Question 2. Organization of the work of medical units of the emergency medical service in emergencies (additional units)

Medical and nursing formations
The possibilities of emergency medical care in large foci are limited and quickly dry up, and therefore, it is possible to strengthen ambulance stations by creating primary highly mobile emergency medical teams (medical and nursing teams). Medical and nursing teams are created on the basis of medical institutions : hospitals, medical units, clinics, dispensaries, sanatoriums. The main purpose of these brigades in emergency situations is to strengthen the ambulance brigades in the disaster area in order to provide timely and effective first aid to the victims and conduct medical evacuation as directed. The team consists of : a doctor, 2 nurses and 2 orderlies. For 6 hours of work in the center of the disaster, they must provide EMF to 50 victims.
In emergency situations, the use and efficient work of medical and nursing teams (MSB) significantly affects the efficiency of providing timely emergency medical care to a large number of victims. Teams are formed by healthcare facilities in accordance with the plan-task of the committee (management) for healthcare, from among full-time employees. It is expedient for chief physicians, before signing the order on the creation of the WSB, to select personnel, guided by the principles of coherence, collectivism and compatibility of the formation being created.
Nurses in emergency situations fully share with doctors the difficulties of field work, responsibility for the lives of the victims. There is also an additional burden on their shoulders. They quickly prepare packing, tools, prepare the operating room and dressing room for work, and maintain medical records. All this must be done clearly and professionally, despite physical fatigue, intense work schedule, and unusual situation. In addition, nurses still have time to cheer up the victims, arrange temporary housing, cook food and find kind words for both patients and exhausted colleagues.

The Republican Center for Emergency Medical Care is designed to provide qualified and specialized medical care to the mass flow of the injured, as well as to carry out organizational, methodological, advisory and scientific work, and train personnel in regional centers.
Similar centers are being created in regional centers on the basis of regional hospitals or emergency hospitals. They are branches of the Republican Center, maintain constant contact with it and carry out its orders on special issues.
Each emergency medical center has its own clinical base.

Specialized medical brigades of permanent readiness (SMB PG) are formed on the basis of republican, regional, city diversified or specialized medical institutions, as well as clinics and specialized centers. They are intended to strengthen medical institutions that provide qualified medical care to victims outside the disaster zone.
SEMP forms the following PMS PG: traumatological, burn, neurosurgical, general surgical, anesthesiology and resuscitation, toxic and therapeutic, psychiatric, etc. provision of qualified medical care. The team consists of 2-5 doctors, 2-6 nurses.
SMB PG are designed for:
1) organization and provision of emergency specialized inpatient medical care to the population and their treatment in extreme conditions of peacetime and wartime.
2) providing advisory and methodological assistance to specialists from other departments on the tactics of treating victims with the corresponding pathology.

Sanitary and epidemiological institutions are included in the emergency medical service.
To carry out sanitary-hygienic and anti-epidemic measures in the disaster area, the following are being created:
Epidemiological reconnaissance groups consisting of 2 people (paramedic epidemiologist, driver – orderly).

Sanitary-epidemiological detachments (SEO) are designed to organize and carry out activities for sanitary-hygienic and anti-epidemic support of the population in emergency situations. They are created on the basis of regional, city and district centers of hygiene and epidemiology and represent a means of strengthening the local grass-roots structures of the sanitary service. The structure includes management, anti-epidemic, sanitary-toxicological, radiological, disinfection specialized teams. The number of the detachment is 42 people (doctors – 12, assistants to sanitary doctors – 3, laboratory assistants – 6, disinfectants – 6, orderlies – 3, others – 12).

Republican Sanitary and Preventive Brigade on the basis of the Republican Center for Hygiene and Epidemiology. The brigade carries out operational activities in institutions in order to maintain the working capacity of the population in the emergency area, preserve its health and ensure sanitary well-being. The turnaround time for the brigade is 3 hours.

Republican operational anti-epidemic brigade , created on the basis of the Republican Center for Hygiene and Epidemiology, which is designed to quickly study and assess the epidemic situation, organize and provide anti-epidemic measures in the focus of a disaster or disaster. The turnaround time for the brigade is 2 hours.

Additional medical formations:
Groups of specialized medical care have been created on the basis of military hospitals to strengthen medical institutions. They provide qualified and specialized medical care (20 people in 12 hours).

Rescue teams are formed on the basis of individual military units and formations. They are designed for rescue work in the outbreak, in 6 hours they can provide first aid to about 500 victims.

Fire and emergency recovery trains are formed by the Belarusian Railway in order to eliminate the consequences of railway accidents. There are 23 fire and 14 emergency recovery trains in the Republic of Belarus.

Specialized detachments of paramilitary fire protection (Republican specialized detachment of paramilitary fire protection of the Ministry of Emergency Situations of the Republic of Belarus, etc.) form the Ministry of Emergency Situations to work in the focus of an emergency. They carry out first-priority emergency and fire-rescue work.

Specialized formations of potentially hazardous facilities of the national economy of various ministries and departments (gas rescue squads of chemically hazardous facilities, mine rescue squad of Belaruskali, etc.) are also designed to carry out work to eliminate the consequences of emergencies of various nature within their facility, and, if necessary, on other objects.

Special medical units that are planned to be deployed in the healthcare system in wartime in accordance with the mobilization task include civil defense medical units (MO), multidisciplinary hospitals, specialized beds for the Ministry of Defense, and sanitary and epidemiological units.

Thus, the work of medical personnel in emergency situations has its own medical, organizational, legal, ethical, psychological features, the knowledge of which can ensure the efficiency of work and save the maximum number of lives.

Question 3. Organization of work of health organizations in case of an emergency

The work of a medical and preventive institution in emergency situations is organized in accordance with the plan of the CoES (Emergency Commission) of the facility . Its success depends on the completeness of the list of activities developed in the plan for this period and its implementation in accordance with the calendar plan. The work of the institution is organized in a certain sequence:
In the event of a threat or emerging natural disaster or technological disaster, a plan is put in place to notify management, hospital staff and patients about the disaster . Higher health and civil defense authorities are notified. The work of the headquarters of the civil defense facility is being organized. Specific tasks are assigned to subordinates.

The brigade of emergency specialized medical care and other formations (recruitment of personnel, receipt of medical equipment, etc.) are put on alert.

An observation post for radiation and chemical reconnaissance is being set up.

Organized reconnaissance and surveillance at the facility.

Alert signals (sound, light, etc.) are set.

A picket line is installed outdoors and indoors indicating the direction of the flow of movement of the affected .

The means of individual and collective protection of the personnel and patients of the hospital are brought to readiness and measures are taken to accumulate them. The protective properties of hospital buildings (windows, doors, etc.) are increasing.

Lists of patients who can be discharged for outpatient treatment are being specified. Measures are being taken to increase the hospital’s bed capacity for the affected, not only due to discharged patients, but also the use of additional space for internships, corridors, etc. It is undesirable to plan the joint placement of inpatients, especially purulent departments, with those coming from the disaster zone.

Measures are being taken to prepare all the main medical departments and, in particular, the admissions department to receive a mass influx of victims. Increasing the number of reception staff.

They check the availability and knowledge of the instructions for receiving and sorting the possible profile of the affected, the availability of a reserve of emergency medical care in case of mechanical, burn, radiation injury and damage to hazardous chemicals, the readiness of the sanitary checkpoint to carry out partial and complete sanitization, the availability of an exchange fund of stretchers and linen .
To carry out sorting, sorting teams are created not only from the medical staff of the reception, but also from other departments. Brigades are being trained to receive and sort the injured. The procedure for communication with medical departments and the delivery of victims to them is being established.
The ability of employees to use a dosimeter and other equipment, sorting and registration documents is checked when receiving the injured.
If there is not enough stretcher to accommodate the affected, bedding material is prepared (mattresses, straw, hay, covering them with linen and other material).

The hospital must be ready to receive and provide emergency care to any profile of the affected, with subsequent re-profiling according to the main profile for it . And with the strengthening of its brigades of specialized medical care, the list of specialized medical departments is expanding.
In the surgical dressing department, in the intensive care unit and intensive care, measures are being taken to increase the bed capacity and their throughput. An additional number of operating dressing tables, tripods and other devices for fixing infusion equipment, oxygen equipment, etc. are being installed.

Stocks of medicines and other means of providing medical care are being created.

A round-the-clock duty of medical personnel is established. If possible, pensioners, senior students of medical schools are involved in the work. The replacement of medical personnel, departing as part of the formations of the emergency medical service in emergency situations, is being carried out.

The presence of emergency lighting and water supply is checked.

A supply of food, bedding is being created.

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