List of first aid measures. Sidorov P.I. Medical support in emergencies - file n1.doc


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    • n1.doc

    In the list of activities of the first medical care included:

    • extracting victims from under the rubble, from the fires, extinguishing burning clothes;

    • restoration of patency of the upper respiratory tract(cleaning them from mucus, blood, possible foreign bodies, fixing the tongue when it retracts, giving a certain position to the body);

    • artificial ventilation lung method "mouth to mouth" or "mouth to nose";

    • conducting indirect massage hearts;

    • temporary stop of external bleeding (finger pressing of the vessel, application of a pressure bandage, twist, tourniquet);

    • bandaging (aseptic) for wounds and burns;

    • the imposition of an occlusive dressing with open pneumothorax;

    • immobilization with improvised means and simple tires for fractures, extensive burns and crushing of soft tissues of the limbs;

    • “tubeless” gastric lavage (artificial induction of vomiting) in case of ingestion of chemical and radioactive substances into the stomach;

    • iodine prophylaxis, taking radioprotectors and means of stopping the primary radiation reaction when exposed to ionizing radiation;

    • the use of non-specific prophylaxis infectious diseases;

    • fixation of the body to the board or shield in case of spinal injuries;

    • plentiful warm drink (in the absence of vomiting and evidence of organ injury abdominal cavity);

    • warming the affected;

    • protection of the respiratory system, eyesight and skin by using service (respirators ShB-1 "Petal", R-2, filtering gas masks GP-5, GP-7) and improvised personal protective equipment (cotton-gauze bandages, covering the face with wet gauze, a scarf , towel, etc.);

    • prompt removal of the affected person from the contaminated area;

    • partial sanitization (washing of exposed parts of the body with running water and soap);

    • partial decontamination (decontamination) of clothing and footwear.

    First aid aims to eliminate and prevent disorders (bleeding, asphyxia, convulsions, etc.), life threatening injured and preparing them for further evacuation.

    Optimal turnaround time before medical care- no later than one hour after receiving the defeat.

    In addition to first aid measures, pre-hospital medical care includes:


    • elimination of shortcomings in the provision of first aid (correction of incorrectly applied bandages, improvement of transport immobilization, control over the correctness and expediency of applying a tourniquet with continued bleeding);

    • elimination of asphyxia (toilet of the oral cavity and nasopharynx, if necessary, the introduction of an air duct, oxygen inhalation, artificial ventilation of the lungs with an AMBU breathing apparatus);

    • the use of painkillers, cardiovascular, sedative, antiemetic, anti-inflammatory, anticonvulsants, respiratory analeptics, antidotes;

    • drug prevention of wound infection;

    • infusion therapy;

    • additional degassing, decontamination of open areas of the skin and adjacent clothing;

    • the imposition of aseptic dressings;

    • putting on a gas mask (cotton-gauze bandage, respirator) on the affected person when he is in a contaminated (infected) area.
    The medical staff providing first aid, in addition, monitors the correctness of the provision of first aid.

    Upon receipt of a significant number of the affected, a situation may arise when it turns out to be impossible (within an acceptable time frame) to this stage medical evacuation to all those in need of first aid. Under such conditions, the activities of this type of medical care are divided into two groups: urgent activities and activities that can be involuntarily delayed or provided at the next stage. Urgent measures are those that must be carried out where the first medical aid is provided for the first time. Failure to comply with this requirement threatens the affected person with death or the occurrence of a serious complication.

    Urgent actions include:


    • elimination of asphyxia (suction of mucus, vomit and blood from the upper respiratory tract), introduction of an air duct, stitching and fixation of the tongue, clipping or hemming of hanging flaps soft palate and lateral parts of the pharynx, tracheostomy according to indications, artificial ventilation of the lungs, application of an occlusive dressing in case of open pneumothorax, puncture pleural cavity or thoracocentesis for tension pneumothorax);

    • stopping external bleeding (flashing a vessel in a wound, applying a clamp or pressure bandage to a bleeding vessel);

    • carrying out anti-shock measures (transfusion of blood substitutes, novocaine blockade, administration of painkillers and cardiovascular means);

    • cutting off a limb hanging on a flap of soft tissues;

    • catheterization Bladder with evacuation of urine with urinary retention;

    • carrying out measures aimed at eliminating desorption chemical substances from clothing and allowing you to remove the gas mask from the affected, coming from the focus of a chemical accident;

    • the introduction of antidotes;

    • the use of anticonvulsants and antiemetics;

    • degassing of the wound (if it is contaminated with AOHV);

    • gastric lavage with a probe in case of ingestion of chemical and radioactive substances into the stomach;

    • the use of antitoxic serum in case of poisoning with bacterial toxins and non-specific prophylaxis infectious diseases.
    First aid measures that may be delayed include:

    • elimination of shortcomings in the provision of first medical and pre-medical aid (correction of dressings, improvement of transport immobilization, etc.);

    • dressing change when the wound is contaminated with radioactive substances;

    • conducting novocaine blockades in case of damage moderate;

    • antibiotic injections and tetanus seroprophylaxis for open injuries and burns;

    • the appointment of various symptomatic agents for conditions that do not pose a threat to the life of the affected person.
    The optimal time for first aid is the first 4-6 hours from the moment the lesion is received.

    Qualified medical care activities (as well as first aid) are divided into urgent activities and activities that can be delayed.

    Urgent measures are performed, as a rule, with lesions that pose a direct threat to the life of the affected. If they are not performed in a timely manner, the likelihood of death or extremely severe complications.

    The main list of urgent actions includes:


    • elimination of asphyxia and restoration of adequate breathing;

    • the final stop of internal and external bleeding;

    • complex therapy acute blood loss, shock, traumatic toxicosis; "Lamp" incisions for deep circular burns of the chest and extremities;

    • prevention and treatment of anaerobic infections;

    • surgical treatment and suturing wounds with open pneumothorax;

    • surgical interventions for wounds of the heart and valvular pneumothorax;

    • laparotomy for wounds and closed injury abdomen with injury internal organs, with closed damage to the bladder and rectum;

    • decompression trepanation of the skull in case of wounds and injuries accompanied by compression of the brain and intracranial bleeding;

    • complex therapy for acute cardiovascular insufficiency, violations heart rate, sharp respiratory failure, coma;

    • dehydration therapy for cerebral edema;

    • correction of gross violations of the acid-base state and electrolyte balance;

    • the introduction of painkillers, desensitizing, anticonvulsant, antiemetic and bronchodilator drugs;

    • the introduction of antidotes and anti-botulinum serum;

    • the use of tranquilizers and neuroleptics in acute reactive conditions.
    The optimal term for the provision of qualified medical care is the first 8-12 hours after the injury.

    There are surgical (neurosurgical, ophthalmological, otorhinolaryngological, dental, traumatological, burned, pediatric (surgical), obstetric-gynecological, angiosurgical) and therapeutic (toxicological, radiological, neuropsychiatric, pediatric (therapeutic), assistance to general somatic and infectious patients) specialized medical care.

    The experience of eliminating the medical and sanitary consequences of many emergencies indicates that in real conditions the above list of activities of a particular type of medical care, depending on qualifications medical personnel, equipment used, working conditions may be reduced or expanded. Therefore, the concepts of "first aid with elements of qualified medical care", "qualified with elements of specialized medical care" are often used. However, with all such clarifications of the scope of medical care, the following requirement must be met: before the injured are admitted to hospital-type medical institutions, in all cases, when providing any type of medical care, they must take measures to eliminate phenomena that directly threaten life in this moment, preventing severe complications and ensuring transportation without a significant deterioration in the condition.

    1.1.4. Medical evacuation of the injured (sick) to emergency situations

    An integral part of medical and evacuation support in emergency situations is medical evacuation.

    The rapid delivery of the injured to the first and final stages of medical evacuation is one of the main means of achieving timeliness in the provision of medical care to the injured.

    In addition to this goal, medical evacuation ensures the release of stages of medical evacuation from the injured to receive newly arriving wounded and sick.

    Medical evacuation begins with the removal (removal) of the injured from the outbreak, district (zone) of emergency situations and ends with their delivery to medical institutions that provide a full range of medical care and provide final treatment.

    Obviously, the evacuation medical point vision is a forced event that adversely affects the condition of the affected person and the course pathological process. Evacuation is only a means to achieve best results when performing one of the main tasks of the QMS - fastest recovery the health of those affected and the maximum reduction in the number of adverse outcomes. Therefore, evacuation should be short-term, sparing and medically secured.

    The practice of medical support for the population in peace and war time confirmed the vitality of the basic principles of medical evacuation. The main principle of medical evacuation is the principle of "evacuation on oneself" (by ambulances, transport of medical institutions, etc.). In some cases, “evacuation from oneself” is carried out (by transport of the affected object, rescue teams, etc.) or “evacuation through oneself”.

    The main rule when transporting a victim on a stretcher is the non-removability of the stretcher, and their replacement is carried out from the exchange fund.

    A medical evacuation stage is a medical unit or facility deployed or located on medical evacuation routes affected.


    Currently, there are two types of medical evacuation: by direction and by destination. In terms of direction, evacuation begins in the general flow from the place of first aid and ends at the first stage of medical evacuation, from where the injured are sent to the hospital of the second stage according to the type of injury.

    On the evacuation direction or on the ways of medical evacuation of the injured from the focus of the lesion (the place of collection of the injured), at the stages of medical evacuation, medical distribution post, which is an emergency medical evacuation management body. It is designed for a clear organization of the evacuation of the injured to medical institutions, taking into account the uniform load and the presence of profiled departments in them, corresponding to the leading defeat of those evacuated by this transport. Spontaneity in this process leads to significant unjustified interhospital transportation of the affected.

    Medical evacuation begins with the removal (removal) of the injured from the outbreak, area (zone) of the emergency, therefore, to provide medical care and care for the injured in their concentration areas before the arrival of transport, it is necessary to allocate medical personnel from the rescue teams, sanitary teams and other units working in the zone Emergency.

    The places of loading of the injured on the transport are chosen as close as possible to the center of sanitary losses outside the zones of fires, contamination with RV and AOHV.

    The complexity and tragedy of the situation in the emergency zone, the massive loss of life, elements of panic often cause chaos in the work of medical personnel. The desire to evacuate as soon as possible on a passing unsuitable transport without preparing the injured for evacuation leads to the development of severe complications, which negatively affects the results and outcome of treatment.

    Preparation of vehicles for evacuation includes, along with general work preparation of vehicles for use, a set of measures for the installation of special equipment for the installation of stretchers and other property, adding ballast to the car body to soften the shaking of the car, covering truck bodies with awnings, providing transport with bedding material, blankets, providing light, a water tank, and, if necessary, heating.

    The choice of vehicles for the evacuation of victims from the emergency area depends on many conditions of the situation (availability local opportunities, distance of transportation, road conditions, nature of the terrain, weather, time of day, number of people affected, etc.).

    The practice of organizing medical evacuation in peacetime and wartime emergencies made it possible to identify the general requirements for it:

    1. Medical evacuation should be carried out on the basis of triage and in accordance with the evacuation conclusion.

    2. Medical evacuation must be short-term, ensuring the speedy delivery of the affected to the hospital for its intended purpose.

    3. Medical evacuation must be as gentle as possible.

    Preparing casualties for evacuation

    The concept of non-transportability

    Preparation of the injured for evacuation is the most important event of the LEA in emergency situations. Any transportation of seriously affected adversely affects the state of health and the course of their pathological process. Many seriously injured people are not able to transfer transportation from the source of emergency situations to a stationary health care facility and may die along the way. Therefore, LEO in emergency situations is carried out on the basis of staged treatment with evacuation as directed, on the basis of the separation of forces and means of health care along the routes of transportation of the injured from the focus of the lesion to the health facility, capable of providing comprehensive medical care and carrying out complete treatment until the final outcome.

    According to the evacuation sign, all the affected are divided, as a rule, into the following groups:


    • subject to evacuation;

    • subject to the severity of the condition, leaving at this stage of medical evacuation temporarily or until the final outcome;

    • subject to return to the place of residence for outpatient observation of a local doctor and treatment.
    At each stage, the injured are provided with an appropriate amount of medical care before being sent to the next stage (at the stage of qualified medical care, surgical interventions for urgent reasons).

    After urgent surgical interventions affected, as a rule, for some period become temporarily non-transportable. The terms of their non-transportability depend on the nature of the injury, the complexity of the operation and the type of vehicle allocated for evacuation to the next stage of medical evacuation. Non-transportable, in this case, are placed in the anti-shock compartment (compartment intensive care) or in the department of temporary hospitalization, where they carry out the necessary pathogenetic treatment until they are removed from the state of non-transportability.

    Absolute contraindications to medical evacuation of those affected by any transport and the terms of non-transportability of the affected after suffering surgical operations are the following:


    • suspicion of ongoing internal and uncontrolled external bleeding;

    • severe blood loss;

    • early dates after performing complex surgical interventions;

    • shock II-III degree;

    • non-drained closed or uncorrected tension pneumothorax;

    • injuries and injuries of the skull and brain with loss of pupillary and corneal reflexes, syndrome of compression of the head and spinal cord, meningoencephaly, ongoing liquorrhea;

    • condition after tracheostomy (until stable external respiration);

    • severe forms of respiratory failure, pleural empyema and septic condition in case of injuries (damages) of the chest;

    • diffuse peritonitis, intraperitoneal abscesses, acute intestinal obstruction, threat and signs of eventration of internal organs;

    • purulent-urinary streaks, septic condition with injuries of organs urogenital area;

    • acute purulent-septic complications in wounds of long tubular bones, pelvic bones and large joints;

    • anaerobic infection and tetanus;

    • thrombosis main vessels, condition after ligation of the external and common carotid artery (before the removal of sutures);

    • signs of fat embolism;

    • acute hepatic and renal insufficiency;

    • injuries (injuries) incompatible with life (terminal state).
    First of all, the affected are subject to evacuation after the provision of medical care according to urgent indications; penetrating wounds of the abdomen, skull, chest; with applied hemostatic tourniquets, etc. Other things being equal, preference in the order of evacuation is given to children and pregnant women.

    The most common and traumatic mode of transport is road transport (Table 10). When loading vehicles, it is important to correctly place the affected in the passenger compartment of the bus or in the back of the car. Severely injured, in need of more gentle transportation conditions, are placed on a stretcher mainly in the front sections and not higher than the second tier. Stretcher stricken with transport tires and plaster bandages located on the upper tiers of the cabin. The head end of the stretcher should be turned towards the cabin and raised 10-15 cm above the foot end in order to reduce the longitudinal movement of the affected during the movement of vehicles. The speed of traffic on the road should ensure the gentle transportation of the injured. The lightly injured (sedentary) are placed on the buses last.

    When evacuating those affected by road transport, it is necessary to observe the following terms after the provision of qualified surgical care:


    • those affected with gunshot fractures of the extremities can be evacuated 2-3 days after the operation;

    • affected with wounds in the chest after thoracotomy, suturing of pneumothorax or thoracocentesis - for 2-4 days;

    • affected with wounds in the head - 21-28 days after the operation.
    Table No. 10

    Characteristics of road transport used for medical evacuation
    Number of seats


    Fuel range, km

    on a stretcher + sitting

    just sitting

    A/M ambulance UAZ-452A

    4+1
    7
    95
    530

    A/M ambulance AS-66

    9+4
    22
    85
    530

    Bus PAZ-651 (KLVZ-6P)

    9+4
    12
    70
    500

    Bus PAZ-652 (PAZ-672)

    14+4
    16
    80
    400

    Bus RAF-997D (RAF-982)

    4+2
    11
    110
    330

    Bus LIAZ-677

    24+5
    25
    70
    550

    Cargo A/M

    GAZ-53


    6+9
    18
    80
    300

    Cargo A/M

    GAZ-66


    6+9
    18
    80
    300

    Cargo A/M

    ZIL-130


    6
    21
    90
    445

    Continuation of table number 10


    Car brand (Car - A / M)

    Number of seats

    Maksim. movement speed, km/h

    Fuel range, km

    on a stretcher + sitting

    just sitting

    Cargo A/M

    ZIL-131


    6
    21
    80
    645

    Cargo A/M

    Ural-375D


    6
    21
    75
    480

    Cargo A/M

    Kamaz-5320


    6
    21
    75
    480

    If air transport is used for evacuation, then 75-90% of the affected can be evacuated in 1-2 days (Table 11). At the same time, the evacuation of those affected by air transport to postoperative period has its contraindications.

    These include:


    • ongoing internal or uncontrolled external bleeding;

    • unrepaired severe blood loss;

    • severe disorders of the cardiovascular and respiratory systems requiring intensive care;

    • shock II-III degree;

    • undrained closed or valvular pneumothorax;

    • severe intestinal paresis after laparotomy;

    • septic shock;

    • fat embolism.

    Table No. 11

    Aircraft evacuation capabilities


    aircraft type

    Apparatus


    Number of seats

    With layout option


    conversion time to

    Sanitary option, min


    Loading (unloading) time, min.

    Required quantity

    porters

    For loading (unloading)


    Stretcher

    Combined

    landing

    on a stretcher

    sitting

    on a stretcher

    sitting

    sitting

    Aircraft Yak-40

    18
    -
    9
    14
    24
    10
    25
    6

    Mi-6 helicopter

    40
    -
    20
    29
    60
    30
    30
    12

    Mi-8 helicopter

    12
    -
    6
    12
    24
    15
    15
    3

    Mi-26 helicopter

    60
    8
    -
    -
    74
    30
    60
    10

    - temporary stop of external bleeding and control of previously applied tourniquets;

    - elimination of asphyxia of all types;

    - the imposition of airtight bandages with open pneumothorax;

    - the introduction of painkillers and the implementation of novocaine blockades in shock;

    -catheterization or puncture of the bladder with urinary retention;

    - cutting off a limb hanging on a flap;

    - elimination of shortcomings of transport immobilization in case of a threat of shock development or in case of already developed shock;

    -administration of antibiotics subcutaneously or orally;

    -special measures for combined radiation and chemical damage.

    2. Measures of first medical aid, the implementation of which may be involuntarily postponed:

    - elimination of shortcomings of transport immobilization that do not threaten the development of shock;

    - novocaineblockade in case of damage to the limbs without pronounced shock phenomena;

    - the introduction of antibiotics into the circumference of the wound.

    The first medical aid of the full volume includes all the activities of both groups. The volume of medical care is reduced by partial or complete rejection of the activities of the 2nd group.

    To eliminate asphyxia, it is necessary to clean the upper respiratory tract with a swab. Atsinkingtongue behind the root of the tongue, an air duct should be inserted(S-shapedtube) or flash the tongue with a ligature and fix it to the chin.Tracheostomyshown only with swelling of the glottis andsubglotticspaces. In such a situation, it is easier and faster to performcricoconicotomy.

    Suitable for external bleedingligationbleeding vessel orclamping hemostatic forceps in the wound. If this fails, then you have to resort to a temporary stop of bleeding, including re-application of the tourniquet.

    External bleeding in wounds of the chest, pelvis and buttocks is stopped with the help of tamponade. To do this, the edges of the wound are moved apart with hooks and wide gauze swabs are inserted into the depth of the wound to the source of bleeding. Tampons in the wound are strengthened both by circular tours of the bandage, and with the help of sutures tightening the edges of the wound over the tampons, capturing large areas of intact tissues.

    Measures to remove the wounded from traumatic shock include:

    - novocaine blockade for bone fractures, extensive burns and soft tissue injuries;

    - introductionanalgesics;

    - transfusion of blood and blood substitutes;

    - elimination of acute respiratory failure, oxygen inhalation;

    - transport immobilization.

    Open pneumothorax must be closedocclusalbandage or bandage with vaseline according to the method of S.I.Banaitis.With tension pneumothorax in the secondintercostal spaceinsert a thick needleDufo),which is fixed to the chest wall. Preferred executionthoracentesisin the second intercostal spacemid-clavicular lines with the introduction into the pleural cavity through the trocar of the drainage tube. A valve from the finger of a rubber glove is mounted to the outer end of the tube.

    Injured with acute urinary retention, it is necessary to empty the bladder with a catheter. If the urethra is damaged, the bladder is emptied by suprapubic puncture.

    When working in a dressing room, a sterile gown is required only for a nurse working at sterile tables. Medical staff wear clean gowns, caps, masks and sterile rubber gloves.

    In the omedra, the volume of first medical aid can be expanded by the followingandmeroPriyatiyami:

    Elimination of asphyxia through tracheal intubation followed by artificial lung ventilation;

    - subcutaneousstitchingneurovascular bundle on the thigh;

    - catheterization of the central and main veins;

    - trocarepicystostomy;

    - complexantishockactivities withinfusion-transfusion

    therapy (into the central veins).

    With the action of the brigade in isolation from the main forces and the absence of evacuation inomedrit is possible to perform qualified surgical care for urgent indications.

    Skilled surgical care is provided by general surgeons andanesthesiologists-resuscitatorsin advanced field medical institutions (omedr,omedb,PPG).

    The main content of qualified surgical care is- elimination of the consequences of injuries that pose a threat to the life of the wounded, the prevention of complications and preparation for further evacuation.

    Depending on the specific working conditions, the combat and medical situation (massive influx of the wounded, the need for emergency redeployment), it is possible to change the volume of surgical care. In this regard, the measures of qualified surgical care are divided into 3 groups according to urgency.

    The 1st group consistsurgent measures for injuries that pose a real threat to the life of the wounded. Failure to perform these measures leads to death or the development of extremely serious complications.

    The urgent measures of qualified surgical care include:

    - elimination of asphyxia of all types and provision of adequate ventilation of the lungs;

    - final stop of outer and inner bloodaboutflows of any localization;

    - complex therapy of severe shock, acuteblood losstraumatic toxicosis;

    - decompressivetrepanation of the skull in case of its damage with signscompressionbrain;

    - operations(thoracocentesis,thoracotomy)with chest injury with open and intense pneumothorax, heart injury,suturingopen pneumothorax;

    - operations in case of injury of the main vessels: ligation, temporaryshuntingor (under appropriate conditions) the seam of the vessel;

    - laparotomywith penetrating wounds and closed injuries of the abdomen,intraperitonealruptures of the bladder and rectum;

    - amputation with detachments and destruction of limbs;

    - operations for anaerobic infections;

    - necrotomy with deep circular burns of the chest, neck and limbs, accompanied by respiratory and circulatory disorders.

    Ko 2 and group fromnosIthere are activities that can be delayedheno- them inypolnI"aboutt dlI prevent serious complications, create favorableIconditions forthe fastesthealing the wounded and returning to duty, andpyuizhennychlhaholding inevitably leads to serious complications. forcedabouttsrochethese activities include

    ~ amputeeationtowith "Chechno"Withyou atischemicnecrosisinconsequence of injuryistralb"sx coWithudov; primary surgeryGandh severe treatment of wounds with significant destruction of soft tissues, long bones, great vessels, as well as wounds contaminated with toxic and radioactive substances;

    - imposition of suprapubic fistula in case of damageextraperitonealdepartment of the bladder and urethra;

    -- overlaycolossomasatextraperitonealrectal injuries.

    The activities included in the first 2 groups constitute a reduced volume of qualified surgical care.

    The 3rd group includes delayed events. They include surgical interventions, which may be delayed, although to threatens the development of a number of complications. The risk of their occurrence and spread can be reduced byathe earliest possible use of antibiotics (if possibleintravenio).

    Delayed interventions for skilled surgical care include:

    - primary surgical treatment of soft tissue wounds;

    -necrotomy with deep circular burns of the neck, chest and limbs that do not cause respiratory and circulatory disorders;

    ~ primary arrabotka(tuglet)heavily pollutedburnwounds;

    - treatment of facial woundsaatpatchworkwounds with lamellar sutures;

    - leagueturn binding of teeth in fractures of the lower jaw.

    Care of the wounded is carried out in the anesthesiology and intensive care unit, which is deployedt intensive care units, as well as in the hospital department. In the process of admission and placement of the wounded in the intensive care unit anesthesiology Mr. resuscitatorfirst of all, it identifies those in need of emergency resuscitation and operational assistance and takes measures toee rendering.T the severity of the condition of the wounded in the process of removing from shock, the moment of the start of the operation and its sequence is determined by the surgeon together with anesthesiologist-resuscitator.Emergency operations performed with symptoms of traumatic shock, massiveblood lossshould be accompanied by the forced use of the appropriate complexantishock measures. After the operation, the wounded, depending on the severity of the condition, are sent to intensive care units or andin the respective wards of the hospital department.

    As a rule, qualified surgical care must be provided in full.ewith surgical interventions inWithex 3 groups thatrealityin conditionsmactleniyaa littlethe number of wounded (200 people persugki).On theabbreviatedvolume surgical care is transferred when the stage is overloaded (300 wounded per day), and to the minimum, which includes the execution of only nurgent measures, - in case of mass admissionnand the wounded (more than 400 people per day).

    Delay in the provision of surgical care is possible after a comprehensive assessment of the nature of the injury, general condition the wounded, the possibility of prompt evacuation to the stage of specialized care, the likelihood of severe complications.

    Specialized surgical care is provided in medical institutionsGBF.

    The organization of work and the profile of hospitals or departments, the volume of qualified and specialized care in them, as well as the terms of treatment of the wounded in the GBF are determined by specific conditions, the size and structure of sanitary losses, and the operational situation.

    In GBF, usually formedSVPSHGthe following types:VPSG;VPMG;VPGLR;

    neurosurgical SVPCHG;thoracoabdominalSVPSHG; traumatological SVPCHG; SVPKhG for burnt.

    To strengthen the SVPKhG when they are reloaded or when victims are admitted to the HBF from the source of mass losses that arose in the front rear area, the HBF contains OSMP. The detachment includes specialist doctors for the specialization of general surgical hospitals in 5 profiles: 1) a group for the treatment of wounded in the head, neck and spine (2 neurosurgeons, a neuropathologist, ENT specialist,ophthalmologist andstamatologist);2) a group for the treatment of those wounded in the chest, abdomen, pelvis (abdominal surgeon,thoracicsurgeon, urologist and obstetrician-gynecologist); 3)orthopedic-traumatologicalgroup (2 orthopedic traumatologists);

    MINISTRY OF HEALTH AND SOCIAL DEVELOPMENT OF THE RUSSIAN FEDERATION

    ORDER

    On approval of the list of conditions under which first aid is provided, and the list of first aid measures


    Document as amended by:
    (Russian newspaper, N 303, December 31, 2012).
    ____________________________________________________________________

    In accordance with Article 31 of the Federal Law of November 21, 2011 N 323-FZ "On the basics of protecting the health of citizens in the Russian Federation" (Collection of Legislation Russian Federation, 2011, N 48, item 6724)

    I order:

    1. Approve:

    a list of conditions under which first aid is provided, in accordance with Appendix N 1;

    list of first aid measures in accordance with Appendix No. 2.

    2. Recognize invalid the order of the Ministry of Health and Social Development of the Russian Federation dated May 17, 2010 N 353n "On First Aid" (registered by the Ministry of Justice of the Russian Federation on July 12, 2010 N 17768).

    Minister
    T. Golikova

    Registered
    at the Ministry of Justice
    Russian Federation
    May 16, 2012
    registration N 24183

    Appendix N 1. List of conditions under which first aid is provided

    Appendix No. 1

    ________________
    * In accordance with Part 1 of Article 31 of the Federal Law of November 21, 2011 N 323-FZ "On the Fundamentals of Protecting the Health of Citizens in the Russian Federation" (Sobraniye Zakonodatelstva Rossiyskoy Federatsii, 2011, N 48, Art. 6724) (hereinafter referred to as the Federal Law of November 21, 2011 N 323-FZ), first aid before medical assistance is provided to citizens in case of accidents, injuries, poisoning and other conditions and diseases that threaten their life and health, by persons who are obliged to provide first aid in accordance with federal law or with a special rule and having appropriate training, including employees of the internal affairs bodies of the Russian Federation, employees, military personnel and employees of the State Fire Service, rescuers of emergency rescue units and emergency rescue services. In accordance with Part 4 of Article 31 of the Federal Law of November 21, 2011 N 323-FZ, drivers of vehicles and other persons have the right to provide first aid if they have the appropriate training and (or) skills.

    1. Absence of consciousness.

    2. Stopping breathing and circulation.

    3. External bleeding.

    4. Foreign bodies upper respiratory tract.

    5. Injuries various areas body.

    6. Burns, exposure effects high temperatures, thermal radiation.

    7. Frostbite and other effects of exposure to low temperatures.

    8. Poisoning.

    Appendix N 2. List of first aid measures

    Appendix No. 2

    1. Measures to assess the situation and ensure safe conditions for first aid:

    1) identification of threatening factors for one's own life and health;

    2) determination of threatening factors for the life and health of the victim;

    3) elimination of threatening factors for life and health;

    4) termination of the effect of damaging factors on the victim;

    5) assessment of the number of victims;

    6) removal of the victim from the vehicle or other hard-to-reach places;

    7) movement of the victim.

    2. Calling an ambulance, other special services, whose employees are required to provide first aid in accordance with federal law or with a special rule.

    3. Determination of the presence of consciousness in the victim.

    4. Measures to restore the patency of the respiratory tract and determine the signs of life in the victim:

    2) promotion mandible;

    3) determining the presence of breathing with the help of hearing, sight and touch;

    4) determination of the presence of blood circulation, checking the pulse on the main arteries.

    5. Events for holding cardiopulmonary resuscitation before the appearance of signs of life:

    1) pressure with hands on the chest of the victim;

    2) artificial respiration "Mouth to mouth";

    3) artificial respiration "Mouth to nose";

    4) artificial respiration using an artificial respiration device*.
    ________________

    by order of the Ministry of Health of Russia dated November 7, 2012 N 586n.

    6. Measures to maintain airway patency:

    1) giving a stable lateral position;

    3) extension of the lower jaw.

    7. Measures for a general examination of the victim and a temporary stop of external bleeding:

    1) general examination of the victim for the presence of bleeding;

    2) digital pressure of the artery;

    3) application of a tourniquet;

    4) maximum flexion of the limb in the joint;

    5) direct pressure on the wound;

    6) applying a pressure bandage.

    8. Measures for a detailed examination of the victim in order to identify signs of injuries, poisoning and other conditions that threaten his life and health, and to provide first aid in case of detection of these conditions:

    1) examination of the head;

    2) examination of the neck;

    3) conducting a breast examination;

    4) examination of the back;

    5) examination of the abdomen and pelvis;

    6) examination of the limbs;

    7) application of dressings for injuries of various areas of the body, including occlusive (sealing) in case of injury chest;

    8) immobilization (using improvised means, auto-immobilization, using products medical purpose*);
    ________________
    * In accordance with approved packaging requirements medical devices first aid kits (packages, kits, kits) for first aid.
    (Footnote in the wording put into effect on January 11, 2013 by order of the Ministry of Health of Russia dated November 7, 2012 N 586n.

    9) fixation cervical spine (manually, with improvised means, using medical devices*);
    ________________
    * In accordance with the approved requirements for completing first-aid kits (packages, kits, kits) with medical products.
    (Footnote in the wording put into effect on January 11, 2013 by order of the Ministry of Health of Russia dated November 7, 2012 N 586n.

    10) termination of exposure to hazardous chemicals on the victim (gastric lavage by taking water and inducing vomiting, removal from the damaged surface and washing the damaged surface with running water);

    11) local cooling for injuries, thermal burns and other exposure to high temperatures or thermal radiation;

    12) thermal insulation during frostbite and other effects of exposure to low temperatures.

    9. Giving the victim an optimal body position.

    10. Monitoring the state of the victim (consciousness, breathing, blood circulation) and providing psychological support.

    11. Transfer of the victim to the ambulance team, other special services, whose employees are required to provide first aid in accordance with federal law or with a special rule.



    Revision of the document, taking into account
    changes and additions prepared
    JSC "Kodeks"

    HIGHER PROFESSIONAL EDUCATION

    "KRASNOYARSK STATE MEDICAL UNIVERSITY"

    NAMED AFTER PROFESSOR V.F. VOYNO-YASENETSKY"

    MINISTRIES OF HEALTH AND SOCIAL DEVELOPMENT

    RUSSIAN FEDERATION

    COLLEGE OF PHARMACEUTICS

    Specialty Pharmacy

    Qualification Pharmacist

    TO THEORETICAL LESSONS

    Approved at the CMC meeting

    Protocol number …………….

    "___" ____________ 2012

    Chairman of the CMC "General professional disciplines"

    ………… Donguzova E.E.

    Compiled by:

    ………… Shumkova V.A.

    Krasnoyarsk

    Lecture #1

    Topic “The concept of first aid.

    Aseptic and antiseptic.

    1. General concepts about first aid. Types of first aid.

    2. Activities that include first aid

    3. General principles first aid.

    4. Identification of signs of life and signs of death.

    5. Basic concepts of asepsis and antisepsis.

    6. Chemical antiseptics. biological antiseptics.

    7. Sterilization.

    General concepts of first aid.

    Types of first aid.

    First aid- a complex of emergency medical measures taken by a suddenly ill or injured person at the scene of the incident and during the period of his delivery to a medical facility.

    The main purpose of first aid: providing assistance to a person until qualified assistance arrives.

    There are the following types of first aid:

    1) first medical unskilled assistance (it is carried out by a non-medical worker, often without the necessary funds and medicines);

    2) the first qualified medical (pre-medical) care provided by a medical worker (not a doctor);

    3) first medical aid, which is provided by a doctor who has at his disposal the necessary medicines and instruments.

    Activities that include first aid.

    First medical (pre-medical) aid includes 3 groups of events:

    1) immediate cessation of exposure to external damaging factors and its removal from the adverse conditions in which it fell (extraction from water, removal from a gassed room, etc.).

    2) Providing first aid to the victim, depending on the nature and type of injury, accident or sudden illness.

    3) Calling medical specialists and organizing the speedy delivery (transportation) of a sick or injured person to medical institution.

    The activities of the first group are first aid in general. It is often provided in the order of mutual and self-help.

    The second group of activities is medical care. It can be provided by medical workers or persons who have studied the main signs of damage and special first aid techniques.

    The fastest delivery of the victim to a medical institution is of great importance. The sick or injured person should be transported quickly and correctly, i.e. in the position most safe for him, in accordance with the nature of the disease or the type of injury.

    Measures (volume) of first aid also include: inspection of the scene, evacuation from danger zone, temporary stop of bleeding, prevention and control of shock, resuscitation, application of a sterile dressing on the wound, transport immobilization, etc.

    First aid- a set of urgent, simple measures aimed at restoring or preserving the life and health of the victim, performed at the site of the lesion, mainly in the order of self-help and mutual assistance, as well as by members of emergency rescue teams using service and improvised means.

    The list of conditions and measures for providing first aid was approved by order of the Ministry of Health and Social Development of the Russian Federation dated May 4, 2012 No. 477n (as amended on November 7, 2012) “On approval of the list of conditions under which first aid is provided, and the list of measures for first aid”.

    Status List

    1. Absence of consciousness.

    2. Stopping breathing and circulation.

    3. External bleeding.

    4. Foreign bodies of the upper respiratory tract.

    5. Injuries to various areas of the body.

    6. Burns, effects of exposure to high temperatures, thermal radiation.

    7. Frostbite and other effects of exposure to low temperatures.

    8. Poisoning.

    First aid measures include:

    1. Measures to assess the situation and ensure a safe environment for first aid:

    Identification of threatening factors for one's own life and health;

    Determination of threatening factors for the life and health of the victim;

    Elimination of threatening factors for life and health;

    Termination of the effect of damaging factors on the victim;

    Estimation of the number of victims;

    Extraction of the victim from the vehicle or other hard-to-reach places;

    Movement of the victim.

    2. Calling an ambulance, other special services, whose employees are required to provide first aid in accordance with federal law or with a special rule.

    3. Determination of the presence of consciousness in the victim.

    4. Measures to restore the patency of the respiratory tract and determine the signs of life in the victim:

    Promotion of the lower jaw;

    Determination of the presence of breathing with the help of hearing, sight and touch;

    Determining the presence of blood circulation, checking the pulse on the main arteries.

    5. Measures to conduct cardiopulmonary resuscitation before the appearance of signs of life:

    Hand pressure on the chest of the victim;

    Artificial respiration"from mouth to mouth";

    Artificial respiration "from mouth to nose";

    Artificial respiration using a device for artificial respiration.

    6. Measures to maintain airway patency:

    Giving a stable lateral position;

    Head tilt with chin lift;

    Protrusion of the lower jaw.

    7. Measures for a general examination of the victim and a temporary stop of external bleeding:

    General examination of the victim for the presence of bleeding;

    Finger pressing of the artery;

    tourniquet;

    Maximum flexion of the limb in the joint;

    Direct pressure on the wound;

    Applying a pressure bandage.

    8. Measures for a detailed examination of the victim in order to identify signs of injuries, poisoning and other conditions that threaten his life and health, and to provide first aid in case of detection of these conditions:

    Carrying out a head examination;

    Examination of the neck;

    Carrying out a breast examination;

    Performing a back examination

    Examination of the abdomen and pelvis;

    Examination of limbs;

    Applying dressings for injuries of various areas of the body, including occlusive (sealing) for chest wounds;

    Carrying out immobilization (using improvised means, auto-immobilization, using medical products);

    Fixation of the cervical spine (manually, with improvised means, using medical products);

    Termination of exposure to hazardous chemicals on the victim (gastric lavage by taking water and inducing vomiting, removal from the damaged surface and washing the damaged surface with running water);

    Local cooling in case of injuries, thermal burns and other effects of high temperatures or thermal radiation;

    Thermal insulation against frostbite and other effects of exposure to low temperatures.

    9. Giving the victim an optimal body position.

    10. Monitoring the state of the victim (consciousness, breathing, blood circulation) and providing psychological support.

    11. Transfer of the victim to the ambulance team, other special services, whose employees are required to provide first aid in accordance with federal law or with a special rule.

    One of essential conditions first aid the victim is its urgency: the faster it is provided, the greater the hope for a favorable outcome. Therefore, such assistance can and should be provided in a timely manner by those who are close to the victim.

    The first aid provider should know:

    The main signs of violation of vital important functions the human body;

    General principles, rules and techniques of first aid in relation to the nature of the damage;

    The main methods of carrying and evacuating victims.

    Signs by which you can quickly determine the condition of the victim are as follows:

    Consciousness: clear, absent or disturbed;

    Respiration: normal, absent or disturbed;

    Pulse on carotid arteries: determined (rhythm correct or incorrect) or not determined;

    Pupils: narrow or wide.

    With certain knowledge and skills, the first aid provider is able to quickly assess the condition of the victim and decide how much and how to provide assistance to him.

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