the state service of medicine catastrophe as the system of medical provision of the population in...
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The The State service of medicine State service of medicine catastrophe as the system of medical catastrophe as the system of medical provision of the population in extreme provision of the population in extreme
situation periodsituation period. . Treatment and evacuating provision Treatment and evacuating provision
THE DISASTER MEDICINE DEPARTMENTTHE DISASTER MEDICINE DEPARTMENT
LECTURE 3LECTURE 3
Arsen Gudyma, MD, prof.Arsen Gudyma, MD, prof.Vasyl Demianenko, MCVasyl Demianenko, MC, , as. profas. prof..
Mastering of the treatment-evacuating provision peculiarities of the population in extraordinary conditions of peace-time
The lecture’s The lecture’s purposepurpose
1.The staging principles of an organization of the medical aid for the casualties in mass disaster
2. The Volume of the medical aid for the population on the evacuating stages
3.Algorithms of the medical aid rendering
Key questionsKey questions
Operating rescue service
emergency
allocation of damage
““0101””
Saving brigade
Point of Point of emergency emergency
“operative information”
““0303””
phys
icia
n
(med
ical
assi
stan
t)
brig
ade
1.1. Mobile hospitalsMobile hospitals
2.2. Mobile brigadeMobile brigade
3.3. Medical brigade of all-time readiness Medical brigade of all-time readiness
of the first turnof the first turn
4.4. Special medical brigade of all-time Special medical brigade of all-time
readiness of the second turnreadiness of the second turn
Medical units of SSMC Medical units of SSMC
1.1. Must be responsible to required level of the readiness to Must be responsible to required level of the readiness to
rendering the first aid for the population in the cause of rendering the first aid for the population in the cause of
appearance of the extraordinary situationsappearance of the extraordinary situations..
2.2. Be capable by the health state to perform works in Be capable by the health state to perform works in
extreme situationextreme situation..
3.3. Must be certificated.Must be certificated.
4.4. Must be written in the special list of rescue servicesMust be written in the special list of rescue services..
5. Personnel has right on the warrant of social 5. Personnel has right on the warrant of social
protection and takes responsibility in accordance protection and takes responsibility in accordance
with Law of the Ukraine “About rescue services”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 Mobile hospital IF the Ministry of Extraordinary SituationsExtraordinary 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 Medical brigade of all-time readiness
of the first turnof the first turn
1. Brigade of EM.2. Brigade of the regional authorities of SSMC
and branches hospitals.
EMEM Helping for the population in Helping for the population in on allocated regionon allocated region
In ES out of the given territory that brigade be directed for the mishap
sequelae
Medical brigade of all-time readiness Medical brigade of all-time readiness of the first turnof the first turn
Enumaration of medical brigade of all-time readiness Enumaration of medical brigade of all-time readiness ofof
the first turn the medical brigade of all-time readiness the first turn the medical brigade of all-time readiness of the first turnof the first turn
1. 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 Material supply of the medical brigade of all-time readiness of the first turnreadiness of the first turn
1. On the each station the medical brigade of the medical brigade of all-time readiness of the first turn are created no all-time readiness of the first turn are created no much than 20 much than 20 %% of all their quantity. 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 Area of disasterdisaster
First medical aid and First medical aid and delocation of the casualties by delocation of the casualties by
means of savors means of savors
Pre-hospital medical aid
Hospitalization of the Hospitalization of the casualtiescasualties
55The first evacuating stageThe first evacuating stage The second evacuating stageThe second evacuating stage
Emergency medical aid means of Emergency medical aid means of personnel of hospitals and personnel of hospitals and
special medical brigade of all-time special medical brigade of all-time readiness of the second turnreadiness of the second turn
Creation of the emergency point by Creation of the emergency point by means of emergency brigade and means of emergency brigade and
medical brigade of all-time medical brigade of all-time readiness of the first turnreadiness of the first turn
Discovering and taking out the casualties
from the area of disaster
Rendering the first aid (when possible)
Savors of MES
Area 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 medical brigade of all-time readiness all-time readiness
of the first turnof the first turn
Bed ridden casualties
Easy-wounded
Hard-wounded
Middle woundedІ
Emergency brigade
Emergency brigade,
Volonters para-medicus
Volonters para-
medicus
Emergency medical aid
Medical aid should be put off
First medical aid The emergency medical station
Model of the first stage evacuationModel 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 Development of the first evacuating stageevacuating stage
Area of disasterArea of disaster
Rendering of the first aid and Rendering of the first aid and taking out of the casualties by tge taking out of the casualties by tge
savorssavors
Development of the first-aid pointDevelopment of the first-aid point
Rendering of the pre-physician aidRendering of the pre-physician aid
Preparing the casualties for Preparing the casualties for the evacuatingthe evacuating
11
22
33
44
23 april 2002, California. USA23 april 2002, California. USA
Passanger train поїзд crashed with goods 5 persons lost, 256 – hospitalizedPassanger train поїзд crashed with goods 5 persons lost, 256 – hospitalized
In the area of the accident 100 firemen worked and 30 emergency cars take participation. In the area of the accident 100 firemen worked and 30 emergency cars take participation.
Common script of the first aid giving for the casualties Common script of the first aid giving for the casualties on the on the І І evacuating stageevacuating stage
ФільмФільм
Clearing by the feature of danger for the
others
Medical care not to be given
Qualified physician’s assistant or nurse
Entry at hospital
Surgery’s injuries
Clearing casualties,
allocation at departments
Qualified surgeon
Therapeutic injuries
Surgery department
Pediatrician
department
Therapy department
pediatrician,
surgeriesof child
age
Skill therapeutics
Skill surgeries
Qualified (special) medical care
Qualified (special) medical care
Qualified (special) medical care
Clearing station near delivery’s departnment
The model of an organization of the The model of an organization of the ІІ ІІ stage of evacuationstage of evacuation
Children
medical brigade of all-time medical brigade of all-time readiness of the second readiness of the second
turnturn
Allocation of the types of medical care in accordance with stage of medical evacuation
types of medical care
First aidFirst aid
Pre-physicianPre-physiciancarecare First First
physician aidphysician aid
Qualified Qualified care care
Special Special care care
the the І І stage of evacuationstage of evacuation the the ІІ ІІ stage of evacuationstage of evacuation
This is a unit of SSMC that raised for the hospital increase This is a unit of SSMC that raised for the hospital increase by the high qualified specialists by the high qualified specialists
Special medical brigade of all-time readiness of the Special medical brigade of all-time readiness of the second turnsecond turn
(surgery, neurosurgery, traumatology, combustiology, intensive care, psychiatry, pediatrics, obstetric-gynecology, infectology etc.)
11 brigade is raised for brigade is raised for 200 200000 peoples000 peoples
The brigade profileThe brigade profile, , their enumeration are their enumeration are determined in accordance with dependence determined in accordance with dependence of foreseen medico-sanitarian consequences of foreseen medico-sanitarian consequences of local extraordinary situations and real of local extraordinary situations and real provision of the hospital by needed provision of the hospital by needed physiciansphysicians
are raised in hospitals out of the state are raised in hospitals out of the state
Special medical brigade of all-time readiness of the Special medical brigade of all-time readiness of the second turnsecond turn
11 brigade is raised for brigade is raised for 200 200000 peoples000 peoples
These brigade are supplied with the inviolable These brigade are supplied with the inviolable equipment storage in accordance with equipment storage in accordance with expectation for the work during expectation for the work during 1 1 day,day, (2 (2 days – for regional centre of emergency days – for regional centre of emergency medical care)medical care)
are determined on the base of foreseen medico-are determined on the base of foreseen medico-sanitarian consequences of extraordinary sanitarian consequences of extraordinary situationsituation
Medical organizations (hospitals) that Medical organizations (hospitals) that develop additional bed-stock develop additional bed-stock
Additional Additional bed-stockbed-stock
Discharge the ills with chronic diseases and discovering patients from the hospital and delivering them to hospitals out of the SSMC system
Development 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 complementThe state level SSMC complement::
• 571 571 medical brigade of all-time readiness of the
first turn• 190 medical brigade of all-time readiness of the
second turn• 14659 beds-places of the special bed-stock
The Order of HCM of Ukraine The Order of HCM of Ukraine 20.11.97 20.11.97 № 334 № 334
First aid
The provision of limited care for an illness or The provision of limited care for an illness or injury, which is provided usually by a lay injury, which is provided usually by a lay person, to a sick or injured patient until person, to a sick or injured patient until definitive medical treatment can be accessed, definitive medical treatment can be accessed, or until the illness or injury is dealt with (as not or until the illness or injury is dealt with (as not all illnesses or injuries will require a higher all illnesses or injuries will require a higher level of treatment).level of treatment).
AmountAmount:: 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 aid
6. 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-syndrome
Be done in timeBe done in time: : up to 30 minup to 30 min
First aid
• During giving the medical care the casualties in the area of an accident it’s 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 PurposePurpose:: 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.
AmountAmount:: 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 aid
• 5. 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 aidPre-physician aid
8. 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 timeDone in time: : 1-2 1-2 hh
First physician aidPurposePurpose:: The casualties life saving, stabilization of the The casualties life saving, stabilization of the main functional systems of an organism for the much main functional systems of an organism for the much sooner evacuation them on the point of qualify medical sooner evacuation them on the point of qualify medical care and prevention the possible complicationscare and prevention the possible complications
Emergency Emergency measures measures
First physician aidFirst physician aid
Medical care Medical care measures may be put measures may be put
off off
Done in timeDone in time: : 1-2 1-2 hh
Emergency measures of the first aid
AmountAmount:: 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 aid
3. 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 aid
7. 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 measure
AmountAmount:: :: 1. Removal of the недоліків 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 don’t threaten for the casualties life.
Qualify medical carePURPOSEPURPOSE:: The casualties life saving, and prevention the The casualties life saving, and prevention the possible complications, creation the provision needed conditions for possible complications, creation the provision needed conditions for the treatment and recoverythe treatment and recovery..
Qualify medical care
Qualify therapeutic careQualify surgery care
2 2 groupgroup1 1 groupgroup 3 3 groupgroup
Measures of terminated Measures of terminated Emergency Emergency measuresmeasures Measures Measures
may be put off may be put off
Qualify surgery care
AmountAmount:: 1. Fight against an asphyxia and restoration the 1. Fight against an asphyxia and restoration the breathing functions.breathing functions.
2. The final stopping of the internal and external 2. The final stopping of the internal and external bleeding.bleeding.
3. Complex therapy of sharp blood lost, shock, 3. Complex therapy of sharp blood lost, shock, traumatic intoxication.traumatic intoxication.
4. Treatment of anaerobic infection.4. Treatment of anaerobic infection.5. Surgical treatment and sewing wounds 5. Surgical treatment and sewing wounds
and opened and opened pnepneumatothorax, umatothorax, tthhoraorasic centesis and valve sic centesis and valve pnepneumatothorax.umatothorax.
6. 6. LaparotomyLaparotomy at penetrable wounds and closed at penetrable wounds and closed trauma of stomach and internal organs damage.trauma of stomach and internal organs damage.
1 1 groupgroup:: emergency surgery invasions and other emergency surgery invasions and other measuresmeasures, , non-perfecting of which may be realized with non-perfecting of which may be realized with death death at the nearest timeat 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 care1 1 groupgroup:: emergency surgery invasions and other measures, un-perfecting of which may be realized with death at the nearest time
Qualify surgery care
AmountAmount:: Surgery wound processing at long tube bones without intensive damage of the soft tissues.
2 2 groupgroup:: not done in time care may be resulted not done in time care may be resulted with appearance of serious complicationwith appearance of serious complication..
Qualify surgery care
AmountAmount:: 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 3 groupgroup:: Postpone care (due to usage of antibiotics) may Postpone care (due to usage of antibiotics) may not be complicatednot be complicated..
Qualify therapeutic care
AmountAmount:: 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 measuresEmergency measures
Qualify therapeutic care
AmountAmount:: 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 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 casualtiesContingent 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 Algo-rhythm of the observation and of the observation and rendering of the first aid rendering of the first aid
Primary observation (АВС):
А – airways;В – breathing;С - circulation
Approaching to the casualty
Determination of the
consciousness
presence
Performing in the safe conditions in the area of an accident
Possible acting
Impossible acting
consciousnesspresent consciousness
absent
Secondary observation
Status inspection
Doing possible
Doing impossible
Vital signs presence
Vital signs absence
status of an
organism
inspection
Vital signs appearance impossible
Secondary observation
Airways provision
Putting behind the head and rising of the chin or moving the jaw forward
Inspecting breathing activity
Two inspires Breathing absence
Дихання присутнє
state of an organism
inspection
Breathing presence
ineffective
effective
ineffective
effective
Pulse checking
Airways provision
presence absence
Artificial breathing
Cardiac-pulmonary
resuscitation
Special methodic of the airways Special methodic of the airways provisionprovision
Casualty in consciousness
(method by Hymlic)
Casualty inunconsciousn
ess
Casualty alone
at home
age adult (> 8 yr) Child (1-8 yr) Baby (up to 1 yr)
POSITION:
Head Chin up Chin up carefully Head up gently
Nose closed closed
Mouth Rescuer clasps lips and mouth of the casualty
Rescuer clasps lips and mouth of the casualty
Rescuer clasps nose and mouth of the baby
Number of blowing into
12 blowings/min 20 deep blowings/min 12 light blowings/min
Frequency of blowing into
1b/5 sec 1b/3 sec 1b/3 sec
Duration 1,5-2 sec 1-1,5 sec 1-1,5 sec
Pulse control a.carotis ext. a.carotis ext. a.brachiale
Methodic of the artificial breathingMethodic of the artificial breathing
Methodic of cardiac-pulmonary resuscitationMethodic of cardiac-pulmonary resuscitation
age adult (> 8 yr) Child (1-8 yr) Baby (up to 1 yr)
ARMS POSITION:
Deep of pulses Approximately 4-5 cm
Approximately 4-5 cm
Approximately 4-5 cm
Blowing Slowly up to rising thorax (1-2 sec)
Slowly up to rising thorax (1-1,5 sec)
Slowly up to rising thorax (1-1,5 sec)
Cycle 15 impulses 2 bl 5 impulses 1 bl 5 impulses 1 bl
Temp 15 imp. – 10 sec 5 imp. – 3 sec 5 imp. – 3 sec
Relation 1b/5 sec 1b/3 sec 1b/3 sec
Duration 1,2,3 ….15/2 blowings
1,2,3 …. 15/1 blowing
1,2,3,4,5 /1 blowing
Special methodic of the cardiac-pulmonary Special methodic of the cardiac-pulmonary resuscitation
Child to 1 yr
Child of 1-8 yr
Adult
The endThe end!!