The principles of the The principles of the medical evacuating medical evacuating provision the provision the extraordinary extraordinary situationsituation

Arsen Gudyma, MD, prof.Arsen Gudyma, MD, prof.

Vasyl Demianenko, MCVasyl Demianenko, MC, , as. profas. prof..

The Disaster Medicine departmentThe Disaster Medicine department

Lecture 5Lecture 5

In extraordinary situations not only In extraordinary situations not only medical aid should be given for the medical aid should be given for the population but they are to be protected population but they are to be protected from infecting and other negative and from infecting and other negative and danger actions of factors that threaten danger actions of factors that threaten for people’s health and life. In these for people’s health and life. In these conditions readiness to organize the conditions readiness to organize the projecting of medico-sanitarian projecting of medico-sanitarian guarantee in extreme situation by the guarantee in extreme situation by the region’s health care administration is region’s health care administration is very important.very important.

The main demands to the The main demands to the medical-sanitarian medical-sanitarian guarantee, which are used guarantee, which are used in extraordinary situation: in extraordinary situation: done in time, portability, done in time, portability, compactness, simplicity compactness, simplicity and reliability in and reliability in effectiveness and using, effectiveness and using, possibility of long keeping possibility of long keeping and protection.and protection.

At prognosis of extreme situation in At prognosis of extreme situation in region local authority (territorial region local authority (territorial centers of SSMC) are based on centers of SSMC) are based on information, which is received from information, which is received from the Stuff, calculation of need in the Stuff, calculation of need in medical-sanitarian supply for every medical-sanitarian supply for every units and medical-preventing units and medical-preventing institution (hospital), analysis of institution (hospital), analysis of information and tables of sanitarian information and tables of sanitarian equipment and means.equipment and means.

Chiefs of medical-preventing Chiefs of medical-preventing institutions compose on basis institutions compose on basis of calculation summary of calculation summary information of need in information of need in medical supply (remedies, medical supply (remedies, equipages and other stores), equipages and other stores), send them to regional send them to regional (territorial) center of SSMC.(territorial) center of SSMC.

In chemist shop's depots, in chemist's In chemist shop's depots, in chemist's shop and medical-preventing institution shop and medical-preventing institution inviolable stock of medical supply is inviolable stock of medical supply is created. Providing with remedies of created. Providing with remedies of medical protection of evacuative medical protection of evacuative population is accomplishing from the population is accomplishing from the depots, also from chemist's shops, depots, also from chemist's shops, which are on the route of evacuation which are on the route of evacuation and places of temporary settings.and places of temporary settings.

At some special situations (accident At some special situations (accident of APS or other danger objects, of APS or other danger objects, which produces or uses poisoned which produces or uses poisoned chemical substances, fire etc) chemical substances, fire etc) medical supply could be exposed to medical supply could be exposed to the influence radio-nuclides, poison the influence radio-nuclides, poison and toxic substances, water, high and toxic substances, water, high or low temperature, soiling with or low temperature, soiling with land. land.

In order to protect medical stores In order to protect medical stores some protective methods are used, some protective methods are used, which allows to preserve medical which allows to preserve medical equipment or relieve influence of equipment or relieve influence of unfavorable factors. It is necessary to unfavorable factors. It is necessary to mention such of them: dispersal of mention such of them: dispersal of depots in advance with medical depots in advance with medical property on territory of possible property on territory of possible dangerous region, engineering dangerous region, engineering equipment of premises depots, equipment of premises depots, hermetisation hermetisation of premises and of premises and package where medical remedies are package where medical remedies are kept, providing possibility of quick kept, providing possibility of quick evacuation if it is necessary.evacuation if it is necessary.

For keeping medical property direct For keeping medical property direct in district of catastrophe the main is in district of catastrophe the main is the character of its package. In the character of its package. In hermetic embolic package (glass hermetic embolic package (glass ampoules and tubes with ground in ampoules and tubes with ground in stoppers, metallic cupping glasses stoppers, metallic cupping glasses and containers) remedies and other and containers) remedies and other preparations are in safe till its preparations are in safe till its opening or destruction.opening or destruction.

Medical means Medical means included in such included in such package may be package may be used after a special used after a special treatment of treatment of package package (decontamination, (decontamination, degassing, washing degassing, washing with water after the with water after the soiling by the soiling by the ground, dust etc).ground, dust etc).

The other kinds of packages (wooden The other kinds of packages (wooden boxes and pasteboard-boxes, bags made boxes and pasteboard-boxes, bags made by polyethylene, paper, cotton etc) don't by polyethylene, paper, cotton etc) don't protect enough of getting inside nuclear protect enough of getting inside nuclear substances, poison and toxic substances, substances, poison and toxic substances, water. In case of contamination of contents water. In case of contamination of contents of this equipment (remedies, equipages) of this equipment (remedies, equipages) should be selected and inspected by should be selected and inspected by means of dosiemetric (chemical) control means of dosiemetric (chemical) control and conducted directly at place and in the and conducted directly at place and in the conformed laboratories, sanitary epidemic conformed laboratories, sanitary epidemic station (SES) and others. station (SES) and others.

In confirmation of In confirmation of contamination by contamination by nuclear substances, nuclear substances, poison and toxic poison and toxic substances its substances its decontamination decontamination (degassing) of (degassing) of contaminated contaminated stares is conducted. stares is conducted.

The remedies, The remedies, vitamins, vitamins, bacterial bacterial preparations preparations contaminated by contaminated by SAPS mustn’t be SAPS mustn’t be used and used and destined to destined to destruction. Tdestruction. T

The contamination by nuclear substances, The contamination by nuclear substances, poison and toxic substances surgical set or poison and toxic substances surgical set or instruments, metallic medical and instruments, metallic medical and pharmaceutical articles, also glass, pharmaceutical articles, also glass, porcelain and plastic objects are degassed porcelain and plastic objects are degassed (decontaminated) by means of washing in (decontaminated) by means of washing in detergents or wiping by organic solutions detergents or wiping by organic solutions (spirit, benzene) with the washing in water (spirit, benzene) with the washing in water next and wiping dry by wad of cotton wool. next and wiping dry by wad of cotton wool. The devices and sets are treated in such a The devices and sets are treated in such a way.way.

The dressings that The dressings that are kept in packages are kept in packages made of gummed made of gummed cloth or a waxen cloth or a waxen paper, is not directly paper, is not directly contaminated by contaminated by toxic substances and toxic substances and radio-nuclides and radio-nuclides and may be used in a may be used in a general way after general way after removing of a removing of a package. package.

In case, when such In case, when such products and liquids products and liquids being contaminated being contaminated by toxic substances by toxic substances and radio-nuclides and radio-nuclides or contaminated or contaminated parts of them should parts of them should be destroyed or be destroyed or used after the used after the degassing. degassing.

The rubber products contaminated by The rubber products contaminated by radio-nuclides - the surgical gloves, the radio-nuclides - the surgical gloves, the drainpipes, the catheters - are treated by drainpipes, the catheters - are treated by the contaminate solutions and the the contaminate solutions and the products contaminated they should be products contaminated they should be treated by soapy water, the solutions of treated by soapy water, the solutions of detergents or destroyed. Decontamination detergents or destroyed. Decontamination litters is made in the next way: wooden litters is made in the next way: wooden and metallic parts are treated by soapy and metallic parts are treated by soapy water or solutions of detergents with water or solutions of detergents with washing them with water to be next. The washing them with water to be next. The litter’s cloth has to be washed.litter’s cloth has to be washed.

The medical household property (the tents, The medical household property (the tents, the dressing gowns, the sheets, the the dressing gowns, the sheets, the underwear, the blankets etc) is underwear, the blankets etc) is decontaminated (degassed) be the means decontaminated (degassed) be the means accepted in the treatment of material accepted in the treatment of material property. If time conditions are available such property. If time conditions are available such property is passed to storage where it's property is passed to storage where it's ventilated, washed and its contamination is ventilated, washed and its contamination is controlled. The remedies which are controlled. The remedies which are influenced by high or low temperatures are influenced by high or low temperatures are pharmacologically controlled once again.pharmacologically controlled once again.

Medical and sanitarian providing of the Medical and sanitarian providing of the

populationpopulation

Medical and evacuating measuresMedical and evacuating measures

Providing of emergency medical Providing of emergency medical aid for the casualties and ills in aid for the casualties and ills in the area of disaster, their next the area of disaster, their next evacuation and treatment are evacuation and treatment are charged with the system of charged with the system of medical-evacuating measures. medical-evacuating measures.

Medical and evacuating measures Medical and evacuating measures include the next types of medical include the next types of medical aid:aid:

first aidfirst aid pre-physician’s aidpre-physician’s aid first professional (qualified) first professional (qualified)

medical caremedical care professional (doctor’s) medical professional (doctor’s) medical

care care special medical care. special medical care.

For rendering of pre-hospital and first For rendering of pre-hospital and first profession’s health care in area of profession’s health care in area of disaster on a signal of the notification disaster on a signal of the notification put forward brigade - put forward brigade - medical health medical health care units (MEHCU), medical military care units (MEHCU), medical military units as parts of the State Civilian units as parts of the State Civilian Protective Service (SCPS). Protective Service (SCPS). The first The first stage of medical evacuation can be stage of medical evacuation can be developed by developed by medical emergency medical emergency health care units (MEHCU), medical health care units (MEHCU), medical military units or other military units or other medical group of medical group of the first medical aid.the first medical aid.

Medical brigade is intended for Medical brigade is intended for rendering the first medical and rendering the first medical and qualified medical aid to the qualified medical aid to the injured both patient and injured both patient and preparation them to evacuation in preparation them to evacuation in medical establishments of the medical establishments of the second stage of medical second stage of medical evacuation.evacuation.

MEHCU MEHCU consists of:consists of:

senior doctor of unit;senior doctor of unit; senior medical sister of unit;senior medical sister of unit; 2-5 brigades of emergency medical service – 6 2-5 brigades of emergency medical service – 6

workers: the doctor - 1, medical sister - 3, workers: the doctor - 1, medical sister - 3, hospital attendant-stretchers, driver - hospital hospital attendant-stretchers, driver - hospital attendant;attendant;

3-5 brigades emergency pre-hospital medical aid 3-5 brigades emergency pre-hospital medical aid – 4 workers: senior medical sister, medical sister, – 4 workers: senior medical sister, medical sister, hospital attendants — stretchers, driver - hospital attendants — stretchers, driver - hospital attendant. Besides, at large-scale hospital attendant. Besides, at large-scale accidents the medical forces are amplified by accidents the medical forces are amplified by brigade of the qualified surgical medical aid (10-brigade of the qualified surgical medical aid (10-12 surgeons), acoucheur-gynecologist, 12 surgeons), acoucheur-gynecologist, pediatrician, etc.pediatrician, etc.

The basic sections of The basic sections of medical unit:medical unit:

clearing platoon;clearing platoon; operating;operating; hospital wards;hospital wards; cleansing station;cleansing station; laboratory;laboratory; utilities section;utilities section; drug store.drug store.

The basic sections of The basic sections of medical unit:medical unit: Reception of the injures and patients, their Reception of the injures and patients, their

registration, temporary placing of the injures registration, temporary placing of the injures and patients in hospital;and patients in hospital;

realization of medical clearing;realization of medical clearing; rendering by the injures and patient by first rendering by the injures and patient by first

medical and qualified of medical care;medical and qualified of medical care; temporal isolation of the infectious and temporal isolation of the infectious and

mental patients;mental patients; deliveries aid and newborns care;deliveries aid and newborns care; getting ready of the injures and patients to getting ready of the injures and patients to

the further evacuation;the further evacuation; medical accounting and registration.medical accounting and registration.

The brigade of the first physician The brigade of the first physician aid are created in public health aid are created in public health services on a line of civil services on a line of civil protection and get ready under protection and get ready under the order of the chiefs of the order of the chiefs of hospitals, on the basis of which hospitals, on the basis of which they are created. they are created.

The brigade makes a march by one The brigade makes a march by one marching column with the most marching column with the most possible velocity ensuring safety of possible velocity ensuring safety of movement and performance of a movement and performance of a put task in target dates! Usually put task in target dates! Usually speed of movement the column is speed of movement the column is established in the day-time of 30-40 established in the day-time of 30-40 km/h, at the night-time — 25-30 km km/h, at the night-time — 25-30 km /h./h.

The following tasks are assigned to The following tasks are assigned to brigade of the first physician aid:brigade of the first physician aid:

To carry out medical investigation in area of To carry out medical investigation in area of unit’s disposition outside a town, on a route unit’s disposition outside a town, on a route of movement and in the center of an of movement and in the center of an accident.accident.

To put out of partial cleaning of the To put out of partial cleaning of the casualties, their clothes and footwear;casualties, their clothes and footwear;

Reception and medical clearing of the Reception and medical clearing of the casualties;casualties;

To render pre-hospital and first medical aid To render pre-hospital and first medical aid for the injured and urgent surgical (according for the injured and urgent surgical (according to the vital indications) aid (at an to the vital indications) aid (at an opportunity);opportunity);

Temporary hospitalization of the Temporary hospitalization of the non-transportable patients;non-transportable patients;

Temporary isolation of the Temporary isolation of the infectious patients and infectious patients and casualties with sharp mental casualties with sharp mental frustration;frustration;

To get ready the casualties for To get ready the casualties for their evacuation in hospitals in their evacuation in hospitals in the country;the country;

Working out elementary laboratory Working out elementary laboratory researches and dosimetric control;researches and dosimetric control;

Maintenance by medical Maintenance by medical equipment;equipment;

Boarding the casualties that Boarding the casualties that preserved by unit;preserved by unit;

Medical accounting and Medical accounting and registration.registration.

The basic task of this unit is The basic task of this unit is rendering the first medical rendering the first medical (physician) aid for the casualties.(physician) aid for the casualties.

The common principles of emergency medical The common principles of emergency medical care for the casualtiescare for the casualties

Inspection of the area of an accidentsInspection of the area of an accidents The primary examination (A,B,C): The primary examination (A,B,C): A. Airway;A. Airway; B. Breathing,B. Breathing, C. Circulation.C. Circulation. The improved primary examination (A,B,C+ The improved primary examination (A,B,C+

D,E):D,E): D. Neurological disturbance, D. Neurological disturbance, E. Exposure (additional investigations).E. Exposure (additional investigations). The secondary examination (from the head The secondary examination (from the head

to the feet).to the feet).

How to stop bleeding:How to stop bleeding:

Driving the first firmly into the suprapubic Driving the first firmly into the suprapubic abdominal midline to compress the aorta abdominal midline to compress the aorta against the sacral promontory may effectively against the sacral promontory may effectively diminish gross distal blending.diminish gross distal blending.

Reduction of arterial haemodynamic pressure Reduction of arterial haemodynamic pressure by elevation of involved area if critical flow by elevation of involved area if critical flow not overly compromised (e.g. tilt0table not overly compromised (e.g. tilt0table treatment of intracranial hemorrhage). treatment of intracranial hemorrhage).

Temporary blockade of surgically Temporary blockade of surgically unaccessible vessels with an intravascular unaccessible vessels with an intravascular

balloon tampon or autogenous clots.balloon tampon or autogenous clots.

Sanitarian and hygienic measuresSanitarian and hygienic measures

Sanitarian and hygienic Sanitarian and hygienic measures are to be provide be measures are to be provide be SSMC together with sanitarian SSMC together with sanitarian services in the area of disaster on services in the area of disaster on all steps and points of evacuation all steps and points of evacuation casualties and ills, in the places of casualties and ills, in the places of the population’s settle from the the population’s settle from the area of catastrophe. area of catastrophe.

Sanitarian and hygienic measures Sanitarian and hygienic measures must provide due sanitarian and must provide due sanitarian and proper hygienic level in places of proper hygienic level in places of feed on, water, settlement, work feed on, water, settlement, work and rest for the saver-personnel, and rest for the saver-personnel, other population, the injured and other population, the injured and ills. ills.

Anti-epidemic measuresAnti-epidemic measures

This type of work is This type of work is provided in order to provided in order to prevent of prevent of appearance appearance epidemic sources epidemic sources and if they and if they appeared – to appeared – to localized and localized and liquidate them as liquidate them as the sources of the sources of infecting diseases.infecting diseases.

For providing planned medical and For providing planned medical and evacuating measures in area of evacuating measures in area of disaster it’s needed to knowdisaster it’s needed to know

11. Main principles of medical-sanitarian . Main principles of medical-sanitarian guarantee for the population in guarantee for the population in extraordinary situation.extraordinary situation.

2. Ways of participation of the SSMC 2. Ways of participation of the SSMC brigade, hospitals in maintenance of brigade, hospitals in maintenance of medical-sanitarian guarantee for the medical-sanitarian guarantee for the population.population.

3. Organization of supply by sanitarian 3. Organization of supply by sanitarian remedies to EMC brigade in emergency.remedies to EMC brigade in emergency.

4.Organization of supply of medical-4.Organization of supply of medical-preventing establishments and preventing establishments and population in area of disaster.population in area of disaster.

5.Inspection of sanitarian situation in 5.Inspection of sanitarian situation in the area of extraordinary situation. the area of extraordinary situation.

For providing planned medical and For providing planned medical and evacuating measures in area of evacuating measures in area of disaster it’s needed to skilldisaster it’s needed to skill 1. To definite requirement of medical 1. To definite requirement of medical

supply in part of the medical-sanitarian supply in part of the medical-sanitarian guarantee for the population in guarantee for the population in extraordinary situation.extraordinary situation.

2.To do independently calculations and 2.To do independently calculations and requirement of necessary medical property requirement of necessary medical property for formations and institutions of SSMC in for formations and institutions of SSMC in part of the medical-sanitarian guarantee for part of the medical-sanitarian guarantee for the population in extraordinary situation.the population in extraordinary situation.

3.To work out the table of devices of EMC 3.To work out the table of devices of EMC brigade at catastrophe accordingly to tasks brigade at catastrophe accordingly to tasks of the medical-sanitarian guarantee for the of the medical-sanitarian guarantee for the population in extraordinary situation.population in extraordinary situation.

The endThe end