Objectives, organizational structure and basic activities of the All-Russian Service for Disaster Medicine. Definition, tasks, organization of the All-Russian Service for Disaster Medicine See what the “Organization of the All-Russian Service for Disaster Medicine” is in other words

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a system of forces and means to provide medical assistance to victims in emergency situations. The All-Russian Disaster Medicine Service (VSMS) is organized at 5 levels: federal, regional, territorial, local and facility. The federal level (on the scale of the Russian Federation) is represented by: the All-Russian Center for Disaster Medicine "Zashchita" (VTsMK), with its headquarters VSMC, branches of the VCMK "Zashchita" (in seven federal districts and in special cases can be temporarily created in individual constituent entities of the Russian Federation), a disaster medicine clinic with a field multidisciplinary hospital (PMG), an Institute for Disaster Medicine, a center for medical examination and rehabilitation, a research department for medical and technical problems of extreme medicine, a department for medical care in case of radiation accidents, a department for medical supply (reserve warehouse for emergency situations) ; specialized formations and institutions of the State Sanitary and Epidemiological Service and the Federal Administration "Medbioextrem"; All-Army Center for Emergency Medical Care and medical formations and institutions centrally subordinate to the Russian Ministry of Defense; institutions centrally subordinate to the Ministry of Internal Affairs of Russia, other ministries and departments intended to participate in the elimination of health consequences of emergency situations. In addition, in the interests of VSMC, non-staff formations, clinical bases of federal executive authorities, as well as scientific bases designed to eliminate the health consequences of emergencies, provide emergency and advisory, ambulance and emergency medical care to the population are used. The regional level (on a regional scale) is represented by: branches of the All-Russian Central Medical Commission “Zashchita” (RTsMK) with their staff formations and institutions in the federal districts (Northwestern, Central, Southern, Volga, Ural, Siberian and Far Eastern); interregional centers for emergency situations of the State Sanitary and Epidemiological Service in Moscow and Novosibirsk and centers of the State Sanitary and Epidemiological Supervision at the regional level with their constituent units; formations at the regional level of the Russian Ministry of Defense, the Russian Ministry of Internal Affairs, other ministries and departments intended to participate in the elimination of health consequences of emergency situations, as well as clinical and scientific bases. The territorial level (on the scale of the constituent entities of the Russian Federation - republics, territories, regions, national districts, Moscow and St. Petersburg) is represented by: territorial centers of disaster medicine with their staff formations; centers of State Sanitary and Epidemiological Supervision at the territorial level with their constituent units; non-standard formations of the VSMC; formations of the Russian Ministry of Defense, the Russian Ministry of Internal Affairs, etc. departments located in a given territory and intended to participate in the elimination of health consequences of emergency situations; clinical bases designed to eliminate the health consequences of emergency situations and provide emergency and advisory medical care to the population. The local level (at the scale of individual districts, cities, urban areas) is represented by: disaster medicine centers (where they are created) or emergency medical care stations (substations) with their constituent formations that perform the functions of the management bodies of the disaster medicine service; State Sanitary and Epidemiological Surveillance centers in cities and regions forming brigades and epidemic reconnaissance groups; formations of constant readiness of military medical institutions, formations of the Ministry of Internal Affairs of Russia, other federal executive authorities participating in the liquidation of emergency situations in accordance with their responsibilities; treatment and preventive institutions designed to provide health care to the population in emergency situations. The facility level (facility scale) is represented by: emergency health officials; medical units; sanitary and epidemiological surveillance units; treatment and preventive institutions designed to provide health care to the population in emergency situations.

Disaster medicine services are branches of the VTsMK "Zashchita" (RCMK). They ensure the implementation of the tasks of the VTsMC “Protection” at the regional and territorial levels, measures in the field of protecting the life and health of the population, its medical and sanitary support during emergency response.

The branch of the VCMK "Zashchita" performs the functions of the headquarters of the VCMK of the region and is subordinate to the VCMK "Zashchita". On operational and tactical issues within the scope of the tasks performed, the branch is guided by the documents of the RCMC on civil defense and emergency situations.

The organizational and staffing structure of the branch of the All-Russian Central Medical Center “Zashchita”, the list, number, composition of units of the disaster medicine service and the clinical base of the center are determined taking into account the predicted medical and tactical situation,

material, technical and personnel capabilities of the region and are approved by the Russian Ministry of Health.

The main divisions of the regional branches of VTsMK "Zashchita" are:

· mobile medical unit;

· specialized medical care teams;

· medical supply department;

· department of logistics and transport support.

The VCMK “Zashchita” branch interacts with the regional authorities, formations and institutions of the Ministry of Defense, the Ministry of Emergency Situations, the State Sanitary and Epidemiological Supervision, the Ministry of Internal Affairs of the Ministry of Railways of Russia and other federal executive authorities participating in accordance with their responsibilities in eliminating the consequences of emergency situations.

At the territorial level, the governing body of the disaster medicine service is the territorial center of disaster medicine (TCMC). He reports to the head of the territorial health management body, and on operational and tactical issues within the scope of the tasks performed by the TCMK, he is guided by the documents of the territorial headquarters (department, committee) for civil defense and emergency situations.

At the facility level, the management of the disaster medicine service is carried out by specially appointed officials for civil and emergency situations

Disaster Medicine Service of the Russian Ministry of Health, its formation.

The formations of the QMS of the Ministry of Health of the Russian Federation include:

· mobile hospitals,

· squads,

· brigades,

· groups.

They are created in accordance with the approved states and are provided with special equipment and equipment according to the timesheets. The formations are intended to work in zones (districts) and can work autonomously or as part of other formations and institutions involved in eliminating the health consequences of emergencies. Disaster medicine service units are organized at all levels and can be regular or non-regular.

Regular units are permanently financed from funds allocated to the disaster medicine service of this level.

Emergency formations of the disaster medicine service (detachments, brigades, groups) are created on the basis of medical educational, research, treatment and preventive and sanitary institutions at the expense of their personnel at all levels. Ensuring their readiness for work rests with the heads of the relevant institutions. In the event of an emergency, these formations come under the operational subordination of the management bodies of the disaster medicine service at the appropriate level.

The means of the QMS are medical, sanitary, economic and special property and equipment, which consist of equipping management bodies, formations and service institutions and are intended to ensure the fulfillment of their tasks.

The main mobile diagnostic and treatment unit of the disaster medicine service is the Field Multidisciplinary Hospital (MFH) of the All-Russian Central Clinical Hospital “Zashchita”.

It is designed to move into an emergency zone, receive the injured, triage them, provide qualified medical care with elements of specialized medical care to the injured, prepare them for evacuation, temporary hospitalization of those who cannot be transported, as well as outpatient care to the population. When fully deployed, the hospital can receive up to 250 casualties per day. For hospitalization of non-transportable patients, the hospital can deploy up to 150 beds.

The regular departments of the hospital include: management, main departments (reception and diagnostic, surgical, resuscitation and anesthesiology, hospital, evacuation), support units (pharmacy, engineering and technical department, logistics department).

The non-staff departments of the hospital are 17 teams (triage, diagnostic, emergency response duty, general surgery, pediatric surgery, trauma, neurosurgical, burn, ophthalmology, resuscitation, extracorporeal detoxification, therapeutic, psychiatric, infectious, radiological, toxicological and evacuation). The teams are formed from highly qualified specialists from basic medical institutions.

The hospital can move into the emergency zone in whole or in part.

Depending on the nature of the emergency, the hospital is staffed with teams of various profiles and is deployed as a surgical, toxicological, radiological, therapeutic, pediatric, tuberculosis or multidisciplinary hospital.

Emergency medical care teams are mobile units of the disaster medicine service and are intended to specialize or strengthen medical institutions involved in eliminating the consequences of emergencies. They can be regular or non-standard.

The main tasks of the emergency hospital are: medical triage of those affected who need specialized medical care; provision of specialized medical care to those affected and treatment of non-transportable victims; preparing the injured for evacuation to specialized healthcare facilities; providing advisory and methodological assistance to those affected in health care facilities.

The staff and equipment lists for emergency medical care are determined on the basis of the Standard Regulations on Specialized Medical Care Teams of the Disaster Medicine Service, approved by the Ministry of Health and Medical Industry of the Russian Federation on December 29, 1995.

The teams are formed by healthcare authorities on the basis of republican, regional (territorial), city multidisciplinary and specialized hospitals, central district hospitals, emergency hospitals, clinics of medical universities, research institutes and specialized medical centers and are staffed by highly qualified specialists on a voluntary basis .

The appointment and change of the main staff and backup personnel of the Emergency Hospital are carried out by orders of the head of the forming institution. In the modes of daily activity and high alert, emergency medical services are subordinate to the head of the founding institution and are operationally subordinate to the head of the corresponding disaster medicine center. In high-alert mode, specialists from regular teams are on duty at home on holidays and weekends - according to a schedule approved by the head of the forming institution in agreement with the disaster medicine center. In an emergency mode, management of the team’s activities is entrusted to the head of the disaster medicine center.

The supply of emergency medical facilities with medical, sanitary, economic and special equipment is carried out by the forming institution on the principle of priority provision according to the equipment sheet. The brigade's property is completed and stored in the formation institution in special storage units, ready for quick release.

In accordance with the Standard Regulations on specialized medical care teams of the disaster medicine service, there are 21 types of teams. The most often involved in emergency response are surgical, traumatological, neurosurgical, burn, pediatric surgical, obstetric-gynecological, transfusiological, toxic-therapeutic, psychiatric and infectious emergency hospitals.

Surgical Emergency Hospital is intended to provide qualified and specialized medical care to surgical patients.

The scope of medical care of the team includes: clinical and instrumental examination of the affected; complex antishock therapy; interventions for urgent reasons; carrying out all types of surgical interventions for damage to the organs of the chest, abdominal cavities, and pelvis; surgical treatment of wounds; providing assistance to those affected by long-term compression syndrome, damage to the main blood vessels, various types of acute vascular pathology in combination with extensive damage to adjacent anatomical formations; antibacterial therapy, etc.

Team composition: leader (surgeon), 2 surgeons, anesthesiologist-resuscitator, 2 operating nurses, nurse anesthetist and dressing nurse (plaster) - 8 people in total.

Traumatological emergency hospital is intended to provide qualified and specialized medical care to those affected with mechanical damage, mainly to the musculoskeletal system, and their treatment. The scope of medical care of the team includes: clinical and instrumental examination of the affected, complex anti-shock therapy, immobilization and anesthesia, osteosynthesis operations, various surgical interventions for lifelong indications, anesthesiological and resuscitation measures.

Team composition: leader (traumatologist), traumatologist, anesthesiologist-resuscitator, 2 operating nurses, nurse anesthetist and dressing nurse (plaster) - 7 people in total.

In 12 hours of work, the team can perform up to 10 surgical interventions.

Neurosurgical Emergency Hospital is intended to provide qualified and specialized medical care to those affected with skull injuries, bruises of the brain and spine, who require surgical care. The scope of medical care of the team includes: clinical and instrumental examination of the affected; primary surgical treatment of wounds of soft tissues of the head; elimination of depressed fractures of the calvarial bones; placement of burr holes; resection osteoplastic trepanations; stopping intracranial bleeding, removing intracranial hematomas, areas of brain injury and foreign bodies; decompression and stabilizing interventions on the spine, removal of hematomas and foreign bodies from the spinal canal and spinal cord; anesthesiological and resuscitation measures, etc.

Team composition: leader (neurosurgeon), neurosurgeon, anesthesiologist-resuscitator, 2 operating nurses and a nurse anesthetist - 6 people in total.

During 12 hours of work, the team performs up to 6 surgical interventions.

Burn emergency hospital designed to provide qualified and specialized medical care to those affected by thermal injuries. The scope of medical care of the team includes: carrying out (continuing) measures to prevent and treat burn shock; intensive infusion-transfusion detoxification therapy; tracheostomy for burns of the respiratory tract; stripe incisions for circular burns of the chest, which impede breathing, and limbs (with impaired blood supply); carrying out (continuation) of measures for the prevention and treatment of acute cardiopulmonary failure, infectious complications, etc.

Team composition: team leader (surgeon-combustiologist), surgeon-combustiologist, anesthesiologist-resuscitator, 2 operating nurses and a nurse anesthetist - 6 people in total.

Pediatric surgical The emergency hospital is designed to provide qualified and specialized surgical care to children and their treatment. These teams are created on the basis of children's clinics of medical universities, research institutes, advanced training institutes for doctors, regional and city children's hospitals with surgical departments. The need to have such emergency medical facilities in the disaster medicine service is due to the fact that, on average, 25% of those affected by emergencies are children.

The scope of medical care of the team includes: clinical and instrumental examination of the affected; complex antishock therapy; surgical treatment of wounds; all types of surgical interventions for damage to the thoracic, abdominal and pelvic organs; surgical care for bone fractures, long-term compartment syndrome, thermal injuries; transfusion and antibacterial therapy; anesthesiological and resuscitation measures, etc.

Team composition: leader (pediatric surgeon), pediatric surgeon-tramatologist-orthopedist, anesthesiologist-resuscitator, 2 operating nurses, 1 nurse anesthetist and 1 dressing nurse (plaster) - 7 people in total.

In 12 hours of work, the team can perform up to 10 surgical interventions.

Obstetrics and gynecology The emergency hospital is intended to organize and provide qualified and specialized obstetric and gynecological care to the affected and sick people in need of it, and their treatment.

The scope of medical care provided by the team includes: clinical and instrumental examination; complex antishock therapy; curettage of the uterine cavity during uterine bleeding of any etiology; acceptance of uncomplicated (emergency) and pathological childbirth, including surgically through the natural birth canal and cesarean section; surgical aid for intra-abdominal bleeding of gynecological etiology; operations of supravaginal amputation and hysterectomy; anesthesiological and resuscitation measures; transfusion and antibacterial therapy, etc.

Team composition: leader (obstetrician-gynecologist), obstetrician-gynecologist, anesthesiologist-resuscitator, midwife, senior operating nurse, 2 nurses (anesthetist and children's nurse) - 7 people in total.

Transfusiological I emergency hospital is intended for intensive infusion-transfusion therapy, therapeutic plasmapheresis, hemodialysis and hemosorption for the affected. The team is created on the basis of blood transfusion institutes (stations) and hematology centers. The scope of medical care of the team includes: transfusion therapy, therapeutic plasmapheresis, hemodialysis, hemosorption; determination of group and Rh affiliation of blood of donors and victims; conducting a biological test and a compatibility test during transfusion of blood and its components; medical examination of donors; procurement and testing of donor blood and its components.

Team composition: leader (resuscitator), surgeon-transfusiologist, physician-organizer for donor blood collection, nephrologist, laboratory assistant, senior nurse (hemodialysis, blood collection, plasmapheresis), nurse anesthetist and a medical laboratory assistant - 8 people in total.

In 12 hours of work, the team can provide assistance to 50 injured people.

Toxic-therapeutic The emergency hospital is designed to organize and provide qualified and specialized medical care and treatment of those affected by hazardous chemicals and toxic substances. It is created on the basis of toxicology centers, toxicology departments and intensive care units of hospitals.

The scope of medical care provided by the team includes: intensive care and resuscitation measures; intensive and supportive antidote therapy; intensive detoxification; symptomatic treatment of complications of the somatogenic phase.

Team composition: leader (anesthesiologist-reanimatologist), toxicologist, toxicologist, nurse (anesthetist) and paramedic (nurse) - 5 people in total.

In 12 hours of work, the team can provide assistance to 30 injured people.

Psychiatric Emergency care is designed to organize and provide qualified and specialized medical care to those affected by acute reactive psychoses and other mental disorders in emergencies. It is created on the basis of psychiatric hospitals and dispensaries.

The scope of medical care of the team, depending on the place of work, includes: differential diagnostic assessment of mental disorders; relief of reactive states; psychological and psychiatric assistance for stressful conditions; adequate treatment of those affected with reactive psychoses and severe neurotic disorders before their evacuation; treatment of those affected in health care facilities and specialized medical institutions; prevention of neurotic, asthenic, psychosomatic disorders among the affected population and persons performing emergency rescue operations.

Team composition: leader (psychiatrist), 2 doctors (psychiatrist and psychophysiologist), 2 nurses - 5 people in total.

In 12 hours of work, the team can provide assistance to 50-100 injured people.

Infectious The emergency hospital is designed to provide specialized medical care and treatment of infectious patients. It is created on the basis of infectious diseases health care facilities and health care facilities with infectious diseases departments. The scope of medical care of the team includes: administration of therapeutic serums, gamma globulins, immune drugs; antibacterial therapy with targeted antibiotics, chemotherapy drugs; detoxification therapy, administration of desensitizing drugs; symptomatic treatment, etc.

Team composition: leader (infectious disease doctor), 2 doctors (infectious disease therapist and pediatrician), 3 nurses - 6 people in total.

In 12 hours of work, the team can provide assistance to 50-100 patients.

Medical institutions involved in eliminating the consequences of emergency situations can, if necessary, be strengthened and other emergency hospitals : anesthesiology, resuscitation, ophthalmology, otorhinolaryngology, maxillofacial surgery, therapeutic, pediatric, laboratory and diagnostic. All these teams are headed by doctors of relevant specialties, have as part of 2-3 doctors and 3-5 paramedics.

The composition of the sanitary-toxicological emergency hospital includes: a director (a hygienist), a toxicologist, 2 analytical chemists, an electronics engineer, a total of 5 people.

The radiological emergency hospital includes: a director (hygienist), 2 radiation medicine specialists, a hematologist laboratory assistant, 2 dosimetrist physicists, a spectrometrist physicist - 7 people in total.

The disaster medicine service units intended to provide first aid to those affected include mobile emergency medical teams and medical and nursing teams.

Medical mobile ambulance teams are created on the basis of stations, substations, emergency medical care departments. The main tasks of the team are: medical triage of the injured, provision of first medical aid to the established extent and evacuation of the injured from the source (zone) of the emergency.

Team composition: leader - doctor, 2 paramedics (or paramedic and nurse anesthetist), orderly and driver - 4 people in total. When equipped, the brigade has special equipment, staffed according to the report card.

50 affected.

Medical and nursing teams are non-standard mobile formations of the disaster medicine service, designed to provide first medical aid, organize and conduct medical triage and prepare for the evacuation of those affected from the outbreak. They are created on the basis of city, central district, interdistrict, district hospitals, as well as outpatient clinics and health centers.

Team composition: leader - doctor, senior nurse, 2 nurses, orderly, driver-orderly - 6 people in total.

The provision of medical equipment to medical and nursing teams is carried out by the formation institutions according to the timesheet. The property, ready for work, is stored in special storage facilities at the parent institution. The staffing of transport with drivers is carried out by order of the head of the forming institution or by decision of the city (district) administration.

In one hour of work, the team provides medical care to 50 injured people.

The main formations intended to provide first aid are first aid teams and paramedic line ambulance teams.

First aid teams are mobile medical healthcare units designed for medical triage of the affected, providing them with pre-medical care and preparing for evacuation.

They are created and staffed according to the report card based on the decision of the territorial health authorities on the basis of city, central, district and district hospitals, as well as outpatient institutions, health centers and are used to work in the outbreak area (on the border of the outbreak).

Team composition: leader - paramedic (nurse), 1-2 nurses, driver-orderly - 3-4 people in total.

In 6 hours of work in an emergency, the team can provide assistance 50 amazed.

Paramedic mobile ambulance teams are created on the basis of emergency medical care stations (substations, departments). Team composition: 2 paramedics (one of them is the leader), an orderly and a driver - 4 people in total. When equipped, the brigade has special equipment, staffed according to the report card.

In 6 hours of work in an emergency, the team can provide assistance 50 amazed.

Tasks to understand the topic of the lesson:

Test questions:

1. The All-Russian Disaster Medicine Service (VSMC) was created in:

2. VSMC is a functional subsystem:

a) the Russian Ministry of Defense;

b) Ministry of Internal Affairs of Russia;

d) Ministry of Health of Russia;

e) other ministries and departments.

3. The VSMK includes:

a) QMS of the RSChS, QMS of the Ministry of Health of the Russian Federation, QMS of the Ministry of Railways, QMS of the Ministry of Internal Affairs;

b) QMS of the Ministry of Health of the Russian Federation, QMS of the Ministry of Defense of the Russian Federation and other ministries and departments;

c) QMS of the Ministry of Health, forces and means of eliminating the consequences of emergencies of the FSB, Ministry of Atomic Energy, Ministry of Emergency Situations, RSChS;

d) Ministry of Emergency Situations, RSChS, Civil Defense and Emergency Situations;

e) MSGO, VSMK, RSChS, Ministry of Emergency Situations and Civil Defense.

4. The basis of the VSMC is:

a) QMS of the Ministry of Defense of the Russian Federation;

b) QMS of the Ministry of Internal Affairs of Russia;

c) QMS of the Ministry of Health of the Russian Federation;

d) QMS RS ES;

d) QMS FSB.

5. VSMK formations are intended to:

d) all of the above.

6. VSMK institutions are intended to:

a) to move to the emergency zone and perform their regular tasks;

b) to perform routine tasks in places of permanent deployment;

c) to provide qualified and specialized medical care;

d) for medical triage, provision of the appropriate type of medical care. help and honey evacuation of the affected;

d) all of the above.

7. The VSMK service is organized at the following levels;

a) federal;

b) regional;

c) territorial;

d) local and object;

d) all of the above.

8. At each level, the VSMC organizationally consists of:

a) formation and establishment;

b) governing bodies, main divisions and support divisions;

c) governing bodies, formations and institutions;

d) hospitals and supply base;

d) all of the above.

9. The head of the VSMC at the federal level is:

a) Minister of Health and Social Development of the Russian Federation;

b) the head of the Health Department at the appropriate level;

c) Russian Minister of Defense;

d) Prime Minister of Russia;

e) President of Russia.

10. The head of the VSMC at the regional, territorial and local levels is:

a) Minister of Health and Social Development of the Russian Federation;

b) head of health care management at the appropriate level;

c) Russian Minister of Defense;

d) Prime Minister of Russia;

e) President of Russia.

11. The governing body of VSMC at the federal level is:

b) VTsMK “Zashchita”;

12. The management body of the QMS at the territorial level is:

a) All-Army Center for Disaster Medicine of the Russian Defense Ministry;

b) VTsMK “Zashchita”;

e) official for civil defense and emergency situations.

13. The management body of the QMS at the regional level is:

a) All-Army Center for Disaster Medicine of the Russian Defense Ministry;

b) VTsMK “Zashchita”;

e) official for civil defense and emergency situations.

14. Management of the QMS at the facility level is carried out by:

a) All-Army Center for Disaster Medicine of the Russian Defense Ministry;

b) VTsMK “Zashchita”;

e) official for civil defense and emergency situations.

15. Management of the QMS at the local level is carried out by:

a) All-Army Center for Disaster Medicine of the Russian Defense Ministry;

b) deputy chief physician of the Central District Hospital;

e) official for civil defense and emergency situations.

16. The formations of the QMS of the Ministry of Health of Russia include:

a) mobile hospitals, detachments, brigades, groups;

b) field multidisciplinary hospital;

c) VTsMK “Zashchita”;

d) OPM, JV, SD;

e) medical and nursing teams, first aid teams, emergency hospitals.

17. The means of the QMS are:

a) medical, sanitary, economic and special property and equipment;

b) standard personal protective equipment;

c) respiratory and skin protection;

d) medicines, instruments, devices and equipment;

e) property of current and long-term storage.

18. The main mobile diagnostic and treatment unit of the QMS is:

a) TTPG, HPG, IPG, OPM;

b) field multidisciplinary hospital (MFH) of the All-Russian Central Clinical Hospital “Zashchita”;

c) medical centers of hospitals in suburban areas;

d) military field hospitals;

d) all of the above.

19. The field multidisciplinary hospital is intended to:

d) for medical sorting, providing the appropriate type of medical care. assistance and preparation for the evacuation of the affected;

e) for isolation and treatment of infectious patients.

20. When fully deployed, the SMG can receive in a day:

a) up to 50 affected;

b) up to 500 affected;

c) up to 150 affected;

d) up to 250 affected;

e) up to 1000 affected.

21. For hospitalization of non-transportable affected patients, PMG can deploy:

a) up to 50 beds;

b) up to 100 beds;

c) up to 200 beds;

d) up to 150 beds;

e) up to 500 beds.

22. The main departments of the SMG are:

a) admission and diagnostic, surgical, anesthesiology and resuscitation, hospital, evacuation;

b) management, main departments, logistics department, emergency medical service teams;

c) reception and sorting department, special treatment department, surgical dressing room, hospital room, evacuation department;

d) reception and evacuation department, emergency department, surgical, hospital, laboratory and diagnostic departments;

e) reception and triage, laboratory, intensive care, hospital, evacuation departments.

23. Specialized medical care teams (SMT) are intended to:

a) to provide pre-medical and first medical aid;

b) to provide first medical care with elements of qualified medical care;

c) to provide qualified medical care with elements of specialized care;

d) to conduct medical triage, provide the appropriate type of medical care and prepare for the evacuation of the injured;

e) for specialization or strengthening of health care facilities.

24. The main task of the emergency hospital is:

a) provision of specialized medical care and treatment of non-transportable patients in health care facilities;

b) provision of first medical care with elements of qualified medical care;

c) provision of qualified medical care with elements of specialized care;

d) carrying out medical triage, providing the appropriate type of medical care and preparing for the evacuation of the injured;

e) isolation and treatment of infectious patients.

Situational tasks:

1. 82 victims with injuries of varying severity were delivered to the Central District Hospital from the source of the disaster, of which 45% required abdominal operations on the abdominal organs, 40% required operations on the musculoskeletal system, 40% required combustiological care 10 %, the rest with closed and open injuries to the brain and spinal cord.

2. When moving to the source of the disaster - an oxygen explosion in the workshop of the enterprise, the medical mobile ambulance team found 76 victims of varying degrees of severity at the scene of the accident.

3. In low visibility conditions, a regular bus and a freight train collided at a railway crossing. At the time of the collision there were 52 passengers and the driver on the bus. The ratio of dead to wounded was 1:2.

Question: How many emergency medical technicians will be needed to provide medical care at the scene of an accident?

4. It is planned to deploy a psychiatric emergency hospital to the source of the disaster (collapse of the building of a shopping complex).

5. It is planned to deploy the VCMK “Zashchita” SMG to the source of the earthquake with a magnitude of 7 points. The total number of those affected was 670 people.

List of topics on UIR, UIRS offered by the department:

1. Brief history of the development of VSMC:

2. Definition, tasks and basic principles of organization of the All-Russian Disaster Medicine Service.

3. Organization of the VSMC: levels, management: definition, principles of organization, interaction, management of the VSMC during emergency response.

Lesson No. 2.

Topic: “Tasks, organizational structure and fundamentals of activity of the All-Russian Service for Disaster Medicine”(Tasks and organizational structure of the territorial units of the QMS, the QMS service of the Ministry of Defense of the Russian Federation and the sanitary-epidemiological service for work in emergency situations) .

Importance of studying the topic: With the increasing frequency of peacetime emergencies, one of the most important tasks of the state is to protect the population in emergency situations. In this regard, doctors must know the principles and measures to protect the population and be able to organize their implementation by the VSMC formations.

Lesson objectives: To prepare a specialist in organizing medical support in emergency situations in peacetime and war to provide assistance to victims.

Know principles of construction and structure of the All-Russian Disaster Medicine Service. Know the basics of organizing the activities of VSMC.

Topic study plan:

1. Initial knowledge control (tests)

2. Independent work

History of the creation of the All-Russian Disaster Medicine Service

In 1971, the WHO Executive Committee for Disaster Relief (UNDRO) was established by the UN General Assembly. It has a permanent emergency health sector and a task force for natural and other disasters. There are standing emergency committees (departments) in all WHO regional offices.

In 1975, the International Society of Disaster Medicine (ISMC) was organized in Geneva, into which about 30 states were accepted.

At the end of the 80s, many major emergencies occurred in the USSR, accompanied by large casualties. The experience of eliminating their consequences has shown that the healthcare system, as well as the Civil Defense Ministry, aimed at working in conditions of outbreaks of mass sanitary losses among the civilian population in wartime, were unable to carry out the necessary set of health care measures in a timely and high-quality manner during emergencies. .

The creation of a disaster medicine service (emergency medical care) in the USSR began Resolution of the Council of Ministers of the USSR dated 04/07/90 No. 339 “On the creation of an emergency medical service in the country in emergency situations.” The resolution determined:

The Ministry of Health of the USSR - to organize 6 emergency medical care centers in 1990, entrusting them with preparing the service for action in emergencies, planning, organizing and conducting scientific and development work, taking into account local conditions; create a reserve of medical equipment, medicines, transport, communications and other resources at the centers;

Organize republican and regional (territorial) emergency medical care centers in union, autonomous republics, regions and regional centers;

The USSR Ministry of Defense - to form 4 multifunctional special purpose detachments in 1990;

Implement during 1990-1991. at local bases, mandatory training of all doctors of clinical specialties in diagnosis and provision of first aid in emergency conditions.

In furtherance of the requirements of this resolution by order of the USSR Ministry of Health dated May 14, 1990 No. 193 organizational principles for creating an emergency medical service on the basis of existing and newly organized health care institutions were determined, a material and personnel basis was laid to ensure the readiness of the service to work in emergencies and the necessary mobility of its forces and means to move to emergency areas. The structure of the service proposed to have emergency medical care centers, specialized medical teams on constant readiness (EMT), emergency medical care stations (departments), and emergency and planned advisory medical care stations (departments) (air ambulance).

IN Decree of the Government of the Russian Federation dated 05/03/94 No. 420 “On the protection of life and health of the population of the Russian Federation in the event of and liquidation of the consequences of emergency situations caused by natural disasters, accidents and catastrophes” was regulated creation of a unified All-Russian Service for Disaster Medicine (VSMC), functionally uniting the disaster medicine service of the Russian Ministry of Health, the Russian Ministry of Defense, as well as the medical forces and means of the Ministry of Railways, the Russian Ministry of Internal Affairs, and other ministries and departments involved in eliminating the health consequences of emergencies. In furtherance of this resolution, it was developed “Regulations on the All-Russian Service for Disaster Medicine,” which was approved by Decree of the Government of the Russian Federation dated February 28, 1996 N° 195.

The Government of the Russian Federation confirmed the priority importance of the disaster medicine service in solving the problem of preserving the life and health of the population in emergencies. Thus, at present, in medical science and in the healthcare system of our country, there are three independent areas that deal with the problems of medical (medical and sanitary) support in emergencies.

Issues of medical support for the Armed Forces of the Russian Federation in wartime are developed by military medicine, and a set of practical measures is carried out by the medical service of the Russian Ministry of Defense.

The development of the scientific foundations of medical provision for the country's population in wartime and the implementation of a set of relevant practical measures are entrusted to the MSCD.

The “youngest” section of medical science and branch of the health care system are, respectively, disaster medicine and the disaster medicine service - the theory and practice of health care for the country’s population in peacetime emergencies.

Recently, opinions have been quite persistently expressed about the advisability of creating a single body on the basis of the MSCD and the disaster medicine service, intended for medical and sanitary provision of the population in emergencies in peacetime and wartime. This is due to the fact that both of these services are created and headed by the Russian Ministry of Health, have a similar purpose and solve largely the same problems. The bases for their creation, operating conditions and applied organizational forms of health care provision are basically similar. This problem is currently being studied, but no practical solution has yet been found.

Definition and tasks of the All-Russian Disaster Medicine Service

Emergency Medicine is a branch of medicine and is a system of scientific knowledge and a field of practical activity aimed at saving lives and preserving the health of the population during accidents, catastrophes, natural disasters and epidemics, preventing and treating injuries (diseases) resulting from emergencies, preserving and restoring the health of participants emergency response.

All-Russian Service for Disaster Medicine (VSMK)- a functional subsystem of the Unified State System for the Prevention and Elimination of Emergency Situations, functionally uniting the disaster medicine services of the Russian Ministry of Health, the Russian Ministry of Defense, as well as the forces and means of the Ministry of Railways, the Ministry of Internal Affairs of Russia and other federal executive authorities intended to eliminate the health consequences of emergencies.

The basis of the VSMC is the disaster medicine service of the Ministry of Health of the Russian Federation.

Disaster Medicine Service of the Russian Ministry of Health- organizational and functional branch of the healthcare system of the Russian Federation, intended for the organization and implementation of medical and sanitary support during the liquidation of peacetime emergencies.

The main tasks of the VSMS are:

Organization and implementation of medical and sanitary provision for the population during the liquidation of the consequences of emergencies, including in local armed conflicts and terrorist acts;

Creation, preparation, ensuring readiness and improvement of management bodies, formations and service institutions for actions in emergencies;

Creation and rational use of reserves of medical equipment, financial, material and technical resources, ensuring emergency supplies of medicines during emergency response;

Training and advanced training of VSMC specialists, their certification;

Development of methodological foundations for training and participation of the population and rescuers in preparation for providing first aid in emergencies;

Participation in identifying sources of emergencies that may be the causes of adverse health consequences and in organizing constant health control over them;

Carrying out a set of measures to prevent or reduce the severity of possible emergencies;

Implementation of state examination, supervision and control in the field of protection of the population and territories in emergencies;

Development and implementation of measures for social protection of the population;

Carrying out humanitarian actions;

Research work and international cooperation in the field of disaster medicine.

Considering that the basis of the VSMC is the disaster medicine service of the Russian Ministry of Health, the indicated tasks equally apply to it.

Formation of VSMC- medical units (groups, brigades, etc.) and medical mobile formations (hospitals, detachments, etc.) intended to move to the emergency zone (district) and perform their regular tasks there.

VSMC institutions- medical institutions performing their regular tasks in the VSMC system in places of permanent deployment.

Non-standard formations of the VSMC- medical units (groups, teams, etc.) formed on the basis of hospitals, clinics, ambulance stations, sanitary and epidemiological surveillance centers, not included in the staff of disaster medicine centers and performing tasks in the VSMC system.

Organization of the All-Russian Disaster Medicine Service

The All-Russian Disaster Medicine Service is organized on the general principles of health protection and provision of medical care to the population accepted in our country. The main ones are the following.

State and priority nature. It is ensured by the relevant decrees of the President of Russia, decrees of the Government of the Russian Federation and the creation in the country of a Unified State System for the Prevention and Elimination of Emergency Situations. The above documents identified the protection of the population and its medical and sanitary provision in emergencies as the most important state task.

The principle of the main functional purpose of the forces and means of the VSMC means that the formation of the service and the means attached to it can be used to solve relevant problems and have a specific functional purpose - to provide pre-medical, first medical, qualified and specialized medical care; implementation of anti-epidemic and sanitary measures; supply of medical equipment. Taking into account the characteristics of certain emergencies, the service should include various formations.

The principle of material interest and the responsibility of personnel of formations and service institutions involved in eliminating the health consequences of emergencies. The implementation of this principle can be carried out through various incentive measures.

Mobility, efficiency and constant readiness of formations and institutions to work in emergencies are achieved by the presence of mobile medical units that are in constant readiness and capable of working autonomously; regular training of their personnel and their high professionalism; using modern high-speed vehicles to deliver forces and equipment to emergency areas and evacuate affected areas; creating reserves of property and medicines; improving the communication and warning system, ensuring timely receipt of information about the occurrence of an emergency, the current situation and the efficiency of using the forces and means of the disaster medicine service.

Legal and social protection of medical and other service specialists. This principle is implemented in accordance with the Federal Law “On Emergency Rescue Services and the Status of Rescuers”, adopted by the State Duma on July 14, 1995. The personnel of the disaster medicine service participate in eliminating the health consequences of interethnic conflicts only on a voluntary basis (under contract).

General training of the population and persons in high-risk professions, for actions in various emergencies to provide first aid to those affected, the rules of adequate behavior are implemented by creating a clear system of training the population and an educational and methodological base.

All-Russian Service for Disaster Medicine. It was created taking into account the tasks assigned to it, the structure of the RSChS and the requirements of the “Regulations on the All-Russian Service for Disaster Medicine.”

As can be seen from rice. 2, 3, VSMC unites the disaster medicine services of the Ministry of Health, the Ministry of Defense of Russia, as well as the forces and means of the Ministry of Internal Affairs and the Ministry of Railways of Russia and other federal executive authorities intended to eliminate the health consequences of emergencies. The service is organized at the federal, regional, territorial, local and facility levels. At each level, the service has governing bodies, formations and institutions.

Federal level VSMC(on the scale of the Russian Federation) includes: the All-Russian Center for Disaster Medicine "Zashchita" of the Ministry of Health of Russia (VTsMK "Zashchita") with its staff formations and institutions, the Department for Sanitary and Epidemiological Surveillance of the Ministry of Health of Russia, the Federal Center for State Sanitary and Epidemiological Surveillance with specialized formations and institutions of the State Sanitary and Epidemiological Service and the Federal Administration "Medbioextrem", the All-Army Center for Disaster Medicine and medical formations and institutions of central subordination of the Russian Ministry of Defense; establishments and formations of the central subordination of the Ministry of Internal Affairs, non-staff formations, clinical bases of the Ministry of Health of Russia, other ministries and departments, as well as scientific bases designed to eliminate the health consequences of emergencies, provide emergency and advisory, ambulance and emergency medical care to the population.

Regional level of VSMC(on a regional scale) is represented by:

Branches of the VTsMK "Zashchita" (RTsMK) with their staff formations and institutions in the federal districts (North-Western, Central, Southern, Volga, Ural, Siberian, Far Eastern);

Interregional centers for emergency situations of the State Sanitary and Epidemiological Service in Moscow and Novosibirsk and centers of the State Sanitary and Epidemiological Supervision at the regional level with their constituent units;

Formations at the regional level of the Ministry of Defense, the Ministry of Internal Affairs and the Ministry of Railways of Russia, other ministries and departments intended to participate in the elimination of the health consequences of emergencies, as well as clinical and scientific bases.

Territorial level of VSMC(on the scale of the constituent entities of the Russian Federation - republics, territories, regions, national districts, Moscow and St. Petersburg) is presented:

Territorial centers for disaster medicine with their staff units;

State Sanitary and Epidemiological Supervision Centers at the territorial level with their constituent units;

Non-standard formations of the VSMC;

Formations of the Ministry of Defense, the Ministry of Internal Affairs and the Ministry of Railways of Russia, and other departments located in this territory and intended to participate in the elimination of the health consequences of emergencies;

Clinical bases designed to eliminate the health consequences of emergencies and provide emergency and advisory medical care to the population.

Local level of VSMC(on the scale of individual districts, cities, urban areas) includes:

Disaster medicine centers (where they are created) or emergency medical care stations (substations) (with the formations of other health care facilities included in them), performing the functions of management bodies of the disaster medicine service;

State Sanitary and Epidemiological Surveillance Centers in cities and regions, forming sanitary-epidemiological teams and epidemiological intelligence groups;

Formation of constant readiness of military medical institutions, formation of bodies of the Ministry of Internal Affairs, Ministry of Railways of Russia, institutions of the Federal Directorate of Medical-Biological and Extreme Problems under the Ministry of Health of Russia, other federal executive authorities participating in accordance with their responsibilities in emergency response;

Treatment and preventive institutions intended for medical and sanitary provision in emergencies.

Object level VSMC(at the object scale) includes:

Officials for medical and sanitary support of the facility in emergency situations;

Medical formations;

Sanitary and epidemiological surveillance units;

Treatment and preventive institutions intended for medical and sanitary provision in emergencies.

When creating and improving the VSMC, special attention is paid to the territorial, local and facility levels of service, since the effectiveness of health care provision for the population in various emergencies depends on the readiness and success of the work of these levels. It should be noted that this trend occurs throughout the RSChS.

The head of the VSMC at the federal level is the chairman of the federal interdepartmental coordination commission of the VSMC, at the regional, territorial and local levels - the chairmen of the corresponding interdepartmental coordination commissions of the VSMC.

Disaster Medicine Service of the Russian Ministry of Health is the basis of the VSMC and the organizational and functional branch of the healthcare system of the Russian Federation. It carries out its tasks jointly with the Department of State Sanitary and Epidemiological Surveillance in cooperation with the Federal Administration "Medbioextrem", governing bodies and institutions of other healthcare sectors (therapeutic and preventive, provision of medicines and medical equipment, personnel training, MSGO, etc.).

The head of the disaster medicine service of the Russian Ministry of Health is the Minister of Health and Social Development of the Russian Federation. The service is directly supervised by the First Deputy Minister of Health and Social Development of the Russian Federation. The head of the disaster medicine service at the regional level is the representative of the Minister of Health and Social Development in the federal district. The heads of disaster medicine services at the territorial and local levels are the heads of health care management bodies of the relevant executive authorities, and at the facility level - the heads of facility health care institutions.

Disaster Medicine Service of the Russian Ministry of Defense is a powerful departmental service that is part of the VSMC; she is well prepared to work in various emergencies. The service is mainly focused on eliminating the health consequences of emergencies in areas where troops and military-strategic facilities are deployed. However, as experience shows, formations of the disaster medicine service of the Russian Ministry of Defense are also involved in work when emergencies occur in other areas.

The organization and management of the service's activities is carried out by the Main Military Medical Directorate of the Russian Ministry of Defense.

The disaster medicine service of the Russian Ministry of Defense includes: military command and control bodies; officials; special purpose medical units; formation, forces and means of medical military units and institutions of the Russian Ministry of Defense, medical military educational institutions and research organizations intended to participate in the elimination of the health consequences of emergencies.

To perform similar functions and participate in solving the general tasks of the VSMC, the system of the Ministry of Internal Affairs and the Ministry of Railways of Russia also has special management bodies, formations and institutions.

Coordination of the preparation and interaction of government bodies, as well as the use of formations and institutions that are part of the VSMC, is entrusted to the disaster medicine service of the Ministry of Health of Russia, which provides:

Development of scientific and methodological principles for the activities of VSMC;

Training, advanced training and certification of VSMC specialists;

Development of methodological foundations for preparing the population to provide first aid in emergencies;

management of forces and means involved in eliminating the health consequences of emergencies.

Governing bodies of the All-Russian Disaster Medicine Service

■ At the federal level The governing body is the All-Russian Center for Medical Management "Zashchita" of the Russian Ministry of Health. VTsMK "Zashchita" is a state multidisciplinary head institution of the disaster medicine service of the Ministry of Health of Russia of a special type, performing the functions of the governing body of the VSMC and the disaster medicine service of the Ministry of Health of Russia at the federal and regional levels, an educational, research and treatment institution. Its main divisions are:

· management;

VSMK headquarters

· branches of VTsMK "Zashchita" in seven federal districts;

· disaster medicine clinic with field multidisciplinary

hospital (PMG);

· emergency and planned advisory medical department

assistance (air ambulance);

· Institute of Disaster Medicine Problems;

· center for medical examination and rehabilitation;

· medical supply department with a reserve warehouse of the Ministry of Health

Russia for emergencies and other units.

In special cases, by decision of the Ministry of Health of Russia, branches can be created in individual constituent entities of the Russian Federation due to the medical and sanitary consequences of emergencies, develop and organize the implementation of federal targeted and research programs to improve and increase the readiness of the HSMC.

VTsMK "Zashchita" is a working body of the Federal Interdepartmental Coordination Commission of the VSMC.

The permanent (regular) body of military management of the disaster medicine service of the Russian Ministry of Defense is All-Army Center for Disaster Medicine of the Russian Ministry of Defense , which is organized and operates under the Main Military Medical Directorate.

In the medical department of the Ministry of Internal Affairs of Russia to organize measures to prevent and eliminate emergencies - group for organizing medical care in emergencies .

In the Ministry of Railways of Russia, general coordination and control over the implementation of the necessary medical-evacuation, sanitary-hygienic and anti-epidemic measures in emergency situations on the railways is carried out by the Department of Health of the Ministry of Railways of Russia through department of operational and administrative services.

■ At the regional level The governing bodies of the disaster medicine service are the branches of the All-Russian Central Medical Center “Zashchita” (RTsMK). They ensure the implementation of the tasks of the VTsMC “Protection” at the regional and territorial levels, measures in the field of protecting the life and health of the population, its medical and sanitary support during emergency response.

The main circumstances determining the feasibility of the existence of a regional level of service are, firstly, the presence of such a level in the RSChS and, secondly, the coincidence of the boundaries of the regions with the boundaries of federal districts. This allows you to maintain the vertical control of the VSMC as a subsystem of the RSChS and successfully interact with the forces and means of the medical service of the military district.

In its activities, the branch of the VTsMK “Zashchita”, as already indicated, performs the functions of the headquarters of the VSMC of the region and is subordinate to the VTsMK “Zashchita”.

On operational and tactical issues within the scope of the tasks performed, the branch is guided by the documents of the regional center for civil defense and emergency situations.

The main divisions of the regional branches of VTsMK "Zashchita" are:

· mobile medical unit with teams of specialized

medical care;

· medical supply department;

· department of logistics and transport support.

The VTsMC branch “Zashchita” interacts with the regional authorities, formations and institutions of the Ministry of Defense, the Ministry of Emergency Situations, the State Sanitary and Epidemiological Supervision, the Ministry of Internal Affairs, the Ministry of Railways of Russia and other federal executive authorities participating in accordance with their responsibilities in eliminating the consequences of emergencies.

The governing bodies, forces and means of the State Sanitary and Epidemiological Supervision of Russia at the regional level are:

Interregional centers for emergency situations and hygienic expertise of the European part, Siberia and the Far East of the Russian Federation;

Regional level centers - research institutes of epidemiology and microbiology;

Coordination centers of the state sanitary and epidemiological service at the regional level - centers of the State Sanitary and Epidemiological Supervision in the cities. Moscow and St. Petersburg, in the Krasnoyarsk and Khabarovsk territories, Rostov, Samara, Sverdlovsk, Novosibirsk, Chita regions;

Centers at the regional and territorial levels - anti-plague stations;

State Sanitary and Epidemiological Supervision Centers for Transport.

■ At the territorial level The governing body of the disaster medicine service is the territorial center of disaster medicine (TCMC). He reports to the head of the territorial health management body, and on operational and tactical issues within the scope of the tasks performed by the TCMK, he is guided by the documents of the territorial headquarters (department, committee) for civil defense and emergency situations.

The basis for the creation and organizational and staffing structure of the TCMC are approved upon the proposal of the head of the healthcare management body by the executive body of the constituent entity of the Russian Federation.

Mobile formations (hospital, detachment) are created at the clinical base of the disaster medicine center. They are designed for prompt deployment to emergency zones and provision of qualified and specialized medical care to the affected population. In daily activities, the clinical base of the center ensures the provision of qualified and specialized medical care in the area of permanent deployment and emergency advisory medical care to the population.

TCMC performs the functions of the headquarters of the disaster medicine service of the territory, interacts with governing bodies, formations and institutions of other ministries and departments participating in accordance with their responsibilities in eliminating the consequences of emergencies on the territory of a given subject of the Russian Federation, manages disaster medicine services at local and facility levels . They are obliged to maintain the forces and means of disaster medicine services at the territorial, local and facility levels in constant readiness for work.

The management bodies of the forces and means of the State Sanitary and Epidemiological Supervision of Russia at the territorial level are the centers of the State Sanitary and Epidemiological Supervision in republics, territories, regions, federal cities, autonomous regions, autonomous entities, including regional-level centers located in a given territory.

In the Ministry of Defense, the Ministry of Internal Affairs, the Ministry of Railways of Russia, and other ministries and departments, the management bodies of the forces and means of the disaster medicine service at the regional, territorial, local and facility levels are managers (chiefs) or officials specially appointed by them of the management bodies of the relevant departmental medical services.

Formation and establishment of the disaster medicine service of the Ministry of Health of Russia

The formations of the disaster medicine service of the Russian Ministry of Health are represented by mobile hospitals, detachments, brigades, and groups. They are created in accordance with the approved states and are provided with special equipment and equipment according to the timesheets. The formations are intended to work in emergency zones (districts). They can work independently or as part of other units and institutions involved in eliminating the health consequences of emergencies. Disaster medicine service units are organized at all levels and can be regular or non-regular.

Regular units are permanently financed from funds allocated to the disaster medicine service of this level.

Emergency formations are created on the basis of medical educational, research, treatment and preventive and sanitary institutions at the expense of their personnel at all levels of the disaster medicine service. Ensuring their readiness for work rests with the heads of the relevant institutions. In the event of an emergency, these formations come under the operational subordination of the management bodies of the disaster medicine service at the appropriate level.

The main mobile diagnostic and treatment unit of the disaster medicine service is Field Multidisciplinary Hospital (MFH) VTsMK "Zashchita" . It is designed to move into an emergency zone, receive the injured, triage them, provide qualified medical care with elements of specialized medical care to the injured, prepare them for evacuation, temporary hospitalization of those who cannot be transported, as well as outpatient care to the population. When fully deployed, the hospital can receive up to 250 casualties per day. For hospitalization of non-transportable patients, the hospital can deploy up to 150 beds.

The staff departments of the hospital include:

Control;

The main divisions are presented in 6 departments - modules

· sorting and diagnostic;

· surgical;

· anesthesiological;

· therapeutic;

· nephrological (detoxification);

hyperboric oxygenation

Support units

· pharmacy;

· engineering and technical department;

· logistics department.

Non-staff units The hospital has 17 teams (triage, diagnostic, emergency response duty, general surgery, pediatric surgery, traumatology, neurosurgical, burns, ophthalmology, resuscitation, extracorporeal detoxification, therapeutic, psychiatric, infectious diseases, radiological, toxicological and evacuation). The teams are formed from highly qualified specialists from basic medical institutions.

The hospital can move into the emergency zone in whole or in part. Depending on the nature of the emergency, the hospital is staffed with teams of various profiles and deployed as a surgical, toxicological, radiological, therapeutic, pediatric, tuberculosis or multidisciplinary hospital.

Specialized medical care teams (SMT) may be regular or non-standard. They are mobile units of the disaster medicine service and are intended to specialize or strengthen medical institutions involved in eliminating the consequences of emergencies.

The appointment and change of the main staff and backup personnel of the Emergency Hospital are carried out by orders of the head of the founding institution.

In the modes of daily activity and high alert, emergency medical services are subordinate to the head of the founding institution and are operationally subordinate to the head of the corresponding disaster medicine center.

In high-alert mode, specialists from regular teams are on duty at home on holidays and weekends - according to a schedule approved by the head of the forming institution in agreement with the disaster medicine center. In an emergency, management of the team’s activities is entrusted to the head of the disaster medicine center. The timing of departure (departure) of emergency medical services with property to the emergency area is determined based on local conditions, but no later than 6 hours after receiving the order. The work hours of the brigade in emergencies are on average 12 hours a day.

The supply of emergency medical facilities with medical, sanitary and economic special equipment is carried out by the forming institution on the principle of priority provision according to the equipment sheet. The brigade's property is completed and stored in the formation institution in special storage units, ready for quick release.

The head of the founding institution is directly responsible for the formation of emergency medical care and their readiness to perform the tasks assigned to them.

These requirements apply equally to the heads of institutions entrusted with the task of creating other units of the disaster medicine service.

In accordance with the standard regulations on specialized medical care teams of the disaster medicine service, there are 21 types of teams. The most often involved in emergency response are surgical, traumatology, neurosurgical, burn, pediatric surgical, obstetric-gynecological, transfusiology, toxic-therapeutic, psychiatric and infectious emergency hospitals.

Surgical Emergency Hospital is intended to provide qualified and specialized medical care to surgical patients.

Team composition: leader (surgeon), 2 surgeons, anesthesiologist-resuscitator, 2 operating nurses, nurse anesthetist and dressing nurse (plaster) - 8 people in total.

The scope of medical care of the team includes: clinical and instrumental examination of the affected, complex anti-shock therapy, immobilization and anesthesia, osteosynthesis operations, various surgical interventions for life-saving indications, anesthesiological and resuscitation measures.

Team composition: leader (traumatologist), traumatologist, anesthesiologist-resuscitator, 2 operating nurses, nurse anesthetist and dressing nurse (plaster) - 7 people in total.

In 12 hours of work, the team can perform up to 10 surgical interventions.

Neurosurgical Emergency Hospital is intended to provide qualified and specialized medical care to those affected with skull injuries, bruises of the brain and spine, who require surgical care.

All-Russian Disaster Medicine Service (VSMC)– a functional subsystem of the Unified State System for the Prevention and Elimination of Emergency Situations (RSChS), functionally uniting the Disaster Medicine Services of the Ministry of Health and Social Policy, the Ministry of Defense of Russia, as well as the forces and means of the Ministry of Railways (MPS) and Internal Affairs (MVD), other federal executive authorities designed to eliminate the health consequences of emergency situations.

VSMC is organized at the federal, regional, territorial, local and facility levels. At each level, the service has governing bodies and subordinate formations and institutions.

Federal level VSMC(on the scale of the Russian Federation) includes: the All-Russian Center for Disaster Medicine "Zashchita" of the Ministry of Health of Russia (VTsMK "Zashchita") with its staff formations and institutions, the Department for Sanitary and Epidemiological Surveillance of the Ministry of Health of Russia, the Federal Center for State Sanitary and Epidemiological Surveillance with specialized formations and institutions of the State Sanitary and Epidemiological Service and the Federal Administration "Medbioextrem", the All-Army Center for Disaster Medicine and medical formations and institutions of central subordination of the Russian Ministry of Defense; establishments and formations of the central subordination of the Ministry of Internal Affairs of Russia, the Ministry of Railways of Russia, other ministries and departments intended to participate in the elimination of the health consequences of emergencies. In addition, in the interests of VSMC, non-staff formations, clinical bases of the Russian Ministry of Health, other ministries and departments, as well as scientific bases designed to eliminate the health consequences of emergencies, provide emergency and advisory, ambulance and emergency medical care to the population are used.

Regional level of VSMC(on a regional scale) is represented by:

Branches of the VTsMK "Zashchita" (RTsMK) with their staff formations and institutions in the federal districts (North-Western, Central, Southern, Volga, Ural, Siberian, Far Eastern);

Territorial level of VSMC(on the scale of the constituent entities of the Russian Federation - republics, territories, regions, national districts, Moscow and St. Petersburg) is presented:

Territorial centers for disaster medicine with their staff units;

State Sanitary and Epidemiological Supervision Centers at the territorial level with their constituent units;

Non-standard formations of the VSMC;

Clinical bases designed to eliminate the health consequences of emergencies and provide emergency and advisory medical care to the population.

Local level of VSMC(on the scale of individual districts, cities, urban areas) includes:

Disaster medicine centers (where they are created) or emergency medical care stations (substations) (with units included in them and formed in other health care facilities), performing the functions of QMS management bodies;

State Sanitary and Epidemiological Surveillance Centers in cities and regions, forming sanitary-epidemiological teams and epidemiological intelligence groups;

Formation of constant readiness of military medical institutions;

Formation of bodies of the Ministry of Internal Affairs, Ministry of Railways of Russia, institutions of the Federal Department of Medical-Biological and Extreme Problems under the Ministry of Health of Russia, other federal executive authorities participating in accordance with their responsibilities in emergency response; medical and preventive institutions intended for medical and sanitary provision in emergencies.

Object level VSMC(at the object scale) includes:

Officials for medical and sanitary support of emergency facilities;

Medical formations; sanitary and epidemiological surveillance units;

Treatment and preventive institutions intended for medical and sanitary provision in emergencies.

The Disaster Medicine Service of the Russian Ministry of Health is the basis of the VSMC and organizational and functional branch of the healthcare system of the Russian Federation. The head of the disaster medicine service of the Russian Ministry of Health is the Minister of Health of the Russian Federation. The service is directly supervised by the First Deputy Minister of Health of the Russian Federation. The head of the disaster medicine service at the regional level is the representative of the Minister of Health in the federal district. The heads of disaster medicine services at the territorial and local levels are the heads of health care management bodies of the relevant executive authorities, and at the facility level - the heads of facility health care institutions.

Disaster Medicine Service of the Russian Ministry of Defense is a powerful departmental service that is part of the VSMC; she is well prepared to work in various emergencies. The service is mainly focused on eliminating the health consequences of emergencies in areas where troops and military-strategic facilities are deployed.

However, as experience shows, formations of the disaster medicine service of the Russian Ministry of Defense are also involved in work when emergencies occur in other areas.

The organization and management of the service’s activities is carried out by the Main Military Medical Directorate of the Russian Ministry of Defense (GVMU MO RF).

Development of scientific and methodological principles for the activities of VSMC;

Training, advanced training and certification of VSMC specialists;

Development of methodological foundations for preparing the population to provide first aid in emergencies;

Management of forces and means involved in eliminating the health consequences of emergencies.

In 2012, 437 emergencies occurred in our country, of which 228 were man-made, 148 natural, 56 biological-social. 819 people died and 95,105 people were injured.

Up to 30 thousand people die a year in car accidents in the Russian Federation; 49 people die in fire every day in the country. Over the past decades, the number of droughts, fires, hurricanes, floods and epidemics has increased sharply (the latter by 2 times).

In our country, to eliminate the medical consequences of a peacetime emergency, the Civil Defense Medical Service (MCDS) was initially involved, but its structure was cumbersome, its forces and means were not mobile enough, which did not meet the main requirement that arises during an emergency, namely the provision of emergency medical assistance to victims in a short time.

An analysis of the organization of medical care for those affected by major technological and natural disasters also showed the unpreparedness of health care, poor professional training of medical personnel at all levels to work in this situation.

This was the prerequisite for the creation of mobile forces within healthcare, namely disaster medicine, capable of providing timely assistance to those affected and reducing the time isolation phases.

1. The concept of Disaster Medicine (MC). Objectives, principles of organization and modes of activity of the All-Russian Service for Disaster Medicine (VSMC).

MK, as a new scientific and practical direction in world medicine, emerged in the 70s of the 20th century. In 1975 The International Society of MK (IMS) was created in Geneva, into which 30 states were admitted.

The beginning of the creation of MK in our country was determined by the decree of the government of the former USSR dated 04/07/90 No. 339 “On the creation of an emergency medical service in emergencies.” In development of this resolution, by order of the Minister of Health of the USSR No. 193 of May 14, 1990. the creation of an emergency medical care service was determined on the basis of existing and newly organized health care institutions.

IN purposes system improvement liquidation of the medical and sanitary consequences of emergencies (there was a disunity of forces, an insufficiently clear vertical structure of the service structure), the Government of the Russian Federation issued a resolution № 420 dated May 3, 1994. “On the protection of life and health of the population of the Russian Federation in the event of the occurrence and elimination of the consequences of emergencies caused by natural disasters, accidents and catastrophes.” This resolution proclaimed the creation in the Russian Federation All-Russian Disaster Medicine Service.

To develop the service, the Government of the Russian Federation approved the “Regulations on

VSMK" (Government Decree No. 195 of February 28, 1996). With this resolution, the government confirmed the priority importance of the QMS in solving the problem of preserving the life and health of the population in emergencies.

The changes that have occurred in the activities of VSMC since its formation in our country, namely since 1994, are enshrined in the new “Regulations on VSMC” approved by Decree of the Government of the Russian Federation No. 734 on August 26, 2013.

Disaster Medicine (MC) is a branch of medicine that studies medical and sanitary consequences emergency situations, develops principles, forms and organization of health care provision for the population during their elimination. Designed to save lives, preserve public health in case of accidents, disasters, natural disasters, epidemics; prevention, treatment of injuries and diseases in emergencies, preservation and restoration of the health of emergency response participants.

The practical side of MK activities is carried out by Disaster Medicine Service (CMS), which is a complex of management bodies, forces and means, methods of managing healthcare in emergencies .

Medical and sanitary support (MSS) includes:

Medical and evacuation support (LES),

Sanitary, hygienic and anti-epidemiological provision,

Measures to supply medical equipment,

Measures for medical protection of the population and rescuers,

Organization of Service management.

All-Russian Disaster Medicine Service (VSMC) is a functional subsystem of the RSChS, designed to eliminate the health consequences of emergencies. Functionally unites for joint actions:

Ø QMS of the Ministry of Health of the Russian Federation;
Ø QMS of the Ministry of Defense of the Russian Federation;
Ø the forces and means of the Ministry of Emergency Situations, the Ministry of Internal Affairs of the Russian Federation, the Federal Service for Supervision in the Sphere of Protection of Consumer Rights and Human Welfare (Rospotrebnadzor), other Federal Executive Bodies (FEB), Executive Authorities of the Subjects of the Russian Federation, local governments, the Russian Academy of Medical Sciences and other organizations, V whose powers include:

resolving issues in the field of protecting the population and territories from emergencies,
liquidation of health consequences of emergencies,
solving MK problems.

The main objectives of the VSMC are:

Organization and implementation of MCO during emergency response (including in local armed conflicts and terrorist acts);
Providing emergency and advisory medical care to victims (patients) and carrying out medical evacuation;
Ensuring the readiness of management bodies, communication and warning systems, formations and institutions of the Service to respond and act in emergencies;
Collection, processing, exchange and provision of health information in the field of protecting the population and territories in emergency situations;
Participation in the implementation of state examination, supervision and control in the field of protection of the population and territories in emergency situations;
Creation and rational use of reserves of financial, medical and material and technical resources to ensure the work of the Service;
Participation in the development and implementation of measures for social protection of the population, carrying out humanitarian actions, providing conditions for citizens to exercise their rights and responsibilities in the field of protection from emergencies;
Development and continuous improvement of the system of medical support for the population in the event of an emergency;
Forecasting and assessing the health consequences of emergencies;
Participation in preparing the population and rescuers to provide first aid in emergencies;
International cooperation in the field of MC;
Methodological management of the system of training and advanced training, as well as certification of specialists of the Service;
Scientific research work on the development and improvement of the structure and activities of the Service.

Basic principles of organization and functioning of VSMC:

1. State and priority nature of the service.

This is ensured by regulations of the Government of the Russian Federation. Among other services, along with rescue services, it has a priority in ensuring the constant readiness of forces and assets and their mobility.

2. Territorial production principle.

Formations, institutions and governing bodies are created on the basis of treatment and preventive, sanitary and epidemiological institutions of territorial and departmental health care, central clinical, research and other institutions using their human and material resources.

3 . Centralization and decentralization of management.

Centralization presupposes unified management of all services of the RF MC, regardless of their departmental affiliation and ensures the creation of a unified information and dispatch system for the service.

Decentralization of management provides, based on the specific situation, the ability of each unit of the service to autonomously carry out tasks for the medical and sanitary provision of those affected by emergencies.

4. Planned nature.

It provides for advance preparation of forces and assets, planning of interaction with other services of the rapid response system, forecasting options for the use of forces and assets in various regions, special training and advanced training of all service personnel.

5. The principle of universalism of the created formations .

Formations and institutions of the service must be ready to work in any areas of destruction without significant restructuring.

6. The principle of the main functional purpose of forces and means.

Service formations are typically created to perform specific tasks. For example: providing a certain type of medical care, carrying out anti-epidemic and sanitary measures.

7. Principle staged treatment those affected with their evacuation to their destination.

8. The principle of unity of medical science and practice.

The organization of the service and its functioning in emergencies should be built taking into account the achievements of domestic and foreign medical and pharmaceutical science.

9. The principle of material interest and moral responsibility of medical and other specialists, involved in medical units and units providing emergency assistance to those affected by emergencies.

This principle is supported by the Government Resolution and the Directive of the Ministry of Health, in accordance with which the conditions for remuneration and payment of compensation for duty and participation in the provision of emergency medical care during rescue operations in emergencies are established.

10. Mobility and constant readiness of units and institutions to work in emergencies.

It is achieved by creating reserves of property and medicines, regular training of personnel of the formations, improving the communication and warning system, constant readiness of medical teams, detachments, hospitals and clinics, and the use of modern vehicles.

11. Legal and social protection of medical and other service specialists.

Carried out in accordance with the current law of the Russian Federation dated July 14, 1995 “On emergency rescue services and the status of rescuers.” JMC personnel participate in eliminating the health consequences of interethnic conflicts only on a voluntary basis.

12. General training of the population on providing first aid to those affected by emergencies and the rules of adequate behavior in various emergencies.

QMS operating modes:

Modes: daily activity, high alert and emergency mode.

In daily activities the following is carried out:

Emergency planning;

Creation, equipment and training of service units;

Preparing medical institutions to work in emergencies;

Creation of reserves of medical, sanitary, household and special equipment for emergencies;

Preparing the ground defense for the deployment of LU BB (for wartime).

In high alert mode:

Alerting control bodies, forces and means;

Strengthening medical surveillance and laboratory control over the state of the external environment;

Providing the population with means of first aid;

Withdrawal of medical units and evacuation of medical institutions to the ZZ,

Deployment of a hospital base (for wartime).

In emergency mode it carries out:

Medical reconnaissance of the disaster area (locus);

Organization of the entry of service forces into the affected area or focus;

Organization of the work of the service forces to provide medical assistance to the injured;

Organization of evacuation of those affected outside the outbreak for subsequent treatment;

Carrying out sanitary and anti-epidemic measures.

2. Organization of VSMK.

The organization of VSMC includes:

I. Three components, namely:

QMS of the Ministry of Health of the Russian Federation;
QMS of the Ministry of Defense of the Russian Federation;
forces and means of the Ministry of Emergency Situations, the Ministry of Internal Affairs of the Russian Federation, the Federal Service (FS) for supervision in the field of protection of consumer rights and human well-being (Rospotrebnadzor), other Federal executive authorities (FEB), executive authorities of the constituent entities of the Russian Federation, local governments, the Russian Academy of Medical Sciences and others organizations in whose powers include:

Ø resolving issues in the field of protecting the population and territories from emergencies,
Ø liquidation of health consequences of emergencies,
Ø solving MK problems.

II. Five organizational levels

VSMC, like the entire RSChS system, carries out its activities at the next levels: federal, interregional, regional, municipal and facility.

III. Each organizational level includes:

Coordinating bodies. These are the Commission for Emergency Situations and Fire Safety of the CoES and Fire Safety Committee (Ministry of Health, Executive Inspectorate of a constituent entity of the Russian Federation, local government body, facility);

Permanent governing bodies. These are the executive authorities authorized in the field of public health, namely the departments (ministries) of health of the constituent entities of the Russian Federation and the headquarters of the Service (VTsMK);

Organs of daily management. These are interregional CMCs and territorial CMCs;

Strengths and means;

Reserves of financial, medical and material and technical resources;

Communication, warning and information systems.

VSMK forces.

These include institutions and formations that are intended to participate in the elimination of the health consequences of emergencies.

VSMC institutions- are disaster medicine centers, hospitals, supply bases. They perform routine tasks in places of permanent deployment. Formations are created on their basis.

VSMK formations - these are mobile hospitals, detachments, brigades, groups . Created in accordance with approved states from the personnel of treatment and preventive, sanitary and preventive, medical educational and research institutions, to solve the tasks assigned to the QMS and are provided with property according to special timesheets.

Ensuring their readiness for work is the responsibility of the heads of the relevant institutions. In the event of an emergency, they are sent to the operational management of the Service’s governing bodies. appropriate level.

The formations are designed to work in emergency areas. They can work both independently and as part of other units and institutions involved in eliminating the health consequences of emergencies.

To service facilities includes any property (medical, sanitary, household, special) necessary for the activities of the service and sanitary transport equipment.

VSMC is represented at various levels:

At the federal level:

The coordinating body is the CoES and Fire Department of the Ministry of Health;

A permanent management body, simultaneously performing the functions of a day-to-day management body, is the headquarters of the Service.

By forces and means:

With the forces and means of the Federal State Institution VTsMK "Zashchita" and other FGUs under the jurisdiction of the Ministry of Health; FMBA; Federal Service for Supervision of Consumer Rights Protection and Human Welfare; RAMS, with its constituent units, intended and allocated (involved) to eliminate the health consequences of emergencies.
By forces and means of formations and institutions of the QMS of the Ministry of Defense of the Russian Federation.
Forces and means of formations and institutions of the Ministry of Emergency Situations, intended and allocated (involved) to eliminate the health consequences of emergencies.
By forces and means of formations and institutions of the Ministry of Internal Affairs and other federal authorities.
By forces and means of formations and institutions of JSC Russian Railways, as well as formations of other organizations whose powers include the elimination of the health consequences of emergencies.

At the interregional level:

Day-to-day management bodies. Such bodies are the interregional Central Medical Commissions, operating on the meringue Central Medical Commission, in the cities. Ekaterinburg, Nalchik, Nizhny Novgorod, Novosibirsk, Rostov-on-Don, St. Petersburg, Khabarovsk, Moscow.

By forces and means of federal-level formations and institutions located on the territory of the relevant federal district.

At the regional level:

The coordinating body is the CoES and PB of the OIV of the constituent entity of the Russian Federation;

The permanent governing body is the executive authority of the constituent entity of the Russian Federation in the field of healthcare (Department of Health).

The daily management body is TCMK.

By forces and means - formations intended and allocated (involved) to eliminate the medical and sanitary consequences of emergencies at TCMC and other state healthcare institutions of the constituent entities of the Russian Federation, as well as by forces and means of formations and federal-level institutions located on the territory of the relevant constituent entities of the Russian Federation.

At the municipal level:

The coordinating body is the CoES and PB of the local government body;

A permanent governing body, simultaneously performing the functions of a day-to-day management body, a local government body authorized to manage the healthcare sector.

By the forces and means of Municipal Health Institutions (MHIs), including Emergency Medical Services Stations, as well as by the forces and means of Federal State Institutions (FGU) under the jurisdiction of the FMBA, the Ministry of Defense of the Russian Federation, in the absence of MHIs on the territory of certain municipalities.

At the object level:

The coordinating body is the CoES and PB;

A permanent management body, simultaneously performing the functions of a day-to-day management body, an official authorized to carry out MSO of an object (organization) in an emergency.

Forces and means of the relevant emergency formations at the facility (organization), intended and allocated (involved) to eliminate the health consequences of an emergency.

3. Characteristics of the QMS of the Russian Ministry of Health.

QMS of the Ministry of Health of Russia - is part of VSMK, intended to carry out a set of activities on warning health consequences and MCO ( health care ) of the population in case of natural disasters, accidents, catastrophes, epidemics, local armed conflicts, terrorist attacks and other emergencies, as well as the organization and provision of emergency and advisory medical care to the population and the evacuation of the affected (sick).

She completes her tasks when interacting With:

governing bodies of other sectors of healthcare (therapeutic and preventive, sanitary and hygienic and anti-epidemic, maternal and child health, personnel training, provision of medicines and medical equipment, MSGO, etc.),
Department of State Sanitary and Epidemiological Supervision,
Federal Medical and Biological Agency (FMBA).

The QMS of the Ministry of Health plays a leading role in the VSMK because she:

ü Organizes coordination of training and interaction between management bodies and incoming forces and assets of the Service.

ü Organizes the training, improvement and certification of VSMC specialists.

ü It is the most powerful and numerous in the VSMC system.

In accordance with the structure of RSChS and VSMC, the QMS of the Ministry of Health of Russia operates at the federal, interregional, regional, municipal and facility levels and has the appropriate coordination bodies, management bodies, forces and means.

The QMS forces of the Ministry of Health of the Russian Federation are conventionally divided into: stationary And movable.

TO stationary forces relate:

1. Disaster Medicine Centers (CDMC). They are public health institutions (GHI) of a special type.

TCMK includes:

administration,
operational department, with an operational management group.
duty control department.
department of emergency, planned and advisory medical care and medical evacuation.
organizational and methodological department.
psychophysiological laboratory.
department of material and technical supply.
mobile professional medical units (Medical teams, emergency response teams, Emergency Hospital PG).
transport division.

All CMCs support the work force and resources in the PG, working around the clock under the guidance of the relevant health authorities.

In their work, they interact with the medical services of the Ministry of Defense, Russian Railways, Civil Defense, available in the given territory, with emergency rescue units of constant readiness and transport organizations of other ministries and departments.

VTsMC "Zashchita" simultaneously performs the functions of the regional CMMC of the Central region of the Russian Federation, the Euro-Asian CMMC of the CIS member states and the WHO Collaborating Center for MMC and Emergencies.

In daily activities, the clinical base of the center ensures the provision of emergency, planned, advisory and specialized medical care to the population in the area of permanent deployment.

2. SMK hospitals.

To the moving forces services include formations, divided into:

1. Established formations, which are created on the clinical basis of the CMC and financed by the CMC. These include hospitals, detachments, and emergency medical care facilities, which are intended for prompt movement to the emergency zone and provision of medical care to the population.

2. Non-standard formations(teams, groups). They are created on the instructions of governing bodies on the basis of: medical educational institutions, healthcare facilities, research institutes, sanitary and preventive institutions.

The profile, quantity, and timing of readiness of emergency units are determined based on the possible medical and sanitary situation during an emergency.

Ensuring the readiness of non-standard formations for work rests with the head of the forming institution. In the event of an emergency, they come under the operational subordination of the management bodies of the Service at the appropriate level.

Moving forces of QMS MZ:

1.Established formations:

— field multidisciplinary hospital (PMG). Created at the clinical base of the All-Russia Medical Center "Zashchita". Designed for prompt movement to the emergency area, receiving the injured, sorting them, providing qualified medical care with elements of specialized medical care to victims of up to 250 people. per day, preparing them for evacuation, temporary hospitalization of non-transportable people (150 places), as well as outpatient care for the population. Autonomy 15 days.

The hospital consists of:

1. From the permanent part , These are different types of departments:

reception and diagnostic, surgical, hospital, anesthesiology, etc. It also has two rooms: detoxification (hemodialysis) and hyperbaric oxygenation.

2. Variable part - or specialized medical care teams. It is used in accordance with the nature of the emergency and the prevalence of a particular pathology among those affected. There are 17 types of teams in total (pediatric surgery, traumatology, neurosurgical, burns, ophthalmology, intensive care, therapeutic, psychiatric, infectious diseases, radiological, toxicology).

To increase the mobility of the hospital, there is a special structural unit as part of the variable part - emergency response team on duty (ERB).

Composition of this brigade:

supervisor,
general surgeon,
traumatologist,
anesthesiologist-resuscitator,
operating room nurse,
nurse anesthetist.

Depending on the real situation in the emergency area, the PMG, during the liquidation of the medical and sanitary consequences of the emergency, is capable of moving to the destination area as part of the forces (individual brigade, department, etc.), and in full force, deploying to work like a multidisciplinary diagnostic and treatment facility.

Depending on the nature of the emergency, the hospital is deployed as a surgical, toxicological, radiological, therapeutic, pediatric, etc.

The total number of personnel of the SMG VCMK "Zashchita" is 205 people, of which 127 are full-time and 78 part-time employees. Full-time employees include 74 doctors.

— field hospitals (FH), are created on the basis of some central medical centers and are intended for prompt deployment to the emergency area and provision of qualified medical care with elements of specialized medical care to those affected in the outbreak (on the border of the outbreak), their temporary hospitalization and preparation for further evacuation. Such hospitals are initially created for a certain structure of losses. Org. their structure will be discussed in the next topic (MSGS).

—Specialized medical care teams of constant readiness (EMS PG), designed to provide qualified and specialized medical care, medical triage, and deployment of hospitals according to their profile.

Brigades have:

Surgical profile (traumatological, surgical, neurosurgical, burn, transfusiological and others).

Therapeutic profile (toxico-therapeutic, radiological-therapeutic, psychotherapeutic, infectious and others).

A total of 21 types of specialized teams can be created . Departure time from the moment of receiving the order is no later than 6 hours.

2. Non-standard formations.

- emergency hospital. Designed to provide qualified and specialized medical care in inpatient settings, strengthen and repurpose medical institutions, deploy hospitals (departments) according to their profile on the basis of hospitals to which these teams are assigned. The profile of these teams is similar to the Emergency Hospital PG.

- emergency medical teams:

a) paramedics- team composition: paramedic (nurse), orderly and driver - 3 people in total. The brigade has special equipment when it comes to equipment. In 12 hours of work in an emergency, the team can serve up to 50 affected. The main tasks of the brigade are: provision of pre-hospital medical care and medical support for the evacuation of the injured.

b) medical- team composition: doctor, paramedic (nurse), driver - 3 people in total. When equipped, the team has a special arrangement. In 12 hours of work in an emergency, the team can service 50 affected. The team's tasks are: medical triage, first aid and evacuation to destinations.

V) specialized (intensive care, toxic-therapeutic, radiological, psychiatric, pediatric, etc.) Designed to provide qualified and specialized medical care. The capabilities of the teams are assessed by providing assistance 20 people. per day. The team consists of a doctor + 2 nurses + driver.

First aid teams (BAB) - to provide first aid (50 affected in 6 hours), participation in medical triage of the injured, preparation of the injured for further evacuation. Composition: paramedic, 1-2 nurses, driver, orderly.

Medical and nursing teams (MSB) - designed to work in the outbreak (on the border of the outbreak), provide pre-medical and first medical aid (50 affected in 6 hours), carry out medical triage and prepare the affected for further evacuation. Team composition: Doctor, Art. nurse, 2 nurses, orderly, driver. Total 6 people; The time of advancement to the lesion is no more than 3 hours.

Medical squads - They are deploying a medical aid station (MAP), which is designed for reception, medical triage, provision of pre-hospital and first aid, and preparation of the injured and sick for further evacuation. Consists of 2-5 VSB and 3-5 BDP united by a single leadership.

Forces of the Disaster Medicine Service of the Ministry of Health of Russia:

Stationary forces

(perform their functions in permanent locations)

Formations

(designed to work in or near an emergency zone)

Regular formations (Created on the basis of the Central Committee, located in the PG and financed by the JMC)

Non-staff formations (created at the clinical base of the QMS in accordance with the approved staff from the staff of health care facilities, emergency medical care, clinics of medical universities, medical research institutes, etc.)

All-Russian Center for Disaster Medicine (VTsMC) “Zashchita” with clinical and scientific bases
Regional centers for disaster medicine with clinical sites
Territorial disaster medicine centers (TCMC) with clinical bases
Hospitals, medical warehouses.
1. Field Multidisciplinary Hospital (MFH)
2. Field hospitals (FH)
3. Specialized medical care teams of constant readiness (EMS PG):

—surgical profile: (traumatological, surgical, neurosurgical

burns, transfusiology, pediatric surgery), etc.;

therapeutic profile: toxic-therapeutic, radiological-therapeutic,

psychoneurological, infectious, etc.

Specialized medical care teams (SMT). The profile of these teams is similar to the Emergency Hospital PG.
Emergency medical teams:

Paramedics,
Medical,
Specialized (intensive care, toxic-therapeutic, psychiatric, pediatric, etc.).

First aid teams (FAT).
Medical and nursing (VSB)
Medical units (MO)

4. QMS of the Russian Ministry of Defense. Forces and means of eliminating the medical and sanitary consequences of emergencies of Russian Railways and the Ministry of Internal Affairs of Russia.

The main task of the QMS of the Ministry of Defense is the timely and effective provision of medical care to personnel and civilian personnel of military units and military-strategic facilities during the liquidation of the consequences of security incidents, major accidents and disasters, local armed conflicts

The structure of the QMS in the medical service system of the Russian Armed Forces includes:

military management bodies of the medical service of the RF Armed Forces,
Special Purpose Medical Units (MOSN). There are 6 of them now.
reserve beds of medical military units and institutions (military hospitals),
formation of QMS (VSB and BSMP), created on their basis by health care facilities of the Ministry of Defense of the Russian Federation,
mobile groups of specialists from sanitary and epidemiological institutions,
evacuation vehicles,
stocks of current medical property of medical warehouses.

Service management bodies.

Permanent- this is the Main Military Medical Directorate (GVMU) of the Ministry of Defense, medical departments of branches, branches of the military, military districts, as well as the main and central departments of the Ministry of Defense of the Russian Federation

Day-to-day controls- this is the operational duty officer of the State Military Medical University or medical department.

Temporarily created for the period of liquidation of the consequences of an emergency - operational groups.

Forces to eliminate the health consequences of the emergency:

These include:

- Stationary forces- these are military hospitals (central, district and garrison), medical warehouses with stocks of current medical equipment and,

- Moving forces- formations.

Formations are divided into regular and non-regular:

I. Regular formations.

* Special Purpose Medical Units (MOSN).

The medical service of the RF Armed Forces includes 6 detachments, of which 5 are in constant readiness. The detachment has a staff of 154 people, including 22 doctors.

MOSN is a mobile field hospital, designed to provide qualified medical care with elements of specialized medical care - 300 affected per day. In the field, it deploys a hospital with 100 beds and has a stock of equipment to provide emergency medical care to 1,200 injured people.

In 16 hours, the squad can perform up to 60 complex surgical operations.

II. Non-standard formations:

* Medical and nursing teams (MSB).

They include 5-7 medical workers (2 doctors, 3-5 nurses) and an ambulance. Designed to provide first aid. They are created on the basis of military hospitals, sanatoriums, and clinics.

* Specialized medical care teams (SMT).

Designed to strengthen LUs that carry out mass treatment of the affected. They are created on the basis of military hospitals with a bed capacity of 500 beds or more, military medical educational institutions and research institutes. They include 3-5 health workers (1-2 doctors, 2-3 nurses).

* Mobile groups of sanitary and epidemiological specialists (PG SEP). Composition 4 - 12 people. The numerical composition of the groups depends on the capabilities of the SEA, who are the shapers of these groups.

* Mobile groups of specialists from healthcare facilities of the Ministry of Defense of the Russian Federation.

Medical evacuation means:

Search and rescue complex "Bissektrisa" based on the MI-8 helicopter.

Designed to search and evacuate injured people, providing first aid in flight and on the ground for life-saving reasons. Equipped with a dressing room. Evacuation capacity is three stretchers and one seat.

Military transport aircraft prepared for medical evacuation (IL-76, IL-112, AN-72, etc.),
Hospital ships: “Svir” (Northern Fleet), Yenisei (Black Sea Fleet), “Irtysh” and “Ob” (Pacific Fleet), ambulance boats.
Railway facilities (sanitary trains and sanitary flights)
Automotive sanitary products. These are ambulances based on off-road vehicles; based on armored vehicles (armored personnel carrier, infantry fighting vehicle, MTLB, Tiger vehicle)

The forces of the medical service of the Ministry of Internal Affairs, intended to eliminate the health consequences of emergencies.

The main task of the medical service Ministry of Internal Affairs In Russia, when eliminating the consequences of an emergency, it is to provide medical assistance to the personnel of the internal affairs department and military personnel involved in actions in emergency situations.

In accordance with this, the medical service of the Ministry of Internal Affairs includes relevant institutions, formations and specialized departments.

* For work in the emergency area, the structure of the medical department of the Ministry of Internal Affairs has group for organizing medical care in emergencies.

* On the basis of the Main Military Clinical Hospital VV was created MOSN, designed to provide qualified and specialized medical care in zones of local armed conflicts.

* In medical institutions of the healthcare system of the Ministry of Internal Affairs of Russia of 16 constituent entities of the Russian Federation - Emergency departments have been deployed , which can, if necessary, be involved and included in the general system of health care for the population in emergencies in a specific territory.

* On the basis of district hospitals of four districts of internal troops, they are organized and functioning emergency departments .

* On the basis of hospitals and clinics of the Main Internal Affairs Directorate, the Internal Affairs Directorate of the constituent entities of the Russian Federation, medical care is organized for the injured mobile VSB, capable of providing pre-medical and first aid.

These forces and means make it possible to provide police personnel with first medical, qualified and specialized medical care, both directly within the territories of the constituent entities of the Russian Federation and beyond.

The forces and means of the sectoral health care of Russian Railways intended to eliminate the medical and sanitary consequences of the emergency.

The railway medical service is an integral part of the railway transport system for preventing and eliminating emergencies on railways. and at the same time a functional subsystem of the VSMC.

General coordination and control over the implementation of necessary medical-evacuation, sanitary-hygienic and anti-epidemic measures in emergency situations on the railway. carried out by the Russian Railways Department of Health

The Russian Railways healthcare system has an extensive network of hospitals. As part of Russian Railways, there are central, road and departmental health facilities, on the basis of which special units are created for deployment and work in areas of sanitary losses.

These formations include:

* Emergency medical teams of constant readiness. They are formed on the basis of railway health facilities. Designed to provide first medical, emergency surgical and anesthetic care. They arrive at the scene of an emergency as part of an emergency recovery train.

* Emergency Hospital(surgical, traumatological, resuscitation, neurosurgical, therapeutic, obstetric-gynecological, urological) are staffed from among the leading specialists of central and road clinical hospitals. The profile of the teams and their number are determined by the capacity and capabilities of medical institutions.

* The railway network has created and operates about 90 mobile formations(outpatient car, dressing room car, sanitary flight, ambulance unit, radiological laboratory car, etc.).

* To speed up the arrival of forces and means, railway hospitals have been created (on a local basis) medical teams who are sent to the disaster zone on the transport of their institutions immediately after receiving the relevant information.

* Issues of hospitalization of victims railways are resolved in cooperation with regional health care institutions.

In addition to the listed forces that are part of the VSMC, a number of ministries and departments have special, quite numerous units that are designed to carry out emergency rescue operations in mines, under water, etc.

These units include medical personnel who work closely with the QMS and can be included in the system of providing emergency medical care to the population in emergencies.

5. Objectives and organizational structure of the sanitary-epidemiological service (SES) for work in emergencies"

SES is a functional element of RSChS. Establishment and formation of it carry out state sanitary and epidemiological surveillance , analyze the impact of harmful factors on public health, as well as included into the civil defense surveillance and laboratory control system.

The SES is assigned the following tasks:

Supervision of the sanitary and epidemiological situation in the emergency zone and around it.

Organization and implementation of sanitary, hygienic and anti-epidemiological measures in the emergency zone and around it.

Participation in the development and implementation of measures to prevent emergencies, reduce damage from the consequences of accidents, catastrophes, and safety.

Providing PG control bodies, forces and means of service for actions in emergencies;

Organization of material and technical support for service institutions to solve problems in emergencies;

Preparation of service specialists for actions in emergencies and a number of other tasks.

When carrying out sanitary-hygienic and anti-epidemic measures during localization and liquidation of the consequences of emergency situations, all institutions of the sanitary-epidemiological surveillance system of other ministries and departments of Russia (MoD, Ministry of Internal Affairs, Russian Railways) located in this territory become operationally subordinate to the chief state sanitary doctor of the republic, region (the edges).

The list of permanent readiness forces of the Russian State SES at the interregional and regional levels includes 89 centers of the State Sanitary and Epidemiological Supervision in the territories of the constituent entities of the Russian Federation, 5 anti-plague institutes, an anti-plague center in Moscow and 11 anti-plague stations. These service institutions operate in their permanent locations.

These institutions can form non-standard specialized rapid response units to work in the emergency zone: 70 SEO, 19 SEB and 15 SPEB.

These formations are intended to monitor the sanitary-epidemiological situation and carry out sanitary-hygienic and anti-epidemiological measures in emergency zones.

- Sanitary-epidemiological teams (SEO) - are formed by the centers of the State Sanitary and Epidemiological Surveillance in the constituent entities of the Russian Federation from the staff of the institutions of the State Sanitary and Epidemiological Service, due to the functional combination of radiological, sanitary-hygienic (toxicological) and epidemiological teams. The staffing of the SES is carried out in the mode of daily activities from among the full-time employees of the Center for State Sanitary and Epidemiological Supervision - the formation. Responsibility for the readiness of the SEO and SES to act in emergency situations rests with the chief physician of the GSEN center forming a detachment or team . The squad is ready to work in emergencies 24 hours. The squad consists of 21 people, 11 of them are doctors.

Upon arrival at the scene, the SEA works under the direction of the regional emergency response headquarters.

	Sanitary-epidemiological detachment (21 people)
Head of SEO - 1 Epidemiologist - 1 Radiation hygiene doctor - 1 General hygiene doctor - 2 Disinfectionist - 2 Laboratory assistant - 2 Bacteriologist (virologist) - 2 Radiological engineer - 1		Assistant sanitary doctor (paramedic) - 1 Assistant epidemiologist - 1 Laboratory chemist (medium qualification) - 1 Laboratory assistant (microbiologist of average qualification - 1 Instructor-disinfector - 1 Dosimetrist technician - 2 Drivers - 2
TOTAL - 21 people, incl. doctors - 11; paramedical workers - 4

- Sanitary and epidemiological teams (SEB) - TsGSN are formed that do not have the ability to form SEA.

Epidemiological - consisting of 5 people, of which: epidemiologists - 2 (one chief), paramedic (epidemiologist assistant), disinfectant instructor, driver.
Radiological - consisting of 5 people. Chief (doctor), radiation hygiene doctor, assistant san. doctor (paramedic), dosimetrist technician, driver.
Sanitary and hygienic (toxicological) - consisting of 5 people. Chief (doctor), sanitary doctor - toxicologist, assistant san. doctor - paramedic laboratory assistant, driver;

In order to implement special events, mixed teams may be created. Readiness for operation of the ESB - 12 hours.

- Specialized anti-epidemic teams (SPEB) are created on the basis of anti-plague institutions. The teams report directly to the Department of State Sanitary and Epidemiological Supervision.

SPEB structure:

Control,

Bacteriological department with a virological group.

Total 40 people. Consumable property allows teams to work for 2 weeks.

Specialized anti-epidemic teams (SPEB)

	Management (2 people) Head of SPEB (epidemiologist)

		Bacteriological department with virological group (26 people)

Head of department (deputy head of SPEB) - 1 Sanitary doctor - 1 Epidemiologist - 3 Zoologist - 1 Epidemiologist assistants (laboratory assistants) - 3 Disinfector - 1		Head of department - 1 Bacteriologist - 6 Virologist - 1 Laboratory assistant-virologist - 1 Laboratory assistant (paramedic-laboratory assistant) - 9 Laboratory assistant-medium maker - 1 Orderlies - 4 Autoclave operators - 2 Mechanical engineer - 1





In total, SPEB has 40 people, incl. doctors - 15; nursing staff - 14; junior medical staff - 7

- Epidemiological Intelligence Groups (ERG). They are created on the basis of regional (territorial), city and district TsGSN. The group consists of three people: an epidemiologist, an assistant epidemiologist (paramedic) and a driver-medic. If necessary, other specialists may be included in the group. The group takes samples from the environment and conducts an epidemiological survey of infectious foci. It is equipped with a sampling kit and has a vehicle. Group in 1 hour able to survey an area of 2 km. Sq. and take 8 samples from environmental objects.

6. QMS management.

Management of the QMS is the purposeful activity of chiefs, managers, management bodies of the Service to maintain in constant readiness forces and means of service, preparation them for medical provision of the population during emergencies and manual them when performing assigned tasks during the elimination of the health consequences of emergency situations.

Service management is based on the following principles:

Unity of command and centralization of management with the presentation of initiative to subordinates in determining how to perform the tasks assigned to them.

The ability to analyze the situation, draw the right conclusions, and anticipate the course of events.

Efficiency, creativity and high organization in work.

Firmness and perseverance in carrying out decisions and plans.

Personal responsibility of the QMS manager for the decisions made and the results of fulfilling the tasks assigned to him.

Management includes the following operations:

Continuous collection, study, synthesis and analysis of situational data;

Decision making (clarification) and planning;

Bringing tasks to subordinates (clarification of tasks to subordinates);

Organizing the implementation of planned (scheduled) activities;

Organizing and maintaining interaction;

Organization (restoration) of the management system, including communications;

Monitoring the implementation of planned activities and providing assistance to management facilities.

The management requirements are as follows: requirements:

ü Stability,

ü Continuity,

ü Efficiency,

ü Qualification,

ü Efficiency.

The head of the QMS of the Ministry of Health of Russia is the Minister of Health of the Russian Federation. The service is directly supervised by his first deputy.

The head of the QMS at the interregional level is the representative of the Minister of Health in the federal district.

The heads of the QMS at the regional and municipal levels are the heads of healthcare management bodies of the relevant executive authorities, and at the facility level - the heads of facility healthcare institutions.

Measures to eliminate the consequences of emergency situations are carried out in accordance with plan for health care provision for the population during emergencies, which is developed by the relevant headquarters of the VSMC, in agreement with the Ministry of Emergency Situations and approved by the head of the Service.

The plan is drawn up in writing with the attachment of the necessary maps, diagrams, calculation tables using symbols and signs (a set of formalized documents).

The plan includes:

Medical-tactical characteristics (MTC) of a given territory (object), taking into account possible emergencies.
Characteristics of the service at this level.
Schedule plan for transferring the QMS to various readiness modes.
Private health care plans for the elimination of health consequences of the most likely emergencies.

In the interests of the integrated use of all the forces and means of the VSMC, the QMS of the Ministry of Health is assigned a leading role. For the period of liquidation of the medical and sanitary consequences of an emergency, the forces and means of the QMS of the Russian Ministry of Defense, institutions and formations participating in the liquidation of the consequences of emergency situations of the Ministry of Internal Affairs, Russian Railways, the State Committee for Sanitary and Epidemiological Supervision of Russia, and other ministries and departments are transferred to its operational subordination.

Control is carried out from the main and reserve control points, the latter can be mobile and located on road, rail, air and water transport.

When eliminating the medical and sanitary consequences of an emergency, the QMS has to to interact with other services, including the medical services of some ministries and departments.

Interaction is the coordination of joint actions on goals, objectives, place, time and volume of tasks performed by management bodies, forces and means of the MK service with the medical forces of interested ministries and departments of all levels, and RSChS services.

Interaction is reflected in the plan for medical and sanitary provision of the population during emergencies or a separate interaction plan is created.

Interaction tables are being developed in individual formations and institutions of the VSMC. Extracts from the interaction plan are communicated to all participants in the interaction.

Management of VSMC during the liquidation of consequences Emergency

To facilitate emergency management, sets of formalized documents are developed in advance. Depending on the situation in the emergency situation, two options are possible in managing the VSMC:

1st - when during an emergency there are small sanitary losses and there are relatively favorable conditions for medical and sanitary provision. In this situation, management of forces involved in emergency response ensured by a control system operating in daily activities .

2nd - when large-scale emergencies arise and significant forces from various ministries and departments are involved to eliminate them. In these cases it is necessary to create special control systems , closely interacting with management bodies, forces and means of the RSChS participating in emergency response.

Namely - a system of auxiliary control points is being created. For this purpose, operational groups of QMS headquarters are sent to the RSChS control centers. Control points are also created in the formations and institutions of the Supreme Military Command participating in the liquidation of the consequences of emergencies.

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