SYSTEM of ANTI-EPIDEMIC PROVIDING Armed Forces — set of the actions directed to the prevention and fight against distribution in troops of infectious diseases with use of forces and means intended for these purposes.
The page of the item of the lake has three the main the interdependent and connected among themselves subsystems: network of sanitary and epidemiologic institutions in all links of Armed Forces (army, army, front, the center), administrative board and shots of specialists of these institutions, and, at last, the scientific and methodical and organizational leadership in anti-epidemic providing Armed Forces on the basis of the last achievements of science and practice.
The main (first) subsystem is the network of sanitary and epidemiologic institutions with the certain organizational structure, material equipment and order of subordination and the management providing their concentration in the appointed districts and also efficiency, maneuverability and efficiency of their actions. This requirement has basic value as anti-epidemic providing is, as a rule, directed to service not of individuals, and the big contingents of staff estimated by many thousands. The quantity, organizational structure and material equipment of sanitary and epidemiologic institutions are defined by real economic and technical capabilities of the state.
In the period of the Great Patriotic War there were following sanitary and epidemiologic (anti-epidemic) institutions (divisions) and positions of specialists. In an army link — a sanitary platoon medical and sanitary battalion (see) divisions. In an army link — the epidemiologist of army, the food and water supply inspector, the chief of sanitary and epidemiologic department of medical-department of army; sanitary and epidemiologic group (SEG), infectious field mobile hospital (see), the sanitary checkpoint (SC), the obmyvochno-disinfection company (ODC), field mobile bathing groups, field laundry groups, prachechno-disinfection group at management of the field evacuation point (FEP). In a front link — hl. epidemiologist of the front, chief of sanitary and epidemiologic department of medical management of the front, food and water supply inspector; the sanitary and epidemiologic laboratory (SEL), the sanitary and epidemiologic group (SEG), the infectious field mobile hospital (IFMH), infectious evacuation hospital at management of the front evacuation point (FEP), sanitarnokontrolny points (SKP), dezin-fektsionno-instructor group of the front (DIOF), prachechno-disinfection groups at managements of front and local evacuation points (FEP and MEP); on nek-ry fronts military and sanitary anti-epidemic groups (VSPEO) were created, besides, were available garrison bathing prachechno - the disinfection groups intended for service of spare parts.
The chief epidemiologist and anti-epidemic and bath-and-laundry management were on the staff of the Head Military and Sanitary Department (HMSD). At the disposal of GVSU were available bathing prachechno - disinfection and bathing and disinfection trains, to-rye as required depending on a specific epidemic situation were given to fronts; in some cases they were used for processing of mid-flight replenishments and the local civilian population.
The second subsystem to a predstavla on administrative board and specialists a dignity. - epid. institutions (are listed above). Thanks to their high qualification (epidemiologists, microbiologists, virologists, infectiologists, parasitologists, hygienists, etc.) this subsystem in many respects defined success of anti-epidemic providing Armed Forces in the Great Patriotic War.
Also the third subsystem — the scientific and methodical and organizational leadership in anti-epidemic providing has important value.
Experience of the Great Patriotic War convincingly confirmed direct dependence of effectiveness of anti-epidemic providing troops on the level of the management. So, in 1941 — 1943 on the Southern, Southwest and Western fronts in troops epidemic flashes of a tularemia appeared. Due to the military operations in nek-ry areas harvesting was not finished. Reproduction of mouse-like rodents in districts with untidy bread accepted mass character. Among them the epizooty of a tularemia extended. Excrement of sick rodents contaminated not threshed bread, straw. Considerable time was required to distinguish the nature of a disease that was possible only on the basis of knowledge mechanism of transmission of infection (see). Dominating there was an aerogenic way of infection as a result of inhalation of dust, the straw used as covering material. It was new to the specialists who were not knowing about such mechanism of infection of people at a tularemia. Only after establishment of this «unusual» way of infection fight against a tularemia in troops became efficient.
In a crust, time it is known that the aerosol way of infection of people is possible at nek-ry infectious diseases, at to-rykh it still rather recently did not assume. It has special value at the infections which are characterized by allocation of activators by sick people and animals, and also bacilli carriers. Their excrement, the infecting objects of the environment, after drying become a source of microorganisms, to-rye, being dispersed, infect air. As a result of epidemiological observations and pilot studies it was established that aerosol transfer of activators is possible, except a tularemia, at a brucellosis and nek-ry salmonellosises.
It is obvious that the rates of development of medical science are higher, the high readiness of shots on many aspects of epidemiology, microbiology, virology, immunology, parasitology and clinic inf is more important. diseases, especially in the field of early clinical and laboratory diagnosis of diseases, early detection of ways of transfer of activators, in specific prevention, disinfection (see), disinsections (see) and deratization (see).
S.'s efficiency of the item of the lake. Armed forces it can be provided only with observance of a number of the requirements and provisions connected with specifics of anti-epidemic work — need of bystry and maneuverable reorientation of the available forces and means.
The main requirement consists in the continuous, interconnected, interdependent and successive activity of sanitary and epidemiologic institutions and certain specialists as among themselves, and with other formations of military-medical service in all links forming other systems of medical support of Armed Forces, first of all medical and evacuation (see. System of medical and evacuation providing Armed Forces ). It belongs first of all to sanitary and epidemiologic investigation (see. Medical investigation), where the continuity, reliability, timeliness and succession provide identification inf. patients and an unsuccessful epidemic situation that allows to take urgent anti-epidemic measures (see. Anti-epidemic actions ). If sanitary and epidemiologic investigation is carried out purposefully with the obligatory accounting of geographical and climatic conditions of this area, then it can significantly help with the choice of the main direction of anti-epidemic actions.
The close and continuous interrelation and succession of anti-epidemic providing Armed Forces with sanitary and hygienic is important (see. System of sanitary and hygienic providing Armed Forces ) and medical and evacuation providing. Experience of the Great Patriotic War showed that only constant vigilance of medics of all levels and specialties concerning early detection inf. patients at all stages medical evacuation (see) provides success of anti-epidemic work.
Crucial importance in prevention and fight against parasitic typhus belongs to bath-and-laundry and disinfection service (see Obmyvochno-dezinfektsionnaya of the technician), a cut shall be in hands of military-medical service what experience of the Great Patriotic War convincingly testifies to. Activity of the sanitary and epidemiologic institutions providing bath-and-laundry and disinfection service shall rely on the centralized management from the corresponding chief of military-medical service taking into account data of sanitary and epidemiologic investigation. Continuous and close interaction of sanitary and epidemiologic institutions and certain specialists (heads) who are carrying out, on the one hand, sanitary and epidemiologic investigation, and with another — bath-and-laundry and disinfection service of staff, are the key to success of anti-epidemic providing Armed Forces.
In days of the Great Patriotic War the anti-epidemic barriers protecting the acting troops from a drift inf. diseases from the back, there were army and front sanitary checkpoints (SC). They were deployed at large and junction railway stations, and also in the rear front district and controlled a dignity. a condition of staff of military echelons, removed and hospitalized the diseased. At detection of pediculosis subjected staff of an echelon (in each case with the permission of GVSU, and in the front area — Military and sanitary management of the front) to cleansing (see) with change of underwear and disinsection of regimentals. SKP carried out the tasks also concerning the military teams following in passenger trains, organizing carrying out if necessary a dignity. processings of staff in insulating check points (see) the railroads or in sanitary inspection rooms of bodies of municipal services (see. Sanitary inspection room ). During offensive operations outside our country for these purposes used bathing prachechno - disinfection and bathing and disinfection trains.
Principle of medical and evacuation service inf. patients was that they were hospitalized in the infectious field mobile hospital (IFMH) and the infectious evacuation hospital (IEH) and treated on site, without the subsequent evacuation (see. Infectious field mobile hospital ). It was one of philosophy of anti-epidemic providing troops, importance to-rogo is convincingly confirmed with experience of the Great Patriotic War. It showed also obligation of direct evacuation inf. patients (to destination) from regimental or divisional first-aid posts in army IPPG, to-ry it was whenever possible pushed forward.
Small part inf. finished the cure of patients, being conformed with combat conditions, in IEG, but already within the front district. A responsible role in early detection, isolation and non-admission to evacuation inf. patients among wounded belonged to sortirovochnoevakuatsionny hospitals (see. Sorting hospital ). Where it was dictated by an epidemic situation, kontrolnoevakuatsionny classifying sections hospital with obligatory participation in their work of infectiologists were developed. In 1943 during the Kursk fight of GVSU it was for the first time forced to conduct evacuation of wounded from Kursk through control and evacuation sorting hospital. This measure was caused by epidemic of a sapropyra among the population of the freed districts of the Kursk and Oryol regions, and also existence of cases of a sapropyra in the troops which resulted from contacts of staff with the civilian population which was before release in the occupied territory.
Escalating value in S. of the item of the lake. Armed forces specific prevention in a specific epidemic situation gets. The most perspective drugs — the associated vaccines of single use for mass express immunization (or by means of needleless an injekto-ditch, or in the form of aerosols, by peroral introduction) allowing to vaccinate once in short terms the big contingents of troops (see. Immunization, troops ).
At the same time the immunity created by some live vaccines (plague, brucellous, etc.), is short, no more than several months remain. In these cases for a revaccination it is reasonable to use chemical vaccines since residual immunity will interfere with a reproduction of strains of live vaccines in an organism of vaccinated persons. Chemical vaccines shall be most cleared, concentrated and occluded. For these purposes it is important to reveal the most effective monoantigens in the immunogene relation.
The main specifics of anti-epidemic providing consist that it is always directed in compliance with a specific epidemic situation to the prevention and elimination of epidemic flashes certain inf. the diseases demanding strictly differentiated actions with coverage them the big contingents of staff. At the same time it is necessary to mark out the main, defining anti-epidemic actions. So, in fight against a sapropyra bath-and-laundry and disinsection service of staff is main. Other complex of actions including first of all improvement water supply of troops (see) and food (see), it is necessary to carry out at fight against intestinal infections. Special approaches and efforts are required at zoonoza (a malignant anthrax, a tularemia, a brucellosis, etc.), and also at malaria and nek-ry other infectious diseases. At different nozol. forms complexes of necessary actions significantly differ from each other. So, fight against malaria and the infectious diseases caused by an arbovirus demands work on destruction of mosquitoes and mites in big territories; prevention of a malignant anthrax and a brucellosis is based on the prevention of contact of people with patients and the fallen animals, and also on prevention of use of animal raw materials and prohibition to eat the products received from these animals; for prevention of infection of staff with the activator of a malignant anthrax the arrangement of the military contingents out of dangerous territories is of particular importance that assumes existence of intelligence information about an epizootic situation.
The main specifics are shown not only in the choice of the main measures, but also in all complex of anti-epidemic actions in general and each action separately. The nature of an infection defines means and methods of preventive treatment, vaccination and revaccination, disinfection and disinsection. Specifics high-contagious inf. diseases (plague, natural smallpox, cholera) need of the organization of an observation (see) and a quarantine dictates (see the Quarantine, a karantinization). Any area of pathology does not demand so differentiated and strictly specific approaches as prevention inf. diseases and fight against them.
The necessary condition of effective anti-epidemic providing Armed Forces following from its main contents and the main specifics is ability of the available forces and means of all links of medical service to bystry reorientation of the activity that provides a possibility of timely and operational maneuver. The specific epidemic situation generates need of switching of efforts from one measures to others, napr, about a dignity. processings of the big contingents of staff on prevention of zoonotic infections (see. Zoonoza ), from actions for fight against intestinal infections for broad works on disinsection, in particular at elimination of the centers of malaria, yellow fever, a dengue, encephalitis and encephalomyelitis.
It must be kept in mind that in case of use by the opponent nuclear weapon (see) the epidemic situation on many infectious diseases will seriously become complicated in connection with sharp deterioration a dignity. - a gigabyte. conditions.
Experience of Hiroshima and Nagasaki showed huge destructive force yaderno go weapon, use to-rogo is followed by destruction of water handling and sewerages, dwellings, buildings of public appointment and to lay down. institutions. All this demands broad sanitary actions, including full sanitary cleaning of the big contingents.
At the same time all types of defeat by nuclear weapon (mechanical injuries, burns, radoactive radiation) considerably reduce immunobiological abilities of an organism, first of all its nonspecific resistance. Damage of mechanisms of natural resistance of the irradiated organism, first of all the systems and bodies providing an immunogenesis reduces efficiency of the vaccinal immunity created in these conditions. Significantly reactogenicity of vaccines, especially live (in these conditions it is reasonable to apply chemical vaccines and anatoxins) increases. All this aggravates a current inf. diseases at the faces affected with nuclear weapon also promotes their distribution. Along with it massive use by the opponent of nuclear weapon, especially neutron, will cause disturbance of evolutionarily developed ecological relationship between microorganisms and macroorganisms therefore can be changed a way of circulation of microorganisms, and also ways and mechanisms of infection of people and animals.
Due to the incubation by Pentaton and the countries of NATO of plans of limited nuclear war during the planning and the organization of anti-epidemic providing Armed Forces it is necessary to consider all features of fight against infections in these conditions.
The system of anti-epidemic ensuring fighting of Navy is based on the same principles, as anti-epidemic providing Armed Forces, but has a number of the features connected with fighting of the fleet in districts with various klimatogeografichesky conditions and with basing of the ships (parts) in the districts which are characterized various a dignity. - epid. state.
Anti-epidemic actions are carried out, first of all, by forces and means of medical service of the ships (parts), to-rye if necessary can be strengthened taking into account specifically developing fighting and medical situation by forces and means of anti-epidemic institutions of the fleet (flotilla) or other divisions of medical service.
During the planning and the organization of anti-epidemic actions by the ships which are carrying out fighting tasks it is necessary to consider need of long isolation and treatment inf. patients in regular insulators, and at their mass receipt and in the rooms adapted for insulators; limited opportunities of medical service in carrying out various a lab. researches, including at diagnosis inf. diseases; need of broad carrying out in some cases deratization and disinfection actions, and also use of means of the emergency prevention (see) among the persons put risk of infection.
The important place is taken by the sanitary and epidemiologic investigation allowing to receive beforehand data on possible sources of a drift of an infection on the ships (in a part) in districts of their basing (dislocation) and to provide necessary actions for the prevention of a drift or distribution inf. diseases.
At the organization of anti-epidemic actions it is necessary to consider nek-ry features of medical and evacuation actions in the relation inf. the patients revealed among staff of the ships conducting fighting. At the same time the following options of rendering medical aid inf are provided. patient: patients are treated in the ship insulator before full treatment; direct to treatment in the emergency hospital developed by one of the ships (courts) of providing; direct in inf. department of the hospital vessel or the hospital developed ashore, which is for them a final stage of medical evacuation.
Bibliography: V. D.'s white hares and E. G Bug. The manual on military hygiene and epidemiology, M., 1978; E lx and I. I N. The military and epidemiological doctrine (by experience of anti-epidemic protection of troops in the Great Patriotic War of 1941 — 1945), Zhurn. mikr., epid. and immun., No. 5, page. And, 1980; Experience of the Soviet medicine in the Great Patriotic War of 1941 — 1945, t. 32, M., 1955; Practical epidemiology for doctors of navy, under the editorship of V. I. Agafonov, M., 1975; Smirnov E. I. War and military medicine, 1939 — 1945, M., 1979; Smirnov E. I. and Garin N. S. War and anti-epidemic protection, Zhurn. mikr., epid. and immun., No. 5, page 6, 1980; they, Problems of immunology in system of anti-epidemic protection of troops in the Great Patriotic War, Immunology, No. 3, page 5, 1980; Smirnov E. I., Lebedinsky V. A. and Garin H. G. Epidemic process (problems and judgments), M., 1980; Encyclopaedic dictionary of military medicine, t. 4, Art. 914, M., 1948.
E. I. Smirnov; N. S. Garin, B. A. Kozhevnikov (Navy).