The following types of medical triage are distinguished. Alternative places of care

Before entering one of the functional units of the primary care unit, the entire flow of victims is sent to the triage department. This is one of the important and responsible moments when providing medical care a large number of wounded. In the triage department, medical triage of the affected is carried out.

Medical triage - This is the distribution of victims into groups in need of homogeneous treatment and evacuation measures.

Depending on the conditions and capabilities of the primary care unit, as well as on the number of victims, the indications for treatment may vary. The scope of medical care can be extremely narrowed when there is a massive influx of victims and expanded when their number is relatively small or in the absence of opportunities for evacuation to the second stage.

For the first time, medical triage was used by N. I. Pirogov when providing assistance to the wounded who arrived from the battlefield. He pointed out the need, dictated by the specific situation, to establish a priority for providing assistance. When there are massive numbers of injured people, it is impossible to provide assistance to everyone, and therefore you should focus on those who urgently need help, and not deal with those victims whose lives are currently not in obvious danger, and those who have injuries that are incompatible with life.

Medical triage should be trusted exclusively to competent, experienced, attentive and absolutely balanced medical workers, capable of not being led by his own feelings of compassion. Only in this case will the main goal of triage be achieved - timely provision of medical care in the required volume and correct timely evacuation.

The triage team includes a doctor, a nurse or paramedic, a receptionist and orderlies. Orderlies, on the orders of the doctor, deliver the victims to the emergency medical services units. The registrar, according to the doctor or nurse, fills out the primary medical card stricken.

To speed up triage, two victims are examined simultaneously: one is examined by a doctor, the other by a nurse. After making a triage decision, the doctor goes to the affected person, examined by the nurse, listens to her message, signs the victim’s initial card filled out by her and makes a triage decision. If in doubt, the doctor performs an additional examination. Then the next two victims are examined in the same order (Diagram 6).

When performing medical triage, it is very important to ensure Free access to the victims. The stretchers should be in rows, with wide aisles between them. The sorting team usually makes a decision based only on external inspection data. As a rule, it does not provide medical assistance, but the triage team must be equipped with dosimeters to determine radiation contamination.

11principles and types of sorting are presented in Diagram 7.

During medical triage, there are five triage groups of victims.

1 - group . Victims who are suffering or have injuries incompatible with life. They are sent to an isolation ward for those in agony, where they are cared for and given drug therapy aimed at alleviating suffering. This group of victims is not sent to the next stage of medical evacuation.

2nd group . Those affected with disorders of vital functions important organs and systems. They need priority therapeutic measures and sent to the appropriate

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Increasing number emergency situations recently has led to a more frequent involvement of emergency personnel to eliminate the consequences of various types of disasters and terrorist attacks. Distinctive feature All emergencies involve the need to provide medical care to a large number of victims who arrive almost simultaneously. In these situations, the basis for the organization of medical care is the principle of medical triage, which we will talk about in this article.

The introduction of a unified doctrine of medical triage is extremely important, since this presupposes the same type of actions by all employees of emergency medicine units, which significantly improves the quality of medical care for victims in general when they are massively admitted.

For example, during the explosion in the Minsk metro on April 11, 2011, it was of great importance to provide timely assistance The victims were assisted by competent triage of victims at the scene of the tragedy, carried out by EMS personnel. Thanks to her, all the victims were correctly and timely distributed to the city’s medical institutions according to their profile. This made it possible to ensure an almost uniform load on the staff of nearby hospitals, although at the very beginning certain part victims were sent to the 3rd city clinical hospital, which was closest to the scene of the incident. However, later the flow was distributed: victims with head trauma and associated trauma were sent to the city emergency hospital, where there is a powerful neurosurgical service and a department for associated trauma; victims with severed limbs and other injuries were sent to the city center of traumatology and orthopedics, while the rest were evenly distributed among all surrounding hospitals where there is an emergency surgical service. I'm sure she's competent sorting work The EMS played a significant role in minimizing the consequences of this terrorist attack.

Medical triage is the “backbone” of disaster medicine. It is based on the need to provide medical care to the maximum extent possible. short time Maybe more victims who have a chance to survive. This principle is fundamentally different from the focus on providing assistance to isolated victims, which is what civil medicine most often encounters. Given that during disasters there is always a disproportion between the number of people affected, the severity of injuries and the amount of forces and means of the medical service, the simultaneous provision of medical care to all victims is practically impossible, this should be clearly understood. In the event of a natural disaster or terrorist attack with a massive number of casualties, it is extremely difficult to make the right decision that determines priority activities. The impossibility of treating all those in need of medical care, due to a lack of personnel, resources and capacity to receive victims, leads to the creation of a system of dividing the affected into various groups, depending on the severity of the condition. This is medical triage, developed by military medicine.

A little theory

Medical triage is the distribution of those affected into groups based on the need for homogeneous treatment and preventive measures, depending on medical indications and the established volume of medical care. Medical triage is a specific, continuous, repeating process that begins at the site of injury (damage, injury) and ends when the injured person is admitted to the hospital. medical institution. It is carried out on the basis of diagnosis and prognosis. Depending on the tasks solved during the triage process, it is customary to distinguish 2 types of medical triage:

Intrapoint medical triage;
- evacuation and transport medical triage.

Intrapoint medical triage– distribution of those affected into homogeneous groups depending on the nature and severity of the lesion and establishing the priority of medical care. It determines the functional departments where the victim should be treated. It is carried out in a hospital when there is a mass admission of victims.

Evacuation and transport– distribution of victims into groups in order to establish the order of evacuation, evacuation location, type of transport and position of the victim during transportation. This type of sorting is carried out at the DGE.

The sorting is based on 3 main criteria:
- danger of the victim to others, which involves sanitization or isolation from others (damage to potent substances, mental disorders);
- curative sign, which determines the degree of need of the victim for medical care, the order of its provision and the place where it should be provided;
- evacuation sign, determines the need and order of evacuation of the victim to the next stage of evacuation.

Sorting groups

When carrying out medical triage, all victims are divided into four triage groups, which were identified by N.I. Pirogov.

Sorting groups are indicated by different colors.

I. " Agonizing" (indicated in black) - this includes dying victims with traumatic injuries and (or) poisonings incompatible with life (severe head injuries with crushing of the brain, burns incompatible with life, etc.) and agonizing. They only need symptomatic therapy. The prognosis is unfavorable for life. They are not subject to evacuation. The dead also belong to this group. The number of victims in this group, depending on the lesion, can reach 20%.

II. " Urgent Care " (red color) - severe injuries and poisonings that pose a threat to life, i.e. victims with rapidly increasing life-threatening disorders of the main vital functions important functions body (shock), the elimination of which requires urgent treatment and preventive measures. Temporarily untransportable. The prognosis may be favorable if they receive prompt medical attention. Patients in this group need help for urgent life reasons. Evacuation first, after providing the necessary medical care. Medical transport. Lying position. Composition - up to 20%.

III. " Urgent help " (yellow) - damage and poisoning moderate severity, i.e. not posing an immediate threat to life. Life-threatening complications may develop. The prognosis is relatively favorable for life. Assistance is provided in the 2nd stage, or may be delayed until admission to the next stage of medical evacuation. This also includes victims in satisfactory condition for whom medical care is indicated in the 2nd line. The prognosis is favorable for life. Secondary evacuation. Medical transport. Composition up to 20%.

IV. " Non-emergency assistance " (green color) - easily affected, i.e. victims with minor injuries who require outpatient treatment. The prognosis is favorable for life and ability to work. Evacuate independently or by transport general purpose. Composition - about 40%.

Triage poses a number of challenges, one of which is well known to medical personnel and those involved in rescue operations. This problem is of a moral and ethical nature. In disasters, triage, regardless of location, creates prospects for assistance based on the categorization of victims. This approach may be in conflict with the everyday practice of providing emergency medical care, in which one severely injured, and sometimes hopeless, person is treated necessary help for a long time. The moral responsibility of the doctor in charge of triage is enormous, and therefore the decision to transfer to group 1 should, if possible, be made collectively by a team of the most experienced doctors. Traditionally medical staff experiences difficulties in categorizing those affected from the first group due to the fact that in normal work everyone is involved available methods modern medicine and everyone is accepted necessary measures to save their lives. In case of disasters, when resources are limited, decisions can be made according to which a large number of medicines and equipment are sent to a limited contingent with a real chance of survival, and some victims will receive only palliative care with incompatible or incompatible lesions with life. In case of mass casualties, prolongation of life of this contingent medical supplies leads to unnecessary losses of medical forces and resources to the detriment of less injured people who have a real chance of survival.

Practical implementation of medical triage at the prehospital stage

When liquidating the consequences of disasters or terrorist attacks, the first EMS team that arrived at the source (to the border of the source) of the emergency must perform medical triage duties until the doctor/paramedic of the EMS team is no longer replaced experienced specialist, if necessary. The same team attracts additional personnel to carry out medical triage and implement triage decisions at the initial stage.

The triage doctor (paramedic) must know the location and distance to local hospitals, as well as the capabilities of the departments emergency care and location of specialized centers (trauma, toxicology, burns). This information can usually be obtained from the hospitalization department.

In some cases, to ensure the smooth operation of emergency services in the affected area, the involvement of law enforcement officers is required.

At the very early dates a central sorting zone (sorting site) must be determined, located as close as possible to the source of the disaster (terrorist attack), but free from the dangerous influence of damaging factors. It is advisable to establish a collection point for victims at the border of the affected area; there should be adequate access and convenient exit. In large-scale disasters, multiple triage points may be required, and competent coordination is required. When freeing damaged structures from the rubble of collapsed structures, which requires lengthy efforts, it is necessary, if possible, to stabilize their condition throughout the entire extraction process, and then re-assess their condition at the sorting site.

At the source of the lesion, the simplest medical triage is carried out by the EMS and rescue teams, with the allocation of the corresponding groups of the affected.
First of all, the affected children and pregnant women, who are the priority contingent, need help and removal from the outbreak, then those affected with external and internal bleeding, in a state of shock, asphyxia, with convulsions, in unconscious, with penetrating wounds of the chest cavity and abdomen, under the influence of damaging factors that aggravate the injury (burning clothing, the presence of potent or radioactive substances on exposed parts of the body).

Although evacuation of the injured person is very important, basic resuscitation methods are the priority. Initial triage should be carried out quickly and interrupted only in cases requiring urgent measures (release respiratory tract, stop bleeding or if necessary primary definition category of the affected person). At this stage, it is very important for a specialist to resist the desire to devote Special attention to some one affected. After initial triage, victims are sent to the central triage area for continued triage and periodic reassessment of the severity of the condition. Here, if necessary, they are redistributed into categories.

Working at the sorting yard

At the triage site there is a triage team consisting of a doctor and a paramedic (or a doctor and two paramedics), which attracts additional emergency medical services teams to implement triage decisions. Undoubtedly, the ideal is to create a triage group according to wartime models (a doctor, two nurses, two registrars (stretcher sorting) or a doctor, nurse, registrar (sorting of walkers)), but this is not always possible. At the first stage of evacuation, the recommended time of working with one affected person is from 15 to 40 seconds.

Medical personnel must first carry out selective triage and identify among those affected those who are dangerous to others (persons with mental disorders and affected by highly toxic and radioactive substances). Then, through a quick review of those affected, identify those most in need of medical care according to vital indications (presence of external bleeding, asphyxia, shock, convulsive state, pregnant women, children, etc.) These patients are immediately provided with assistance by emergency medical services teams. The rest of the stream is divided into walkers and stretchers. This is more expedient and allows us to avoid the disorganization in work that constantly occurs when there is a massive influx of affected people.

After the selective sorting method, the sorting team proceeds to a sequential (conveyor) inspection of the affected stretchers. The team simultaneously examines two stretchers: one has a doctor (himself or with a paramedic), and the second has a paramedic. The doctor, having made a triage decision on the 1st affected person, moves on to the 2nd one and receives information about it from the paramedic. If there are two paramedics, then at the moment of examining the second victim, the paramedic moves from the first to the third. Having made a decision on the second patient, the doctor moves on to the 3rd, receiving information from the paramedic. At this time, the paramedic examines the 4th affected person, etc. A link of porters from among the lightly affected or additional emergency medical teams implements the doctor’s decision in accordance with the triage group. Sorting is carried out without removing the bandages and without using labor-intensive research methods, based on external examination data. When sorting, the victim is assigned a certain sorting category (group), according to the classification outlined above. To indicate the triage group on the victim, sorting marks are used, but as a rule, they are not available, so you can use the color marking method used in military medicine. In this case, with colored markers, designations are applied to the skin of the frontal area of ​​the victims, as the most visible part of the body.

Once the issues of primary sorting and marking of victims are resolved, there is a need to distribute medical transport, depending on needs. It is necessary to provide for the type of vehicle and all available territorial resources. In the case of the terrorist attack in the Minsk metro, taxi drivers provided enormous assistance to the EMS teams, transporting the victims to medical institutions completely free of charge.

A few words in conclusion

Medical triage is one of the most important organizational methods aimed at more successful implementation of a two-stage system of treating the population in emergency situations. Properly organized sorting contributes to the most rational use forces and means of the medical service for the timely and more complete provision of all types of medical care to victims, their treatment and evacuation. At present, a single mechanism has not yet been developed by which it is possible to accurately and accurately distribute those affected into categories. Each area of ​​medicine is trying to choose its own method that approximately meets the criteria for reducing mortality in the event of a mass influx of affected people.

It is impossible to strictly adhere to any one sorting system in all situations; each of them can be supplemented by successful various techniques taken from other systems. Here the cardinal role is played clinical assessment, training and experience of personnel. Preparing and planning for disasters is very important for successfully dealing with their consequences. To do this, medical personnel must constantly improve their knowledge, skills and abilities, and have the necessary training.

All medical institutions responsible for medical support When responding to the consequences of disasters, they must conduct appropriate training of personnel, exercises in a planned manner and constantly improve in this regard, so that all personnel know the responsibilities of the triage doctor, its concept, and are also informed about the available equipment and resources. A catastrophic situation is not the time to test a new system.

One method of improving and strengthening triage skills when triage is not carried out daily is to set aside a special "sort day". Each affected person is assigned an appropriate triage category. Another option is to routinely triage situations where five or more people need to be treated. Often triage is not carried out for reasons of ignorance of the methodology for its implementation or due to the existing possibility of immediate evacuation of victims, due to the proximity of the location medical institutions and ease of transportation.

On the scale of CIS integration, to combat disasters, the consequences of terrorist attacks and provide medical care to those affected, it would be ideal to use a standardized international approach, known to all organizations and specialists of the disaster medicine service.

1. Borchuk, N.I. Medicine of extreme situations: textbook. student manual medical institutes/ N.I. Borchuk. – Minsk: Higher School, 1998. – 240 p.

2. Bova, A.A. Military toxicology and toxicology of extreme situations: textbook - Minsk: BSMU, 2005. - 700 p.

3. Kutsenko, S.A. Military toxicology, radiobiology and medical defense. St. Petersburg: Foliant Publishing House LLC, 2004. – 528 p.

4. Kolb, L.I. Medicine of disasters and emergencies / L.I. Kolb, S.I. Leonovich, I.I. Leonovich. – Minsk: Higher School, 2008. – 447 p.

Medical triage is the distribution of the affected and sick during their mass arrival, depending on the nature and severity of the lesion (disease), into groups in need of homogeneous treatment and preventive or evacuation measures, determining the priority and place of care for each group or the priority and method of evacuation.

Since the conduct of hostilities began to be accompanied by significant sanitary losses (see), there has been a need to use medical triage in order to provide timely medical care to those most in need. N. I. Pirogov was the first to theoretically substantiate the doctrine and methodology of medical triage and brilliantly put them into practice. Arriving in besieged Sevastopol in 1854, he began his activities not with surgical aids, but with establishing order at dressing stations and, first of all, with conducting medical triage. N.I. Pirogov wrote: “Having realized soon after my arrival in Sevastopol that simple order and order at the dressing station is much more important than purely medical activity, I made a rule for myself: not to begin operations immediately when transferring the wounded to these points, not to waste time for long-term benefits and immediately start sorting them out.”

It is impossible to do without medical triage in all those cases when a large number of injured or sick people simultaneously enter a medical institution, even in peacetime. If, for example, a large number of victims are brought to the hospital at the same time as a result of a natural disaster or train accident, doctors first of all have the task of conducting medical triage. In a combat situation, when mass arrivals of casualties are the rule, medical triage becomes especially important.

When carrying out medical triage at stages (see), first of all, from the general flow of those affected, those dangerous to others are identified (infected with radioactive substances, persistent agents, infectious or suspected patients) in order to prevent contact with them and to take possible measures to neutralize them (decontamination , etc.). Groups of affected people who need to be provided with medical care are identified. at this stage and by which it can be postponed until the next one. In relation to the first group, in accordance with the nature and localization of the lesion (disease) and general condition the victim is determined what medical care (in terms of volume, nature) he needs and in what order it should be provided. Depending on this, the functional unit of this stage (operating room, anti-shock, etc.) in which this assistance should be provided to him is determined. Next, questions are resolved about the indications for delaying the affected (patients) at this stage, depending on the severity of the lesion (disease). Thus, those who are not transportable are left until further evacuation becomes possible, and those who are easily injured are left until they recover. For each person subject to further evacuation, it is established where he should be evacuated, on what transport, in what position (sitting, lying down) and in what priority (first or second).

Medical triage is carried out only on the basis of diagnosis and prognosis. Depending on the diagnosis, questions are resolved about the need to provide assistance to the affected (patient) at a given stage, its nature and place, the order of provision of this assistance is determined, indications and contraindications for evacuation, the urgency and order of this evacuation are established. Depending on the prognosis, the question of the possibility of curing the injured or sick person at this stage with his subsequent return to duty or the need for his further evacuation to the rear (due to the length of the recovery period) is decided.

Medical triage is usually divided into two types: intra-point, which determines the order of passage of the affected (patients) inside the first-aid post, while establishing the order and place of care at this stage; and evacuation transport, which determines the order of sending the affected (patients) beyond this stage, while deciding the order and method of their evacuation, as well as where they should be evacuated (destination).

Certain conditions are created to organize medical triage. At each of them, a specially equipped receiving and sorting department, including a sorting area, is allocated for these purposes. Admission to the stage in a short time large quantity of the injured forces the doctor performing medical triage, as a rule, to carry it out without removing the bandage and carefully collecting an anamnesis, most often guided only by an external examination of the victim. Because of this, medical triage should be entrusted to the most experienced doctors.

The results of medical triage are recorded with appropriate colored marks (markings), which are attached to the clothes of the affected person (patient) or to the handles of the stretcher (Fig.). Marking allows junior medical staff, without additional instructions, guided only by sorting marks, to send to certain units or load the affected persons onto transport in strict accordance with the decision of the doctor who carried out the triage.

Elements of medical triage are already used on the battlefield. Average and junior medical staff in the presence of several affected people, deciding on the order of care for them or the order of removal (removal), essentially carries out medical triage.

The importance of medical triage especially increases in a war with the use of nuclear weapons by the enemy, characterized by the simultaneous and massive occurrence of sanitary losses and the arrival of a large number of casualties at the stages of medical evacuation in a short time.

The civil defense medical service must be ready to provide medical and evacuation services to large masses of the affected population. Because of this, medical personnel called upon to provide this support must know the principles and methods of conducting medical triage. There are no significant differences in the conduct of medical triage in civil defense conditions. It should only be emphasized that, in addition to diagnosis and prognosis, medical personnel performing medical triage in these conditions are required to be guided by certain social aspects. For example, women in labor, postpartum women, and children should be given priority for priority evacuation.

Sorting marks: E - evacuation, SO - sanitary treatment (numbers indicate priority).

In the event of an emergency, as a rule, there are massive sanitary losses and a lack of medical forces and resources to promptly organize assistance to all those affected. We have to use priority in providing medical care and evacuation. Medical triage required.

Medical triage is a method of dividing victims and patients into groups, which is based on the need for uniform treatment, preventive and evacuation measures, depending on medical indications and the specific circumstances of the emergency.

Medical triage is carried out starting from the moment of first aid at the injury site and continues during the provision of all pre-hospital and hospital types of medical care.

Depending on the tasks being solved, there are two types of medical triage:

1. Intra-point sorting determines the order of passage of the victim inside the medical institution (point of medical care);

2. Evacuation transport sorting is carried out with the aim of distributing victims into homogeneous groups according to evacuation order, types of evacuation transport, position of the victim (sitting, lying down) and evacuation destination (destination).

During the provision of first aid in the process of medical triage, the following groups are distinguished:

1) Victims who need medical attention first (presence of flaming clothing; external or internal arterial bleeding; shock; asphyxia; convulsions; collapse; loss of consciousness; traumatic amputation of limbs; prolapse of intestinal loops; open pneumothorax; involuntary release of urine and feces; a sharp change in the color of the skin and mucous membranes; severe shortness of breath, etc.);

2) Affected people, for whom assistance can be provided in the second place, that is, delayed for the near future (continued influence of the damaging factor aggravating damage to the body - smoldering clothing, the presence of SDYA on open parts of the body, increased content of carbon monoxide in the surrounding atmospheric air; finding parts of the body under structures of a destroyed building, etc.). Delay in providing them with help may aggravate the condition, but does not create an immediate threat to life.

3 ) All other victims;

4) Victims who need to be removed or transported to the nearest medical and preventive institution in the first place (victims who received medical care in the first place) and in the second place (all other victims);

5) Slightly affected (ambulatory) patients who can, independently or with assistance, outside help get to a medical facility.

The following basic principles are taken as the basis for sorting: sorting criteria:

Danger to others determines the degree of need of those affected for sanitary or special treatment, isolation. Depending on this, those affected are divided into groups:

Those in need of special (sanitary) treatment (partial or complete);

Subject to temporary isolation (in an infectious disease or psychoneurological isolation ward);

Not requiring special (sanitary) treatment.

Curative sign – the degree of need of victims for medical care, the priority and place (medical unit) of its provision.

According to the degree of need for medical care in the relevant units of the evacuation stage, those affected are distinguished:

Those in need of emergency medical care;

Not in need of medical care (care may be delayed);

Those affected with an injury incompatible with life, in need of symptomatic help, that is, relief of suffering.

Evacuation sign – necessity, order of evacuation, type of transport and position of the injured person in transport. Based on these signs, those affected are divided into groups:

Those subject to evacuation outside the outbreak (affected area) to other territorial, regional medical institutions or centers of the country, taking into account the evacuation purpose, priority, method of evacuation (lying, sitting), type of transport;

Not subject to evacuation outside the outbreak (must be left in this medical institution due to the severity of the condition, non-transportability, temporarily or until recovery);

Subject to return to place of residence (resettlement) or short-term delay for medical stage for medical supervision.

In the emergency departments of medical institutions (MPIs), triage teams are formed to conduct medical triage. The optimal composition of a medical triage team is as follows: a doctor, a paramedic (nurse), a nurse, two registrars, a section of porters (four people). Sorting is usually based on data from an external examination of victims, their interview, and review of medical documentation (if any), without the use of labor-intensive examination methods. The medical staff of the triage team first carries out selective triage in order to identify those affected, those who are dangerous to others, and those who primarily need medical care (the presence of external bleeding, asphyxia, women in labor, children, etc.). After the selective sorting method, the brigade personnel proceed to the “conveyor” inspection of the victims. Two people are examined at the same time: near one of them there is a doctor, a nurse and a registrar; near the other there is a paramedic (nurse) and a receptionist. Having made a triage decision on the first victim, the doctor moves on to the second, receives information from the paramedic, and, if necessary, additionally examines the victim. Then, having made a triage decision on the second victim, the doctor moves on to the third, receives information from the nurse about his condition, if necessary, supplements it with a personal examination, and makes a decision. The paramedic and the receptionist are currently examining the fourth victim, and thus the triage process continues.

If necessary, the victims are provided with medical assistance. The results of sorting are recorded with sorting marks, on the basis of which porters carry out the doctor’s sorting decisions. Given the uneven flow of victims, if there are a significant number of them, additional triage teams are formed from other departments of the hospital.

One triage team in 1 hour of work can sort from 20 to 40 trauma victims or those affected by SDYV with the provision of emergency medical care.

Currently, the attention of modern medicine is focused on finding methods for accelerating diagnosis and prognosis for grouping those affected with the goal of a differentiated approach according to the urgency of care and the order of evacuation. Various directions for this work have been identified. One of them is based on mathematical modeling using mathematical formulas, algorithms, point system multifactorial assessment of the severity of injury, symptoms of its detection and some complications. Tables of assessment scores, values ​​of trauma-logical indices, parametric scoring scales, as well as nomograms for calculating indices and prognosis of damage to the adult and child population are recommended.

Another direction to speed up the sorting of the affected is the use of differential diagnostic assessment tables possible prognosis in those affected by the number of identified most informative signs about the severity of the condition in the case of burn injury, trauma to the peritoneum and chest, acute radiation sickness, purulent-septic complications.

However, as the experience of the exercises and the work practice of medical personnel during the period of admission of a large number of conditionally injured during exercises and those actually injured (during tornadoes, hurricanes, earthquakes, disasters and accidents) shows, medical personnel do not use either nomograms or mathematical formulas in the triage process, nor indexes. But they can be used to clarify the degree of damage and determine the prognosis in subsequent periods of medical evacuation stages.

In addition, with appropriate training, the nursing staff of the triage teams can collect data on visible anatomical and accessible functional disorders in the affected people, taking into account the score, to inform the triage team doctor about the condition of the affected person, and the doctor, having specified additional clinical symptoms of the lesion if necessary, accepts the final triage decision. solution. These techniques with positive results can be used in the hospital and surgical dressing department to determine therapeutic tactics for each severely affected patient (surgical, conservative, symptomatic and other treatments).

Table methods for determining the severity of radiation injury (acute radiation sickness), prognosis of thermal injury, as well as indicators of the volume of bleeding and some others are of absolute practical importance for medical triage.

An important element in organizing emergency medical care for the population during mass casualties is medical evacuation.

Medical evacuation is a system of measures to remove those affected from the disaster zone who need medical care and treatment outside it. It begins with the organized removal, withdrawal and removal of victims from the disaster zone and ends with their delivery to medical institutions that provide the full scope of medical care and ensure treatment until the final result. Rapid delivery of the injured to the first and final stages of medical evacuation is one of the main means of achieving timely provision of medical care to the injured.

In disaster situations, sanitary and unsuitable vehicles, as a rule, are one of the main means of evacuating those affected in the link - the disaster zone - the nearest medical institution where the full scope of medical care is provided. If it is necessary to evacuate those affected to specialized centers in the region, air transport is usually used.

During evacuation, it is important to correctly place the injured in the bus or the back of the car. Severely wounded people who require careful transportation conditions are placed on stretchers mainly in the front sections and no higher than the second tier. The injured on stretchers with transport tires, plaster casts are placed on the upper tiers of the cabin. The head end of the stretcher should face the cabin and be 10–15 cm above the foot end in order to reduce the longitudinal movement of the affected persons during transport. Slightly affected (sedentary) patients are placed in buses last on folding seats, and in trucks on wooden planks (boards) that are secured between the side walls. The speed of vehicles is determined by the condition of the road surface, visibility on the roads, time of year, time of day, etc. and is usually set within 30 - 40 km/h.

Some advantages over by car, together with railway, also has river (sea) transport (commodity and passenger ships, barges, speed boats, fishing and cargo ships).

Among the air means for evacuating the injured, various types of civil and military transport aircraft, as well as specially equipped An-2, Yak-40, etc. can be used. Devices for stretchers, placement of sanitary equipment, and medical equipment are installed in aircraft cabins. The most convenient are the An-26M and “Spasatel” resuscitation and operating aircraft with an operating room, intensive care ward, etc.

As the experience of services in disaster zones has shown, the most difficult thing to implement organizationally and technically is the evacuation (removal, removal) of those affected from rubble, fires, etc. If it is not possible to vehicles to the location of the affected people, they are carried out on stretchers, improvised means (boards) to the place of possible loading onto transport (using a relay race).

During mass evacuation of victims by rail (water) transport (evacuation and sanitary trains, railway flights), access roads are equipped at loading points, using the simplest devices to ensure loading (unloading) of victims (ladders, bridges, shields). Platforms, gangways, and piers are also used for this purpose. In bad weather conditions, measures are taken to protect those affected from rain, snow, cold, etc.

Evacuation is carried out on the principle of “on your own” (ambulances, medical institutions, regional, territorial emergency medical care centers, etc.) and “on your own” (by transport of the affected facility, rescue teams, etc.). The general rule when transporting injured people on stretchers is that the stretchers are not replaceable, with their replacement from the exchange fund.

It is very important to organize evacuation management in order to uniformly and simultaneously load medical units (hospitals) with treatment and preventive measures, as well as ensure the referral of victims to medical institutions of the appropriate profile (departments of medical institutions), reducing to a minimum the movement of those affected by destination between medical institutions of the region (city) ).

Medical triage represents the distribution of the wounded and sick into groups based on the need for certain homogeneous treatment and evacuation and preventive measures in accordance with medical indications and the volume of medical care that can be provided at this stage of medical evacuation in specific conditions of the situation.

Medical triage is the most important event that ensures clear organization of the stages of medical evacuation to provide medical care. Its role especially increases with the mass arrival of affected people. Sorting was first used by N.I. Pirogov in the dressing detachment in March 1855.

Purpose of medical triage– ensure the fastest provision of medical care maximum number the wounded and sick who need it. Medical triage is carried out on the basis of determining the diagnosis of an injury or disease and its prognosis, and therefore is diagnostic and prognostic in nature. The most important people should participate in its implementation experienced doctors. It is advisable to carry out medical triage by triage teams consisting of a doctor, two nurses(paramedics), two registrars. As a rule, the sorting team is assigned a link of orderlies-porters. One triage team can triage 15-20 affected people within an hour of work.

Based on the methods of organizing (carrying out) medical triage, it can be divided into:

A) Systematic – this is a classic medical triage using the “rolling” method(diagram 6) . The doctor, moving from the first affected person to the second, third, and so on, assesses their condition, determines medical purposes and a triage destination for each affected person. The first pair - a nurse (paramedic) and a registrar fill out documents and carry out medical prescriptions first for the first affected person, then move on to the third, fifth, etc., that is, for each odd affected person. The second pair - a nurse (paramedic) and a registrar fill out documents and carry out medical appointments first for the second affected person, then move on to the fourth, sixth, etc., that is, for each even-numbered affected person. The results of sorting are indicated by special sorting marks and marks in the medical documents accompanying the wounded (primary medical card - form 100), evacuation envelope, list of evacuated wounded and sick).

B) Transitional (transport)– when a large number of people affected come from the centers of mass sanitary losses and in case of any threat of EME. It is carried out directly on the evacuation transport, the doctor climbs on board the vehicle, selects the wounded who need emergency care at this stage, who are unloaded from the vehicles and left at the EME. And the rest of the wounded are sent in transit to the next EME.

IN) Selective- This First stage triage using the standard “roll over” technique, where the triage team first identifies and works with the most seriously injured in the triage area, those in need of urgent measures medical care.

Depending on the tasks being solved, there are two types of medical triage: intra-point and evacuation-transport.

Intra-point sorting is carried out with the aim of dividing the wounded and sick into groups for referral to the appropriate functional units of a given stage of medical evacuation and establishing the order of their referral to these units.

Evacuation and transport sorting represents the distribution of the wounded and sick into groups for referral to subsequent EME in accordance with the evacuation purpose, priority, methods and means of further evacuation.

Intrapoint and evacuation-transport sorting are often carried out simultaneously, i.e. along with identifying the flow of wounded and sick people who need certain medical care at this stage, the evacuation purpose, sequence, method and means of evacuating the wounded and sick who do not need medical care at this stage are determined. The provision of assistance at this stage ends with evacuation and transport triage.

The main groups of casualties identified as a result of triage at the stage of medical evacuation:

1. Posing a danger to others(infectious patients, patients in a state of psychomotor agitation, infected with BS, having contamination skin and uniforms of chemical agents and radioactive substances with dose rate measurements exceeding permissible), and, therefore, subject to sanitization or isolation.

Subsequently, from the isolation ward, patients go for evacuation in a separate stream, and from the special treatment department to the reception and triage department and the medical care department.

Those who do not pose a danger to others go from the distribution post to the reception and sorting department.

2. Those in need of medical assistance at this stage; go from the reception and triage department to the medical care department, then to evacuation or to the hospital department, after which either evacuation or return to production is possible.

3. Subject to further evacuation and not requiring medical assistance at this stage; are leaving the reception and sorting department for evacuation.

4. Suffered injuries incompatible with life and those in need of care only (agoning).

This group is identified conditionally, a place for such patients is selected separately, and in the future, despite their injuries, they will be evacuated for subsequent EME. In all cases we must keep humane treatment to the wounded and take all measures to save the lives of as many wounded as possible.

5. To be returned to production(after appropriate medical care and short rest).

The results of medical triage are recorded using sorting marks, as well as by recording in the primary medical record (form 100). Sorting marks are attached to the victim’s clothing in a visible place with pins or special clips. The designation on the stamp serves as the basis for sending the affected person to one or another functional unit and determining the priority of delivery.