How to determine the severity of bodily injuries. Injuries

Neglect of safety rules, non-compliance with rules traffic can lead to serious injuries that pose a serious threat to the health and life of the victim. The prospects for preserving life and future recovery depend on a timely correct assessment of the severity of the victim at the scene of the incident and first aid medical care.

Assessment of the victim’s vital functions

Vital functions of a person are called vital functions, the absence of one of them is mortally dangerous. First of all, 3 functions are assessed: consciousness, breathing and blood circulation. The level of consciousness is assessed using the Glasgow scale according to 3 criteria: eye opening, speech reaction and motor reaction. Maximum amount points - 15 and corresponds to clear consciousness, 12 - 14 - stupor, 9 - 11 - stupor, 4 - 8 - coma, and 3 points - brain death. At the prehospital stage, it is not possible to diagnose brain death, since this requires a special study (oxygen saturation of the blood that flows from the brain).

Respiratory function is assessed using observations during excursions. chest, the color of the skin (a person with adequate breathing cannot have bluish skin), holding a mirror to the mouth. In the absence of breathing or ineffective breathing, it is recommended to transfer the patient to artificial ventilation.

The effectiveness of blood circulation is assessed by studying pulsation in the carotid arteries or measuring blood pressure. In case of low blood pressure or severe tachycardia, it is recommended to establish venous access and carry out infusion therapy, and, if necessary, add drugs to maintain blood pressure. In the absence of pulsation in the carotid arteries, a precordial blow is performed (in parallel with infusion therapy) and closed cardiac massage.

Assessing the integrity of the limbs and skin

It is very important to determine the presence of external bleeding at the scene of the incident (internal bleeding cannot be stopped at the prehospital stage) and, if possible, stop it (apply a tourniquet, a pressure bandage, press the vessel in the wound with a finger).

Examination of the limbs allows you to diagnose a fracture (open, closed, displaced and non-displaced). Signs of a fracture are pain in the area of ​​the suspected fracture, pathological mobility, and swelling. If the described clinical signs are present, the patient must be anesthetized and the affected limb immobilized. When open fracture you need to apply an aseptic dressing to the wound area to avoid additional infection.

Signs by which the severity of the injury caused to health is classified

Signs of injury severity include:

If the injury is life-threatening;

Duration of health impairment;

Long-term disability;

Impairment of any organ or loss of function;

Loss of speech, hearing and vision;

Complete loss of professional skills;

Violation of pregnancy up to its termination;

Injuries leading to facial deformity that are difficult to correct;

Mental disorders.

Classification of severity of injury by degree

The severity of injuries during trauma is usually divided into 3 degrees: mild, moderate and severe.

At mild degree The severity of the injury is understood as a short-term loss of health (if the disability lasts no more than 21 days) or a minor long-term loss of ability to work.

The average severity of injury is characterized by:

No threat to life;

Duration of incapacity for work more than 21 days;

Significant long-term disability less than one third (10% to 30%)

Severe bodily injuries include:

Injuries that threaten the patient's life (if timely medical care fatal outcome can be prevented, it does not change the assessment of the severity of the injury);

Loss of speech, hearing and vision;

Loss of function of an organ or loss of the organ itself;

Uncorrectable facial deformities;

Health impairment associated with permanent disability of more than 33%;

Complete loss of professional skills. In this case, it means performing those types of activities that use special human skills or special biological data (musicians, dancers, athletes). The injury will be considered severe if the athlete is unable to return to sport;

Termination of pregnancy as a result of injury;

The appearance of mental disorders.

Diagnosis and determination of the severity of traumatic shock

Traumatic shock is a life-threatening condition that occurs as a result of the action of super-strong damaging phenomena on the human body. Shock is characterized by hypovolemia (decrease in circulating blood volume), impaired microcirculation, centralization of blood circulation (as a result of peripheral spasm, blood volume is directed to vital important bodies- brain and heart). Most common cause shock is blood loss. The rate of development of traumatic shock depends on the state of compensatory mechanisms and the presence of concomitant pathology. Centralization of blood circulation and tachycardia (increased heart rate) are compensatory mechanisms and, with timely assistance (stopping bleeding, pain relief, establishing infusion therapy), are reversible. In a patient who has gross violations work of cardio-vascular system(IHD in the form of angina pectoris, atrial fibrillation, post-infarction cardiosclerosis) compensatory mechanisms may not work, which may lead to the rapid death of the victim at the scene of the incident.

There are many scales and methods for determining the severity of traumatic shock. The main criteria are: the level of systolic blood pressure, heart rate, level of consciousness, volume of blood loss and volume of diuresis.

Mild severity of traumatic shock is characterized by: systolic blood pressure level not lower than 90 - 100 mmHg, heart rate - 90 - 100 beats per minute, clear consciousness, blood loss volume not more than 1 liter, diuresis volume not less than 60 ml per minute. hour.

For medium degree severity is characterized by: systolic blood pressure level within 70 - 90 mmHg, heart rate 110 - 130 beats per minute, approximate volume of blood loss is from 1 to 1.5 liters, level of consciousness - stunning, urine output within 30 - 40 ml per hour.

Severe traumatic shock is characterized by: systolic blood pressure reduced to 50 - 70 mmHg, heart rate within 120 - 160 beats per minute, level of consciousness - stupor, approximate volume of blood loss - 1.5 - 2 liters, volume diuresis - less than 30 ml per hour.

The terminal stage of shock is characterized by the following symptoms: systolic blood pressure is not determined (only pulsation in the carotid arteries), heart rate is 120 - 160 beats per minute, the estimated volume of blood loss is more than 2 liters, the level of consciousness is coma, anuria (no diuresis).

The severity level of the victim’s condition shows how the body reacts to injury in certain time. This indicator can change and is determined by a number of indicators: the age of the victim, the presence of concomitant pathology, as well as the time and quality of care.

Various methods for assessing the severity of a patient’s condition after injury should solve the following problems:

Determining the nature of visible and invisible damage to organs in order to track the dynamics of the patient’s condition and the return of functions to the affected organ;

The ability to sort victims to provide them with qualified medical care;

Assessment of the general condition of the victim at the time of admission to the hospital medical institution and on different stages recovery, choice of treatment tactics;

Prognosis of the course of a traumatic illness and the possibility of full recovery.

Last updated February 2019

Criminal liability for causing bodily harm is individualized to the maximum extent possible. The legislator prudently took into account almost all possible details influencing the mitigation or toughening of punishment in one or another specific situation related to the beating.

Undoubtedly, only an experienced practicing lawyer will understand the intricacies of jurisprudence, but the basic “classification” of crimes related to causing bodily harm to another person is useful for everyone to know.

Three main types of bodily injury

So, the main criterion for the gradation of crimes and, accordingly, the size possible punishment, serve the consequences caused by the beating. The criminal law lists articles for intentional attack damages in order of increasing severity of consequences with a simultaneous increase in liability:

• Assault(Article 116 of the Criminal Code of the Russian Federation and 116.1 of the Criminal Code of the Russian Federation). At the same level (taking into account a similar punishment) with this type of crime is Article 115 of the Criminal Code of the Russian Federation, which provides for liability for causing minor bodily injury;
• Injuries moderate severity . Let us note that when considering criminal cases of this category, there is the possibility of termination due to reconciliation between the perpetrator and the victim, in otherwise Punishment for such damage may include, among other things, imprisonment;
• Causing grievous bodily harm– Article 111 of the Criminal Code of the Russian Federation provides maximum terms punishments in the form of imprisonment, in comparison with other crimes against health.

Punishment for beatings

Effective July 2016 important changes The Criminal Code of the Russian Federation differentiates beatings; liability for such actions is provided for in two articles:

• Article 116 of the Criminal Code of the Russian Federation - for beating those who are part of the circle of loved ones. Such victims may include parents, spouses, children, grandmothers, grandchildren, guardians and trustees, adopted children, etc. Also, according to the same provision of the Criminal Code, those who started a fight from hooligan motives, as well as for national reasons;
• Article 116.1 of the Criminal Code of the Russian Federation - for repeated beating, subject to the presence of a previously prescribed administrative punishment for such actions.

Thus, the legislator divided responsibility for beatings taking into account specific circumstances. At the same time, a beating that does not result in consequences in the form of health problems and does not fall under any of the listed criteria does not entail criminal liability.

In the first case, the punishment varies from 360 hours compulsory work up to two years of isolation.

In case of repeated beatings, the punishment can be either a fine of up to 40,000 rubles or compulsory labor (up to 240 hours) and correctional labor(up to 6 months).

In case of damage light weight the punishment is similar in type, but somewhat harsher in size (up to 480 hours of compulsory labor, up to a year of correctional labor). If there is a proven hooligan or national motive (Part 2 of Article 115 of the Criminal Code of the Russian Federation), the punishment can reach two years in a penal colony.

Minor bodily injury

What is the difference between beatings and mild injuries?

The fact is that beatings may not lead to consequences in the form of bruises, scratches, cuts, hematomas; For liability for battery under Article 116 of the Criminal Code of the Russian Federation, inflicting severe physical pain on the victim is sufficient. Prosecution for easy application the degree of bodily injury presupposes a deterioration in health recorded by a forensic medical examination for a period not exceeding three weeks (see).

How to prove that you were beaten if there are no noticeable injuries on your body?

In this case, you will have to provide other evidence, depending on the specific situation:

• this may be recordings from a surveillance camera (if the beating occurred in a public place)
• interrogation of eyewitnesses
• as well as those who helped you.

Under no circumstances refuse to undergo an examination if there are no bruises, since only a specialist can correctly record the consequences of a beating: if the physical manifestations of the beating are not visible, he will note in the document complaints of headaches, fatigue, dizziness, and pain in the internal organs. Such an act of examination will also serve as evidence of the accusation (see).

If there are consequences in the form of damage skin you must go to the emergency room if you were given a referral by the police department, or, in the absence of a statement left with law enforcement agencies, undergo an examination at a paid examination bureau. A similar procedure for confirming harm to health is provided for light beatings.

Eg, if you and your friend were beaten at the same time, while you were both on inpatient treatment 24 days, then the guilty person may be sentenced to imprisonment for up to five years (instead of three years, which are provided for in Article 112 of the Criminal Code of the Russian Federation for beating one victim).

The same punishment (up to five years) awaits someone who uses moderate violence against a child under 14 years of age.

Serious bodily harm

Serious harm to health, as in previous versions, is determined forensic expert. Such harm entails serious consequences for the health of the victim, sometimes irreversible and not treatable. According to the rules, approved by the Resolution Government of the Russian Federation, harm may be considered grave in the event of:

• causing him life-threatening injuries
• the onset of a mental disorder in the victim
• the development of drug addiction, etc.

Eg, the criminal stabbed a woman in the face. There was no danger to the victim's life, but deep cuts left scars on her face. IN in this case in the actions of the attacker there will be a crime provided for in Article 111 of the Criminal Code of the Russian Federation, since grave harm is confirmed in this situation by the sign “ permanent disfigurement faces." The punishment that may be imposed on the perpetrator is imprisonment for up to 12 years, depending on other circumstances.

The most difficult cases to qualify are those where grievous bodily harm resulted in the death of the victim. In such cases, it is difficult to establish a cause-and-effect relationship between the actions of the batterer and the occurrence of death.

Eg, after severely beating a man with a bat, his death was recorded, the cause of which was named bilateral pneumonia. At the same time, experts established that the bodily injuries present to the deceased corresponded to grave harm, and it was they that resulted in the weakening of the body, fastest development pneumonia and death. In this case, it is obvious that the offender inflicted the beatings intentionally, but did not think about the consequences in the form of weakening of the body and death. In such a case, the person who caused the damage will be charged with intentionally inflicting grievous bodily harm resulting in death through negligence; by a court verdict, punishment is possible for a term up to fifteen years.

Question:
What kind of article will the person who beat me have if I was in treatment for exactly three weeks?

In your case, the crime of the perpetrator will be qualified under Part 1 of Article 115 of the Criminal Code of the Russian Federation, since his actions caused a short-term disorder in your health. According to the Rules for Determining the Severity of Health Harm, a disorder that requires treatment for 21 days inclusive is considered short-term.

Question:
How will the coach who beat my child be punished?

Criminal liability of a coach for beatings will occur only if there is a health disorder, that is, under Art. 115 of the Criminal Code of the Russian Federation. If a child suffers physical pain without consequences, liability under Art. 116 of the Criminal Code of the Russian Federation will be avoided by the coach (taking into account changes dated July 14, 2016 in the Criminal Code of the Russian Federation). At the same time as executive, which due to professional responsibilities the child was entrusted, the coach may be held liable for cruel treatment with minors (Article 156 of the Criminal Code of the Russian Federation). Moreover, in addition to punishment in the form of imprisonment, he may be deprived of rights to work in children's institution for a period of up to three years.

Question:
What will happen - murder or infliction serious injuries with the onset of death, if after being stabbed in the chest the victim died a week later?

If the blow was struck with a knife directly to the heart area, the actions of the perpetrator contain signs of murder, and it does not matter when the victim died - on the same day or after a while. Based judicial practice, it is usually believed that by delivering such a blow to a vital organ, the accused could not but know that the consequences could be death. Consequently, negligence in relation to the consequences is excluded, intent is confirmed.

Question:
What does “national motive” mean when beating?

State policy has long been promoting counteraction to manifestations of extremism. Nationally motivated beating means infliction of bodily harm due to hatred of a certain group of people belonging to a particular nationality. This motive is currently directly provided for in the disposition of Article 116 of the Criminal Code of the Russian Federation and is one of mandatory features deeds. Also, a national motive may be provided in the form of an additional qualifying feature (for example, Part 2 of Article 115 of the Criminal Code of the Russian Federation) or be an aggravating circumstance when assigning punishment.

If you have questions about the topic of the article, please do not hesitate to ask them in the comments. We will definitely answer all your questions within a few days. However, carefully read all the questions and answers to the article; if there is a detailed answer to such a question, then your question will not be published.

The health of every Russian can safely be called an object legal protection. This concept appears in all systems human society, functioning independently of the physical or mental state citizen. Actions against health that cause bodily harm are unlawful, regardless of whether they are intentional, or the result of negligence, or are aimed directly at causing mental or physical harm to the health of someone. Additional components of the crime may include dignity and honor of the individual.

Heaviness - what is it?

The Criminal Code of the Russian Federation qualifies the term “bodily injury” as injuries that cause harm physical condition victim. However, the interpretation of this concept is very broad - both an accidental bruise and a specially inflicted deep wound that causes disability or provokes death can be considered bodily injury.

What are the types of body injuries?

Depending on the degree of harm caused to health, physical injuries can be divided into three main types:

• Mild severity;
• Average degree;
• Heavy.

It is very important that each injury is unique in its own way, so only a professional can accurately determine which category a particular injury falls into.

Lungs

When causing minor damage, we are usually talking about light damage. This type represents the most common degree of harm to a person. In case of bodily injuries of this type, there is no threat to health as such. As a rule, these are bruises, contusions, bruises, etc. This also includes more serious marks that are visible and cause inconvenience for up to seven days.

Average

The degree of bodily injury, which includes injuries that did not have a significant impact on health, did not worsen the victim’s condition for a long time, or did not irreparably affect his condition, is called average. Such injuries include burns, fractures, cuts and puncture wounds that do not touch internal organs and so on.

Severe

In criminal law, the list of grievous bodily harm is very diverse. This category includes any injury that results in serious violation health and mental health of the victim. It should be noted that serious bodily injuries in many cases provoke deterioration state of mind faces. For this reason, even if the injury was not serious, but affected the mental balance of the victim, the damage may be classified as severe. IN real life grievous bodily harm is considered to be anything that aggravated the victim’s health condition and has consequences for her bad consequences, such as disability or death: severe beating, torture, beatings, cutting, stabbing, gunshot wounds, etc. Serious bodily harm is very dangerous and serious.

Article of criminal law that qualifies bodily harm

In the Russian Criminal Code there is a section related to grievous harm health, takes special place. It consists of twenty articles that make up a whole chapter - the sixteenth. However, not only these articles of the current Criminal Code of the Russian Federation characterize the damage caused serious damage health. If we talk about the most common causes of any bodily injury, then three articles of this Criminal Code of the Russian Federation are mainly applicable to them - 115, 112, 111 - causing mild degrees of bodily injury, moderate and severe, respectively.

Minor bodily injury - which article of this Criminal Code of the Russian Federation is applicable?

Article 115 of the Criminal Code of the Russian Federation considers the infliction of various mild physical injuries. It consists of only two parts. The first mentions damage to health that is not associated with aggravating circumstances or any special features. The punishment for this type of offense, according to this article of the Criminal Code of the Russian Federation, is as follows:

• Fine in the amount of up to 40,000 rubles;
• Correctional labor lasting 480 hours;
• Correctional labor for up to 12 months;
• Stay behind bars for up to 4 months.

The second part of Article 115 of the Criminal Code of the Russian Federation examines in detail the infliction of minor bodily injuries aggravated by certain circumstances. The latter includes light bodily harm:

• For hooligan reasons;
• Due to religious, political or other similar motives;
• Using weapons of any kind.

The Criminal Code of the Russian Federation punishes such crimes more harshly:

• One year of correctional labor;
• Two years' imprisonment;
• Two years of forced labor;
• Six months of arrest.

Medium damage

Article 112 of the current Criminal Code of the Russian Federation is reserved for cases involving damage of moderate severity. The first part refers to harm caused to health without the presence of aggravating factors. For such a serious crime criminal law provides:

• Three years in prison;
• Three years of correctional labor;
• Arrest for a period of up to six months;
• Staying behind bars for up to three years;

Infliction of bodily harm, in accordance with the second part of this article of the Criminal Code, is aggravated by such circumstances as:

• There are more than two victims;
• The person injured was a minor;
• The offense was committed by a group of citizens;
• The reason for what was done was hooligan motives;
• The criminal's use of his official position;
• Use of weapons;
• The crimes were committed on the basis of national religious or other hostility.

Causing serious injury

In the Russian Federation, the article of this Criminal Code devoted to crimes involving the infliction of grievous bodily harm is quite extensive and contains four parts. The first deals with the infliction of grievous bodily harm without the presence of additional circumstances and any aggravating factors. The punishment for the crime will be imprisonment for a period of up to 8 years.

In the second part of this article 111 of the Criminal Code of the Russian Federation, cases of a serious offense are aggravated by such components as:

• Causing damage in a socially dangerous manner;
• Damage to civil servants;
• The mercenary inflicted serious bodily injuries;
• Hooligan motive;
• Infliction of grievous bodily harm due to national, racial, political, religious hostility;
• Use of any type of weapon;
• A minor was seriously injured.

The Criminal Code of the Russian Federation defines punishment for such actions as imprisonment for a period of 10 years with further restrictions on the latter.

Article 111 of the current Criminal Code of the Russian Federation, part 3, considers the above-mentioned offenses that were committed by a group of previously agreed persons. Criminals are also punished by being behind bars, only for longer long term- 10 years. There is also a restriction of freedom in the future.

In the fourth part, the infliction of grievous bodily harm is associated with the occurrence of death. If this happens, the perpetrator will be sent to prison for a term of 15 years. The most serious, dangerous bodily injuries are punished by the Criminal Code of the Russian Federation in the most severe manner.

Often causing grievous bodily harm or any even minor injuries is not an independent crime, but serves as one of the aggravating circumstances. This becomes the reason for changing not only part of the article, but also the accusation itself.

Doctor performing forensic medical examination to determine the severity of bodily injuries, he is first of all obliged to familiarize himself with the case materials and medical documents, if any. He then proceeds to collecting anamnestic data. When interviewing victims, it is necessary to find out when, under what circumstances and by whom the injuries were caused, what they were inflicted on, in what areas of the body, the number of blows, etc. It is very important to establish what the victim did after receiving the injury, where and by whom it was caused first aid.

When collecting anamnesis, the expert should avoid leading questions. , for example, about loss of consciousness, nausea, vomiting, since often victims, out of a desire to punish the offender more strongly, aggravate and willingly confirm similar questions doctor

One may also encounter pathological or deliberate malingering.

Next, the expert proceeds to examine the victim, drawing attention to general state, and then examines and describes the existing bodily injuries according to the standard forensic medicine scheme. Unhealed wounds should be examined under aseptic conditions.

During an examination, it is often necessary to carry out special types examinations (radiographic, laboratory, etc.) and consultations with specialists. Having collected all the necessary data, the expert proceeds to analyze, evaluate and formulate his conclusions.

Nature of damage (diagnosis).

When making a diagnosis, it is necessary to take into account

Number of damages;

Anatomical nature of the damage (abrasion, bruise, wound, fracture, etc.);

Features associated with the damaging weapon and the mechanism of its action (bruised wound, stab wound, etc.);

Additional features of the anatomical nature of the damage (penetrating or non-penetrating wound, through, blind or tangential wounds, etc.);

Localization of injuries (for example: “two bruises on the upper and lower eyelid of the right eye”; “three penetrating stab wounds of the abdomen with liver damage”; “a through gunshot wound to the right thigh with a splintered fracture of the femur”).

Mechanism of damage , as well as the type of weapon that could have caused the damage, are determined based on the study of objective data obtained both by the expert himself and by other specialists. In this case, the results of the study of the damage itself, clothing, etc. are important.

Duration of damage is established on the basis of studying the severity of damage healing processes at the time of examination. It is difficult to determine from these changes exact time damage, and the expert is usually limited to the conclusion that the damage could or could not have been caused at the time indicated in the case file or the witness's story.

The severity of the injury. The first step is to determine whether the injury was life-threatening. If this is established, then it should be classified as serious regardless of the outcome. If the injury is not life-threatening, its assessment is determined by the consequences or outcome.

When assessing the outcome of the injury, first of all, it is necessary to find out whether it entailed consequences that characterize serious bodily injury (loss of vision, hearing or any organ or loss of an organ’s functions; mental illness; termination of pregnancy). If there are consequences in the form of a permanent loss of general ability to work, then the percentage of this loss must be established. Finally, the duration of the impairment associated with the injury must be determined.

The conclusion about the severity of bodily injuries must necessarily contain a qualifying sign: danger to life, permanent loss ability to work in a certain percentage, etc.

An important question is whether medical interventions should be taken into account when assessing the severity of injuries. It was already noted above that when determining the danger to life of injuries, their normal course is taken into account without taking into account the provision of medical care. It is a different matter when assessing the outcome of damage. In this case, the actual harm caused to the health of the witness must be assessed.

In practical expert work The principle of assessing damage based on the actual outcome is always adhered to when medical intervention improves the outcome of the injury. The situation is more complicated in cases where diagnostic and therapeutic measures aggravate the injury or worsen its outcome. Most forensic doctors and lawyers believe that medical interventions that worsen the outcome of an injury should not be taken into account as accidental circumstances, although this contradicts the principle of assessing non-life-threatening injuries based on their actual outcome.

The current “Rules” consolidate the established expert practice, indicating that the exacerbation of previous diseases after the infliction of bodily injury, as well as other consequences of injury arising due to accidental circumstances, individual characteristics body or defects in the provision of medical care, in themselves should not serve as a basis for changing the classification of the severity of bodily injuries. IN similar cases the expert must indicate in his

In conclusion, the nature of the deterioration or complication that has occurred and what connection it has with this damage.

A forensic medical expert should refrain from determining the severity of bodily injuries in the following cases:

- ambiguities clinical picture or insufficient clinical and laboratory examination of the victim;

- unclear outcome of non-life-threatening injury;

- refusal of the witness to undergo additional examination or failure to appear for a second examination, if this deprives the expert of the opportunity to correctly assess the nature of the damage and its outcome;

-absence medical documents, including the results of additional research, without which it is not possible to judge the nature and severity of bodily injuries.

In such cases, the conclusions must set out the reasons that do not allow the issue of the severity of bodily injuries to be resolved, and indicate what information is necessary to resolve it, as well as determine the time frame re-examination. It is not allowed to compile so-called preliminary conclusions, containing a presumptive judgment about the severity of bodily injuries.