range
from several hours to several days.
During the early phase of the Chernobyl disaster was 9 days, fully radiation
situation stabilized within 15 days after the start of the accident.
Medium (intermediate) phase covers the period from the date of formation of
radioactive trace the implementation of all measures to protect the population. The
duration of this phase can range from several days to several months. In this phase,
people acting external and internal exposure.
Late phase lasts from the moment of completion of all measures to protect the
population in the period of the abolition of all restrictions on the livelihoods of
people. The duration of this phase is determined decades.
When chemical accidents, most of which can occur owing to the release into
the environment SDYAV measures during medical evacuation support should be
considered:
- To transfer SDYAV the direction of wind over long distances and related
lesions of the population at a considerable distance from the source of release;
- The possibility of penetration SDYAV nehermetyzovani in the room and
where they accumulate in concentrations at toxic doses may pose a risk cheer-tion of
people;
- SDYAV diversity, making it difficult to create effective standardized means
of protecting people from destruction;
- Possibility of simultaneous occurrence of a significant number of lesions in
the territory of the big, making it impossible to quickly provide emergency medical
care to all the victims.
Analysis tactics emergency medical chemical accidents can distinguish three
phases of medical care:
The first phase (30 min.) - After exposure to toxicants person requires removal
(removal) of the area of chemical lesion of the partial decontamination of clothing
and skin, use an emergency antidote symptomatic therapy.
The second phase (up to 2-4 hours.) - Includes a medical sort of victims and
provide them skilled or specialized medical care.
The third phase (up to several weeks) consisting of rehabilitation measures
and determine the level of disability affected.
Features medical assistance at traffic accidents.
When car accidents Organization medical evacuation stages should provide
medical assistance to victims and evacuate them to their destination. This type of
injury is the most common. According to WHO, the number of those killed in traffic
accidents 20.0% could be saved if first aid was given to them in the first 30 minutes.
after the accident, and of antishock measures in the first 6 hours after injury would
reduce mortality further 25,0-30,0%.
Timeliness of emergency medical care depends on the crash site. If it occurred
in or near the service safety representatives (DAI) cause brigade ambulance.
When an accident far from the settlements start for emergency medical care is
delayed and depends on the distance to the treatment facility and readiness brigade
SMP for immediate departure to the scene. First aid in these conditions is through
self-help and mutual aid. To continue to provide necessary medical care of victims
evacuated the nearest medical institution.
Alert MTF of accidents is traffic police, witnesses adventure. Number of
teams ambulance leaving the spot, calculated as the ratio: one team of 1-2 victims.
Physician Brigade SMP at the accident determines the venue of victims and
providing medical care for the ABC algorithm.
When the number of victims is 10-15 people sorting victims. With more
affected sorting sorting out 2 teams. After giving victims first aid (emergency
measures) they evacuated in hospitals. On admission to hospital victims in receiving
separated by their sorting into the following groups:
The first group - those in violation of the vital functions of the body;
second group - those moderate and severe degrees;
third group - easily affected;
fourth group - persons who do not require inpatient treatment.
Carrying out urgent measures first physician and skilled medical care starting
in the emergency department and continued in medical offices, and for easy victims in outpatient facilities.
When a plane crash at the airport or near the alarm provides dispatch service
airport. Another Relations sends an alarm to the station SMP city and the hospital,
which serves the airport. Crew SMP or medical brigades of permanent readiness of the
first stage come to an aid station airport, which became the center of care. Victims at
the crash site provide first aid. With a large number of victims unfolding capabilities of
the first stage of medical evacuation State service medicine.
If the crash occurred outside of the airport or the settlement, the amount of
medical care at the first stage of medical care can be develop-shyrenyy to the level of
emergency medical care. Further victims evacuated to hospitals second phase of
medical care where they get qualified or specialized medical care in full volumes with.
Principles of medical assistance to the victims, their treatment and evacuation of
remains such as in a plane crash in the area of aerosol-roportu.
When accidents in airport management and coordination of emergency response
relies on the administration of the airport in accidents outside the airport, these
functions are performed by a representative of executive authority administrative area
where there was an accident.
To participate in the elimination of health consequences involved capabilities
DSMK, whose task is to conduct medical sorting victims, giving them medical
emergency and provide medical support during the evacuation. To guide medical
evacuation sorting and appointed coordinator of health issues among management
DSMK territorial level, which is responsible for the medical care to the victims of the
accident.
In a medical sorting and delivery of health care in place of aviation disaster
victims all moved gradually in 4 areas:
- The search area and collection;
- Sorting area;
- Zone of assistance;
- The area of transportation.
Zone searching and collecting - is the scene where the search, collection and
evacuation of the affected area to sort. In this zone, the staff working rescue and fire
services.
Sorting area. Located at a distance of 80-90 m on the windward side of the scene
in order to avoid combustion products, smoke affected. Inside it is the first medical
workers sorting victims.
Area of assistance. It is divided into three subzones according to three categories
of victims:
- Emergency Medical Care (and turn)
- Medical care that may be temporarily delayed (second stage);
- Requiring outpatient and psychotherapy (III stage).
In this zone, deployed mobile medical units, if necessary rozhorta etsya first
stage of medical evacuation.
Area transportation. Designed for registration and evacuation
affected. Hosted zone between the assist and driveways.
When train crash organization of emergency medical aid to victims is not
fundamentally different from providing medical care in a plane crash and car accidents.
As with other types of traffic accidents might catastrophe place of its occurrence
informs nearby hospitals and territorial center of emergency medical care. Immediately
sent to the area of disaster brigade ambulance and formation DSMK regional level, are
on the spot to organize work on medical aid and evacuation of victims in hospitals.
Before the arrival of Task Force DSMK leadership of ambulance crews on the scene
relies on medical brigade, which arrived first.
In place of the train crash are temporary collection points victims by their
medical sorting, registration and emergency medical assistance and further evacuation
to hospitals for the purpose.
When disasters at sea and river transport between isolated first aid provided by
self-help and mutual aid, crew and medical personnel vehicles. The ship or shore
organized temporary collection point for victims, where they own DSMK territorial
level is the first medical aid using basic principles of medical evacuation support. For
evacuation of hospitals using water, air, road and rail.
Accidents in the mines have their own characteristics on the conditions of
treatment and adjustment-evacuation.
Information about the accident at the mine goes to another part of Mountain
Rescue, SMP workstation, another operational departments of emergencies, inform
Manager Center emergency medical care.
For operational management activities of the organization and provide medical
assistance to victims are operational groups.
The main tasks of the medical service in these conditions include:
- Organization and provision of medical assistance to the victims directly into
mine workings mines;
- Providing medical assistance to the victims that were raised from the mine to
the surface, and their treatment in the hospital;
- The preservation and strengthening of health personnel rescue groups.
The system of providing medical assistance to victims consists of several stages:
- First aid provided at the scene of the accident (before and after the release of
the victim of the dam);
- Transport the victim to a bench or shifts of the roadway at an underground
medical base (PMB); '
- The first medical assistance PMB;
- Transporting the victim from the mine to the surface;
- Skilled medical care in a hospital medical unit of the mine or a medical facility
DSMK;
- Specialized medical care in specialized medical centers or branches
multidisciplinary hospitals.
In providing medical assistance to victims should be considered hard action
components combined lesions, the prevalence of the clinical picture of burn injury with
the occurrence of burn shock, the presence of carbon monoxide poisoning, sudden
respiratory function disorders.
Health sorting and preparation for evacuation to hospitals involves their division
into 4 groups:
easily affected;
suffered moderate;
victims in serious condition;
affected in a very serious condition.
After treatment measures are derived from the mine in the first place easily
affected. In the second place evacuated suffered moderate who need a longer time to
give them first aid and emergency first aid. Severe victims trapped on the PMB (for
resuscitation and antishock measures and then evacuated.
Upon arrival to the inpatient hospital victims given qualified and specialized
medical care. Treatment in hospital conducted on the state of the victims and measures
provided they first medical and first aid in the first stage of evacuation.
In hospitals affected are full-depth examination, treatment strictly individualized.
The main features of the treatment of victims in the accident at the mines with
combined lesions lie in the fact that in inpatient therapeutic measures should be applied
to primarily to eliminate symptoms of poisoning gases, mainly carbon dioxide,
prevention and treatment of burns or traumatic shock.
Thus, the organization of medical evacuation in man-made disasters prerequisite
is accounting features forming the health situation in the center of the National
Assembly, which determines the tactics of medical support of the population and the
participants eliminate its consequences, increases the effectiveness of these measures
reduces mortality and disability among the victims, reducing the duration of their
treatment.
Features staged treatment in emergency situations of natural origin.
When earthquakes basic tasks of medical units and establishments of field-hayut
in
- Timely provision of all emergency medical assistance to victims;
- Medical care personnel rescue groups that are in the area of disaster;
- Taking measures to prevent and treatment of neuropsychiatric disorders and
prevention of exacerbations of chronic diseases;
- The prevention and treatment of massive infections.
In large areas there is a need for emergency medical care under rubble of
destroyed buildings in the streets. First aid in these conditions is provided in the form
of self-help and mutual aid, direct personnel rescue units and medical staff teams
ambulance and medical brigades of permanent readiness of the first stage DSMK. To
provide first aid in lesion involved brigade ambulance and medical and nursing teams
who are in hospitals of various departmental subordination. They, along with medical
brigades of permanent readiness of the first stage and mobile medical facilities DSMK
create the first phase of treatment and evacuation of casualties.
Depending on the destructive force and extent caused disasters qualified and
specialized medical care may be provided in the area of natural disaster (provided that
the hospitals) and beyond in special and the plan or health care regardless of their
departmental subordination and forms of ownership.
When floods health care is organized as flooded, and the adjacent territories.
First aid in flood zone takes the form of self-help and mutual aid, as well as by
rescue groups. The composition of such groups should include medical professionals.
First aid is affected directly by boats and provides warm, artificial ventilation, indirect
heart massage, temporary immobilization of fractures, the introduction of anesthetics.
To provide first aid to the victims near the flood zone deployed together with
temporary collection points and sort temporary medical centers. Providing this type of
assistance is generally limited to urgent measures. Further evacuation is carried out in
health care settings, where they are given skilled or specialized medical care.
When fires healthcare organization has some features, such as:
- Search for victims on the smoky area and burning buildings, which carry
special fire rescue units;
- The need for approximation of first aid to the cell fires;
- The need for medical aid plenty burned, suffered from food poisoning burning,
emergency evacuation from their smoky atmosphere.
First aid victims in these conditions gives the units fire, personnel rescue units,
ambulance crews.
The first medical aid should be provided to the maximum short term near the fire
place. Crockery, which sent victims, enhanced specialized brigades of permanent
readiness second stage DSMK (combustiological, toxic-therapeutic).
The second stage of medical evacuation (of skilled and specialized care) is
deployed on a regional burn and toxicological centers (offices) or specialized
departments of regional hospitals.
The above elements of the medical evacuation support in a particular
combination, implemented in any emergency situation regardless of the factors that
caused it. However, as you can see, each type of natural disaster or man-made disaster
has its unique to him characteristics that imprint and taken into account in the
organization of medical care.
Features of care for children.
Among affected by natural disasters are a significant part - children. Their
percentage of the total number of victims varies 12,0-23,0%. Therefore, medical
support children should take into account several features of the flow in these
pathological processes, namely:
1. Children excluded this kind of care, as self-and mutual aid, so first aid is
provided primarily to children and at the same degree of severity of damage they have
an advantage over adults in the lesion, and the stages of medical evacuation.
2. Removal of children and their evacuation to hospitals is necessarily
accompanied by parents or relatives (neighbors and friends), the delay of the first stage
of the evacuation extremely undesirable.
3. One must consider the properties of the flow lesions in children related to their
anatomical and physiological characteristics:
- Sensitivity to blood loss and labile blood pressure contributes seams, witnessed
the development of shock;
- The tendency of the mucous membranes of the upper respiratory tract and
lungs to edema (stress kidney function increases the risk of edema, hydration or
dehydration of the child);
- Elasticity of bone in children reduces the incidence of fractures, but causes
peculiar to childhood bone damage (cracks, dislocation, fracture type "green branches"
etc.);
- Changes in the cardiovascular system and the respiratory system quickly
become pathological features in the future may lead to convulsive syndrome;
- Always keep in mind the psycho-emotional condition of the child, including
the age of 2-4 years, when her behavior may become uncontrollable nature.
Based on the above features, the implementation of treatment and evacuation
measures on children's troops are needed:
- Timely preparation of medical staff to provide care for children;
- When determining the place of hospitalization for affected children - the
allocation of beds in the next cell to the disaster medical institutions;
- During the evacuation - using more benign modes of binding guidance of
medical staff (preferably doctors);
- The maximum possible reduction stages of medical evacuation;
- The maximum possible involvement of care pediatricians;
- Providing qualified and specialized medical care at a children's medical
institutions or transformed by specialized pediatric brigades of permanent readiness
second stage are other medical institutions;
- From the first stage of medical evacuation, should provide 20-25% of the
allocation of hospital beds for children, create the conditions for their temporary
hospitalization using medical assets children's hospitals.
- The allocation of an average of 10% of hospital beds in the structure of
children-divisions for children under 1 year and 30% of beds - for children 1-3, 4-6 and
7-10 years;
- Planning to expand children's houses 20% of total lizhkofondu in specialized
hospitals.