Medical triage definition of goals types principles of organization. Practical application of medical triage
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 are identified who need medical care at this stage and for whom 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 the general condition of the victim, it is established 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. The arrival of a large number of affected people in a short time forces the doctor performing medical triage, as a rule, to carry out it 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 requiring 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; sudden change 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 characteristics:
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), nurse, two registrars, a line 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 for accelerating the sorting of the affected is the use of differential diagnostic tables for assessing the possible prognosis of the affected by the number of identified most informative signs about the severity of the condition in the case of a burn injury, trauma to the peritoneum and chest, acute radiation sickness, purulent-septic complications.
However, as the experience of exercises and work practice shows medical personnel During the period of admission of a large number of conditionally injured during exercises and actually injured (during tornadoes, hurricanes, earthquakes, disasters and accidents), medical personnel do not use nomograms, mathematical formulas, or indices in the sorting process. 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 methods with positive results can be used in the hospital and surgical dressing department to determine treatment tactics for each seriously affected patient (operative, 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 injured people from rubble, fires, etc. If it is not possible to deliver vehicles to the location of the injured, their removal on stretchers is organized , improvised means (boards) to the place of possible loading onto transport (by relay race method).
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) ).
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The increasing number of emergency situations has recently led to the 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 a certain part of the 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 am sure that the competent sorting work of 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 as quickly as possible. 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 enters a medical facility. 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 of 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 requiring 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 personnel have difficulty 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 disasters where resources are limited, decisions can be made that a large number of medicines and equipment are sent to a limited contingent with a real chance of survival, and some of the affected will only receive 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 medical triage before hospital 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-evaluate their condition at sorting yard.
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, stopping bleeding or, if necessary, a primary determination of the category of the affected person). At this stage, it is very important for the specialist to resist the desire to pay special attention to any one affected person. 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 (sorting stretchers) or a doctor, a nurse, a registrar (sorting 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. Type must be provided 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 providing medical care during disaster response must conduct appropriate staff training, exercises routinely and continuously improve in this regard so that all personnel are aware of 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.
Emergency(Emergency) occurs when significant destruction occurs, regardless of its cause, even in the absence of human casualties.
The incident is considered massive already with three victims.
The incident is considered "catastrophe", if the destruction led to the death of one person.
Highlight three phases of the care process in case of mass casualties.
First phase- isolation phase. This is the period from the moment an emergency occurs until the start of first aid by regular rescue units. First aid is provided in the form of self- and mutual assistance.
Second phase- rescue phase. The period from the arrival of rescuers until the evacuation of victims from the affected area. During the rescue phase, regular medical forces provide assistance to victims abroad.
Third phase- recovery phase. This is the period after the evacuation of victims and before the final outcome.
Each affected person is assigned an appropriate triage category.
Medical force leadership at the scene of mass incidents, the first person in charge of any emergency medical service team that first arrived at the scene of the incident assumes responsibility. The person in charge of the EMS paramedic team that was the first to arrive at the scene of the incident takes over the leadership of the medical forces and carries it out until the arrival of the first EMS medical team.
The initial examination during medical triage includes:1) determination of the presence and localization of arterial pulsation;2) determining signs of ongoing bleeding;3) determination of the presence and nature of external respiration;4) assessment of the level of consciousness;5) condition of the skin;6) assessment of the ability to move independently.
Purpose of medical triage- distribution of victims according to the nature and severity of the injury and prognosis.
Primary triage should be carried out quickly and interrupted only in cases requiring urgent measures (opening the airway, stopping bleeding, or if it is necessary to initially determine the category of the affected person). At this stage, for the sorting specialist, it's important to hold on from the desire to pay special attention to one affected person.
Highlight five sorting groups victims:
Sorting group |
Characteristic |
Giving help |
Evacuation |
Extremely severe injuries incompatible with life |
Symptomatic treatment to relieve suffering. |
Not carried out. |
|
Severe injuries characterized by a rapid increase in vital function disorders |
Preventing the increase in vital function disorders. Help is provided first. |
It is carried out primarily on sanitary transport with control and maintenance of vital functions. |
|
III |
Damage is severe and moderate; severe functional disorders without threat to life. |
Observation. Medical care is provided second priority or delayed. |
Secondly or delayed, on ambulance transport with the possibility of simultaneous transportation of several victims. |
Damage to the middle and mild degree severity without functional disorders, the need for further inpatient treatment |
Observation. Delayed medical care. |
It is carried out on a delayed basis, by general transport, accompanied by a medical worker. |
|
Minor injuries requiring outpatient observation |
Providing medical assistance at subsequent stages of evacuation. |
It is carried out last, independently. |
In 1st turnAffected children and pregnant women, who are a priority group, need help and removal from the outbreak.
Then those affected with external and internal bleeding, in a state of shock, asphyxia, convulsions, in an unconscious state, with penetrating wounds of the chest and abdomen, under the influence of damaging factors that aggravate the lesion (burning clothing, the presence of SDYAV, RV on open parts of the body).After the initial triage, the victims are sent to the central site for continued triage and periodic reassessment of the severity of the condition. Here, if necessary, they are redistributed into categories.
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. The triage physician should know the location and distance to local hospitals, as well as the capabilities of emergency departments and the location of specialized centers (trauma, toxicology, burns).
A certain number of teams are sent to the scene of the incident depending on the number of victims:
If there are 3 victims, it is advisable to send 2 emergency medical services teams, including one intensive care team, to the scene of the incident.
If there are 4-5 victims It is advisable to send 3 emergency medical services teams to the scene of the incident, including one intensive care team.
If there are 10 victims at the scene, it is advisable to send 3 emergency medical services teams for every 5 victims.
If there are 50 casualtiesIt is advisable to send 25 emergency medical services teams to the scene of the incident.
Triage at the hospital stage
RECEPTION AND SORTING DEPARTMENTS There are 5 streams:
1. in need sanitization and subject to dispatch to the emergency response site, or PSO;
2. infectious patients and patients with psychomotor agitation are subject to referral to appropriate isolation wards;
3. the flow is directed to the reception and triage department (site) with the selection of stretchers and walking victims;
4. the flow is directed to the evacuation room;
5. flow - the agonizing and the dead.
Sorting and evacuation departments
Experience from past emergencies has shown that for successful implementation triage, it is necessary to create appropriate conditions at the stages of medical evacuation by deploying independent functional units, with sufficient capacity of premises to accommodate victims in rows on stretchers or Pavlovsky machines, with good passages between the rows and sufficient approach to the stretchers. The so-called Pirogovsky rows.
Reception and sorting or sorting and evacuation departments (sites) are equipped with:
- diagnostic dressing rooms, with sufficient room capacity for separate placement of triage groups of the affected- auxiliary triage bodies (RP - distribution point, MRP - medical distribution point).
- allocation of the required number of medical personnel to work in these departments and the creation of triage teams.
- use of colored sorting marks and primary medical cards with tear-off signal strips.
Sorting teams are created primarily by the personnel of the reception and sorting department, with the involvement, if necessary, of the most trained specialists from other departments.
Composition of sorting teams
Reception and triage departments (sites) in each health care facility, with the necessary area to separate the flow into stretchers and walking patients. It is necessary to allocate the required amount of medical personnel, creating triage teams from it, consisting of:
- doctor-1, nurses-2, receptionists-2 (sorting stretchers)
- doctor-1, nurse-1, registrar-1 (sorting of walkers).
Teams must be provided with appropriate instruments, apparatus, and means of recording sorting results, i.e. the necessary minimum.
It is advisable to include in the sorting teamsthe most experiencedclinicians of relevant specialties who are able to quickly assess the condition of the affected person, establish its diagnostic purpose, determine the prognosis, priority and nature of the necessary medical care.
Taking into account the limit of the time factor, at the 1st stage of evacuation, the recommended time for working with 1 affected person is from 15 to 40 seconds.This is determined by the maximum reduction in the time spent at the collection point for the affected. At the second stage, in the hospital’s reception and triage department, the time standards increase to 2-5 minutes. The ability of 1 triage team to handle 20-25 casualties per hour.
In case of mass arrivalIn the emergency department of the injured, it is advisable to temporarily send reserve triage teams from the doctors of the surgical dressing and hospital departments who are not involved in their deployment to triage the flow, because these personnel are the most qualified in matters of diagnosis and prognosis.
Sorting methods
Medical personnel of any level of training and professional competence must first carry outselectivetriage and identify those affected who are dangerous to others. Then, through a quick review of those affected, identify those most in need of medical care, often urgent and emergency for life-saving reasons (presence of external bleeding, asphyxia, shock, convulsive condition, women in labor, children, etc.)
These patients are subject to referral to specialized departments.
The rest of the flow is divided into walkers and stretchers, which are sent to the appropriate premises of the reception and sorting department (site). 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.
Priority remains with those affected who require emergency medical care. After the selective sorting method, the sorting team moves on toconsistent(conveyor) examination of the affected, for preventive preparation for examination by a doctor of each of those admitted.
Technique for examining the affected
The team simultaneously examines two stretchers: one has a doctor, nurse and registrar, and the second has a paramedic (nurse and registrar). 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. Having made a decision, he moves on to the 3rd affected person, receiving information from the nurse. At this time, the paramedic examines the 4th injured person, etc. The porter unit implements the doctor’s decision in accordance with the sorting mark.
With this “conveyor” method of work, one triage team can sort up to 30-40 stretchers affected by trauma or those affected by SDYA (with emergency care) in an hour.
Sorting is carried out without removing the bandages and without using labor-intensive research methods, based on data from an external examination, interviewing the affected people and reviewing medical documentation, if available.
To format the sorting results use:
1. Primary medical card (continuity of sorting to EME);
2. Medical history filled out at the health care facility;
3. Sorting marks indicating where and in what line to send the affected person are attached to clothing or stretchers.
In the absence of sorting marks or a large flow of affected people, you can use the color marking method used in military medicine (Afghanistan, Korea, Pearl Harbor). Colored markers are used to mark the skin of the victims’ frontal area, as the most visible part of the body.
Additional
IN EMERGENCY SITUATIONS.
IN emergency There is always a discrepancy between the need for medical care and the ability to provide it. It should be borne in mind that 25-30% of those affected require emergency treatment measures, which are most effective in the first hours after injury. There is a cruel need for choice, giving priority first of all to those seriously affected who have a chance to survive. One of the administrative methods of action in these conditions is N.I. Pirogov proposed a method of medical triage.
Unfortunately, in the tragic conditions of an extreme situation, doctors, as a rule, get lost and forget about this life-saving method for many affected people. So, this happened during a tornado in the Ivanovo region (1984), during an explosion at a railway station. Arzamas (1988) and during the earthquake in Armenia (1988), etc.
The experience of medical personnel in disaster areas confirms the importance of the time factor when providing medical care to the injured. By providing medical assistance to the first injured person they see, or to all injured people in a row, medical personnel cause irreparable damage and contribute to the unnecessary death of injured people who could have been saved. In this case, nature itself performs the cruel work of the triage doctor.
The main task of medical personnel in an extreme situation is to identify among the affected “...those for whom timely medical care is able to overcome the disease, as well as those who can no longer be saved due to injuries incompatible with life, and who will die in the coming days inevitable" (E.I. Smirnov).
Medical triage - a method of dividing victims into groups based on the principle of need for homogeneous treatment, preventive and evacuation measures, depending on medical indications and the specific situation.
Purpose of sorting , its main purpose, service function, consists to ensure timely provision of medical care and rational evacuation.
This becomes especially important in situations where when the number of people in need of medical care (or evacuation) exceeds the capabilities of local (facility, territorial) healthcare. Medical assistance is considered timely only when it saves the life of the affected person and prevents the development of dangerous complications.
Medical triage is a specific, continuous (emergency categories may change), repeating and successive process in providing victims of all types of medical care. It is carried out starting from the moment of provision of first medical aid at the site (in the zone) of the disaster and in the pre-hospital period outside the affected area, as well as upon admission of the injured to territorial, regional and other medical institutions for them to receive the full scope of medical care and treatment until the final outcome.
Medical triage is based on diagnosis And forecast. It determines the volume and type of medical care.
At the source of the injury, at the site where the injury occurred, the simplest elements of medical triage are performed in the interests of providing first aid. As medical personnel (ambulance teams, disaster medicine service teams) arrive in the disaster area, triage continues and deepens.
Experience in wars and peacetime disaster areas has shown that the specific grouping of those affected during the medical triage process varies depending on the type and volume of medical care provided. The volume of medical care, in turn, is determined not only medical indications and the qualifications of medical personnel, but also mainly by the conditions of the situation.
^ 1. Types of medical triage
Depending on the tasks being solved, it is advisable to distinguish two methods of medical triage:
Intrapoint;
Evacuation and transport.
Intra-point sorting victims at the stages of medical evacuation is carried out with the aim of distributing them into groups depending on the degree of danger to others, the nature and severity of the injury - to establish the need for medical care and its priority, as well as to determine the functional unit (medical institution) of the medical evacuation stage where it should be be provided.
Evacuation and transport sorting carried out for the purpose of:
Distribution of those affected into homogeneous groups according to the order of evacuation, by type of transport (road, aviation, railway);
Determining the location of the injured on means of evacuation (lying, sitting; on the first, second, third tier);
Definition of the destination - evacuation destination.
The following are taken into account: the condition and severity of the affected person; localization, nature, severity of injury. These issues are resolved based on diagnosis, prognosis and outcome. Without them, correct sorting is unthinkable.
Distinguishing other types of triage, for example, prognostic or based on the time of its implementation ("primary, secondary, final") or the qualifications of the medical staff conducting the triage ("pre-hospital, medical", etc.), is unlawful. This does not meet the goals and objectives of sorting. Medical staff of any level of training and qualifications are obliged to provide medical care first of all to those who need it most, if there is a need for choice (for example, when several seriously injured patients are admitted at the same time). IN difficult situation mass catastrophe, as opposed to normal conditions healthcare, a particularly bitter moment from a moral and ethical point of view in the actions of a doctor is the cruel necessity of choice.
^ 2. Basic sorting characteristics.
At the heart of sorting, three main sorting criteria still retain their effectiveness:
A) danger to others;
B) medicinal sign;
B) evacuation sign.
^ Danger to others determines the degree of need of victims for sanitary or special treatment, isolation.
Depending on this, the victims are divided into groups:
1. Those in need of special sanitary treatment (partial or complete).
2. Subject to temporary isolation.
3. 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, those affected are distinguished:
Those in need of emergency medical care;
Not in need of emergency medical care (care may be delayed);
Those affected in terminal conditions, in need of symptomatic care, with injury incompatible with life.
^ Evacuation sign - necessity, order of evacuation, type of transport and position of the injured person on transport.
Based on this, the affected people are divided into groups:
Those subject to evacuation 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;
Those subject to stay in this medical institution (depending on the severity of the condition) temporarily or until the final outcome;
Those subject to return to the place of residence (resettlement) of the population for outpatient treatment or medical observation.
Special attention focuses on identifying victims who are dangerous to others and in need of urgent medical care.
Carrying out medical triage is most effective when creating triage teams, which include sufficiently experienced doctors of the relevant specialty who are able to quickly assess the condition of the victim, determine the diagnosis (leading lesion) and prognosis, without removing the bandage and without using labor-intensive research methods, and establish the nature of the necessary medical care and evacuation procedures. To do this, if possible, given the fluctuating nature of the arrival of the affected, medical personnel from other departments (during the period of their deployment, etc.) and even from other hospitals (emergency medical teams, etc.) are temporarily involved.
^ Optimal composition of the medical triage team :
- for stretchers when providing first medical and qualified medical care: a doctor, a paramedic (nurse), a nurse, 2 registrars and a section of porters;
- for walkers affected, a triage team is created consisting of a doctor, a nurse and a registrar.
Medical personnel of any level of training and professional competence (sanitary squad, nurse, paramedic, doctor) must first perform selective sorting, identify those affected who are dangerous to others. Then, through a quick review of those affected, identify those most in need of medical care (presence of external bleeding, asphyxia, convulsive condition, women in labor, children, etc.). Priority remains for those in need of emergency medical care.
^ After sampling method triage medical staff proceeds to “conveyor” (sequential) inspection affected.
With this “conveyor” sorting method, one sorting team can sort up to 30-40 stretchers of traumatological patients or those affected by hazardous chemicals (with emergency care) in 1 hour of work.
^ Upon external examination of the victim and his interview, the following are determined:
Localization of injury: head, chest, abdomen, pelvis, limbs, spine;
Nature of injury: mechanical injury - local, multiple, combined (severity of injury), presence of bleeding, bone fractures, prolonged compression of tissues; burn injury - damage by combustion products, hazardous chemicals, radiation damage, etc.;
A leading lesion that currently threatens the life of the affected person;
Severity of the condition: presence (absence) of consciousness, forms of disturbance of consciousness - confusion, stupor or coma; reaction of pupils to light; pulse; breathing features; presence of bleeding, convulsions; blood pressure level (according to indications), changes in complexion and skin;
Opportunities for independent movement, etc.;
The nature of the necessary medical care, the time and place of its provision (ambulance team, medical and nursing teams, medical teams, units of a medical institution) or the procedure for further evacuation (removal, removal).
As a result of the information obtained, the diagnosis and prognosis of the injury is established, the degree of threat to the life of the injured person at the time of triage, the urgency, priority of provision and type of medical care at the moment and at the subsequent stage of evacuation, the need to establish special accommodation conditions for the injured person (isolation from others, etc. ) and the order of further evacuation.
^ 3. Medical triage at the prehospital stage.
In the process of medical triage when providing first aid, the following groups of affected people are distinguished:
Firstly those who need this type of assistance in the first place - the presence of burning clothing, external or internal arterial bleeding (in case of damage to the organs of the chest, abdomen, pelvis), shock, acute cardiac and respiratory failure, asphyxia, convulsions, collapse, loss of consciousness, extensive burns more 20% of the body surface, burns of the face and respiratory tract; traumatic amputation of limbs, open hip fracture; prolapsed intestinal loops, open pneumothorax, sudden change in complexion and skin, severe shortness of breath, etc.
Secondly, assistance for which can be provided in the second place (postponed for the near future): with further exposure to a damaging factor that aggravates the damage - smoldering clothing, the presence of hazardous chemicals on exposed parts of the body, carbon monoxide in the surrounding atmosphere, the location of body parts under the structure of a destroyed building; those affected with abdominal and thoracic injuries, with open and closed bone fractures, extensive soft tissue injuries, burns of less than 20% of the body surface, and skull injuries. Delay in providing them with assistance may aggravate the condition, but does not pose an immediate threat to life.
Third, - all the rest are affected.
Fourthly those in need of removal or transportation to the nearest medical facility; In the first and second place, the injured are evacuated, for whom medical care was provided in the first place, or delayed, all others - in the second place. The position of the affected vehicle is determined (sitting or lying down).
Fifthly, easily affected (walkers) emerge from the disaster independently or with outside help (relatives, etc.).
Ambulance medical teams and disaster medicine service teams (medical and nursing teams) identify in places (in the outbreak or outside the outbreak) concentrations of victims who need cardiopulmonary resuscitation, elimination of asphyxia, monitoring the correctness of previously applied tourniquets, during intravenous administration according to vital indications of blood replacement fluids, in the administration of cardiac, painkillers and other medicines subcutaneously, stopping the primary reaction to radiation, giving antidotes, etc. in order to save lives and prepare for evacuation to the nearest medical institutions, taking into account the profile of the lesion (with surgical trauma - to surgical, traumatological, with therapeutic - to therapeutic, gynecological - to maternity hospitals, children - to children's medical institutions, etc.). Medical teams that arrived to work in the outbreak, at the border of the outbreak, triage the affected people, provide them with first medical aid, and prepare for evacuation.
All other things being equal, preference in the order of provision of first medical, pre-medical (paramedic) and first medical aid at the pre-hospital stage is given to children and pregnant women.
^ 4. Medical triage at the hospital stage of medical care.
At the hospital stage, the affected persons are provided with qualified and specialized medical care.
Among the delivered casualties, the following triage groups are distinguished:
^ I sorting group - those affected with extremely severe injuries incompatible with life, as well as those in terminal state, with clearly expressed signs of a violation of the basic vital functions of the body - a deep disturbance of consciousness, a persistent decrease in SBP below critical level, acute respiratory failure (ARF), etc. The prognosis is unfavorable. Those affected in this group need symptomatic treatment to alleviate suffering. Evacuation to other hospitals is not possible.
^ II sorting group - those affected with severe injuries, accompanied by increasing disorders of vital functions.
This group includes:
Severely affected injuries with rapidly increasing life-threatening complications;
Affected by hazardous chemicals with the threat of loss of function of one or more major life-support systems.
To eliminate violations it is necessary urgent implementation therapeutic and preventive measures. The prognosis may be favorable provided that they receive the appropriate amount of medical care. Those affected by this triage group need help for urgent life indications (including urgent surgical interventions). Temporarily untransportable. Evacuation to other hospitals is possible only after stabilization of hemodynamic parameters and breathing.
Those affected by this triage group are sent, depending on the nature of the injury and the condition of the victim, to the anti-shock, intensive care, dressing room, operating room, etc. to receive emergency medical care.
^ III sorting group - those affected with severe and moderate injuries that do not pose an immediate threat to life. The prognosis for life and recovery is relatively favorable. Medical care is provided as a second priority or may be delayed for several hours (however, the possibility of severe complications cannot be ruled out).
^ IV sorting group - moderately and mildly affected. Lesions with mild functional disorders or without them. The life prognosis is favorable. The development of dangerous complications is unlikely. They need outpatient treatment at the place of residence (settlement) of the population. General state those affected by the fourth triage group are satisfactory. There are no hemodynamic or serious respiratory disorders. The prognosis for restoration of working capacity is favorable with relatively short term hospital or outpatient treatment or medical observation will be required for 1-2 days.
Currently, attention is paid to finding methods for accelerating diagnosis and prognosis for grouping victims in order to differentiate the approach according to the urgency of providing assistance and the order of evacuation.
One of them is based on mathematical modeling using mathematical formulas, algorithms, a scoring system for multifactorial assessment of the severity of injury, and symptoms of its manifestation. Another direction in accelerating the sorting of the affected is the use of differential diagnostic tables for assessing the possible prognosis of the affected person based on the number of identified most informative signs about the severity of the condition during burn injury, with trauma to the abdomen and chest (Table No. 1), with acute radiation sickness (Table No. 2), with purulent-septic complications. However, these methods are not used in conditions of mass arrival of affected people.
The experience of medical personnel in disaster situations shows that when triaging the injured, medical personnel are still guided by clinical and diagnostic symptoms identified during an external examination of the injured and the use of simple examination methods.
For work in a disaster zone, diagnostic algorithms and algorithms for the initial examination of the victim are recommended (V.G. Teryaev, A.I. Potapov); airways(revision and mechanical cleaning of the oral cavity); respiratory function (shallow, labored, respiratory rate, participation in breathing of the pectoral and abdominal muscles); state (integrity) blood vessels; the cardiovascular system(determining the pulse in the peripheral arteries, but not counting it; so the presence of a pulse in the ulnar artery radialis assumes that the blood pressure is 80 mm Hg, the absence is less than 80 mm Hg. The presence of a pulse in mm Hg on ulnar artery corresponds to 60 – 80 mm Hg, absence – less than 60 mm Hg); state of the sensory organs (opening the eyes independently or by verbal command, or to painful stimulation); speech reaction (talks, speaks with difficulty); consciousness is confused; orientation in space; motor reactions (on command, meaningfully, determines the localization of pain, etc. This is the so-called initial examination the victim using the AVVS method.
^ 5. A simple method for assessing outcomes in victims with mechanical trauma.
This method can be used to assess the prognosis in the affected area and in the medical team when there is a mass admission of the affected.
In this case, determination of blood pressure indicators is not carried out, which has great importance during medical triage, especially in winter conditions. The severity of the shock is not taken into account, since with shock of the III degree. there is a disturbance of consciousness. It is understood that external bleeding from large vessels is stopped using available means. When choosing the priority of medical care, special attention is paid to victims whose prognostic index is 10 - 20 points (2 - 3 triage groups - table No. 1).
^
Table No. 1
Assessment of initial mechanical injuries
Three visible (visual) signs are taken into account:
damage determined upon inspection;
state of consciousness;
approximate (biological) age.
Assessing the victim's condition with severe multiple concomitant trauma:
Chest (spine) – 3 points
Abdomen – 4 points
Fracture femur feet – 5 points
Fracture of the tibia – 3 points
Fracture of the humerus 3 points
Fracture of the bones of the forearm (hand) – 3 points
State of consciousness: absence – 5 points
Age over: 50 years – 2 points
60 years old – 5 points
70 years old – 7 points
80 years old – 10 points
2. Forecast calculation:
When summing up the points, a prognostic index (coefficient) is obtained, according to which the affected people are divided into 3 groups (Table No. 1).
A prognostic index of over 20 points is more likely to indicate a hopeless condition of the affected person, especially in conditions of mass admission.
If the victim, in addition to mechanical injury, also has a thermal injury, then for every 10% of the body surface affected by the burn (determined by the Wallace “nines” method), 3 points are added to the prognostic index obtained when assessing mechanical injury.
Table No. 2
Tabular method for determining the severity of acute radiation
Diseases in the latent period (main indicators)
| Main features | ARS severity |
|||
| I | II | III | IV |
|
| Radiation dose | 100 – 200 | 200 – 400 | 400 – 600 | 600 |
| Number of lymphocytes in 1 μl of blood on days 3–6 (x1000) | 1,0 | 0,5 – 0,1 | 0,2 – 0,5 | 0,05 – 0,15 |
| Number of leukocytes in 1 μl of blood on days 8 – 9 (x1000) | 3,0 | 2,0 – 3,0 | 1,0 – 2,0 | 1,0 |
| Diarrhea from 7 – 9 days | No | No | No | expressed |
| Epilation, start time | usually expressed | may not be on 12 – 20 days | the majority have 10 – 20 days | the majority have 7 – 10 days |
| Duration latent period | 30 days | 15 – 25 days | 8 – 17 days | no or less 6 – 8 days |
In conditions of mass influx of injured people, to facilitate and speed up the calculation of points, it is advisable to use a simple microcalculator with self-powered power; it is recommended to stick a scale with damage ratings in points on the back cover - for example, “head - 2”, thigh - 5”, etc.
