From Big Medical Encyclopedia

SORTING MEDICAL — distribution struck and patients in first-aid posts and to lay down. institutions on groups, each of to-rykh includes the persons needing homogeneous treatment-and-prophylactic and evacuation actions with definition of priority and the place of rendering medical aid to them, and also the directions, priority and a way of evacuation. The village of m is the organizational action allowing to use most effectively available forces and means of health service, it is correct to organize rendering medical aid struck and the patient, their treatment and evacuation, i.e. to provide successful implementation of the accepted system of medical and evacuation actions.

Need to apply S. of m for the purpose of timely rendering medical aid most in it needing arose since then when fighting began to be followed by considerable sanitary losses (see. Sanitary losses). For the first time proved theoretical provisions, S.'s technique of m and brilliantly N. I. Pirogov carried out in practice. However distribution of wounded and patients to groups was applied at medical providing troops and during the dopirogovsky period. With origin in the Russian army of organized medical care (see Medicine military) official recognition was gained by division of wounded and patients on heavy and easy. So, in wars of 17 century it was carried out mainly for the purpose of delivery «depending on wounds of» various sum of money «for a lechba». In wars of 18 century of wounded and patients distributed on capable to follow with army, subject to leaving in «retrashement» and needing the direction in hospital. During the Russian-Turkish war of 1768 — 1774 of the person, subject to treatment in hospitals, were distributed also in the place of treatment; in the circular letter of the commander-in-chief P. A. Rumyantseva was offered to send the easily patients giving hope for fast recovery in «neighbors hospital», and heavy, «which to fast treatment are not reliable» — «in distant». Division of wounded and patients «on three classes» — chronic patients, seriously ill patients and weak belongs to the end of 18 century. In left in 1807. «The provision on an order of establishment at Foreign army of hospitals» the wounded and patients incapable «are mentioned to transfer further transfer», and also «the slightest delay not suffering». In A. A. Charukovsky's book «The military and marching medicine» (1836) is told about need of identification «on regimental bandaging» the wounded needing the urgent surgical help and the structure of this group is brought. Further development of evacuation tendencies in medical providing army in the first half of 19 century demanded more differentiated division of wounded and patients, proceeding from the possible result and probable terms of treatment.

Therefore, long before N. I. Pirogov in medical support separate elements of sorting of wounded and patients took place, but N. I. Pirogov's genius, his huge knowledge and clinical experience was necessary to create the harmonious and evidence-based doctrine about S. of m. It was promoted by the conditions of medical providing which developed in the besieged Sevastopol. Considerable sanitary losses among defenders of the city and rather small removal of the main dressing points from troops caused revenues to these points during short intervals of time of a large number of wounded. The discrepancy created at the same time between considerable number of the wounded needing medical aid and an opportunity in the nearest future to render it, was the main reason for introduction of sorting as the obligatory organizational action capable to some extent to eliminate this discrepancy. «A thought of sorting of wounded — N. I. Pirogov wrote — to me came then when it was necessary to deal with thousands of wounded...». However for scientific justification of S. of m there was not enough recognition of its need; it was necessary to reconsider the existing views of the organization of rendering medical care to wounded. And here the crucial role was played by N. I. Pi-rogoyea belief that «the benefit brought in the known cases by early operations does not pay back the harm coming from uneven distribution of the help for the most part of cases...». This situation made a basis of the division of wounded into 5 categories offered by Pirogov: «remediless and fatally wounded»; «hard and dangerously the wounded demanding the urgent help», «seriously injured, demanding also urgent, but more safety grant»; «wounded for whom the direct surgical grant is necessary only to make possible transportation»; «lightly wounded or such at which the first grant is limited to imposing of easy bandaging or extraction of superficially sitting bullet».

N. I. Pirogov began the activity in Sevastopol with improvement of the organization of work on dressing points and first of all with introduction of medical sorting. He wrote: «Having convinced soon after my arrival in Sevastopol that simple administrative ability and an order on dressing point much more important purely of profession of a physician, I made to myself the rule: not to start operations immediately during the carrying of wounded on these points, not to waste time for long grants... and to be engaged it is urgent their sorting».

Further, during war of 1877 — 1878, N. I. Pirogov proves a role of medical sorting in ensuring evacuation of wounded and patients. He considered that S. should be carried out by m according to ability of wounded and patients to transfer transportation to a certain distance (seriously wounded who «do not maintain far and difficult transport»; the lightly wounded and sick, not subject evacuations it is far to the back since «they recover soon and are returned to a system» and occupying «the middle between these categories») and recommended the most reasonable ways of transportation.

And now many recommendations of N. I. Pirogov of an order of carrying out S. of m completely kept the value. It is necessary to carry to their number first of all the following: Page of m it is possible only on the basis of «the correct scientific diagnosis» in this connection to S. «the most experienced doctors» shall be attracted by m; for S.'s carrying out of m it is necessary to take special place («the depository place») where wounded and patients «shall be placed with leaving of the passes allowing to approach from all directions them»; Page of m shall begin «at the first reception and analysis» wounded specially allocated medical personnel and to be carried out, «without touching» an initial bandage; first of all it is necessary to separate lightly wounded from «difficult and lying»; for timely you - _ polneniye of the sorting conclusions it is necessary to have sufficient number of «support personnel», certain places for concentration of wounded and patients of each category, etc.

After N. I works. Pirogova and up to the Russian-Japanese war of 1904 — 1905 about S. practically nothing new was brought by m in the doctrine. Moreover, dominance of evacuation tendencies in medical support of troops during this war resulted in oblivion of a number of provisions of N. I. Pirogov. However, chief surgeon of Manchurian army P. P. It is harmful the m to some extent aimed by the corresponding S. to combine evacuation of wounded and patients with their treatment. In particular, he suggested to allocate on the advanced perevyazochnokhm point group of the wounded needing urgent operative measures on the main dressing points. However these offers did not receive full implementation.

During World War I of 1914 — 1918 S. in m was regulated generally by two official documents — the provision on military and sanitary institutions and institutions of military department and the instruction of a sanitary part of the Northwest front on sorting and evacuation of patients and wounded. According to Situation all wounded and patients arriving to the main dressing point were divided into 4 categories: being subject to return, capable to follow in medical institution on foot, being subject to transportation to medical institutions and, at last, incapable without explicit harm for them to sustain transportation. According to the Instruction it was necessary to allocate the following groups of wounded and patients: «demanding... the immediate operational help», «not demanding the immediate help» which after rendering to it «the initial help» were subject to further evacuation, and not being subject to evacuation in connection with weight of their state. However and in World War I, especially in its first years, N. I. Pirogov's doctrine about S. was not realized by m in the considerable part in practice of medical providing the Russian army. But at the same time it gained further theoretical development that is connected first of all with a name B. And. Opel. The main role in the system of stage treatment offered them (see) S. was allocated for m. Whether «We stopped on studying of the principles of stage treatment of wounded — he noted — whether stopped on consideration of questions of surgical tactics, we involuntarily face at once sorting of wounded as a basic element of the organization of the surgical help during war». In S.'s basis of m V. A. Oppel put «two signs: medical and evacuation». In the scientific works it for the first time connected them among themselves within uniform process of medical and evacuation providing troops and showed a role of S. to m in it «Taking the whole army in consideration, going from regimental dressing points to advance parties, infirmaries of divisions, field mobile hospitals and head evacuation points, it is possible to develop the whole plan of sorting of wounded» — V. A. Oppel wrote.

Great October socialist revolution created favorable conditions for successful development on the basis of the principles of socialist humanity of the theory and practice of military medicine. At the same time implementation of regulations on S. of m of N. I. Pirogov, V. A. Oppel, other prominent representatives of military medicine and their further development became possible. B. K. Leonardov entered the concept «punktovy» and «evacuation or transport» sortings, proved S.'s order of m in various functional divisions of stages of medical evacuation, determined S.'s role by m in ensuring evacuation of wounded and patients to destination. It disclosed S.'s essence of m as «group diagnosis». «The individual diagnosis is how important for treatment of the specific patient — B. K said. Leonardov — this criterion is so insufficient for „classification“ of mass of the wounded and patients needing the most various help». Meanwhile in the war the health service should deal with «the mass of wounded and patients». In these conditions «correctly it is possible to organize giving of medical care only if to be not individual, but group diagnosis the basis». In turn, it is possible under a condition when the contingents of wounded and patients are classified not by descriptive or causal signs, and by needs in these or those actions, i.e. not on individual, and by group signs.

Further improvement of the organization of medical support of fighting of troops considerably enriched the doctrine about S. in m. In it the merit as organizers of health service is big (E. I. Smirnova, N. I. Zavalishin, And. N. Grigorieva, etc.), and field surgeons (M. N. Akhutin, S. I. Banaytis, F. F. Berezkin, M. M. Diterikhs, P. A. Kupriyanov, etc.). In particular, A. N. Grigoriev showed need of sorting of wounded since the battlefield. N. I. Zavalishin developed S.'s bases of m in head department of field evacuation point. P. A. Kupriyanov, S. I. Banaytis and M. N. Akhutin's recommendations of S. of m on regimental and divisional first-aid posts based on synthesis of experience of medical ensuring combat operations in the lake Hassan, river Halkhin-Gol and during the Soviet-Finnish military conflict were of great value. Expediency of the majority of their offers was confirmed in the period of the Great Patriotic War of 1941 — 1945 when the doctrine about S. of m gained further development and became one of bases of all system of medical and evacuation actions. The practician S. of m followed from provisions of the uniform field military-medical doctrine and provided successful implementation of stage treatment with evacuation to destination. Emphasizing the defining S.'s role with m, E. I. Smirnov and S. S. Girgolav wrote: «In our military and sanitary business there is no gloss, but if at each stage of this area there is no turmoil, priority of surgical interventions is defined not by groans and complaints of wounded, and weight of damages and the actual opportunities of this stage and at present if in the operating room and a dressing room there is a quiet and hard work if reception and departure of wounded take place orderly, then it is possible to be sure that three quarters of wounded in the next 2 — 6 months will return to a system».

In days of the Great Patriotic War of S. of m, being an integral part of work of all medical parts and institutions, it was issued organizationally: the regular sorting and evacuation hospital (SEH) were created and their place in system of medical and evacuation providing is defined (see. Sorting hospital, System of medical and evacuation providing)', on DMP (see. Medical and sanitary battalion) and in hospitals separate reception sorting rooms for heavy and lightly wounded, and also for patients were developed; placement practiced in evacuation departments of stages of medical evacuation of wounded and patients on homogeneous groups as the measure providing more accurate evacuation to destination etc.

Experience of the past war convincingly showed that S. shall be carried out by m at all stages of medical evacuation and in each functional division of a stage. At the same time it shall be carried out continuously in strict accordance with opportunities of a stage and the volume of medical aid established for it according to purpose and the developing fighting and medical situation. Elements C. of m need to be applied already in the battlefield. Average and younger medical structure in the presence of several struck, resolving an issue of priority of rendering to them the help or priority of carrying out (export), produces m on the substance of S.

At S.'s carrying out of m at stages of medical evacuation (see) first of all from the general flow of struck come to light dangerous to people around: infected with PB and O B infectious patients and persons with suspicion of an infectious disease — to the isolation center are subject to the direction in the division which is carrying out sanitary (special) processing, and. Two groups of struck are established: a) the medical aids needing rendering at this stage; b) struck, medical aid the Crimea can be postponed until the following stage. Concerning the first group according to character and localization of defeat (disease) and the general condition of the victim is defined what medical aid (on the volume and character) struck needs and in what priority it shall it be rendered. Depending on it the functional division of this stage (operational, antishock, dressing is defined and so forth), a cut will provide it such help. Further expediency of leaving of the struck (patients) at this stage depending on weight of defeat (disease) is defined: nontransportable — before emergence of a possibility of their further evacuation, struck and patients, treatment to-rykh can be complete on site — before recovery. Concerning each subject of further evacuation is established where it shall be evacuated on what transport in what situation (sitting, lying) and in what turn (in the first or in the second).

The page of m is carried out on the basis of the diagnosis and the forecast of defeat (disease) at the obligatory accounting of a fighting and medical situation. Depending on the diagnosis need and a possibility of rendering medical aid to the struck (patient), the place and priority of its rendering are defined, indications and contraindications to evacuation, its urgency are established. Extra care needs to be shown at allocation of group struck and the patients having wounds incompatible with life and diseases. This group can include only the persons having undoubted symptoms of such wounds or diseases and not which are subject therefore to reference to other categories. Observance of this condition is necessary to provide everyone struck the maximum and most effective help.

The page of m can be divided into two look: vnutripunktovy, opredelyayushchuyu-order of passing by the struck (patients) of functional divisions of this first-aid post (medical institution), priority and the place of rendering the help to them at this stage, and evakotransportny, the struck (patients) defining an order of the direction out of limits of this stage, priority, a way of their evacuation and evacuation appointment. At the same time in the course of S. of m which is carried out to MSB (OMO). the type of medical institution to which it is necessary to send this struck or the patient to destination («specialized surgical hospital for wounded in the head, a neck, a backbone», «specialized surgical hospital for wounded in a breast and a stomach», «therapeutic hospital», «hospital for treatment lightly wounded», etc. shall be defined). At establishment of a way of evacuation the issue of a type of transport and situation in it evacuated is resolved (lying, sitting).

For the organization C. of m certain conditions are created. At each stage of medical evacuation department is for this purpose developed and equipped special reception and sorting (in MSB and OMO sorting and evacuation). Revenues to PMP, in MSB and OMO in short terms of a large number of struck force the doctor who is carrying out S. by m to carry out it, as a rule, without - removals of a bandage on the basis of short * the anamnesis, results of outer inspection of the struck (patient) and use of the elementary diagnostic receptions. In force of Etogo-S. the m should be assigned on most * the experienced doctors capable in these conditions to make the most exact diagnosis and to make the decision answering both to a state struck, and the situation which is often limiting possibilities of a stage in assistance. Big complexity is represented also by sorting of persons with the combined defeats and identification at the same time of the leading defeat, i.e. that, a cut poses the greatest threat of life struck at present and from to-rogo degree of urgency of rendering medical aid at this stage of medical evacuation depends.

The sorting post (SP), the sorting platform and reception and sorting rooms (tents) are a part of a reception sorting room; in MSB and OMO certain sorting platforms for tyazheloporazhen-ny and easily struck, and priyemnosortirovochny rooms (tents) — for tyazheloporazhenny, easily struck and patients are usually allocated. In hospitals for specification of the diagnosis as a part of this department also diagnostic chambers and a dressing room can be developed.

S.'s results of m are fixed by the corresponding color brands (marking), to-rye are attached to clothes of the struck (patient) or to handles of a stretcher. Marking allows hospital attendants without additional instructions, being guided only by sorting brands, to deliver struck in the relevant divisions or to carry out their loading on transport in strict accordance with the decision of the doctor who was carrying out sorting.

Value C. of m especially increases in war using the opponent of weapons of mass destruction who is characterized by single-step emergence of mass sanitary losses (see) and in this regard revenues to stages of medical evacuation in short terms of a large number of struck. It defined need of further development of S. of m, specification of its organization, justification of methods of its carrying out for difficult conditions of modern fighting. A. N. Berkutov, A. A. Bocharov, A. A. Vishnevsky, E. V. Gembitsky, A.S. Georgiyevsky, I. I. Deryabin, N. G. Ivanov, F. I. Komarov, I. P. Lidov, G. P. Lobanov, I. A. Yurov's works, etc. were devoted to the solution of these tasks.

The problem C. of m is urgent not only in field army, but also in the conditions of Civil protection, at various natural disasters and accidents of peace time with a large number of victims. Earthquakes, accidents on railway transport and other events which are followed by mass defeats among the population demand similar actions in civil medical institutions which personnel shall be prepared for carrying out in these conditions of S. of m. It is only necessary to emphasize that, in addition to the diagnosis and the forecast, the medical staff which is carrying out S. of m in these conditions is obliged to be guided by nek-ry social aspects. So, e.g., women in labor, women in childbirth, children should grant the privilege for first-priority evacuation.

Bibliography: Akhutin M. N. Field surgery, M., 1941; Birches-to and N F. Philosophy of sorting of wounded according to stages of evacuation of the army area, Voyen. - a dignity. business, No. 6, page 32, 1937; A. S Of St. George. Organizational bases of sorting struck in fight and patients, Voyen. - medical zhurn., No. 1, page 8, 1959; Zavalishin N. I. Head field evacuation point, M., 1942; Ivanov N. G. and G. P. Organization's Mullets of medical sorting in medical and sanitary battalion (separate medical group), Voyen. - medical zhurn., No. 7, page 6, 1965; Kupriyanov P. A. and Banaytis S. I. Short course of field surgery, M., 1942; Oppel V. A. The basis of sorting of wounded from the medical point of view on the battlefield, Voyen. - medical zhurn., t. 244, October, page 151, 1915; Pies N. I. Collected works, t. 5, p.1, M., 1961; Smirnov E. I. N. I ideas. Pirogova in days of the Great Patriotic War, Voyen. - a dignity. business, No. 1, page 3, 1943; it, Military medicine and N. I. Pirogov, Voyen. - medical zhurn., January-February, page 6, March, page 3, 1945; it, War and military medicine, 1939 — 1945, M., 1979; Encyclopaedic dictionary of military medicine, t. 3, Art. 1002, M., 1948.

I. P. Leads, G. P. Lobanov.