Emergency Medical Care - This is medical care provided by employees of the emergency medical care system for urgent organizational, diagnostic and therapeutic measures aimed at saving and preserving a person’s life in an emergency and minimizing the consequences of such a condition on health.
Human emergency - this is a sudden deterioration in physical or mental health, which poses a direct and imminent threat to the life and health of a person or others, and occurs as a result of illness, injury, poisoning, or other internal or external causes.
Category emergency include appeals to a patient who is in an emergency, accompanied by: fainting, convulsions, sudden respiratory distress, sudden pain in the heart, vomiting of blood, acute pain in the abdomen, external bleeding, signs of acute infectious diseases, acute mental disorders that threaten the life and health of the patient and / or other persons, or caused by all types of injuries (wounds, fractures, dislocations, burns, severe bruises, head injuries), electric shock, lightning, heat stroke, hypothermia, asphyxia of all kinds (drowning, hit foreign objects in the respiratory tract), injuries of various etiologies during emergencies (traffic accidents, industrial accidents, natural disasters, etc.), poisoning, animal bites, snakes, spiders and insects, disruption of the normal course of pregnancy (premature childbirth, bleeding, etc.), as well as transporting patients, who are in a state, requires mandatory medical sorting and urgent hospitalization in a medical institution.
Category non-extranch belong to the treatment of a patient whose condition is not urgent and is accompanied by a sudden increase in body temperature with cough, runny nose, sore throat, headache, dizziness, weakness; pain in the lower back, joints (radiculitis, osteochondrosis, arthritis, arthrosis), increased blood pressure; pain syndrome in cancer patients; alcohol, narcotic, toxic, withdrawal syndromes or is caused by an exacerbation of a chronic disease in patients under the supervision of a family or district doctor for hypertension, stomach and duodenal ulcers, chronic inflammation of the liver, gallbladder, intestines, kidney disease, joints, etc.
Emergency medical care of the highest standards should be available to every person when needed, anywhere and at any time. This requires an appropriate system of measures for medical care for all people whose lives are suddenly at risk, the concept of providing pre-hospital, hospital and interhospital emergency medical care.
Today in the world there is international classification of emergency medical care , which is divided into the following groups:
BLS (Basic Life Support) - basic life support- a set of measures to maintain or restore the vital activity of the body in out-of-hospital conditions, as well as before the arrival of the brigade;
ILS (Immediate Life Support) - providing emergency medical care in conditions that threaten a person’s life, by the doctor on duty of the hospital (doctor of the BE (Sh) MD, general practice outpatient clinic - family medicine, polyclinic office, including Dental, private dental office, pharmacy of a medical institution) until the arrival of specialized resuscitation care specialists;
ALS (Advance Life Support) - These are specialized resuscitation measures. Performed by physicians and paramedics using appropriate equipment, medicines, tools at the pre-hospital and early hospital stages;
ATLS (Advance Trauma Life Support) - professional qualified emergency medical care various injuries both in the pre-hospital and early hospital periods (mainly doctors, less often nurses, paramedics)
ACLS (Advance Cardiac Life Support) - provision of professional specialized emergency medical care for cardiovascular pathology(provided by doctors, nurses, paramedics)
PALS (Pediatric Advance Life Support) - providing professional emergency medical care to children(carried out by doctors, nurses, paramedics).
The provision of emergency and emergency medical care in Ukraine is carried out at the following levels: pre-medical care; pre-medical (pre-hospital) care; medical medical (pre-hospital) care.
Home care - a complex of emergency simple medical measures that provide the victim or person who suddenly fell ill, at the scene of the incident and for the period of his transportation to a medical facility.
Persons who are obliged to provide pre-medical care to a person in an emergency: rescuers of emergency rescue services, employees of the state fire brigade, employees of police bodies and divisions, pharmaceutical workers, conductors of passenger cars, flight attendants and other persons who do not have a medical education, but with their official duties must possess practical skills to save and preserve the life of a person who is in an emergency.
Range of activities to provide home care provides three main groups of events:
1) immediate termination of the action of external harmful factors (electric current, high and low temperatures, compression of the victim with heavy objects) while observing personal safety and evacuation of the victims from the above unfavorable conditions in which they fell (from damaged transport, water, burning premises or in which accumulated toxic gases)
2) provision of pre-medical care to victims, depending on the nature and type of injury, accident or illness that occurred unexpectedly (stopping bleeding, artificial respiration, indirect chest compression, dressing a wound, etc.);
3) organization of rapid transportation of the sick or injured person to a medical institution.
Rice. 1.18.
pre-medical medical(pre-hospital) care - carry out paramedical BE (Sh) MD. A typical view of a specialized vehicle, equipment and composition of the paramedic team (paramedic, nurse, driver) are shown in Figures 1.18-1.20.
Rice. 1.19.
Rice. 1.20.
In recent decades, such assistance abroad has been provided mainly by paramedics - persons with medical education of 1-2 levels of accreditation or without it, who act in accordance with accepted methods in the provision of medical care. Paramedicine is extremely common in most countries of the world and has proven to be quite effective due to the clear organization and timeliness of medical care.
Medical medical (pre-hospital) care - provide medical teams that have the necessary equipment, tools, medicines, etc. and have theoretical knowledge and practical skills in providing qualified emergency prehospital medical care. The typical composition of the medical team: doctor, paramedic, nurse, driver. The head of the brigade is a doctor, to whom all employees are subordinate, he is personally responsible for its work. The team is located in the premises of stations, substations, departments, points of permanent or temporary stay. The workplace of the team is determined by the head of the Center, taking into account the need to meet the standard for the arrival of teams at the scene.
Below is a list of basic knowledge and professional skills that a graduate of a higher medical educational institution of the Ministry of Health of Ukraine should have in the section "Emergency and emergency medical care":
Production functions, typical tasks of activity and skill , which a graduate of a higher medical institution in the specialty "General Medicine" should have 7.110101
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Code and name of a typical activity task |
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1. PF.E.02 Diagnosis of emergency conditions |
Under any circumstances (at home, on the street, in a medical institution, etc.), in conditions of lack of information and limited time, using standard examination methods and possible anamnesis data, knowledge about a person, his organs and systems, adhering to appropriate ethical and legal standards, by making an informed decision and assessing a person’s condition, establish a diagnosis |
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Determination of emergency medical care tactics |
Under any circumstances, using knowledge about a person, his organs and systems, adhering to relevant ethical and legal standards, by making an informed decision, based on a diagnosis of an emergency condition in a limited time using standard schemes, determine the tactics of emergency medical care |
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Provision of emergency medical care |
Under any circumstances, using knowledge about a person, his organs and systems, adhering to relevant ethical and legal standards, by making an informed decision, based on a diagnosis of an emergency condition in a limited time, according to a certain tactic, using standard schemes, provide emergency medical care |
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Information about the need to provide emergency medical care from any person or operator of the emergency medical care system for the population is received by a single order 112, received by the operational dispatch service of the Center at a single telephone number for emergency medical care 103 from persons who are within the relevant territory. Control over the incoming calls and response is carried out by the hardware-software complex 103, its electronic system records the time of the call, the voice recording is stored for a set time. Dispatcher direction after accepting from dispatcher receiving calls electronic card passes it to the head of the BE (Sh) MD. An electronic card is information support at all stages of emergency medical care, from the volume of emergency care to hospitalization in a medical institution. The team leader reports to the Center on the completion of assistance. The center decides on the allocation of additional teams in case of a large number of victims at the scene.
The team, after accepting the call in electronic form, transfers it to the medical statistical documentation on paper, in addition, informs the dispatcher of the direction about the state of emergency medical care for the (injured) patient and the completion of such care.
The person calling the brigade must answer all the questions of the dispatcher who receives the call. In particular, name the exact address of the call (settlement, street, house number, apartment, floor, code and entrance number, clarify the ways of access to patients), if passport data is not known, you must indicate gender and approximate age, describe complaints, tell who and from what phone number calls the brigade. If possible, provide the team with unhindered access to the patient and the necessary conditions for providing assistance. In addition, isolate animals that can complicate the provision of medical care to the patient, harm the health and property of team members. When a patient is hospitalized, it is advisable to have any document proving his identity with him. In case of aggressive behavior of a patient in a state of alcoholic, narcotic, toxic intoxication or a mental disorder, or he poses a threat to the health or life of medical workers, the medical care and transportation teams are carried out in the presence of police officers. Accompanying the patient in ambulance transport is carried out by one person with the permission of the head of the brigade. Children are transported accompanied by their parents.
The dispatcher for receiving calls has the right to refuse a patient to receive a call to fulfill the planned appointments of the district (family) doctor (injections, dressings, etc.), to patients who are under the supervision of the district (family) doctor, to provide dental care, to remove ticks, issuing sick leave certificates, issuing prescriptions, filling out certificates, conducting forensic medical reports, transporting corpses.
If necessary, by decision of the head of the Center, on the basis of medical teams, specialized teams are formed in the specialties "Psychiatry", "Cardiology", "Neurology", "Pediatrics", "Neonatology", etc., which, by order, are subordinate to the operational dispatcher service of the Centre.
The brigade is provided with a specialized ambulance vehicle, according to its technical and medical indications, must comply with the requirements of national standards, as well as medicines and medical products that comply with the equipment tables approved by order of the Ministry of Health of Ukraine No. 500 dated 29.08.2008.
Team members are provided with special work clothes and footwear. In case of work in adverse or harmful conditions, they are provided with special clothing and personal protective equipment.
The brigade is constantly in the mode of readiness (waiting) to carry out orders from the operational dispatch service of the Center.
The main tasks of the brigade:
Upon arrival at the scene of the incident, on call, examine and provide emergency medical care to victims who need it at the pre-hospital stage;
Transport patients to healthcare facilities designated by the dispatcher of the Center's operational dispatch service;
Inform the dispatcher of the Operational Dispatching Service of the Center about the stages of completing the task on a call, as well as about the threat of an emergency situation;
Timely report on the use of medicinal, narcotic and psychotropic drugs, medical devices, replenishment of their quantity and exchange;
Participate in the elimination of the consequences of an emergency;
Organize medical triage of victims, involve additional teams in providing emergency medical care to victims in the event of an emergency;
Constantly interact with the dispatcher of the Center, teams, employees of healthcare institutions, police officers, including employees of the State Automobile Inspectorate, personnel of fire departments and emergency services.
The brigade has the right:
To hospitalize a patient in case of a sudden threat to his life and health to the nearest place of occurrence of a healthcare institution, regardless of subordination and form of ownership, in which qualified or specialized emergency medical care can be provided to him;
Receive advice from the senior doctor of the operational dispatch service of the Center for medical issues on the sequence of actions. time to provide emergency medical care to patients.
The control room (operational department) SE (Sh) MD is formed at the station, starting from the 3rd category (from 201 to 500 thousand people). The operational department includes a central dispatching office, a field medical team of line control, and an advisory and information service. In the event of an emergency, the line control team arrives at the site of the lesion and coordinates the BU (Sh) MD for the elimination of medical and sanitary consequences, maintains contact with the headquarters for the elimination of emergencies, the station, brigades, and medical institutions to which the victims are delivered.
The structure of SE (W) MD includes hospitalization department , which operates only in stations of the first (from 1 to 2 million people) and the second (from 501 thousand to 1 million people) categories, which provides a constant round-the-clock accounting of the free bed fund of medical institutions and distributes the flow of patients. The hospitalization department interacts with leading specialists of local health authorities on the duty schedules of medical institutions for the provision of emergency medical care, operational changes regarding the profile and the deployment of additional beds of the corresponding profile, needs and prospects regarding the number of beds, interaction with other inpatient medical institutions that are not included in health care management system, on the use of beds for the provision of emergency inpatient medical care.
In the structure of SE (W) MD 1-2 categories is advisory and information service unit , who advises the population by telephone, as well as recommendations for the provision of home health care.
In order to bring closer the provision of medical care to the population at the pre-hospital stage, by ensuring the timely arrival of the BE (SH) MD to the patient (injured), on the basis of a healthcare institution (rural medical outpatient clinic, district (district) hospital, polyclinic of the city are located on the territory of the station , substations (branches)) form temporary bases teams of emergency (ambulance) medical care. The point is opened by the decision of the city (district) executive power after the conclusion of an agreement between the heads of the station and the medical institution that provides premises for the location of the point.
In the city, the brigade is based on a point during peak hours (maximum vehicle traffic) and (or) the maximum number of calls received in the area serviced by the point. The point is a structural subdivision of SE (W) MD or a substation. The service area is determined by the head of the SE (W) MD.
Emergency conditions(accidents) - incidents, as a result of which harm is done to human health or there is a threat to his life. An emergency is characterized by suddenness: it can happen to anyone, at any time and in any place.
People injured in an accident need immediate medical attention. If there is a doctor, paramedic or nurse nearby, they turn to them for first aid. Otherwise, help should be provided by people who are close to the victim.
The severity of the consequences of an emergency, and sometimes the life of the victim, depends on the timeliness and correctness of actions to provide emergency medical care, so each person must have the skills to provide first aid in emergency conditions.
There are the following types of emergency conditions:
thermal injury;
poisoning;
Bites of poisonous animals;
Attacks of diseases;
Consequences of natural disasters;
Radiation damage, etc.
The set of measures required for victims in each type of emergency has a number of features that must be taken into account when providing assistance to them.
4.2. First aid for sun, heat stroke and fumes
Sunstroke called a lesion resulting from long-term exposure to sunlight on an unprotected head. Sunstroke can also be obtained when you stay outside for a long time on a clear day without a hat.
Heatstroke- this is excessive overheating of the whole organism as a whole. Heat stroke can also happen in cloudy, hot, windless weather - with long and hard physical work, long and difficult transitions, etc. Heat stroke is more likely when a person is not physically prepared enough and is very tired and thirsty.
Symptoms of sun and heat stroke are:
Cardiopalmus;
Redness, and then blanching of the skin;
violation of coordination;
Headache;
Noise in ears;
Dizziness;
Great weakness and lethargy;
Decrease in the intensity of the pulse and breathing;
Nausea, vomiting;
Nose bleed;
Sometimes convulsions and fainting.
The provision of first aid for sun and heat stroke should begin with the transportation of the victim to a place protected from heat exposure. In this case, it is necessary to lay the victim in such a way that his head is higher than the body. After that, the victim needs to provide free access to oxygen, loosen his clothes. To cool the skin, you can wipe the victim with water, cool the head with a cold compress. The victim should be given a cold drink. In severe cases, artificial respiration is necessary.
Fainting- This is a short-term loss of consciousness due to insufficient blood flow to the brain. Fainting can occur from severe fright, excitement, great fatigue, as well as from significant blood loss and a number of other reasons.
When fainting, a person loses consciousness, his face turns pale and covered with cold sweat, the pulse is barely palpable, breathing slows down and is often difficult to detect.
First aid for fainting comes down to improving the blood supply to the brain. For this, the victim is laid so that his head is lower than the body, and his legs and arms are somewhat raised. The victim's clothing must be loosened, his face is sprinkled with water.
It is necessary to ensure the flow of fresh air (open the window, fan the victim). To excite the breath, you can give a sniff of ammonia, and to enhance the activity of the heart, when the patient regains consciousness, give hot strong tea or coffee.
frenzy- carbon monoxide (CO) poisoning. Carbon monoxide is formed when fuel burns without an adequate supply of oxygen. Carbon monoxide poisoning is unnoticeable because the gas is odorless. Symptoms of carbon monoxide poisoning include:
General weakness;
Headache;
Dizziness;
Drowsiness;
Nausea, then vomiting.
In severe poisoning, there are violations of cardiac activity and respiration. If the injured person is not helped, death may occur.
First aid for fumes comes down to the following. First of all, the victim must be removed from the zone of carbon monoxide or ventilate the room. Then you need to apply a cold compress to the head of the victim and let him smell the cotton wool moistened with ammonia. To improve cardiac activity, the victim is given a hot drink (strong tea or coffee). Heating pads are applied to the legs and arms or mustard plasters are placed. When fainting, give artificial respiration. After that, you should immediately seek medical help.
4.3. First aid for burns, frostbite and freezing
Burn- this is thermal damage to the integument of the body caused by contact with hot objects or reagents. A burn is dangerous because, under the influence of high temperature, the living protein of the body coagulates, i.e., living human tissue dies. The skin is designed to protect tissues from overheating, however, with prolonged action of the damaging factor, not only the skin suffers from the burn,
but also tissues, internal organs, bones.
Burns can be classified according to a number of criteria:
According to the source: burns by fire, hot objects, hot liquids, alkalis, acids;
According to the degree of damage: burns of the first, second and third degree;
By the size of the affected surface (as a percentage of the body surface).
With a first-degree burn, the burnt area turns slightly red, swells, and a slight burning sensation is felt. Such a burn heals within 2-3 days. A second-degree burn causes redness and swelling of the skin, blisters filled with a yellowish liquid appear on the burned area. The burn heals in 1 or 2 weeks. A third-degree burn is accompanied by necrosis of the skin, underlying muscles, and sometimes bone.
The danger of a burn depends not only on its degree, but also on the size of the damaged surface. Even a first-degree burn, if it covers half the surface of the entire body, is considered a serious disease. In this case, the victim experiences a headache, vomiting, diarrhea appear. The body temperature rises. These symptoms are caused by a general poisoning of the body due to the decay and decomposition of dead skin and tissues. With large burn surfaces, when the body is not able to remove all decay products, kidney failure may occur.
Second and third degree burns, if they affect a significant part of the body, can be fatal.
First aid for burns of the first and second degree is limited to applying a lotion of alcohol, vodka or a 1–2% solution of potassium permanganate (half a teaspoon to a glass of water) to the burned area. In no case should you pierce the blisters formed as a result of a burn.
If a third-degree burn occurs, a dry sterile bandage should be applied to the burnt area. In this case, it is necessary to remove the remnants of clothing from the burnt place. These actions must be performed very carefully: first, the clothes are cut off around the affected area, then the affected area is soaked with a solution of alcohol or potassium permanganate and only then removed.
With a burn acid the affected surface must be immediately washed with running water or a 1-2% soda solution (half a teaspoon per glass of water). After that, the burn is sprinkled with crushed chalk, magnesia or tooth powder.
When exposed to particularly strong acids (for example, sulfuric), washing with water or aqueous solutions can cause secondary burns. In this case, the wound should be treated with vegetable oil.
For burns caustic alkali the affected area is washed with running water or a weak solution of acid (acetic, citric).
frostbite- this is a thermal damage to the skin, caused by their strong cooling. Unprotected areas of the body are most susceptible to this type of thermal damage: ears, nose, cheeks, fingers and toes. The likelihood of frostbite increases when wearing tight shoes, dirty or wet clothes, with general exhaustion of the body, anemia.
There are four degrees of frostbite:
- I degree, in which the affected area turns pale and loses sensitivity. When the effect of cold ceases, the frostbite becomes bluish-red in color, becomes painful and swollen, and itching often appears;
- II degree, in which blisters appear on the frostbitten area after warming, the skin around the blisters has a bluish-red color;
- III degree, at which necrosis of the skin occurs. Over time, the skin dries out, a wound forms under it;
- IV degree, in which necrosis can spread to the tissues lying under the skin.
First aid for frostbite is to restore blood circulation in the affected area. The affected area is wiped with alcohol or vodka, lightly lubricated with petroleum jelly or unsalted fat and carefully rubbed with cotton or gauze so as not to damage the skin. You should not rub the frostbitten area with snow, as ice particles come across in the snow, which can damage the skin and facilitate the penetration of microbes.
Burns and blisters resulting from frostbite are similar to burns from exposure to heat. Accordingly, the steps described above are repeated.
In the cold season, in severe frosts and snowstorms, it is possible general freezing of the body. Its first symptom is chilliness. Then a person develops fatigue, drowsiness, the skin turns pale, the nose and lips are cyanotic, breathing is barely noticeable, the activity of the heart gradually weakens, and an unconscious state is also possible.
First aid in this case comes down to warming the person and restoring his blood circulation. To do this, you need to bring it into a warm room, make, if possible, a warm bath and easily rub the frostbitten limbs with your hands from the periphery to the center until the body becomes soft and flexible. Then the victim must be put to bed, covered warmly, given hot tea or coffee to drink and a doctor called.
However, it should be taken into account that with a long stay in cold air or in cold water, all human vessels narrow. And then, due to a sharp heating of the body, blood can hit the vessels of the brain, which is fraught with a stroke. Therefore, heating a person must be done gradually.
4.4. First aid for food poisoning
Poisoning of the body can be caused by eating various poor-quality products: stale meat, jelly, sausages, fish, lactic acid products, canned food. It is also possible poisoning due to the use of inedible greens, wild berries, mushrooms.
The main symptoms of poisoning are:
General weakness;
Headache;
Dizziness;
Abdominal pain;
Nausea, sometimes vomiting.
In severe cases of poisoning, loss of consciousness, weakening of cardiac activity and respiration are possible, in the most severe cases - death.
First aid for poisoning begins with the removal of poisoned food from the stomach of the victim. To do this, they induce vomiting in him: give him 5-6 glasses of warm salted or soda water to drink, or insert two fingers deep into the throat and press on the root of the tongue. This cleansing of the stomach must be repeated several times. If the victim is unconscious, his head must be turned to the side so that the vomit does not enter the respiratory tract.
In case of poisoning with strong acid or alkali, it is impossible to induce vomiting. In such cases, the victim should be given oatmeal or linseed broth, starch, raw eggs, sunflower or butter.
The poisoned person should not be allowed to fall asleep. To eliminate drowsiness, you need to spray the victim with cold water or give him strong tea to drink. In case of convulsions, the body is warmed with heating pads. After providing first aid, the poisoned person must be taken to the doctor.
4.5. First aid for poisoning
To toxic substances(OS) refers to chemical compounds capable of infecting unprotected people and animals, leading to their death or incapacitating them. The action of agents can be based on ingestion through the respiratory organs (inhalation exposure), penetration through the skin and mucous membranes (resorption), or through the gastrointestinal tract when contaminated food and water are consumed. Poisonous substances act in drop-liquid form, in the form of aerosols, vapor or gas.
As a rule, agents are an integral part of chemical weapons. Chemical weapons are understood as military means, the damaging effect of which is based on the toxic effects of OM.
Poisonous substances that are part of chemical weapons have a number of features. They are capable of causing massive damage to people and animals in a short time, destroying plants, infecting large volumes of surface air, which leads to the defeat of people on the ground and uncovered people. For a long time, they can retain their damaging effect. The delivery of such agents to their destinations is carried out in several ways: with the help of chemical bombs, aircraft pouring devices, aerosol generators, rockets, rocket and artillery shells and mines.
First medical aid in case of OS damage should be carried out in the order of self-help and mutual assistance or specialized services. When providing first aid, you must:
1) immediately put on a gas mask on the victim (or replace the damaged gas mask with a serviceable one) to stop the effect of the damaging factor on the respiratory system;
2) quickly introduce an antidote (specific drug) to the victim using a syringe tube;
3) sanitize all exposed skin areas of the victim with a special liquid from an individual anti-chemical package.
The syringe tube consists of a polyethylene body, on which a cannula with an injection needle is screwed. The needle is sterile, it is protected from contamination by a cap tightly put on the cannula. The body of the syringe tube is filled with an antidote or other drug and hermetically sealed.
To administer the drug using a syringe tube, you must perform the following steps.
1. Using the thumb and forefinger of the left hand, grasp the cannula, and with the right hand support the body, then turn the body clockwise until it stops.
2. Make sure there is medicine in the tube (to do this, press the tube without removing the cap).
3. Remove the cap from the syringe, while turning it a little; squeeze the air out of the tube by pressing it until a drop of liquid appears at the tip of the needle.
4. Sharply (with a stabbing motion) insert the needle under the skin or into the muscle, after which all the liquid contained in it is squeezed out of the tube.
5. Without opening your fingers on the tube, remove the needle.
When administering an antidote, it is best to inject into the buttock (upper outer quadrant), anterolateral thigh, and outer shoulder. In an emergency, at the site of the lesion, the antidote is administered using a syringe tube and through clothing. After the injection, you need to attach an empty syringe tube to the victim’s clothing or put it in the right pocket, which will indicate that the antidote has been entered.
Sanitary treatment of the skin of the victim is carried out with a liquid from an individual anti-chemical package (IPP) directly at the site of the lesion, as this allows you to quickly stop exposure to toxic substances through unprotected skin. The PPI includes a flat bottle with a degasser, gauze swabs and a case (polyethylene bag).
When treating exposed skin with PPIs, follow these steps:
1. Open the package, take a swab from it and moisten it with the liquid from the package.
2. Wipe the exposed areas of the skin and the outer surface of the gas mask with a swab.
3. Re-moisten the swab and wipe the edges of the collar and the edges of the cuffs of the clothing that come into contact with the skin.
Please note that PPI liquid is poisonous and if it enters the eyes, it may be harmful to health.
If the agents are sprayed in an aerosol way, then the entire surface of the clothing will be contaminated. Therefore, after leaving the affected area, you should immediately take off your clothes, since the OM contained on it can cause damage due to evaporation into the breathing zone, penetration of vapors into the space under the suit.
In case of damage to the nerve agents of the nerve agent, the victim must be immediately evacuated from the source of infection to a safe area. During the evacuation of the affected, it is necessary to monitor their condition. To prevent seizures, repeated administration of the antidote is allowed.
If the affected person vomits, turn his head to the side and pull off the lower part of the gas mask, then put the gas mask back on. If necessary, the contaminated gas mask is replaced with a new one.
At negative ambient temperatures, it is important to protect the valve box of the gas mask from freezing. To do this, it is covered with a cloth and systematically warmed up.
In case of damage to asphyxiating agents (sarin, carbon monoxide, etc.), the victims are given artificial respiration.
4.6. First aid for a drowning person
A person cannot live without oxygen for more than 5 minutes, therefore, falling under water and being there for a long time, a person can drown. The causes of this situation can be different: cramps in the limbs when swimming in water bodies, exhaustion of strength during long swims, etc. Water, getting into the mouth and nose of the victim, fills the airways, and suffocation occurs. Therefore, assistance to a drowning person must be provided very quickly.
First aid to a drowning person begins with removing him to a hard surface. We especially note that the rescuer must be a good swimmer, otherwise both the drowning person and the rescuer may drown.
If the drowning man himself tries to stay on the surface of the water, he must be encouraged, a lifebuoy, a pole, an oar, the end of a rope should be thrown to him so that he can stay on the water until he is rescued.
The rescuer must be without shoes and clothes, in extreme cases without outerwear. You need to swim up to the drowning man carefully, preferably from behind, so that he does not grab the rescuer by the neck or by the arms and pull him to the bottom.
A drowning person is taken from behind under the armpits or by the back of the head near the ears and, holding the face above the water, they swim on their backs to the shore. You can grab a drowning person with one hand around the waist, only from behind.
Needed on the beach restore breathing the victim: quickly take off his clothes; free your mouth and nose from sand, dirt, silt; remove water from the lungs and stomach. Then the following steps are taken.
1. The first aid provider gets on one knee, puts the victim on the second knee with his stomach down.
2. The hand presses on the back between the shoulder blades of the victim until the foamy liquid stops flowing out of his mouth.
4. When the victim regains consciousness, he must be warmed by rubbing the body with a towel or overlaying it with heating pads.
5. To enhance cardiac activity, the victim is given strong hot tea or coffee to drink.
6. Then the victim is transported to a medical facility.
If a drowning person has fallen through the ice, then it is impossible to run to help him on the ice when he is not strong enough, since the rescuer can also drown. You need to put a board or ladder on the ice and, carefully approaching, throw the end of the rope to the drowning person or stretch out a pole, oar, stick. Then, just as carefully, you need to help him get to the shore.
4.7. First aid for bites of poisonous insects, snakes and rabid animals
In the summer, a person can be stung by a bee, wasp, bumblebee, snake, and in some areas - a scorpion, tarantula or other poisonous insects. The wound from such bites is small and resembles a needle prick, but when bitten, poison penetrates through it, which, depending on its strength and quantity, either acts first on the area of \u200b\u200bthe body around the bite, or immediately causes general poisoning.
Single bites bees, wasps and bumblebees pose no particular danger. If a sting remains in the wound, it must be carefully removed, and a lotion of ammonia with water or a cold compress from a solution of potassium permanganate or simply cold water should be put on the wound.
bites poisonous snakes life-threatening. Usually snakes bite a person in the leg when he steps on them. Therefore, in places where snakes are found, you can not walk barefoot.
When bitten by a snake, the following symptoms are observed: burning pain at the site of the bite, redness, swelling. After half an hour, the leg can almost double in volume. At the same time, signs of general poisoning appear: loss of strength, muscle weakness, dizziness, nausea, vomiting, weak pulse, and sometimes loss of consciousness.
bites poisonous insects very dangerous. Their venom causes not only severe pain and burning at the bite site, but sometimes general poisoning. The symptoms are reminiscent of poisoning by snake venom. In case of severe poisoning with the poison of a karakurt spider, death may occur in 1-2 days.
First aid for the bite of poisonous snakes and insects is as follows.
1. Above the bitten place, it is necessary to apply a tourniquet or twist to prevent the poison from entering the rest of the body.
2. The bitten limb must be lowered and try to squeeze out the blood from the wound, in which the poison is located.
You can not suck blood from the wound with your mouth, as there may be scratches or broken teeth in the mouth, through which the poison will penetrate into the blood of the one who provides assistance.
You can draw blood along with poison from the wound using a medical jar, glass or glass with thick edges. To do this, in a jar (glass or glass), you need to hold a lit splinter or cotton wool on a stick for several seconds and then quickly cover the wound with it.
Each victim of a snake bite and poisonous insects must be transported to a medical facility.
From the bite of a rabid dog, cat, fox, wolf or other animal, a person becomes ill rabies. The bite site usually bleeds slightly. If an arm or leg is bitten, it must be quickly lowered and try to squeeze the blood out of the wound. When bleeding, the blood should not be stopped for some time. After that, the bite site is washed with boiled water, a clean bandage is applied to the wound and the patient is immediately sent to a medical facility, where the victim is given special vaccinations that will save him from a deadly disease - rabies.
It should also be remembered that rabies can be contracted not only from the bite of a rabid animal, but also in cases where its saliva gets on scratched skin or mucous membranes.
4.8. First aid for electric shock
Electric shocks are dangerous to human life and health. High voltage current can cause instant loss of consciousness and lead to death.
The voltage in the wires of residential premises is not so high, and if at home you carelessly grab a bare or poorly insulated electrical wire, pain and convulsive contraction of the muscles of the fingers are felt in the hand, and a small superficial burn of the upper skin can form. Such a defeat does not bring much harm to health and is not life-threatening if there is grounding in the house. If there is no grounding, then even a small current can lead to undesirable consequences.
A current of a stronger voltage causes convulsive contraction of the muscles of the heart, blood vessels, and respiratory organs. In such cases, there is a violation of blood circulation, a person may lose consciousness, while he turns pale sharply, his lips turn blue, breathing becomes barely noticeable, the pulse is palpable with difficulty. In severe cases, there may be no signs of life at all (breathing, heartbeat, pulse). There comes the so-called "imaginary death". In this case, a person can be brought back to life if he is immediately given first aid.
First aid in case of electric shock should begin with the termination of the current on the victim. If a broken bare wire falls on a person, it must be immediately discarded. This can be done with any object that conducts electricity poorly (a wooden stick, a glass or plastic bottle, etc.). If an accident occurs indoors, you must immediately turn off the switch, unscrew the plugs or simply cut the wires.
It should be remembered that the rescuer must take the necessary measures so that he himself does not suffer from the effects of electric current. To do this, when providing first aid, you need to wrap your hands with a non-conductive cloth (rubber, silk, woolen), put on dry rubber shoes on your feet or stand on a pack of newspapers, books, a dry board.
You can not take the victim by the naked parts of the body while the current continues to act on him. When removing the victim from the wire, you should protect yourself by wrapping your hands with an insulating cloth.
If the victim is unconscious, he must first be brought to his senses. To do this, you need to unbutton his clothes, sprinkle water on him, open windows or doors and give him artificial respiration - until spontaneous breathing appears and consciousness returns. Sometimes artificial respiration has to be done continuously for 2-3 hours.
Simultaneously with artificial respiration, the body of the victim must be rubbed and warmed with heating pads. When consciousness returns to the victim, he is put to bed, covered warmly and given a hot drink.
A patient with an electric shock may have various complications, so he must be sent to the hospital.
Another possible option for the impact of electric current on a person is lightning strike, the action of which is similar to the action of an electric current of very high voltage. In some cases, the affected person instantly dies from respiratory paralysis and cardiac arrest. Red streaks appear on the skin. However, being struck by lightning often comes down to nothing more than a severe stun. In such cases, the victim loses consciousness, his skin turns pale and cold, the pulse is barely palpable, breathing is shallow, barely noticeable.
Saving the life of a person struck by lightning depends on the speed of first aid. The victim should immediately start artificial respiration and continue it until he begins to breathe on his own.
To prevent the effects of lightning, a number of measures must be observed during rain and thunderstorms:
It is impossible during a thunderstorm to hide from the rain under a tree, as the trees "attract" a lightning bolt to themselves;
Elevated areas should be avoided during thunderstorms, as the probability of a lightning strike is higher in these places;
All residential and administrative premises must be equipped with lightning rods, the purpose of which is to prevent lightning from entering the building.
4.9. Complex of cardiopulmonary resuscitation. Its application and performance criteria
Cardiopulmonary resuscitation is a set of measures aimed at restoring cardiac activity and respiration of the victim when they stop (clinical death). This can happen with electric shock, drowning, in some other cases, with compression or blockage of the airways. The probability of survival of the patient directly depends on the speed of resuscitation.
It is most effective to use special devices for artificial ventilation of the lungs, with the help of which air is blown into the lungs. In the absence of such devices, artificial ventilation of the lungs is carried out in various ways, of which the most common is the mouth-to-mouth method.
The method of artificial ventilation of the lungs "mouth to mouth". To assist the victim, it is necessary to lay him on his back so that the airways are free for the passage of air. To do this, his head must be thrown back as much as possible. If the jaws of the victim are strongly compressed, it is necessary to push the lower jaw forward and, pressing on the chin, open the mouth, then clean the oral cavity from saliva or vomit with a napkin and proceed to artificial ventilation of the lungs:
1) put a napkin (handkerchief) in one layer on the open mouth of the victim;
2) pinch his nose;
3) take a deep breath;
4) tightly press your lips to the lips of the victim, creating tightness;
5) blow air into his mouth with force.
Air is blown rhythmically 16-18 times per minute until natural breathing is restored.
In case of injuries of the lower jaw, artificial ventilation of the lungs can be performed in a different way, when air is blown through the victim's nose. His mouth must be closed.
Artificial ventilation of the lungs is stopped when reliable signs of death are established.
Other methods of artificial lung ventilation. With extensive injuries of the maxillofacial region, it is impossible to artificially ventilate the lungs using the mouth-to-mouth or mouth-to-nose methods, therefore, the methods of Sylvester and Kallistov are used.
During artificial lung ventilation Sylvester's way the victim lies on his back, assisting him kneels at his head, takes both his hands by the forearms and sharply raises them, then takes them back behind him and spreads them apart - this is how a breath is made. Then, with a reverse movement, the victim's forearms are placed on the lower part of the chest and compress it - this is how exhalation occurs.
With artificial lung ventilation Kallistov's way the victim is laid on his stomach with arms extended forward, his head is turned to one side, putting clothes (blanket) under it. With stretcher straps or tied with two or three trouser belts, the victim is periodically (in the rhythm of breathing) raised to a height of up to 10 cm and lowered. When lifting the affected as a result of straightening his chest, inhalation occurs, when lowered due to its compression, exhalation occurs.
Signs of cessation of cardiac activity and chest compressions. Signs of cardiac arrest are:
Absence of pulse, palpitations;
Lack of pupillary response to light (dilated pupils).
Once these symptoms are identified, immediate action should be taken. indirect heart massage. For this:
1) the victim is laid on his back, on a hard, hard surface;
2) standing on the left side of him, put their palms one on top of the other on the region of the lower third of the sternum;
3) with energetic rhythmic pushes 50–60 times per minute, they press on the sternum, after each push, releasing their hands to allow the chest to expand. The anterior chest wall should be displaced to a depth of at least 3–4 cm.
An indirect heart massage is performed in combination with artificial ventilation of the lungs: 4-5 pressures on the chest (on exhalation) alternate with one blowing of air into the lungs (inhalation). In this case, the victim should be assisted by two or three people.
Artificial ventilation of the lungs in combination with chest compressions - the simplest way resuscitation(revival) of a person who is in a state of clinical death.
Signs of the effectiveness of the measures taken are the appearance of a person’s spontaneous breathing, the restored complexion, the appearance of a pulse and heartbeat, as well as a return to the sick consciousness.
After carrying out these activities, the patient must be provided with peace, he must be warmed, given a hot and sweet drink, and if necessary, apply tonics.
When carrying out artificial ventilation of the lungs and indirect heart massage, the elderly should remember that the bones at this age are more fragile, so the movements should be gentle. For small children, indirect massage is performed by pressing in the sternum area not with the palms, but with a finger.
4.10. Provision of medical assistance in case of natural disasters
natural disaster called an emergency situation in which human casualties and material losses are possible. There are natural emergencies (hurricanes, earthquakes, floods, etc.) and anthropogenic (bomb explosions, accidents at enterprises) origin.
Sudden natural disasters and accidents require urgent medical assistance to the affected population. Of great importance are the timely provision of first aid directly at the site of injury (self-help and mutual assistance) and the evacuation of victims from the outbreak to medical facilities.
The main type of injury in natural disasters is trauma, accompanied by life-threatening bleeding. Therefore, it is first necessary to take measures to stop bleeding, and then provide symptomatic medical care to the victims.
The content of measures to provide medical care to the population depends on the type of natural disaster, accident. Yes, at earthquakes this is the extraction of victims from the rubble, the provision of medical assistance to them, depending on the nature of the injury. At floods the first priority is to remove the victims from the water, warm them, stimulate cardiac and respiratory activity.
In the area affected tornado or hurricane, it is important to quickly carry out medical triage of the affected, to provide assistance first of all to those most in need.
affected as a result snow drifts and collapses after being removed from under the snow, they warm them, then provide them with the necessary assistance.
In the outbreaks fires first of all, it is necessary to extinguish burning clothes on the victims, apply sterile dressings to the burned surface. If people are affected by carbon monoxide, immediately remove them from areas of intense smoke.
When accidents at nuclear power plants it is necessary to organize a radiation reconnaissance, which will make it possible to determine the levels of radioactive contamination of the territory. Food, food raw materials, water should be subjected to radiation control.
Providing assistance to the victims. In the event of a lesion, the victims are provided with the following types of assistance:
First aid;
First medical aid;
Qualified and specialized medical care.
First aid is provided directly to the affected person at the site of injury by sanitary teams and sanitary posts, other units of the Russian Emergencies Ministry working in the outbreak, as well as in the order of self- and mutual assistance. Its main task is to save the life of the affected person and prevent possible complications. Removal of the injured to the places of loading onto transport is carried out by the porters of the rescue units.
The first medical aid to the injured is provided by medical units, medical units of military units and health care facilities that have been preserved in the outbreak. All these formations constitute the first stage of medical and evacuation support for the affected population. The tasks of first medical aid are to maintain the vital activity of the affected organism, prevent complications and prepare it for evacuation.
Qualified and specialized medical care for the injured is provided in medical institutions.
4.11. Medical care for radiation contamination
When providing first aid to victims of radiation contamination, it must be taken into account that in the contaminated area it is impossible to eat food, water from contaminated sources, or touch objects contaminated with radioactive substances. Therefore, first of all, it is necessary to determine the procedure for preparing food and purifying water in contaminated areas (or organizing delivery from uncontaminated sources), taking into account the level of contamination of the area and the current situation.
First medical aid to victims of radiation contamination should be provided under conditions of maximum reduction of harmful effects. To do this, the victims are transported to an uninfected area or to special shelters.
Initially, it is necessary to take certain actions to save the life of the victim. First of all, it is necessary to organize sanitization and partial decontamination of his clothes and shoes to prevent harmful effects on the skin and mucous membranes. To do this, they wash with water and wipe the exposed skin of the victim with wet swabs, wash their eyes, and rinse their mouth. When decontaminating clothing and footwear, it is necessary to use personal protective equipment to prevent the harmful effects of radioactive substances on the victim. It is also necessary to prevent contact of contaminated dust with other people.
If necessary, gastric lavage of the victim is carried out, absorbent agents (activated charcoal, etc.) are used.
Medical prophylaxis of radiation injuries is carried out with radioprotective agents available in an individual first-aid kit.
The individual first-aid kit (AI-2) contains a set of medical supplies intended for personal prevention of injuries by radioactive, poisonous substances and bacterial agents. In case of radiation contamination, the following drugs contained in AI-2 are used:
- I nest - a syringe tube with an analgesic;
- III nest - antibacterial agent No. 2 (in an oblong pencil case), 15 tablets in total, which are taken after radiation exposure for gastrointestinal disorders: 7 tablets per dose on the first day and 4 tablets per dose daily for the next two days. The drug is taken to prevent infectious complications that may occur due to the weakening of the protective properties of the irradiated organism;
- IV nest - radioprotective agent No. 1 (pink cases with a white lid), 12 tablets in total. Take 6 tablets at the same time 30-60 minutes before the start of irradiation according to the civil defense alert signal in order to prevent radiation damage; then 6 tablets after 4-5 hours while in the territory contaminated with radioactive substances;
- VI slot - radioprotective agent No. 2 (white pencil case), 10 tablets in total. Take 1 tablet daily for 10 days when eating contaminated foods;
- VII nest - antiemetic (blue pencil case), 5 tablets in total. Use 1 tablet for contusions and primary radiation reaction to prevent vomiting. For children under the age of 8 years, take one fourth of the indicated dose, for children from 8 to 15 years old - half the dose.
The distribution of medications and instructions for their use are attached to an individual first-aid kit.
"Providing first aid in various conditions"
Emergency conditions that threaten the life and health of the patient require urgent measures at all stages of medical care. These conditions arise as a result of the development of shock, acute blood loss, respiratory disorders, circulatory disorders, coma, which are caused by acute diseases of the internal organs, traumatic injuries, poisoning and accidents.
The most important place in providing assistance to suddenly ill and injured as a result of natural and man-made emergencies in peacetime is given to adequate pre-hospital measures. According to the data of domestic and foreign experts, a significant number of patients and victims of emergencies could be saved if timely and effective assistance was provided at the pre-hospital stage.
Currently, the importance of first aid in the treatment of emergency conditions has increased tremendously. The ability of nursing staff to assess the severity of the patient's condition, identify priority problems is necessary to provide effective first aid, which can have a greater impact on the further course and prognosis of the disease. From a health worker, not only knowledge is required, but also the ability to quickly provide assistance, since confusion and inability to collect oneself can even aggravate the situation.
Thus, mastering the methods of providing emergency medical care at the prehospital stage to sick and injured people, as well as improving practical skills, is an important and urgent task.
Modern principles of emergency medical care
In world practice, a universal scheme for providing assistance to victims at the prehospital stage has been adopted.
The main steps in this scheme are:
1. Immediate initiation of urgent life support measures in the event of an emergency.
2. Organization of the arrival of qualified specialists at the scene of the incident as soon as possible, the implementation of certain measures of emergency medical care during the transportation of the patient to the hospital.
The fastest possible hospitalization in a specialized medical institution with qualified medical personnel and equipped with the necessary equipment.
Measures to be taken in the event of an emergency
Medical and evacuation activities carried out in the provision of emergency care should be divided into a number of interrelated stages - pre-hospital, hospital and first medical aid.
At the prehospital stage, first, pre-medical and first medical aid is provided.
The most important factor in emergency care is the time factor. The best results in the treatment of victims and patients are achieved when the period from the onset of an emergency to the time of provision of qualified assistance does not exceed 1 hour.
A preliminary assessment of the severity of the patient's condition will help to avoid panic and fuss during subsequent actions, will provide an opportunity to make more balanced and rational decisions in extreme situations, as well as measures for emergency evacuation of the victim from the danger zone.
After that, it is necessary to begin to identify the signs of the most life-threatening conditions that can lead to the death of the victim in the next few minutes:
clinical death;
coma;
Arterial bleeding
Neck injuries
chest injury.
The person providing assistance to victims in an emergency should strictly adhere to the algorithm shown in Scheme 1.
Scheme 1. The procedure for providing assistance in an emergency
Providing first aid in case of an emergency
There are 4 basic principles of first aid that should be followed:
Inspection of the scene. Ensure safety when providing assistance.
2. Initial examination of the victim and first aid in life-threatening conditions.
Call a doctor or ambulance.
Secondary examination of the victim and, if necessary, assistance in identifying other injuries, diseases.
Before helping the injured, find out:
· Is the scene dangerous?
· What happened;
The number of patients and victims;
Whether others are able to help.
Anything that can endanger your safety and the safety of others is of particular importance: exposed electrical wires, falling debris, heavy traffic, fire, smoke, harmful fumes. If you are in any danger, do not approach the victim. Call the appropriate rescue service or police immediately for professional assistance.
Always look for other casualties and, if necessary, ask others to assist you in helping you.
As soon as you approach the victim, who is conscious, try to calm him down, then in a friendly tone:
find out from the victim what happened;
Explain that you are a healthcare worker;
offer assistance, obtain the consent of the victim to provide assistance;
· Explain what action you are going to take.
You must obtain permission from the casualty before performing emergency first aid. A conscious victim has the right to refuse your service. If he is unconscious, we can assume that you have received his consent to carry out emergency measures.
Bleeding
Methods for stopping bleeding:
1. Finger pressure.
2. Tight bandage.
Maximum limb flexion.
The imposition of a tourniquet.
Applying a clamp to a damaged vessel in a wound.
Tamponade of the wound.
If possible, use a sterile dressing (or a clean cloth) to apply a pressure bandage, apply it directly to the wound (excluding eye injury and depression of the calvaria).
Any movement of the limb stimulates blood flow in it. In addition, when blood vessels are damaged, blood coagulation processes are disrupted. Any movement causes additional damage to blood vessels. Splinting limbs can reduce bleeding. Air tyres, or any type of tyre, are ideal in this case.
When applying a pressure dressing to a wound site does not reliably stop bleeding, or there are multiple sources of bleeding supplied by a single artery, local pressure may be effective.
In case of bleeding in the area of the skin of the head, the temporal artery should be pressed against the surface of the temporal bone. Brachial artery - to the surface of the humerus in case of injury to the forearm. Femoral artery - to the pelvic or femur in case of injury to the lower limb.
It is necessary to apply a tourniquet only in extreme cases, when all other measures have not given the expected result.
The principles of applying a tourniquet:
§ I apply a tourniquet above the bleeding site and as close as possible to it over clothing or over several rounds of bandage;
§ it is necessary to tighten the tourniquet only until the peripheral pulse disappears and the bleeding stops;
§ each subsequent tour of the harness must partially capture the previous tour;
§ the tourniquet is applied for no more than 1 hour in the warm period of time, and no more than 0.5 hours in the cold;
§ a note is inserted under the applied tourniquet indicating the time the tourniquet was applied;
§ after stopping the bleeding, a sterile bandage is applied to the open wound, bandaged, the limb is fixed and the wounded is sent to the next stage of medical care, i.e. evacuate.
A tourniquet can damage nerves and blood vessels and even lead to loss of a limb. A loosely applied tourniquet can stimulate more intense bleeding, since not arterial, but only venous blood flow stops. Use a tourniquet as a last resort for life-threatening conditions.
fractures
§ Checking the patency of the respiratory tract, breathing and circulation;
§ the imposition of transport immobilization by personnel means;
§ aseptic dressing;
§ anti-shock measures;
§ transportation to health facilities.
With a fracture of the lower jaw:
Emergency first aid:
§ check airway patency, respiration, blood circulation;
§ temporarily stop arterial bleeding by pressing the bleeding vessel;
§ fix the lower jaw with a sling bandage;
§ If the tongue is retracted, making it difficult to breathe, fix the tongue.
Rib fractures.
Emergency first aid:
§ apply a circular pressure bandage on the chest as you exhale;
§ With chest injuries, call an ambulance to hospitalize the victim to a hospital specializing in chest injuries.
Wounds
Emergency first aid:
§ check ABC (airway patency, respiration, circulation);
§ During the initial care period, simply flush the wound with saline or clean water and apply a clean bandage, elevate the limb.
First aid for open wounds:
§ stop the main bleeding;
§ remove dirt, debris and debris by irrigating the wound with clean water, saline;
§ apply an aseptic bandage;
§ for extensive wounds, fix the limb
lacerations are divided into:
superficial (including only the skin);
deep (capture underlying tissues and structures).
stab wounds usually not accompanied by massive external bleeding, but be careful about the possibility of internal bleeding or tissue damage.
Emergency first aid:
§ do not remove deeply stuck objects;
§ stop bleeding;
§ Stabilize the foreign body with bulk dressing and immobilize with splints as needed.
§ apply an aseptic dressing.
Thermal damage
burns
Emergency first aid:
§ termination of the thermal factor;
§ cooling the burnt surface with water for 10 minutes;
§ the imposition of an aseptic dressing on the burn surface;
§ warm drink;
§ evacuation to the nearest medical facility in the prone position.
Frostbite
Emergency first aid:
§ stop the cooling effect;
§ after removing damp clothing, warmly cover the victim, give a hot drink;
§ provide thermal insulation of the cooled limb segments;
§ to evacuate the victim to the nearest hospital in the prone position.
Solar and heat stroke
Emergency first aid:
§ move the victim to a cooler place and give a moderate amount of liquid to drink;
§ put a cold on the head, on the heart area;
§ lay the victim on his back;
§ if the victim has low blood pressure, raise the lower limbs.
Acute vascular insufficiency
Fainting
Emergency first aid:
§ lay the patient on his back with his head slightly lowered or raise the patient's legs to a height of 60-70 cm in relation to a horizontal surface;
§ unfasten tight clothing;
§ provide access to fresh air;
§ bring a cotton swab moistened with ammonia to the nose;
§ splash your face with cold water or pat on the cheeks, rub his chest;
§ make sure that the patient sits for 5-10 minutes after fainting;
If an organic cause of syncope is suspected, hospitalization is necessary.
convulsions
Emergency first aid:
§ protect the patient from bruises;
§ free him from restrictive clothing;
medical emergency
§ free the patient's oral cavity from foreign objects (food, removable dentures);
§ To prevent tongue bite, insert the corner of a folded towel between the molars.
Lightning strike
Emergency first aid:
§ restoration and maintenance of airway patency and artificial lung ventilation;
§ indirect heart massage;
§ hospitalization, transportation of the victim on a stretcher (preferably in the side position due to the risk of vomiting).
Pelectric shock
First aid for electrical injury:
§ free the victim from contact with the electrode;
§ preparation of the victim for resuscitation;
§ carrying out IVL in parallel with closed heart massage.
Stings of bees, wasps, bumblebees
Emergency first aid:
remove the sting from the wound with tweezers;
treat the wound with alcohol;
Apply a cold compress.
Hospitalization is necessary only with a general or pronounced local reaction.
Bites of poisonous snakes
Emergency first aid:
§ complete rest in a horizontal position;
§ locally - cold;
§ immobilization of the injured limb with improvised means;
§ plentiful drink;
§ transportation in the prone position;
Suction of blood from the wound by mouth is prohibited!
Bites from dogs, cats, wild animals
Emergency first aid:
§ when bitten by a domestic dog and the presence of a small wound, the toilet of the wound is carried out;
§ a bandage is applied;
§ the victim is sent to a trauma center;
§ large bleeding wounds are packed with napkins.
Indications for hospitalization are bite wounds received from unknown and not vaccinated against rabies animals.
poisoning
Emergency first aid for acute oral poisoning:
perform gastric lavage in a natural way (induce vomiting);
Provide access to oxygen
ensure prompt transportation to a specialized toxicological department.
Emergency first aid for inhalation poisoning:
stop the flow of poison into the body;
provide the victim with oxygen;
ensure prompt transportation to a specialized toxicological department or intensive care unit.
Emergency first aid for resorptive poisoning:
stop the flow of poison into the body;
clean and wash the skin from the toxic substance (use a soapy solution for washing)
If necessary, provide transportation to a health facility.
Alcohol poisoning and its surrogates
Emergency first aid:
plentiful drink;
Acetic acid
Emergency first aid:
· while maintaining consciousness, give inside 2-3 glasses of milk, 2 raw eggs;
Ensure that the patient is transported to the nearest medical facility in the supine position.
Carbon monoxide
Emergency first aid: drag the victim to a safe place; unfasten the belt, collar, provide access to fresh air; warm the victim to ensure the hospitalization of the victim in a medical facility.
mushroom poisoning
Emergency first aid:
tubeless gastric lavage;
plentiful drink;
inside adsorbents - activated carbon, and laxative;
Ensure that the patient is transported to the nearest medical facility in the supine position.
Personal safety and measures for the protection of medical personnel in the provision of emergency care
Prevention of occupational infection includes universal precautionary measures, which provide for the implementation of a number of measures aimed at preventing contact of medical workers with biological fluids, organs and tissues of patients, regardless of the epidemiological history, the presence or absence of specific diagnostic results.
Medical workers should treat blood and other biological fluids of the human body as potentially dangerous in terms of possible infection, therefore, when working with them, the following rules must be observed:
In case of any contact with blood, other biological fluids, organs and tissues, as well as with mucous membranes or damaged skin of patients, the medical worker must be dressed in special clothing.
2. Other means of barrier protection - a mask and goggles - should be worn in cases where the possibility of splashing blood and other body fluids cannot be ruled out.
When performing various procedures, it is necessary to take measures to prevent injury from cutting and stabbing objects. Cutting and piercing tools must be handled carefully, without unnecessary fuss, and every movement should be thoughtfully performed.
In the event of an "emergency" it is necessary to use the laying for emergency prevention of parenteral viral hepatitis and HIV infection.
All of us, unfortunately, can find ourselves in a situation where our or someone else's life is in danger. If, walking down the street, you notice a person who has become ill, you should not walk past. Perhaps he has an emergency and urgent medical care is simply necessary for him.
What condition is considered an emergency?
Danger to human health and life can arise at the most inopportune moment and in the most inappropriate place. A condition in which a person experiences serious ailments is called an emergency.
There are two types of emergencies:
- External - the cause of which is the negative impact of environmental factors;
- Internal - occur in the human body, caused by pathology.
Sometimes external emergencies can trigger internal ones.
The most common reasons for calling an ambulance are:
- Traumatic injuries and large blood loss;
- Fainting;
- Poisoning (food, toxic);
- heart attack;
- Stroke.
Whatever the emergency, seconds count. Timely and qualified medical care is very important.
Who will help
There are several types of emergency care:
- First aid - can be provided by a person who does not have a medical education (for example, a lifeguard, fireman, police officer or just a passerby who knows how to provide first aid);
- First aid - it is usually provided by junior medical staff (for example, a nurse);
- First medical aid is provided by generalists (ambulance doctors);
- Assistance is specialized - provided by doctors of a certain orientation.
- In an emergency, all types of assistance can be provided in stages.
Legal regulation
At the legislative level, the provision of emergency medical care is regulated by Federal Law No. 323.
Paragraph 10 of Article 83 of this regulatory document refers to the obligation to provide emergency medical care by healthcare organizations free of charge.
At the same time, it is said that reimbursement of expenses is carried out on the basis of a program of state guarantees for the provision of free medical care.
Article 124 of the Criminal Code of the Russian Federation provides for punishment in case of failure to provide assistance to a sick person who is obliged to do so.
Capital punishment in the form of deprivation of the right to engage in certain types of activities for up to three years and forced labor for a period of not more than four years - upon the death of a patient who was not provided with emergency assistance without good reason.
First aid
The speedy recovery of the patient depends on the correct definition of an emergency and the provision of first aid.
Fainting is a loss of consciousness caused by a violation of the circulatory system of the brain. It is necessary to unfasten tight clothes, feel the pulse, put the victim on a flat surface on his side, put a wet towel on his head, wait for the doctors to arrive.
Myocardial infarction is a violation of the blood supply to the heart. If the patient is conscious, help him take a semi-sitting position, give aspirin, provide oxygen access and call an ambulance.
A stroke is a damage to the central nervous system. Urgent call for specialized assistance, if the patient is conscious, lay him on his side, control pressure, ensure maximum peace.
Poisoning - a disorder of the body due to the ingress of toxic substances or poison. When leaving, it is necessary to rinse the stomach with plenty of water, give activated charcoal, ensure peace and call a doctor.
With a large loss of blood, it is necessary to wash the wound with hydrogen peroxide or brilliant green, tie up the artery above the location of the wound, and give the patient a comfortable position.
Aching tooth
A toothache can also take you by surprise. Not stopped in time, it not only causes discomfort, but can lead to serious consequences (inflammatory processes, fluxes). Therefore, in dentistry, doctors are on duty around the clock.
Emergency assistance in the event of a threat to life is provided by the duty doctor - dentist free of charge.
Evgeny Ivanovich Chazov wrote in detail how emergency care should be provided by doctors in his reference book.
Emergency assistance has existed at all times, because it is simply impossible to do without this type of service. Soviet legislation consolidated its own rules for the provision of emergency emergency assistance.
Since then, the Ministry of Health has changed some aspects of the regulations, but medical workers are still guarding our health and life.
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Article 11 of the Federal Law of November 21, 2011 No. 323-FZ “On the Fundamentals of Protecting the Health of Citizens in the Russian Federation” (hereinafter referred to as Federal Law No. 323) states that emergency medical care is provided by a medical organization and a medical worker to a citizen without delay and is free. Refusal to provide it is not allowed. A similar wording was in the old Fundamentals of Legislation on the Protection of the Health of Citizens in the Russian Federation (approved by the Supreme Court of the Russian Federation on July 22, 1993 N 5487-1, became invalid on January 1, 2012), although the concept of "emergency medical care" appeared in it. What is emergency medical care?
Forms of medical care
Article 32 of the Federal Law No. 323 identifies the following forms of medical care:
emergency
Medical care provided in case of sudden acute diseases, conditions, exacerbation of chronic diseases that threaten the patient's life.
urgent
Medical care provided in case of sudden acute diseases, conditions, exacerbation of chronic diseases without obvious signs of a threat to the patient's life.
Planned
Medical assistance that is provided during preventive measures, in case of diseases and conditions that are not accompanied by a threat to the life of the patient, that do not require emergency and urgent medical care, and the delay in the provision of which for a certain time will not entail a deterioration in the patient's condition, a threat to his life and health.
The difference between the concepts of "emergency" and "urgent" care
An attempt to isolate emergency medical care from emergency, or emergency medical care familiar to each of us, was made by officials of the Ministry of Health and Social Development of Russia (since May 2012 - the Ministry of Health of the Russian Federation).
Approximately since 2007, we can talk about the beginning of some separation or differentiation of the concepts of "emergency" and "urgent" assistance at the legislative level.
However, in the explanatory dictionaries of the Russian language there are no clear differences between these categories. urgent- one that cannot be postponed; urgent. Extra urgent, emergency, emergency. Federal Law No. 323 put an end to this issue by approving three different forms of medical care: emergency, urgent and planned.
As you can see, emergency and emergency medical care are opposed to each other. At the moment, any medical organization is obliged to provide only emergency medical care free of charge and without delay. Are there any significant differences between the two discussed concepts? It is especially important to talk about fixing this difference at the normative level.
Cases of emergency and urgent care
According to officials of the ministry, emergency medical care is provided if the existing pathological changes in the patient are not life-threatening. But from various regulatory legal acts of the Ministry of Health and Social Development of Russia, it follows that there are no significant differences between emergency and emergency medical care. They do not match only on the following points:
Emergency medical care
It turns out with sudden acute diseases, conditions, exacerbation of chronic diseases without obvious signs of a threat to the life of the patient, is a type of primary health care and is provided on an outpatient basis and in a day hospital. For this purpose, an emergency medical service is being created in the structure of medical organizations.
emergency medical care
It turns out with sudden acute diseases, conditions, exacerbation of chronic diseases that are life-threatening for the patient (in case of accidents, injuries, poisoning, complications of pregnancy and other conditions and diseases). According to the new law, emergency medical care is provided in an emergency or emergency form outside a medical organization, as well as on an outpatient and inpatient basis. Any medical organizations and medical workers are required to provide emergency assistance.
The presence of a threat to life
Unfortunately, Federal Law No. 323 contains only the analyzed concepts themselves, and when introducing a new concept of separate provision of emergency and emergency medical care, a number of problems arise, the main of which is the difficulty of determining in practice the existence of a threat to life.
There was an urgent need for a clear description of diseases and pathological conditions, signs indicating a threat to the life of the patient, with the exception of the most obvious (for example, penetrating wounds of the chest, abdominal cavity). It is not clear what the mechanism for determining the threat should be. It follows from the analyzed acts that often the conclusion about the presence of a threat to life is made either by the victim himself or by the ambulance dispatcher, based on the subjective opinion and assessment of what is happening by the person who applied for help. In such a situation, both an overestimation of the danger to life and a clear underestimation of the severity of the patient's condition are possible.
The Need for a Regulatory Definition of a Threat to Life
Therefore, especially at the initial stage of the implementation of the concept that divides the flow of patients according to fuzzy guidelines, we can expect an increase in deaths. Hopefully, the most important details will soon be spelled out in by-laws.
At the moment, medical organizations should probably focus on the medical understanding of the urgency of the situation, the presence of a threat to the life of the patient and the urgency of action. In a medical organization, it is mandatory to develop local instructions for emergency medical care on the territory of the organization, with which all medical workers must be familiarized.
Emergency medical care costs
In accordance with paragraph 10 of Article 83 of Federal Law No. 323, the costs associated with the provision of free medical care to citizens in an emergency form by a medical organization, including a medical organization of a private healthcare system, are subject to reimbursement in the manner and in the amount established by the program of state guarantees of free provision to citizens medical care. However, it is worth noting that to date, the mechanism for such compensation at the legislative level has not been established.
Emergency Medical Licensing
After the entry into force of the Order of the Ministry of Health of Russia dated March 11, 2013 No. 121n “On approval of the Requirements for the organization and performance of work (services) in the provision of primary health care, specialized (including high-tech) ...” (hereinafter - the Order of the Ministry of Health No. 121n ) many citizens have a well-founded misconception that emergency medical care must be included in the license for medical activity. The type of medical service "emergency medical care", subject to licensing, is also indicated in the Decree of the Government of the Russian Federation of April 16, 2012 No. 291 "On Licensing Medical Activities".
Clarifications of the Ministry of Health of the Russian Federation on the issue of licensing emergency care
However, the Ministry of Health of the Russian Federation in its Letter No. 12-3 / 10 / 2-5338 dated July 23, 2013 gave the following explanation on this topic: “As for the work (service) in emergency medical care, this work (service) was introduced for licensing the activities of medical organizations that, in accordance with Part 7 of Article 33 of Federal Law N 323-FZ, have created units in their structure for the provision of primary health care in an emergency form. In other cases of providing medical care in an emergency form, obtaining a license providing for the performance of works (services) in emergency medical care is not required.
Thus, the type of medical service "emergency medical care" is subject to licensing only by those medical organizations, in the structure of which, in accordance with Article 33 of the Federal Law No. 323, medical care units are created that provide the specified assistance in an emergency form.
The article uses materials from the article Mokhov A.A. Peculiarities of emergency and emergency care in Russia // Legal issues in health care. 2011. N 9.
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