Fundamentals of Medical Aid
in Civil Defense
Lesson 5. Provision of medical-evacuation
measures of those affected by
emergencies
Kanan Yusif-zada, MD, PhD, MBA
Content
Medical-evacuation measures: concept and essence.
2 Basic sorting features
Types of medical care (identification, place of performance,
optimal timeliness to render its various types,
attracted forces and means)
Types and volume of medical assistance
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Medical-evacuation measures: concept and essence.
Medical evacuation removal (withdrawal) of
those affected from the lesion site, and their transportation
until the stages of medical evacuation for timely medical
treatment.
Medical evacuation is a forced measure, since it is
impossible (there are no conditions) to organize
comprehensive care and treatment in the area of mass
sanitary losses.
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Contraindications for the evacuation of the affected by
all types of vehicles:
Shock of the 2nd-3rd degree;
State after tracheostomy (prior to the establishment of sustainable
external respiration);
Open eye injury with the threat of the loss of membranes, bleeding
or threat thereof, signs of endophthalmitis, sharp intraocular
pressure during the burns of the eyeball;
Severe respiratory failure, pleural empyema and a septic state with
breast wounds;
Irretrievable loss of blood;
Terminal state;
Wounds and injuries of the skull and brain followed by the loss of
corneal and papillary reflexes, brain compression syndrome,
meningoencephalitis, ongoing liquorrhea;
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Contraindications for the evacuation of the affected by
all types of vehicles:
Diffuse peritonitis, intra-abdominal abscesses, acute intestinal
failure, and threat or eventration signs of internal organs;
Suppurative urinary stasis, septic state in case of injuries of
urogenital sphere;
Acute purulent-septic complications of wounds in case of injuries of
long bones, pelvic bones and large joints;
Anaerobic infection and tetanus;
Fat embolism and pulmonary embolism;
Thrombosis of major vessels, state after ligation of external and
common carotid artery (before removal of sutures);
Acute hepatorenal failure;
Combined radiation injuries with the irradiation equal to or above
the dose of 6gr.
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2 Basic sorting features
Medical sorting is a method of distribution of those
affected into groups according to the principle of need in
homogeneous
medical
and
evacuation
activities,
depending on the medical indication and the specific
situation.
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Medical indications
Evacuation
indications
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Danger to others
Therapeutic
indication
Evacuation sign
Those in need of special (sanitary) treatment (partial
or total);
Those subject to temporary isolation (in the infectious
and psycho-neurological medical isolation facilities);
Those that do not need special sanitary treatment
Those in need of emergency medical assistance;
Those who do not need medical assistance
(assistance may be postponed);
Those with traumas incompatible with life and in need
of symptomatic aid to relieve pain.
Those in need of emergency medical assistance;
Those who do not need medical assistance
(assistance may be postponed);
Those with traumas incompatible with life and in need
of symptomatic aid to relieve pain.
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omposition of the sorting team
Sorting of stretchers
Doctor / paramedic 1
a nurse 2
registering clerks 2
Sorting of walking patients
Doctor / paramedic 1
a nurse 1
registering clerks 1
Sorting teams should be provided with appropriate
instruments, devices, fixing means of the sorting
results, i.e. the necessary minimum.
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Methods of sorting
A nurse, a paramedic, a doctor first identifies the
affected (patients) who are dangerous for others.
Afterwards, those affected in need of medical care and
according to the urgency are identified by means of a
brief inspection:
external bleeding,
asphyxia,
convulsive state,
childbirth.
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The priority is given to affected
in need of emergency medical
care.
After selective method the
medical staff moves to a
consistent (conveyer)
examination of the affected,
to prepare for the examination
by a doctor each received.
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Inspection procedure of affected
Sorting team at the same time examining the two affected: a
doctor, a nurse and a registering clerk is with one of the
patients, while a paramedic (a nurse), a nurse and a
registering clerk are with the other one.
Having taken a sorting decision for the first affected person,
doctor moves to the next one and receives information over
the state of the affected person from a paramedic (a nurse)
and if necessary, completes the survey with personal
information.
Having decided over sorting for the second affected person,
the doctor moves to the third one.
A paramedic with a registering clerk examines the forth
patient and fills in the medical documentation.
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Front side
Form 100
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Sorting groups
1st sorting group severely injured people with the lesion
incompatible with life and writhing in agony, are in need of
symptomatic aid; prognosis is unfavorable, they are not subject to
evacuation.
2nd sorting group those who are affected with severe lesion and
in need of emergency medical care; However, the prognosis may be
favorable, the medical care is given to the affected persons falling
under this group in the first place at this stage.
3rd sorting group those who have severe and moderate lesion,
which do not pose an immediate threat to life. They are given
medical care in the second turn, or may be delayed until the
beginning of the next stage.
4th sorting group those who have injuries of moderate severity.
Prognosis is favourable, medical assistance is provided at the next
stage.
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Receiving-sorting department
Those who require urgent medical care they are sent to the
appropriate functional units a dressing ward, operating room,
anaerobic, anti shock and intensive therapy room.
With removed bandage that require sorting are sent to the
dressing room.
Those who require X-Ray to confirm the diagnosis are sent to
the X-Ray Unit.
All other affected persons and patients (including those who
require to be sent in the second turn to the dressing and
operating rooms) are distributed according to the specialized
hospital departments.
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To perform medical sorting in each
stage of medical evacuation,
specifically designed sortingevacuation is deployed.
Their composition includes:
Sorting station;
Sorting platform,
Reception and sorting tent
(tents, wards, units),
Evacuation tent (tents, wards,
units).
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Types of medical care (identification, place of performance, optimal timeliness
to render its various types, attracted forces and means)
First aid is a set of simple medical activities provided on the spot
as a self and mutual aid by the sanitary helpers (in wartime),
personnel of rescue formations, search-and-rescue services (in
peacetime) with the use of basic and available tools.
The optimal term is up to 30 minutes upon the receipt of the
lesion.
The purpose of the first aid is to halt the exposure of the
damaging factor, elimination of the life-threatening events and
prevention of dangerous complications.
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Predoctor care is a paramedical personnel of the deployed
units (usually in peacetime), with the purpose to prevent lifethreatening disorders.
Optimal term is 1-2 hours. Authorized equipment is used for the
predoctor care.
First medical assistance is provided by general practitioners in
the Medical Detachment (MD), Mobile Medical Detachment
(MMD) (in wartime) and by doctors of medical and nursing
teams, working at the assembly point of the affected or deployed
units of the medical assistance (in peacetime), with the
purpose of elimination of the consequences of life-threatening
lesion, prevention of the development of complications (shock,
wound infection), preparations for further evacuation.
The optimal term is 4-6 hours.
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Qualified medical assistance is performed by doctorssurgeons and physicians in mobile formations, multidisciplinary
medical institutions, already existing or additionally deployed
(both in peacetime and wartime). It is intended to eliminate
effects of life-threatening injuries and diseases.
The optimal term is 6-12 hours.
Specialized medical assistance the highest form of medical
care and is exhaustive in its nature. It is provided by the
appropriate specialists with the necessary equipment, specially
designed for the purpose of medical institutions no later than the
day after the lesion.
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Volume of medical assistance
The volume of medical assistance the number of
activities conducted at the stages of the medical evacuation
depending on the situation.
List of first aid in case of traumatic injuries:
withdrawal of the affected from the debris and destroyed shelters;
restoration of the patency of the upper respiratory tract;
artificial ventilation;
external cardiac massage;
temporary arrest of bleeding with all available means;
adjustment of sterile dressings on the wound and burnt surfaces;
transport immobilization;
assistance in provision of the physiologically advantageous position
for the affected;
adjustment of occlusive dressing in case of open pneumothorax;
introduction of anesthetics, etc.
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In case of radiation accidents and use of nuclear weapons, the first
aid includes:
performance of measures to stop the inflow of radioactive substances
into the body (through air, water, food);
rapid evacuation outside the territory contaminated with radioactive
substances;
use of means that arrest the primary reaction on irradiation, radio
protectors, medication to protect thyroid;
partial sanitization of the open parts of the body, the removal of
radioactive substances from the clothes, shoes.
When mass outbreaks of infectious diseases in the heart of
bacteriological (biological) infection, the first aid includes:
use of available and authorized means of protection;
active detection and isolation of patients and people suspected in
infectious diseases;
performance of emergency nonspecific prevention;
complete and partial special (sanitary) treatment.
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Predoctor care includes:
verification if the bandages are adjusted appropriately and if necessary,
fix the adjusted bandages, tourniquet, immobilization;
adjustment of aseptic dressings, tourniquet;
adjustment of standard splint under the bad immobilization or its
absence;
the elimination of asphyxia (cleaning of the mouth and throat, if
necessary introduction of artificial airway, oxygen inhalation, mechanical
ventilation of lungs);
introduction of anesthetics;
re-introduction of the antidotes according to the indications;
performance of additional partial sanitary treatment (in case of
necessity);
simple measures against shock (warming at low temperatures, giving hot
tea, introduction of anesthetics, cardiovascular means and medicaments
that stimulate respiration).
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First medical assistance
urgent measures
elimination of asphyxia;
arrest of the impaired haemorrhage;
limbamputation (its segments) hanging on the flap;
arrangement of antishock measures;
catheterization or capillary puncture of the bladder under
the damage of urethra;
partial sanitary processing and change of clothes;
introduction of antibiotics, anticonvulsants, bronchodilators
and anti-emetic drugs;
gastric lavage with the help of the probe in case of contact
with toxic substances in the stomach;
decompressive craniotomy (in wartime);
degassing of the wound under its infection with persistent
CWA;
application of antitoxic serum in case of poisoning by
bacterial toxins and non-specific prevention in case of
affection by the biological weapon, etc.
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First medical assistance
may be delayed
elimination of flaws of the first medical and predoctor
care (readjustment of bandages and immobilization);
introduction of tetanus toxoid and antibiotics;
procaine block in case of limb injuries without signs of
shock;
prescription of various symptomatic drugs in
situations that are not life-threatening for the affected.
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Measures of qualified
medical assistance: Final hemostasis;
Elimination of asphyxia and establishment of
Urgent measures of
qualified surgical aid
sustainable respiration;
Complex therapy of acute blood loss, shock,
traumatic toxicosis;
Treatment of anaerobic infections;
Surgical debridement and suturing of the wounds
in case of open pneumothorax, thoracocentesis
in case of valvete pneumothorax;
Laparotomy in case of penetrating wounds and
closed abdominal trauma with damage of
internal organs, in case of closed injury of the
bladder and rectum;
Amputation in case of extremity avulsion and
massive destruction of limbs;
Decompressive craniotomy;
Surgical treatment of long bone fractures with
extensive destruction of the soft tissues;
Necrotomy in case of circular burns of the chest
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and extremities accompanied by the disturbance
of respiration and blood circulation.
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Measures of qualified
medical assistance:
Urgent measures
of qualified therapeutic
assistance
Introduction of antidotes and anti-botulinum serum;
Complex therapy of cardio-vascular insufficiency,
cardiac arrhythmias, acute respiratory failure;
Treatment of toxic pulmonary edema;
Introduction of analgesic, desensitizing means,
anticonvulsants, antiemetic means and
bronchodilators;
Complex therapy of acute renal failure;
Use of tranquilizers and antipsychotic drugs in
case of acute reactive states and others.
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Specialized medical assistance represents the highest form of
health care including a comprehensive range of therapeutic and
preventive measures carried out by medical specialists of different
profiles in specialized hospitals using special equipment.
Providing time should not exceed 3 days from the date of injury.
The main types of surgical specialized medical care are:
neuro-surgical
ophthalmic
otorhinolaryngological
dental
urological
psycho-neurological
toxicological
radiological and other.
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Thank you!
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