EVACUATION MEDICAL —
the system of actions providing export struck and patients from places where there were these defeats or diseases, in medical institutions (in military conditions on stages of medical evacuation) for svoyevrekhmenny delivery of health care and treatment taking into account specific conditions of a situation. In military conditions E. the m is an organic component of system of medical and evacuation providing (see).
The main reason causing the necessity to carry out E. hm., the impossibility to organize treatment struck and patients in the necessary volume directly on site is, as a rule. From the medical point of view for the benefit of struck and sick their treatment on site of emergence of defeat (disease) is most reasonable. In this case necessary rest is provided, the forced partition of medical care and treatment, and also change of attending physicians is excluded. However a не-возхможность to concentrate on site emergence of losses necessary forces and means, and from here insuperable difficulties for treatment struck and patients up to standard neminuyekhmo cause the need to carry out E. m. In military conditions this situation is aggravated with a fighting situation. It obra-zokhm, AA. the m represents an action forced — not indifferent for the health evacuated as it is connected with disturbance of its rest and need to dismember medical care, but at the same time this action is caused by a situation. In this regard E. by m it has to be carried out steadily, on to be combined with medical actions. including along the line, and to be carried out in the most sparing ways and means. The need for evacuation is caused as well by specialization of medical aid. Rendering such help demands creation of special conditions using difficult equipping and high qualification of doctors that it is impossible to reach on site emergence of losses. Even out of a fighting situation at natural disasters the level of development of specialized medical aid forces to resort to E. m in regional hospitals or the republican (allied) centers of highly specialized medical aid.
Especially widely E. the m is applied in military conditions. In wars of the past evacuation was considered, first of all, as a way of release of field army from struck and patients as their accumulation in a rear strip reduced maneuverability of troops. So, in Provisional regulations for evacuation of wounded and patients of the Russian army, «most highly approved»
on August 5, 1914, it was specified
that «the field army needs constant removal from it of wounded and patients that their presence did not constrain its mobility and did not exert adverse impact on the ranks which are in its ranks». At the same time in some cases essential distinction between evacuation of wounded and patients and evacuation of the become useless property and arms, trophies and prisoners of war did not even become. Such installation during World War I of 1914 — 1918 led to mass evacuation to the back of the country practically all struck and patients without due consideration of their needs in these or those types of medical aid that extremely adversely affected a state evacuated and results of treatment, significantly worsened outcomes and extended terms of treatment. Such groundless evacuation was resolutely opposed
by V. A. Oppel. «That evacuation of wounded from the battlefield is necessary — he wrote — it is impossible to argue with it... But at the same time... evacuation to the detriment of grants and treatment represents one of the largest mistakes able to bring a large number of irreparable misfortunes, besides — misfortunes mass, having even the state value». For the maximum restriction of so adverse influence of evacuation for results of treatment - V. A. Op-pel offered in 1915 system of stage treatment (see), in a cut evacuation and treatment were combined in the uniform interconnected process. Thereby evacuation struck and patients gained clearly the expressed medical character that received the reflection in the concept «medical (sanitary) evacuation», essentially differing from «evacuation of wounded» and «system of a delivery» (see System of medical and evacuation providing). Such value E. m as a component of system of stage treatment it was officially regulated in «The guide to sanitary evacuation in RKKA» (1929). However according to this «Management» E. m was under construction on so-called «drainage type» and it was characterized by «evacuation in the direction». Struck and patients were evacuated by the general flow in one direction, passing consistently through all stages of medical evacuation regardless of needs in this or that type of medical care. The main reasons which caused the organization E. m on drainage type, were: poor development of the separate industries of medicine, in particular surgeries, insufficient number of doctors-spetsialis-tov in the country and as a result of it is lack of objective conditions for specialization of medical aid in to lay down. institutions of field army in wartime, and also extremely insufficient number of automobile sa-nitarno-vehicles for evacuation struck and patients on soil ways therefore horse (animal-drawn) transport was widely used, the size of daily transition to-rogo made 25 — 30 km. It resulted in need to have stages of medical evacuation through each 25 — 30 km for providing evacuated by food, rest and rendering necessary medical aid. Such many staging E. m, certainly, had extremely an adverse effect on the terms and results of treatment struck and patients.
In «The charter of military public health service of RKKA» (1933) the first steps to change about E were taken. m in field army and to its organization according to medical indications, i.e. to destination. However the principle of evacuation declared in the charter to destination had no appropriate organizational in the beginning yet and material and technical resources as specialization was not provided field to lay down. institutions of field army.
Practically the realization of the principle of evacuation to destination was enabled only during the Great Patriotic War when as a part of hospital bases of armies and fronts were created specialized to lay down. institutions on primary
branches of clinical medicine (see. With pets iat izirovanny m the editsinsky
help). In other words, the system allowing to send struck and patients to the medical institutions capable to render those types of specialized medical aid was created, in to-rykh evacuated needed.
Experience of the Great Patriotic War showed that one of important tasks E. the m is the correct distribution of a flow evacuated between specialized to lay down. institutions to provide the most accurate evacuation to destination, without allowing at the same time an excessive overload of stages of medical evacuation. It was reached, in particular, by the organization on the ways of evacuation of medical distribution posts (see. Medical distribution post), to-rye for implementation of evacuation to destination and hypodispersion struck and patients between medical aid stations (medical institutions) completed evakotransportny sorting (see Sorting medical) the following through them struck and patients. Such posts were created on all main ways of evacuation, including at entrance on the territory of the developed hospital bases (see. Hospital base).
To avoid completely a multistage-nosti E. the m during the Great Patriotic War did not work well, first of all, owing to need to develop the corresponding echelons of hospital bases of armies and fronts in the places of an overload struck and patients from one type of transport on another, and also in connection with extremely limited opportunities a dignity. aircraft (see System of medical and evacuation providing).
Various sanitary vehicles were used to evacuation struck and patients. At the same time in all cases aimed to use the available most sparing and high-speed means in this situation E. m. Especially great difficulties arose at the evacuation from the battlefield which is carried out by various means (sanitary sledge teams, court shoes drag harrow, a horse medical ambulance, etc.) or by manual carrying out (see Carrying out and export of struck). Further evacuation was more often carried out by a motor medical ambulance. Railway, water and air sanitary vehicles were used preferential for E. m from army to front areas, and also from the battlefield in hospital bases of the back of the country.
Impossibility in some cases to provide E. m all struck and patients only a dignity. transport forced to use for this purpose the return trips of the motor, railway and air transportation of transportation. It was organizationally provided with placement of first-aid posts and hospital collectors (see. Evacuation point) near delivery roads and evacuation, and also preliminary planning of attraction to E. m of transport of transportation. The transport of general purpose attracted to evacuation struck and patients, needed the accessories (the device for installation of a stretcher, the device of seats, warming, etc.). Struck and the patients evacuated on a medical ambulance or transport of general purpose shall accompany, as a rule, medical staff, especially when E. the m is conducted on long distance. The accompanying medical staff along the line watches a state evacuated, and in case of need, renders medical aid by the person in need.
EVACUATION MEDICAL 539
Depending on the nature of fighting and conditions of a situation different types E can be applied. m. As a rule, it will be organized by the higher chief of medical service and carried out by his regular or given sanitarnotransportny means, to-rye it sends to stages of medical evacuation of a subordinate link of medical service forward. Such order of evacuation received the name of evacuation «on itself». Advantage of this look E. the m consists that the senior medical chief allocating vehicles forward has an opportunity to use them more effectively according to a situation, and also it is better to maneuver them. However in the conditions of a specific situation also other types of the organization E can be applied. m: «from» — the vehicles on a stage of medical evacuation of a higher link of medical service, etc.
Large volume E. the m caused the necessity to have as a part of forces and means of medical service on the battlefield and in the back of the country the appropriate authorities of management and establishment which are directly connected with the organization of mass evacuation struck and patients — the evacuation receiver (see), sorting hospital (see), various evacuation points (see. Evacuation point).
Indispensable condition of the accurate organization E. m to destination are evacuation and transport sorting struck and patients (see Sorting medical) at stages of medical evacuation and existence properly of the completed evacuation medical documents: primary medical card, an evacuation envelope, the sheet evacuated struck and patients (see Documentation medical).
The organization E is of particular importance. m in the new conditions of activity of medical service caused by a possibility of use by the opponent of weapons of mass destruction therefore there is very complex challenge — to evacuate to destination in a short time a large number struck, needing different types of medical care. In these conditions the crucial role will be played every possible restriction of multistaging E. m, the accurate control and flexible maneuver by sanitary vehicles, and also perhaps broader use for evacuation struck sanitary and military transport aircraft, including starting with medical and sanitary battalion (see) and separate medical group (see), light hospital aircrafts and helicopters, to-rye do not demand big runways (platforms).
Medical evacuation on the fleet will be organized and carried out on the basis of Armed Forces of the USSR of the principles, uniform for all types, but has a number of the features caused by the nature of fighting of Navy. On the organization and implementation E. the structure of the fleet (flotilla) and its technical equipment, forms and ways of conducting combat operations, system of basing and logistic support, me - wild and geographical conditions of navigation areas and fighting, etc. exert m on the fleet impact. Remoteness of navigation areas p especially fighting from stationing sites, dissociation of the ships and connections operating in various areas of the seas and oceans, complexity of maneuver by transfer struck and patients in the sea from the ship on the ship interfere with bystry and their systematic evacuation (see System of medical and evacuation providing, medical and evacuation providing Navy).
Medical evacuation on the fleet will be organized by the corresponding medical chief. For its implementation all means of transport can be used (first of all water and aviation, and also automobile and railway) that is defined by the nature of the fighting conducted by the fleet and existence of an opportunity to use overland vehicles.
Organization E. the m on the fleet provides: planning and preparation of special evakuatsionnotransportny means and medical structure for ensuring evacuation of wounded and patients; expansion of evacuation prnekhmnik in collection points and transfers of wounded and patients, reception and accommodation of wounded and patients on evacuation vehicles; medical providing wounded and patients in the course of their evacuation; systematic transfer of wounded and patients in destinations; providing vessels with medical forces and means; maintaining the medical account and reporting.
At the organization E. m on the fleet with use of a water medical ambulance (see. Hospital vessels, the Water medical ambulance) and other watercrafts it is necessary to consider a number of negative factors. It is first of all big vulnerability of sea evakotransport-ny means, rather small speed of the movement of most courts, impossibility of year-round evacuation, especially on the North Sea, because of an ice situation and bad weather. Besides, the organization of fighting and special providing the ships, including re-equipment is quite often necessary for evacuation of the vessels which are not adapted for this purpose.
For carrying out E. m on the fleet are used special evacuation vehicles: hospital vessels, medical ambulances, sanitary and transport vessels, sanitary boats, fighting ships and support vessels of Navy, court of the Ministry of navy, Ministry of merchant marine fleet, Ministry of the river fleet, Ministry of fishing industry.
Medical evacuation in system of Civil protection. In system of health service of Civil protection (see) later uses by the opponent of weapons of mass destruction huge value has timely collecting hit to the places which are specially planned for these the targets and the subsequent their carrying out and export on OPM. Collecting struck and rendering first aid to them is carried out a dignity. teams jointly with rescue groups. Export them will be organized by transport of OPM, and also the given means. Evacuation from OPM in hospital base (see) carry out sanitary and transport formations of GO with use of motor, railway and air transport, under the corresponding conditions — the water transport and the given means. It is necessary to emphasize that in the MSGO E system. the m is conducted only on two stages — group of first aid and hospital base, edges is final
ethane E. m. The principles E stated above. m in military conditions to a certain extent keep the value and for MSGO.
At natural disasters or accidents. the victims which are followed by a large number, there is also a need for carrying out E. m. For mitigation of consequences formations of MSGO are attracted. AA. the m of victims in such conditions is, as a rule, carried out directly from areas of disasters in medical institutions where they are treated till a final outcome. At relatively ogrthe nichenny amount of disasters there is a possibility of wider use for the purposes E. m of the air transport that considerably reduces terms. Principles of evacuation and transport sorting and rule E. m of victims shall and in these .usloviya steadily to be observed. Bibliography: Military-medical preparation, under the editorship of F. I. Komarov, with * 80, M., 1984; Provisional regulations for evacuation of wounded and patients, M., 1914; Georgiyevsky A. Medical distribution posts and points, Back and supply of Red Army, No. 40, page 13, 1944; it, Historical sketch of development of health service of army associations, L., 1955; 3 and in and l and sh and N. I N. Medical distribution post as operating controls evacuation, Voyen. - medical zhurn., No. 1-2, page 38, 1945; To r and h e Sunday to and y I. Medical evacuation to destination and questions of management, Back and supply of Red Army, No. 4? page 15, 1945; Materials on field surgery, under р^д. H. N. Burdenko, etc., page 5, M. — D., 1940; Manual on public health service of Red Army, M. — JI., 1941; About p p e l V. A. Organizational issues of the advanced surgical belt of field army, Pg., 1917; Bases of the organization of medical support of troops, under the editorship of N. I. Zavalishin, M., 1961; The Provision on field management of troops in wartime, Appendices, No. 13, page 116, Pg., 1914; Rubbed Sunday to and y P. P. Evacuation in modern war, Voyen. - medical zhurn., t. 221, book 4, page 698, book 5, page 47, 1908; The Guide to sanitary evacuation in RKKA, M., 1929; Smirnov E. I. Problems of military medicine, M., 1944; Formation and development of domestic naval medicine, under the editorship of E. M. Ivanova, JI., 1976; The Charter of military public health service of RKKA (the army area), M. — L., 1934; V. I Poles. Medical and evacuation providing navy in wartime, M. — L., 1939; E yn-horn And. Evacuation and evacuation systems, SPb., 1877.
A.S. Georgiyevsky, I. P. Leads, O. S. Lobastov; A. P. Demidov (medical evacuation on the fleet).