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Civil defense and emergency protection. Casualty triage groups

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 assistance to 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 assistance, but with establishing order at dressing stations and, first of all, with 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 RVs, persistent agents, infectious or suspected patients) in order to prevent contact with them and to accept possible measures to their neutralization (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 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 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 stage B short terms a large number of affected people 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 to additional instructions, guided only by sorting marks, send to certain units or load the affected persons onto transport in strict accordance with the decision of the doctor who carried out the sorting.

Elements of medical triage are already used on the battlefield. Middle 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 performs medical triage.

The importance of medical triage especially increases in war with the use of enemy nuclear weapons, characterized by the simultaneous and massive occurrence of sanitary losses and the arrival of a large number of injured people 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. Due to this medical staff The person called upon to carry out this provision must know the principles and methods of 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 carrying out medical triage in these conditions must 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).

MEDICAL SORTING- distribution of the affected and sick in first-aid posts and treatment. institutions into groups, each of which includes persons in need of homogeneous treatment, preventive and evacuation measures, with the determination of the priority and place of providing them with medical care, as well as the direction, priority and method of evacuation. S. m. is an organizational event that allows the most effective use of available forces and means medical service, correctly organize the provision of medical care to the injured and sick, their treatment and evacuation, i.e., ensure the successful implementation adopted system medical and evacuation measures.

The need to use S. m. for the purpose of timely provision of medical care to those most in need arose from the time when fighting began to be accompanied by significant sanitary losses (see Sanitary losses). Theoretical provisions, S. m.’s technique was first substantiated and brilliantly put into practice by N. I. Pirogov. However, the distribution of the wounded and sick into groups was used in medical cases. providing troops in the pre-Pirogov period. With the emergence of organized medical care in the Russian army (see Military Medicine), the division of the wounded and sick into severe and mild received official recognition. So, in the wars of the 17th century. it was carried out mainly for the purpose of issuing, “depending on the wounds,” various amounts of money “for treatment.” In the wars of the 18th century. the wounded and sick were divided into those who were able to follow with the army, those who were to be left in “retrashements” and those who needed to be sent to hospitals. During the Russian-Turkish War of 1768-1774. persons to be treated in hospitals were also distributed according to the place of treatment; in a circular letter from Commander-in-Chief P.A. Rumyantsev, mildly ill patients were offered, giving hope for get well soon, send them to “nearby hospitals”, and send severe cases, “who are not reliable for a quick cure,” to “distant ones.” By the end of the 18th century. refers to the division of the wounded and sick “into three classes” - chronically ill, seriously ill and weak. The “Regulations on the procedure for establishing hospitals under the Foreign Army”, published in 1807, mentions the wounded and sick who are unable to “endure further transfer”, as well as “not tolerating the slightest delay.” A. A. Charukovsky’s book “Military Camping Medicine” (1836) talks about the need to identify “at the regimental dressing” the wounded who need immediate surgical care, and gives the composition of this group. Further development of evacuation trends in medical. provision of the army in the first half of the 19th century. required a more differentiated separation of the wounded and sick, based on possible outcomes and likely duration of treatment.

Consequently, long before N.I. Pirogov, in medical support there were separate elements of triage of the wounded and sick, but the genius of N.I. Pirogov, his enormous knowledge and clinical experience in order to create a harmonious and scientifically based doctrine about S. m. This was facilitated by the conditions of honey. provisions prevailing in besieged Sevastopol. Significant sanitary losses among the city’s defenders and the relatively short distance from the main dressing points from the troops determined the arrival at these points within short periods of time. large number wounded. The discrepancy that was created between the significant number of wounded who needed medical care and the ability to provide it in the near future was the main reason for introducing triage as a mandatory organizational event that could, to some extent, eliminate this discrepancy. “The idea of ​​sorting the wounded,” wrote N. I. Pirogov, “came to me precisely when I had to deal with thousands of wounded...”. However for scientific justification It was not enough for S. to recognize its necessity; it was necessary to reconsider existing views on the organization of medical care for the wounded. And here the decisive role was played by the conviction of N.I. Pi-rogoEa that “the benefits brought to known cases early operations does not compensate for the harm resulting from the uneven distribution of assistance for the majority of cases...” This provision formed the basis for the division of the wounded into 5 categories proposed by Pirogov: “hopeless and mortally wounded”; “severely and dangerously wounded, requiring immediate assistance”, “severely wounded, also requiring immediate, but more protective assistance”; “wounded for whom immediate surgical assistance is necessary only to make transport possible”; “slightly wounded or those whose first aid is limited to applying a light bandage or removing a superficially seated bullet.”

N.I. Pirogov began his activities in Sevastopol by improving the organization of work at dressing stations and, first of all, by introducing medical triage. He 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 on long-term benefits. .. and immediately start sorting them.”

Subsequently, during the war of 1877-1878, N.I. Pirogov substantiates the role of medical triage in ensuring the evacuation of the wounded and sick. He believed that S. m. should be carried out in accordance with the ability of the wounded and sick to endure transportation over a certain distance (severely wounded who “cannot withstand distant and difficult transport”; lightly wounded and sick who are not subject to evacuation far to the rear, because “they soon recover and return to duty” and occupy “the middle between these categories”) and recommended the most appropriate methods of transportation.

And at present, many of N.I. Pirogov’s recommendations on the procedure for carrying out S. m. have fully retained their significance. These include, first of all, the following: S. m. is possible only on the basis of a “correct scientific diagnosis,” in connection with which “the most experienced doctors” should be involved in S. m.; to carry out S. m. you must have special place(“storage place”), where the wounded and sick “should be placed leaving passages allowing them to be approached from all sides”; S. m. should begin “at the first admission and analysis” of the wounded by specially designated medical personnel and be carried out “without touching” the original dressing; first of all, it is necessary to separate the lightly wounded from the “difficult and lying”; In order to timely carry out triage conclusions, it is necessary to have a sufficient number of “support personnel”, separate places for concentrating the wounded and sick of each category, etc.

After the works of N.I. Pirogov and up to Russo-Japanese War 1904-1905 practically nothing new was introduced into the doctrine of S. m. Moreover, the predominance of evacuation trends in medical support for troops during this war led to the oblivion of a number of provisions of N. I. Pirogov. Is it true, chief surgeon of the Manchu Army, R. R. Vreden sought, through appropriate S. m., to to some extent combine the evacuation of the wounded and sick with their treatment. In particular, he proposed at the forward dressing station to allocate a group of wounded people in need of emergency surgical interventions at the main dressing points. However, these proposals were not fully implemented.

During the First World War 1914-1918. S. m. was regulated mainly by two official documents - the regulations on military sanitary institutions and institutions of the military department and the instructions of the sanitary unit of the North-Western Front on the sorting and evacuation of the sick and wounded. According to the Regulations, all wounded and sick who arrived at the main dressing station were divided into 4 categories: those who were subject to return to duty, those who were able to go to a medical institution on foot, those who were subject to transportation to medical institutions, and, finally, those who were unable to withstand transportation without obvious harm to them. In accordance with the Instructions, it was necessary to allocate the following groups wounded and sick: “requiring... immediate operational assistance”, “not requiring immediate assistance”, who, after providing them with “initial assistance”, were subject to further evacuation, and not subject to evacuation due to the severity of their condition. However, at first world war, especially in its first years, N.I. Pirogov’s teaching about S. m. in its significant part was not implemented in medical practice. provision of the Russian army. But at the same time it received further theoretical development, which is associated primarily with the name of V. A. Oppel. The main role in the system of staged treatment (see) he proposed was assigned to S. m. “Have we stopped at studying the principles of staged treatment of the wounded,” he noted, “have we stopped at considering the issues surgical tactics, we involuntarily immediately come across the triage of the wounded as the main element of the organization of surgical care during the war.” The basis of S. m. V. A. Oppel was based on “two signs: therapeutic and evacuation.” In their scientific works he was the first to connect them with each other within the framework of a single process of medical and evacuation support for troops and showed the role of S. m. in it. “Taking into consideration the whole army, going from regimental dressing stations to forward detachments, division hospitals, field mobile hospitals and head evacuation points , it is possible to develop a whole plan for sorting the wounded,” wrote V. A. Oppel.

The Great October Socialist Revolution created favorable conditions for the successful development of theory and practice based on the principles of socialist humanism military medicine. At the same time, it became possible to implement the provisions on S. m. N.I. Pirogov, V.A. Oppel, other prominent representatives of military medicine and their further development. B. K. Leonardov introduced the concept of “point” and “evacuation or transport” sorting, substantiated the order of sorting in various functional divisions of the stages medical evacuation, defined the role of S. m. in ensuring the evacuation of the wounded and sick as intended. He revealed the essence of S. m. as a “group diagnosis”. “As important as an individual diagnosis is for the treatment of a particular patient,” said B.K. Leonardov, “this criterion is so insufficient for the “classification” of the mass of wounded and sick people who need the most various assistance" Meanwhile, in war, the medical service has to deal with “a mass of wounded and sick.” In these conditions, “it is possible to properly organize the provision of medical care only if it is based not on individual, but on group diagnostics.” In turn, this is possible provided that the contingents of the wounded and sick are classified not according to descriptive or causal characteristics, but according to the need for certain measures, i.e., not according to individual, but according to group characteristics.

Further improvement of the organization medical support military operations of troops significantly enriched the doctrine of S. m. This is a great merit of both the organizers of the medical service (E. I. Smirnov, N. I. Zavalishin, A. N. Grigoriev, etc.) and military field surgeons (M N. Akhutina, S. I. Banaitis, F. F. Berezkina, M. M. Diterichs, P. A. Kupriyanov, etc.). In particular, A. N. Grigoriev showed the need to sort the wounded starting from the battlefield. N. I. Zavalishin developed the basics of S. m. in the head department of the field evacuation point. The recommendations of P. A. Kupriyanov, S. I. Banaitis and M. N. Akhutin about S. m. for regimental and divisional medical services were of great value. points based on a generalization of medical experience. ensuring combat operations on the lake. Hasan, b. Khalkhin Gol and during the Soviet-Finnish military conflict. The expediency of most of their proposals was confirmed during the Great Patriotic War 1941 -1945, when the doctrine of S. m. received further development and became one of the foundations of the entire system of medical and evacuation measures. S.'s practice followed from the provisions of the unified field military medical doctrine and ensured the successful implementation of staged treatment with evacuation as directed. Emphasizing the decisive role of S. m., E. I. Smirnov and S. S. Girgolav wrote: “There is no shine in our military sanitary business, but if at each stage of a given area there is no bustle, the queue surgical interventions is determined not by the groans and complaints of the wounded, but by the severity of the injuries and the actual capabilities of this stage and in given time“If calm and intense work is going on in the operating room and dressing room, if the reception and departure of the wounded are organized, then you can be sure that three quarters of the wounded will return to duty in the next 2-6 months.”

During the Great Patriotic War, medical treatment, which was an integral part of the work of all medical units and institutions, was formalized organizationally: regular triage and evacuation hospitals (SEH) were created and their place in the system of treatment and evacuation support was determined (see Triage hospital, Treatment and evacuation support system)", at the emergency medical service (see Medical battalion) and in hospitals, separate reception and triage departments were deployed for the seriously and lightly wounded, as well as for the sick; it was practiced to place stages of medical evacuation of the wounded and sick in evacuation departments among homogeneous groups as a measure to ensure clearer evacuation to destination, etc.

The experience of the past war convincingly showed that medical evacuation should be carried out at all stages of medical evacuation and in each functional unit of the stage. Moreover, it must be carried out continuously in strict accordance with the capabilities of the stage and the volume of medical care established for it in accordance with the purpose and the developing combat and medical situation. Elements of S. m. must be applied already on the battlefield. Middle and junior honey composition in the presence of several affected people, deciding on the order of assistance to them or the order of removal (removal), essentially produces S. m.

When carrying out S. m. at the stages of medical evacuation (see), first of all, from the general flow of those affected, those dangerous to others are identified: infected with radioactive substances and toxic substances are subject to referral to a unit that carries out sanitary (special) treatment, and infectious patients and persons with suspected infectious disease - to the isolation ward. Two groups of affected people are established: a) those in need of medical care at this stage; b) affected, medical care in Crimea can be postponed until the next stage. 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 determined what medical care (in terms of volume and nature) the affected person needs and in what order it should be provided to him. Depending on this, the functional unit of this stage is determined (operating room, anti-shock, dressing room, etc.), which will provide him with such assistance. Next, the advisability of leaving the affected (patients) at this stage is determined, depending on the severity of the lesion (disease): non-transportable - until the possibility of their further evacuation becomes possible; affected and sick, treatment of which can be completed on the spot - until recovery. 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 order (first or second).

S. m. is carried out on the basis of the diagnosis and prognosis of the lesion (disease) with mandatory consideration of combat and medical conditions. situation. Depending on the diagnosis, the need and possibility of providing medical care to the injured (patient), the place and sequence of its provision are determined, indications and contraindications for evacuation, and its urgency are established. Particular care must be taken when identifying a group of affected people and patients with life-threatening injuries and diseases. Only persons who have undoubted signs of such injuries or diseases and therefore cannot be classified in other categories can be included in this group. Compliance with this condition is necessary in order to provide each affected person with the maximum and most effective assistance.

S. m. is usually divided into two types: intra-point, which determines the order in which the affected (patients) pass through the functional units of a given medical center (medical institution), the order and place of assistance to them at a given stage, and evacuation transport, which determines the order of sending the affected (patients) to the hospital. the limits of this stage, priority, method of evacuation and evacuation purpose. At the same time, in the process of S. m., carried out in SMEs (OMO). the type of medical institution must be determined to which the injured or patient should be sent for its intended purpose (“specialized surgical hospital for those wounded in the head, neck, spine”, “specialized surgical hospital for those wounded in the chest and abdomen”, “therapeutic hospital”, “ hospital for the treatment of lightly wounded”, etc.). When establishing a method of evacuation, the issue of the type of transport and the position of the evacuee in it (lying, sitting) is decided.

Certain conditions are created for the organization of S. m. At every stage honey. evacuation for these purposes, a special reception and sorting department (in SMEs and OMO, sorting and evacuation) department is deployed and equipped. The admission of a large number of affected people to primary care, primary care and general medical treatment in a short period of time forces the doctor conducting S. m. to carry out it, as a rule, without removing the bandage based on a brief* medical history, the results of an external examination of the affected (patient) and the use of simple diagnostic techniques. IN the power of This-C. m. should be entrusted to the most* experienced doctors who are capable of delivering the most accurate diagnosis and make a decision that meets both the condition of the affected person and the situation, which often limits the capabilities of the stage in providing assistance. It is also very difficult to sort people with combined lesions and identify the leading lesion, that is, the one that poses the greatest threat to the life of the affected person. at the moment and on which the degree of urgency of medical care at this stage depends. evacuation.

The receiving and sorting department includes a sorting post (SP), a sorting area and receiving and sorting premises (tents); In SMEs and OMOs, separate triage areas are usually allocated for the severely affected and mildly affected, and reception and triage rooms (tents) are allocated for the severely affected, mildly affected and sick. In hospitals, to clarify the diagnosis, diagnostic wards and a dressing room can also be deployed as part of this department.

The results of S. m. are recorded with appropriate colored marks (marking), which are attached to the clothes of the affected (patient) or to the handles of the stretcher. Marking allows orderlies, without additional instructions, guided only by sorting marks, to deliver the injured to the appropriate units or load them onto transport in strict accordance with the decision of the doctor who carried out the triage.

The importance of S. m. especially increases in a war with the use of weapons of mass destruction by the enemy, characterized by the simultaneous occurrence of mass sanitary losses (see) and in connection with this, the entry into the stages of medical evacuation in a short time of a large number of affected people. This determined the need for further development of combat methods, clarification of its organization, and justification of methods for its implementation in the difficult conditions of modern combat operations. The works of A. N. Berkutov, A. A. Bocharov, A. A. Vishnevsky, E. V. Gembitsky, A. S. Georgievsky, I. I. Deryabin, N. G. Ivanov, F. were devoted to solving these problems. I. Komarova, I. P. Lidova, G. P. Lobanova, I. A. Yurova and others.

The problem of S. m. is relevant not only in the active army, but also in the conditions of Civil Defense, during various natural disasters and peacetime disasters with a large number injured. Earthquakes, accidents railway transport and other events accompanied by mass casualties among the population require similar actions in civilian medical institutions, whose personnel must be prepared to carry out S. m. in these conditions. It should only be emphasized that, in addition to the diagnosis and prognosis, the medical staff performing S. m. in these conditions must be guided by certain social aspects. So, for example, women in labor, postpartum women, and children should be given priority for priority evacuation.

Bibliography: Akhutin M. N. Military field surgery, M., 1941; Berez-k and N F. Basic principles of sorting the wounded according to the stages of evacuation of a military area, Military San. case, No. 6, p. 32, 1937; Georgievsky A. S. Organizational Basics sorting of battle-wounded and sick people, Voyen.-med. zhurn., No. 1, p. 8, 1959; Zavalishin N.I. Head field evacuation point, M., 1942; Ivanov N. G. and Lobanov G. P. Organization of medical triage in a medical battalion (separate medical detachment), Voyen.-med. zhurn., No. 7, p. 6, 1965; Kupriyanov P. A. and Banaitis S. I. Short course military field surgery, M., 1942; Oppel V. A. The basis for sorting the wounded from a medical point of view at the theater of military operations, Voyen.-med. zhur., vol. 244, October, p. 151, 1915; Pirogov N.I. Collected works, vol. 5, part 1, M., 1961; Smirnov E.I. Ideas of N.I. Pirogov during the days of the Great Patriotic War, Military San. case, No. 1, p. 3, 1943; aka, Military Medicine and N.I. Pirogov, Military Med. journal, January-February, p. 6, March, p. 3, 1945; aka, War and military medicine, 1939-1945, M., 1979; Encyclopedic Dictionary of Military Medicine, vol. 3, art. 1002, M., 1948.

I. P. Lidov, G. P. Lobanov.

The most important organizational event that ensures clear organization of the provision of medical care to the injured and their evacuation is medical triage. Special significance medical triage has a significant number of affected people entering the stages of medical evacuation simultaneously. Under these conditions, only properly carried out sorting can ensure high efficiency work, timely provision of medical care to the injured, clear medical evacuation.

Medical triage– this is the distribution of those affected into groups, taking into account the need for homogeneous treatment and evacuation and preventive measures in accordance with medical indications and the type of medical care that can be provided at this stage of medical evacuation in specific conditions of the situation.

Purpose of sorting and its main purpose is to ensure the provision of timely medical care to the affected in the optimal amount, reasonable use of available forces and means, and conduct of rational evacuation.

Medical triage requirements:

1. The continuity of triage lies in the fact that it should begin directly at the collection points of the injured (at the site of the injury) and then be carried out at all stages of medical evacuation and in all functional units through which the injured pass.

The triage groups in which victims are included may change, but each victim, until his evacuation to another stage, is constantly located in one or another triage group.

2. Continuity lies in the fact that medical triage is carried out at all stages of medical evacuation, starting from the moment of first aid at the disaster site and ending with the treatment and rehabilitation of the injured in health care facilities.

At each stage of medical evacuation, triage is carried out taking into account the profile and capabilities of the subsequent institution (medical evacuation stage) where the affected person is sent.

3. The specificity of medical triage lies in the fact that with the slightest change in working conditions at any stage of medical evacuation or health care facilities, triage as a whole changes.

4. Repeatability consists of reassessing the severity of the injury at each subsequent stage of medical evacuation.

At each stage (health care facility), triage is carried out based on the established volume of medical care and the accepted procedure for medical evacuation. It can be carried out before establishing a diagnosis of a lesion or disease based on the determination of triage criteria, which, depending on its objectives, can be, for example, the ability of the affected person to independent movement, contamination with chemical or radioactive substances.


Medical triage criteria. Medical triage of affected (patients) is carried out according to three criteria (sorting criteria).

1. Danger to others(need for isolation and sanitization). According to this criterion, 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 neuropsychiatric isolation ward);

Not requiring special (sanitary) treatment.

2. The need for medical care, determining the place and priority of its provision. According to this criterion, those affected are divided into groups:

Those in need of emergency medical care (first or second priority);

Those who do not need medical care at this stage (help can be delayed) or those who need medical care that cannot be provided under the current conditions;

With an injury incompatible with life, in need of symptomatic help to alleviate suffering.

3. Feasibility and possibility of further evacuation. Based on this sign, those affected are divided into groups:

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

To be left in a given health care facility (depending on the severity of the condition) temporarily or until the final outcome;

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

Types of medical triage. 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 distributing the affected (patients) into groups (depending on the degree of their danger to others, the nature and severity of the injury) for referral to the appropriate functional units of this stage of medical evacuation and establishing a priority to these units.

Evacuation and transport sorting is carried out with the aim of distributing the affected (patients) into homogeneous groups in accordance with the evacuation purpose of the order, methods and means of their evacuation.

These issues are resolved during the triage process based on the diagnosis, prognosis and condition of the affected person. Special attention is focused on identifying victims who are dangerous to others and in need of emergency medical care. In conditions of massive arrival of injured people at the stages of medical evacuation and a reduction in the volume of medical care provided to them, intra-point and evacuation-transport sorting of the majority of injured people should be carried out simultaneously in the interests of maximum savings of effort and resources.

Groups of affected (patients). At the stages of medical evacuation, where first medical and qualified medical care is provided, the affected (patients) are divided into the following groups:

1. dangerous to others (contaminated with radioactive or toxic substances), requiring special treatment, as well as persons requiring isolation in isolation wards for patients with gastrointestinal or infectious diseases(respiratory), and persons with acute mental disorders;

2. those in need of assistance emergency care at this stage of medical evacuation (these injured are sent to the appropriate medical units);

3. subject to further evacuation ( surgical care turns out to be at the next stage);

4. mildly affected (after examination and assistance can be released to continue treatment in outpatient setting);

5. those affected with extremely severe injuries incompatible with life (agoning). Such victims are not subject to evacuation; they are symptomatic therapy aimed at alleviating suffering.

The triage conclusion regarding those affected, allocated to the group with lesions incompatible with life, is subject to mandatory clarification in the process of observation and treatment.

The results of medical triage are recorded in the primary medical card (accompanying sheet for the person affected by the emergency), the medical history, and also using sorting stamps.

Sorting marks are attached to the clothing of the affected person in a visible place with pins or special clips. The designations on the stamps serve as the basis for sending the injured person to one or another functional unit of a given stage of medical evacuation and determining the order of his delivery. After completing the activity indicated by the brand, it is replaced with another. Latest stamp taken away when loading the affected person into a vehicle for evacuation.

Medical triage procedure. To carry out medical triage at each stage of medical evacuation it is necessary:

1. allocate independent functional units with premises of sufficient capacity to separately accommodate the affected (stretchers and walkers) and provide convenient approaches to the affected;

2. organize auxiliary functional units for sorting - distribution posts, sorting sites, etc.

3. allocate the necessary number of medical personnel to work in these departments, create triage teams and equip them with the necessary simple means of diagnosis and medical care during the triage process (thermometer, spatulas, syringes, scissors, dressings for correcting bandages and immobilization, antibiotics, cardiac and respiratory analeptics), as well as provide lighting;

4. be sure to record the results of triage (primary medical card, triage marks, accompanying sheet for the person affected by the emergency) at the time of its implementation.

The injured who arrive at one or another stage of medical evacuation are usually sorted at a sorting (distribution) post or at the time of unloading from vehicles in front of the receiving and sorting department (sorting area) of the functional unit. At the sorting station nurse(paramedic) identifies those affected who need special (sanitary) treatment and must be sent to isolation wards.

From the sorting post, cars with seriously injured people go to the receiving and sorting area (sorting area intended for patients who need to be carried on a stretcher. Here, at the time of unloading, a nurse (paramedic) identifies the injured who need priority assistance (with external bleeding, asphyxia, convulsions, those in a state of shock, women in labor, children, etc.) After examination by a doctor, they are sent to the appropriate functional unit. The rest of the arriving victims are placed in rows at the sorting site or in the reception and sorting departments.

To carry out medical triage, a medical and nursing triage team is formed.

Optimal composition triage team for stretchers of the affected: a doctor, two nurses, two registrars and a section of stretchers. The composition of the team for walking victims: a doctor, a nurse and a registrar.

The triage teams include experienced doctors of relevant specialties who can quickly assess the condition of the victim based on protozoa clinical signs(assessment of the degree of impairment of consciousness, breathing, changes in pulse, reaction of the pupils, ascertaining the presence and location of fractures and bleeding) make a diagnosis, determine the prognosis, establish the nature of the necessary medical care and the procedure for evacuation.

After selective sorting, the triage team proceeds to sequential (“conveyor”) inspection of the affected areas.

The doctor, based on a survey and examination of the injured person, makes a triage decision, dictates to the registrar the necessary data to be recorded in the accompanying sheet (for the injured person in an emergency) and the register of the injured (patients), gives instructions to the nurse (paramedic) to carry out the necessary medical events and designation of the sorting conclusion with a sorting mark. Then the doctor with another paramedic (nurse) and the registrar move on to another affected person. The nurse remaining near the affected person performs medical purposes, and the registrar enters passport data into the accompanying sheet and the logbook of the affected (patients).

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 procedure for the 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 clothes, 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 assistance 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 (walking) people who can independently or with outside help get to a treatment 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 the place of residence (resettlement) or a short delay at the medical stage for medical observation.

In the emergency departments of medical and preventive institutions (MPI), 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, together with the registrar, is examining the fourth victim at this time, 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, a scoring system for 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 persons, 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 not higher than the second tier. The injured are placed on stretchers with transport tires and plaster bandages on the upper tiers of the cabin. The head end of the stretcher should face the cabin and be 10–15 cm higher than 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.

River (sea) transport (commodity and passenger ships, barges, high-speed boats, fishing and cargo ships) also has some advantages over road transport, along with railway transport.

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 the 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) ).

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 in the provision of medical care. a large number 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 following the lead own feelings 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 of the affected person.

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. Medical assistance As a rule, it does not, but the sorting team should 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