Організація медичної допомоги при подіях із масовим ураженням людей

Abstract

Background. Increasing the number of mass casualty incident such as traffic accidents or terrorist attacks which causes significant number of victim needs the medical assistance, so several chapters of health response plan to be revived. The term “event with mass casualty incident” (for healthcare institution) in the article presents the situation, because of which there is a mismatch between the simultaneous admission of a large number of victims and the possibility of provi ding medical assistance without introducing changes in everyday forms and methods of work. Unlike the “emergency situation”, the need to involve external resources by the health care institution is absent or minimal. The purpose of the study was the improving management system of medical assistance for the victims after the mass casualty incident. Materials and methods. The work is based on the own experience of the authors on the organization and the direct provision of medical assistance to victims after mass casualty incident in Ukraine and outside, participation in international projects and exercises, in particular under the auspices of the European Civil Protection and Humanitarian Aid Operations. The research uses bibliographic and semantic methods of cognition. The organizational aspects of medical support in 46 cases of mass casualty incident that occurred in the world during 1979–2015 are summarized, of which 33 (71.7 %) — as a result of terrorist attacks using explosive devices, 6 (13 %) — using firearms against an unprotected civilian population, fires in recreation facilities — 3 (6.5 %), strong poisonous substances — 2 (4.3 %) and due to transport accidents — 2 (4.3 %). Results. The organization of medical care for those who suffered because of mass casualty incident should be based on the principles of 4C crisis management in accordance with the level of the introduced regime of functioning. In the health care system of Ukraine, it is advi sable to introduce the modes of operation of the system that are used in the European Union countries: 1) readiness for the possible admission of a large number of victims (“Green Level”), 2) partial mobilization of available resources of the health care institution (“Yellow Level”), 3) complete mobilization (“Red Level”). The primary medical triage of victims at the prehospital stage provides for dividing into two groups: “urgent” and “non-urgent”. “Non-urgents” to be sent to hospitals that are geographically located near the scene of the incident, but not to the nearest, which should be ready to provide emergency medical care to “urgent” patients and applied independently — “self-reported”, the number of which significantly exceed those who are delivered by ambulance team. The management group of health facilities includes responsible on — duty surgeon and anesthesiologist. The forms of information support of health care management system at the prehospital stage include: 1) the forces and facilities at the scene, 2) the triage of the victims at the scene, and 3) the need to strengthen the prehospital stage. At the hospital stage, the possibilities of conducting surgeries and the number of free hospital beds are determined: 1) the ope rating unit, 2) hospital beds. Conclusions. In the health care system of Ukraine, it is advisable to introduce appropriate levels of functioning in mass casualty incident which applied in the European Union countries. Redistribution of available health care resources when providing medical care to the victims after mass casualty incident at prehospital and hospital stages is critically necessary to save the life and health of people. The medical response requires the adequate information support for the prehospital and hospital stages, and the introduction of sectoral and interagency cooperation.