LESSON 4. “ORGANIZATION OF PROVIDING MEDICAL CARE TO AFFECTED DURING EMERGENCY SITUATIONS ON VEHICLES.

1. Organization of medical care for victims of road accidents. (brought to lectures)

Conditions for timely and high-quality assistance in case of an accident:

1. accurate and timely information about the nature of the incident, the number of victims;

2. quick removal of victims from damaged vehicles by rescuers equipped with appropriate technical means;

3. provision of emergency medical care at the scene and immediate evacuation of victims to medical institutions by air or automobile ambulance transport;

4. providing radio communication between the medical worker of the helicopter and the head of rescue operations and the emergency department of the medical hospital receiving the victim.

5. early identification of medical institutions that carry out hospitalization of victims of road accidents;

6. equipment of helipads at medical institutions receiving victims;

The organization of the provision of emergency medical care to victims of road accidents is based on the principle of forming areas of responsibility of healthcare facilities within municipalities.

The area of responsibility of the health facility is a section of the road assigned to the health facility for medical support of victims of an accident.

The area of responsibility is characterized by the length of the road section, the location and profile of medical institutions located on the road section or not far from it.

The basic principles for the formation of areas of responsibility of health care facilities are as follows.

– Personal responsibility of persons involved in the organization of the provision of effective and timely medical care to victims of road accidents.

– Using the health potential of the municipal level. If necessary, the forces and means of regional health care institutions, health care facilities of neighboring districts can be involved in the provision of medical care to victims of road accidents.

– Obligation and availability of medical care for all victims of road accidents in emergency conditions. At the same time, the area of responsibility of the health care facility may go beyond the administrative boundaries of the district on whose territory the health care facility is located.

– Constant readiness of all healthcare structures of the municipality to provide medical care to victims of road accidents.

– Efficient provision of emergency medical care to victims of an accident due to the timely (no more than 40 minutes after receiving information about the accident) arrival of the ambulance crew to the accident site.

– The length of the evacuation route from the accident site to the health facility should guarantee the timely arrival of the ambulance crew to the accident site.

If the health facility is located on the federal road itself or near it, and also if the road has several traffic lanes and high-quality road surface, the length of the zone in one direction (to the border with another zone) can be 40-45 km, and the total length of the zone – 80 – 90 km. However, with low operational and technical characteristics of the road, the presence of steep or prolonged ascents and descents, sharp turns, places of avalanche and mudflow formation, large sections of narrowing, the length of the LPU responsibility area should not exceed 20-25 km in one direction.

If the evacuation shoulder exceeds the recommended distance or time criterion in the area of responsibility, it is advisable:

– to create (at the expense of TTsMK, LPU) on emergency-dangerous and remote sections of highways route points;

– transfer part of the functions of providing medical care to victims of road accidents to district, city and village hospitals, medical outpatient clinics, reinforcing them with medical personnel, ambulance vehicles, modern resuscitation equipment and means of communication.

The healthcare facility responsible for providing medical care in case of an accident should have a bed fund, it should have all specialists in providing qualified medical care to victims of an accident (surgeons, traumatologists, anesthesiologists, resuscitators, radiologists and X-ray laboratory assistants, clinical laboratory assistants, anesthetists, etc. .).

Special requirements should be imposed on the stations (departments) of the EMS, which must be staffed by experienced medical specialists, equipped with ambulance vehicles, modern equipment, including resuscitation, communications, etc.

The number of teams in health care facilities depends on the status of the institution and the tasks it solves. In the emergency department as part of the Central District Hospital, it is advisable to have at least 3-5 ambulance brigades, including 2-3 brigades on round-the-clock duty.

The medical institution should be equipped with means of communication for the timely call, if necessary, of additional QMS teams from municipal, regional and departmental health facilities.

On sections of roads passing through a deserted and sparsely populated area, it is advisable to use air ambulance to provide medical care to victims of an accident, helipads should be equipped to ensure the arrival of the QMS teams to the accident site and the evacuation of victims to medical facilities.

2. Organization of medical care for victims of emergency situations on vehicles. (brought to lectures)

In case of major emergencies on vehicles, the health management authority and the disaster medicine center of the given territory creates an operational group to organize medical and sanitary support, which immediately leaves for the emergency zone and performs the following tasks:

– evaluates the medical and tactical situation,

– organizes a meeting of the arriving medical forces and means, sets them specific tasks and manages the work,

– determines the places of collection points for the affected,

– determines the deployment sites (if necessary) of mobile medical teams;

– determines the procedure for providing medical assistance during emergency rescue operations;

– determines the need for vehicles,

– determines the ways of access to the points of collection of the affected and the ways of their evacuation to hospitals.

First aid is provided at the site of the defeat in the order of self-help and mutual assistance, and upon the arrival of rescue units – by their employees using standard equipment. It consists in removing the injured from the vehicles that have crashed, placing them as far as possible from the vehicle engulfed in flames or the source of ignition on it, and providing the necessary first aid measures.

Upon the arrival of ambulance teams, medical teams, emergency medical care and primary health care (first aid) are provided. From the place of defeat (collection points), the affected are evacuated to the nearest medical institutions with the provision of medical care during the evacuation.

The head of the liquidation of the medical and sanitary consequences of an emergency should determine the directions for the evacuation of various groups of the affected (to which institutions, how many and which victims should be sent); he is obliged to bring the relevant information to the personnel of the medical units carrying out the evacuation.

With a large distance of local medical institutions from the emergency area in the emergency zone, stages of medical evacuation are deployed to provide first medical or qualified medical care.

In case of transport accidents on the railway, aviation accidents and on the water, medical assistance is also provided by regular medical forces and facilities that are part of the organizational structure of the relevant ministries and departments.

In the event of an emergency on the railway, information with medical information is brought to the chief (duty) doctor of the railway hospital at the parking lot of the emergency recovery train and to the head of the medical railway.

An ambulance wagon with appropriate equipment, equipment and a medical emergency team capable of providing qualified medical care should go to the scene of the accident as part of the emergency recovery train.

To carry out measures to save the lives of passengers and crew members in case of aviation accidents in civil aviation, special units have been created: search and rescue service and emergency rescue teams.

The airport emergency rescue team is formed from employees of the aviation technical base, medical unit and airport security.

The tasks of this team are:

1. rescue of passengers and crew of an aircraft in case of an aviation accident,

2. provision of medical care,

3. fire suppression.

The rescue team includes a medical team, whose tasks include providing first aid to victims at the scene of an aviation accident and preparing for evacuation, and if it is delayed, taking measures to protect victims from the adverse effects of the external environment.

First aid is provided at the airport medical center and by ambulance teams (on the spot and on the way to the hospital).

Often, air crashes do not occur in the airport area, which makes it necessary to organize and promptly search for an aircraft.

Search and rescue operations are carried out with the involvement of aircraft and helicopters equipped with search equipment and rescue equipment, as well as ground vehicles with off-road capability and rescue boats.

When an aircraft is detected, its coordinates are determined, the state of people’s health and the amount of necessary assistance are specified. The possibility of landing and the routes of extension to the location of the aircraft of ground vehicles are determined. If it is impossible to land search aircraft, then the search and rescue team and the equipment necessary for work will land on the crash site, immediately begin to evacuate and move the passengers of the aircraft in distress to a safe distance.

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