The State service of medicine catastrophe as the system of medical provision of the population in extreme situation period. Treatment and evacuating provision THE DISASTER MEDICINE DEPARTMENTLECTURE 3Arsen Gudyma, MD, prof.Vasyl Demianenko, MC, as. prof.

Mastering of the treatment-evacuating provision peculiarities of the population in extraordinary conditions of peace-timeThe lectures purpose

The staging principles of an organization of the medical aid for the casualties in mass disaster The Volume of the medical aid for the population on the evacuating stagesAlgorithms of the medical aid renderingKey questions

Operating rescue service emergencyallocation of damage 01Saving brigade Point of emergency operative information03physician (medical assistant) brigade

Mobile hospitalsMobile brigadeMedical brigade of all-time readiness of the first turn Special medical brigade of all-time readiness of the second turn Medical units of SSMC

Must be responsible to required level of the readiness to rendering the first aid for the population in the cause of appearance of the extraordinary situations.Be capable by the health state to perform works in extreme situation.Must be certificated. Must be written in the special list of rescue services. 5. Personnel has right on the warrant of social protection and takes responsibility in accordance with Law of the Ukraine About rescue services .

Requirements for the personnel of the medical units of the SSMC

Mobile hospital IF the Ministry of Extraordinary Situations

This is a unit of the SSMC for the rendering emergency medical aid for the casualties on pre-hospital stage with damages that threaten their life and health and their hospitalization Medical brigade of all-time readiness of the first turn

1. Brigade of EM.2. Brigade of the regional authorities of SSMC and branches hospitals.EMHelping for the population in on allocated regionIn ES out of the given territory that brigade be directed for the mishap sequelae Medical brigade of all-time readiness of the first turn

Enumaration of medical brigade of all-time readiness ofthe first turn the medical brigade of all-time readiness of the first turn1. At every emergency station operative reserve is created for 3 days of autonomy activity of the brigade for the 10 casualties. 2. Material equipment is packed for the transportation.Material supply of the medical brigade of all-time readiness of the first turn1. On the each station the medical brigade of all-time readiness of the first turn are created no much than 20 % of all their quantity. 2. The brigade quantity is determined from the 1 to 50 000 of the population.

General schemeof the first aid organization and rendering for the casualties in the peace-time extreme situation Area of disasterFirst medical aid and delocation of the casualties by means of savors Pre-hospital medical aid Hospitalization of the casualties5The first evacuating stage The second evacuating stage Emergency medical aid means of personnel of hospitals and special medical brigade of all-time readiness of the second turnCreation of the emergency point by means of emergency brigade and medical brigade of all-time readiness of the first turn

The emergency medical stationDiscovering and taking out the casualties from the area of disaster Rendering the first aid (when possible)Savors of MESArea of disaster Casualties that can move 1. Medico-tactic evaluation the situation 2. Reporting to the medical dispatcher.3. Organization of the point medical clearing of the casualties for the next evacuation.5. Rendering first medical aid (pre-physician and physician)medical brigade of all-time readiness of the first turn

Bed ridden casualties Easy-woundedHard-wounded Middle woundedEmergency brigadeEmergency brigade,Volonters para-medicusVolonters para-medicus Emergency medical aid Medical aid should be put off First medical aid Model of the first stage evacuation

First aid (some-self and mutual )First medical (pre-physician) aid (given by savors)First physician (pre-physician) aid (given by physicians and as. doctors of emergency brigade

Savors begin to give first aid in the area of disaster Medical workers act in safe area Limits of the area of an accident

Development of the first evacuating stageArea of disasterRendering of the first aid and taking out of the casualties by tge savorsDevelopment of the first-aid pointRendering of the pre-physician aidPreparing the casualties for the evacuating123423 april 2002, California. USAPassanger train crashed with goods 5 persons lost, 256 hospitalizedIn the area of the accident 100 firemen worked and 30 emergency cars take participation.

Common script of the first aid giving for the casualties on the evacuating stage

Clearing station near deliverys departnment Clearing by the feature of danger for the others Medical care not to be givenQualified physicians assistant or nurse

Entry at hospitalSurgerys injuries Clearing casualties, allocation at departments Qualified surgeon Therapeutic injuriesSurgery departmentPediatriciandepartmentTherapy department pediatrician, surgeriesof child ageSkill therapeutics Skill surgeries Qualified (special) medical care

Qualified (special) medical care

Qualified (special) medical care The model of an organization of the stage of evacuationChildrenmedical brigade of all-time readiness of the second turn

Allocation of the types of medical care in accordance with stage of medical evacuationtypes of medical careFirst aidPre-physiciancareFirst physician aidQualified care Special care the stage of evacuationthe stage of evacuation

This is a unit of SSMC that raised for the hospital increase by the high qualified specialists Special medical brigade of all-time readiness of the second turn(surgery, neurosurgery, traumatology, combustiology, intensive care, psychiatry, pediatrics, obstetric-gynecology, infectology etc.)1 brigade is raised for 200000 peoplesThe brigade profile, their enumeration are determined in accordance with dependence of foreseen medico-sanitarian consequences of local extraordinary situations and real provision of the hospital by needed physicians

are raised in hospitals out of the state Special medical brigade of all-time readiness of the second turn

1 brigade is raised for 200000 peoplesThese brigade are supplied with the inviolable equipment storage in accordance with expectation for the work during 1 day, (2 days for regional centre of emergency medical care)

are determined on the base of foreseen medico-sanitarian consequences of extraordinary situationMedical organizations (hospitals) that develop additional bed-stock Additional bed-stock Discharge the ills with chronic diseases and discovering patients from the hospital and delivering them to hospitals out of the SSMC systemDevelopment of the additional bed-places in the hospitals, where bed-stock is no less than 180 bed-places (up to 10 %)The reserve of supply is accumulated in the hospital with expecting of 3 days-work? Including remedies on $100 per every additional bed-place

The state level SSMC complement:

571 medical brigade of all-time readiness of the first turn190 medical brigade of all-time readiness of the second turn14659 beds-places of the special bed-stockThe Order of HCM of Ukraine 20.11.97 334

First aidThe provision of limited care for an illness or injury, which is provided usually by a lay person, to a sick or injured patient until definitive medical treatment can be accessed, or until the illness or injury is dealt with (as not all illnesses or injuries will require a higher level of treatment).Amount: 1. Put out fire of flaming clothes.2. Infusion of the analgesic means.3. Prevention of the asphyxia, artificial breathing, non-direct massage of heart.4. Temporary stopping bleeding.5. Dressing wounds and occlusive dressing at pneumatothorax.

First aid6. Immobilization hurt extremities 7. Put on gas-mask in the area of an influence of SATS8. Usage of antidote9. Partial sanitarian cleaning 10. Usage of antibiotics and anti-vomiting means11. Usage of tourniquet at crash-syndromeBe done in time: up to 30 min

First aidDuring giving the medical care the casualties in the area of an accident its impossible to use one by the once and for all developed set up of medico-evacuating maintenance, as it happens to collide with the large variety of types of accidents, structure of medico-sanitary losses, local conditions. The main moment is only that in a point one of an accident it is impossible to give full first aid the injuries, by virtue of what it is necessary to resort to their evacuation.

Pre-physician aid Purpose: stopping threaten for the life state and disorders (bleedings, convulsions, heart insult and cardiac activity), wound protection off secondary infecting, immobilization broken bones of extremities, prevention shock-reactions and its treatment. Amount: 1. Removing asphyxia (toilet of the mouth and nose-gullet, putting in an air-conductor, inhalation of the oxygen, artificial apparatus breathing).2. Controlling for the correctness and necessity the usage of tourniquet in bleeding that prolongs. 3. Injection of analgesic remedies. 4. Improving transport immobilization due to usage of the table means.

Pre-physician aid5. Repeated usage of antidotes in accordance with the indications.6. Additional degassing of the open skin surfaces and adjacent areas of clothes. 7. Worming up the casualties in the law temperature of an air, giving them hot teas and other drinking in the winter time (except of the injured in abdomen).

Pre-physician aid8. Infusing in accordance with the indications the symptomatic cardiac-vessel and breathing acting remedies. 9. Washing eyes, mouth and nose in event of the HATS getting in. 10. Lavage of stomach (without cannulation) in event of the HATS getting in. Done in time: 1-2 h

First physician aid

Purpose: The casualties life saving, stabilization of the main functional systems of an organism for the much sooner evacuation them on the point of qualify medical care and prevention the possible complicationsEmergency measures

First physician aid Medical care measures may be put off Done in time: 1-2 h

Emergency measures of the first aidAmount: 1. Removing asphyxia (exhaustion of mucus and vomits and blood from the high breathing ways, putting in an air-conductor, fixation of tongue, cutting or needlework up strips of the palate tissues and gullet, tracheotomy in accordance with indications, artificial breathing, usage of occlusive dressing at open pneumatothorax, puncture of the pleural cavity or pleurocentesis at external pneumatothorax. 2. Pursue anti-shock measures (transfuse of blood and other solutions at a huge hemorrhage, blocking with novocain solution, usage other analgesics measures and cardiac-vessels remedies.

Emergency measures of the first aid3. Stopping external bleeding (needlework up the vessels inside of wound or usage of clips on the vessel, control the correctness and necessity the usage of tourniquet in bleeding accordingly with indications . 4. Cutting off the extremities, that is hanging on strip of soft tissues.5. Catheter or puncture drainage at urine retard. 6. De-sorption of HATS out of the clothes and usage of measures of individual protection of the casualties, that delivered from the area of chemical disaster (partial sanitarian cleaning (degassing) and change the clothes).

Emergency measures of the first aid7. Repeated usage of antidotes and anti-vomit medicines and broncho-lytics. 8. Degassing of the polluted with HATS wound. 9. Lavage of the stomach by means of cannulation in event of the HATS getting in. 10. Nonspecific prophylactic and the serum injection in event of threaten appearance bacterial damage (in cause of wreck on microbiological industry).

Put off first aid measureAmount: : 1. Removal of the of the first aid and pre-physician care rendering (dressing correction, improving transport immobilization).2. Changing dressing wound in event of radiation and chemical their pollution.3. Blocking with novocain solution in event of middle grade of damage. 4. Injection of antibiotics, tetanus prophylaxis of open wounds and burns. 5. Ordering the different symptomatic measures at the events that dont threaten for the casualties life.

Qualify medical carePURPOSE: The casualties life saving, and prevention the possible complications, creation the provision needed conditions for the treatment and recovery.Qualify medical careQualify therapeutic careQualify surgery care2 group1 group3 groupMeasures of terminated Emergency measuresMeasures may be put off

Qualify surgery care

Amount: 1. Fight against an asphyxia and restoration the breathing functions.2. The final stopping of the internal and external bleeding.3. Complex therapy of sharp blood lost, shock, traumatic intoxication.4. Treatment of anaerobic infection.5. Surgical treatment and sewing wounds and opened pneumatothorax, thorasic centesis and valve pneumatothorax.6. Laparotomy at penetrable wounds and closed trauma of stomach and internal organs damage.1 group: emergency surgery invasions and other measures, non-perfecting of which may be realized with death at the nearest time

7. Amputation in event of the open and massive broken extremities.8. Decompressing the skull at damage of the head added with compression of the brain.9. Surgery care at long tube bones with intensive damage soft tissues.Qualify surgery care

1 group: emergency surgery invasions and other measures, un-perfecting of which may be realized with death at the nearest time

Qualify surgery careAmount: Surgery wound processing at long tube bones without intensive damage of the soft tissues.2 group: not done in time care may be resulted with appearance of serious complication.

Qualify surgery careAmount: 1. Usage of plastic sews at the wounded face.2. Ligature teeth tying when jaw case (broken).3. Primary surgery processing the burns.4. Primary surgery processing of the soft tissues wounds. 3 group: Postpone care (due to usage of antibiotics) may not be complicated.

Qualify therapeutic careAmount: 1. Treatment at toxic burns of the lungs.2. Complex therapy at acute cardio-pulmonary insufficiency and disorders of the heart rhythm. 3. Antidotal treatment and anti-botulism serum.4. Administration of the oxygen therapy and artificial breathing in the case of asphyxia. Usage of tranquilising, neuroleptics in the case of an acute exciting. 6. Administration of desensitizing, anti-vomiting, anti-tetanic and broncholytic medicines.Emergency measures

Qualify therapeutic careAmount: 1. Vitamin-therapy.2. Substitutive haemotransfusion.3. Preventive administration of antibiotics and sulfonamide medicines.4.Administration of the physiotherapeutic procedures.5. Usage of the symptomatic medicines.Put off emergency care

Special medical care 1. Casualties with traumatic damages of the spine, head, neck (neurosurgery, ophthalmology, otorhinolaryngology,face-jaw surgery).2. Casualties with broken tube bones and great joints.3. Casualties with trauma of the chest, abdomen, pelvis.4. Burnt.5. Damaged with radiation.6. Injuries with SATS.7. Ills with neurological diseases and psychiatric disorders. 8. Wounded and ill women.9. Infectious ills.Contingent of the casualties

Main tasks of the evacuation stage 1. Adoption casualties and ills and their registration.2. Sanitary cleansing procedures casualties, ills and their things.3. Emergency medicine care provision in accordance with data evacuating stage.4. Making casualties ready for the evacuation at the next point.5.Isolating infectious and psychic ills.

Every medical worker ought to be ready to supply care for the casualties in the extraordinary conditions of peace- and wartime. The human life is so fragile...

Algo-rhythm of the observation and rendering of the first aid Performing in the safe conditions in the area of an accidentconsciousnesspresent

consciousnessabsent

Primary observation (): airways; breathing; - circulation

Approaching to the casualty

Determination of the consciousnesspresence

Possible acting

Impossible acting

Secondary observation

Status inspection

Doing possible

Doing impossible

Vital signs presence

Vital signs absence

status of an organisminspection

Vital signs appearance impossible

Secondary observation

Putting behind the head and rising of the chin or moving the jaw forward Inspecting breathing activity

Airways provision

Two inspires Breathing absence

Breathing presence

state of an organisminspection

ineffective

effective

Airways provision presenceabsence

ineffective

effective

Pulse checking

Artificial breathing

Cardiac-pulmonaryresuscitation

Special methodic of the airways provisionCasualty in consciousness(method by Hymlic)Casualty inunconsciousnessCasualty alone at home

Methodic of the artificial breathing

Methodic of cardiac-pulmonary resuscitation

Special methodic of the cardiac-pulmonary resuscitation

Child to 1 yr Child of 1-8 yrAdult

The end!