SYSTEM of MEDICAL and EVACUATION PROVIDING Armed Forces — set inherent to a certain historical stage and the level of development of military science and military medicine of the interconnected principles of the organization of medical care, treatment, evacuation and rehabilitation struck and patients during war and these problems of forces and means of health service intended for implementation. Page of l. - e.o. — one of the major components (subsystems) of medical support of Armed Forces (see. Medical support ); its main objective — preservation of life, recovery of fighting capacity and working capacity at perhaps bigger number struck in fights and the diseased that is in the conditions of modern war the most real and efficiently completions of mass fighting losses of staff of troops and the fleet. It is necessary at the same time state successive logical communication of S. of l. - aa. the lake with the principles and methods treatment-and-prophylactic providing Armed Forces (see) in peace time, a number of specific actions to-rogo, e.g. medical control of the state of health of staff of troops, the organization purposeful to lay down. - prof. of actions, keep the value and in the conditions of war.
Experience of World War II of 1939 — 1945 showed need of creation of also special system of the actions and the corresponding formations designed to provide rendering medical aid to the civilian population which was injured at massive air bombings of settlements of the back of the country, evacuation and the treatment struck (see. Health service of civil protection ), what causes importance of establishment of due interaction between both systems, especially in the territory of the country.
Experience of medical providing field armies in last wars demonstrates that S. of l. - aa. lakes changed and improved in process of change of the factors exerting decisive impact on formation and development of military medicine. Treat these factors: economic opportunities of the country, its human resources; organization and number of armed forces; means of armed struggle and hardware of troops; level of development of military art, medical science and health system. The defining value for establishment of the guidelines of creation of S. of l. - aa. the lake has a social and economic and political system of the state, the tool of the power to-rogo are armed forces (see. Meditsina military ). Very essential, constantly increasing role for definition of the most effective forms and methods of the organization of medical and evacuation providing in wars of the end of 19 and 20 centuries character, size and structure began to play a dignity. losses of troops (see. Sanitary losses ).
This or that S.'s features of l. - aa. the lakes depending on specific conditions of warfare and separate operations are very diverse and are defined by two main tendencies in the organization of medical and evacuation providing troops.
The first is characterized by the aspiration to organize treatment struck and patients near the combat zone («treatment on site»), the second — the aspiration to delete (to evacuate) from this zone the most part struck in fight and patients it is possible further to the back. At the same time «treatment on site» was widely adopted during formation of military medicine when the armies limited on number applying slow-moving linear fighting orders had very weak maneuverability and the outcome of war was turned during one or few decisive battles conducted in rather limited territory when ways and intermedia were extremely imperfect, and methods of treatment still quite primitive.
The organization of medical and evacuation providing for evacuation type was caused by impossibility to perform treatment of a large number struck in fight and patients in close proximity to the front line, first of all in connection with significantly the increased danger of their secondary defeat and need of ensuring high mobility of means of medical service at the maneuverable nature of fighting. The great influence on strengthening of an evacuation tendency was exerted by improvement of ways and intermedia, in particular emergence of the railway, then motor and air transportation. Not smaller value had complication of the process of treatment struck and patients, caused by development of medical science and improvement of hardware of medical service. In this regard arose (especially at big a dignity. losses of troops) need of evacuation of a considerable part struck and patients in to lay down. the institutions located not only on the battlefield, but also beyond its limits that allowed to create appropriate conditions for their full treatment, according to requirements of medical science. The necessity of evacuation was caused also by the aspiration to avoid big accumulation struck and patients in to lay down. the institutions located in close proximity to troops that still N. I was accurately formulated. Pirogov: «How it was useful and it is desirable to avoid transport of seriously wounded, but their accumulation near theater of war, and at the beginning of military operations, will inevitably respond afterwards an adverse effect on other wounded».
Historical experience demonstrates that both tendencies stated above (to treat struck and patients «on site» and to evacuate them from a zone of military operations) were shown in specific S. by l. - aa. the lake of armed forces not separately one from another, and at the same time. At the same time depending on conditions of a situation in one cases treatment struck and patients in close proximity to the combat zone, in others — evacuation to the back prevailed. Dominance of an evacuation tendency in S. of l. - aa. the lake was especially brightly shown during the Russian-Japanese war of 1904 — 1905. According to the official report of the Head military and sanitary department, the number of the wounded and patients evacuated out of borders of the battlefield made 83% from arrived in to lay down. institutions of field army. The same situation took place and in the Japanese army where, according to Horn, from 391 265 wounded and patients 80,7% were evacuated by the sea to Japan, i.e. out of borders of the battlefield, apprx. 316 000 people, or. The close interlacing of elements «treatments on site» and evacuations in S. of l is especially characteristic. - aa. lake. The Soviet Army in the period of the Great Patriotic War of 1941 — 1945. If in 1941 — 1942 in this system evacuation, then in 1943 — 1945 a considerable part of wounded and patients prevailed (hl. obr. lightly wounded and a part of wounded and moderately severe patients) remained on treatment in hospitals of field army whereas the seriously wounded and seriously ill patients needing prolonged treatment were evacuated out of borders of the front. So, according to E. I. Smirnov, since January 1, 1943 from 100 wounded who were returned to a system, fighting capacity of 85 people was recovered in to lay down. institutions of army, army and front rear districts.
In wars 19 and the beginnings of 20 centuries, including World War I, evacuation struck in fight and patients was considered by military command only as the action pursuing the aim of the maximum release of field army from the military personnel who lost fighting capacity. At the same time evacuation lost medical character, was not coordinated with to lay down. process, extremely adversely affected a state struck and patients, the result of their treatment. Such nature of transportation struck and patients, unlike medical evacuation (see. Evacuation medical ), when requirements of a military and medical order are equally considered, E. I. Smirnov called «system of a delivery)'. V. A. Oppel the first tried to overcome contradictory tendencies of medical and evacuation providing the Russian field army during World War I. The system of stage treatment offered them in 1916 (see) proceeded from need «closely to connect evacuation with treatment, to consider their composed a single whole». However the principles of stage treatment which are put forward by V. A. Oppel did not receive at that time due organizational registration and were not realized in practice of medical and evacuation providing pre-revolutionary Russian army. Partially V. A. Oppel's ideas found reflection in «The instruction on the organization of the surgical help to wounded developed in 1917 by N. A. Velyaminov at the front». Theoretical development and practical implementation of S. of l. - aa. lakes, integrally combining process of treatment struck in fight and patients with their purposeful evacuation, were carried out only after Great October socialist revolution by medical service AF of the USSR.
System of medical and evacuation providing the Soviet Army
With creation of Red Army in the years of foreign military intervention and civil war of S. of l. - aa. the lake of troops gained consecutive development on the basis of the general principles of construction of the Soviet health care (see. Health care , Communist Party of the Soviet Union , Meditsina military ). For organizational registration of this system transfer of all evacuation business to maintaining bodies of military-medical service had essential value thanks to what the possibility of a combination of medical and evacuation actions was created. However difficulties of formation within the country of medical institutions, and also sending them on fronts forced the management of the Head Military and Sanitary Department (HMSD) to instruct the People's commissar-is sensible of RSFSR to heads of medical service of fronts and armies to create non-standard mobile and stationary medical institutions on places (mobile departments of hospitals, «flying» a dignity. groups, dressing «short meetings» etc.).
In 1919 in connection with blockade of the Soviet republic and ruin on. - transport, difficulties with fuel and food, especially in the central regions of the country, a wide spread occurance of a disease of parasitic typhus of the order of Revolutionary Military Council of the republic and Narkomzdrava RSFSR of December 16, 1919 No. 2314 sharply limited evacuation of wounded and patients to the back of the country. For implementation of this order on. - ways of evacuation were organized at the expense of regular field mobile and evacuation hospitals (see. Hospital military ) and anti-epidemic institutions - block distributors - whether — divisional, army and front. Their tasks included medical sorting of the arriving wounded and patients, their sanitary cleaning, hospitalization for treatment in the respective area and isolation inf. patients. However it was not succeeded to execute this order completely because of explicit discrepancy to the bed network developed on fronts to the number of the arriving wounded and patients. So, according to M. I. Barsukov, a dignity. losses of Red Army in 1920 reached 318 807 wounded and contused and 3 928 894 patients whereas the medical service had by July, 1920 only 397 496 beds (from them apprx. 100 000 beds in internal districts). At the same time this historical experience demonstrated need of organic coordination of medical and evacuation and anti-epidemic providing (see. System of anti-epidemic providing ).
After the end of civil war the principles of stage treatment which are officially regulated in «The guide to sanitary evacuation in RKKA» (1929) were the basis for medical and evacuation providing Red Army. The partition (echeloning) of medical aid, consecutive and its successive rendering on first-aid posts was provided in this Management and in to lay down. the institutions developed on the ways of evacuation. Much attention was paid to medical sorting of wounded and patients (see. Sorting medical ) at all stages of medical evacuation (see). According to the Management of 1929 stage treatment in Red Army was based on so-called drainage system when the evacuated wounded and patients had to pass consistently the general flow through all first-aid posts and lay down. the institutions developed on the ways of evacuation, regardless of character of the rendered grant and that medical aid, in a cut wounded and patients needed the subsequent.
From the beginning of modernization of Red Army, its mechanization and motorization there were conditions for further development of S. of l. - aa. lake. It was promoted also by progress in construction of the Soviet health care (growth of medical shots, creation of the domestic medical industry, development of the specialized industries a wedge, medicine). Acceptance on equipment of medical service of the motor transport and emergence of a possibility of use for evacuation of airplanes was created along with other factors by real premises for failure from drainage type of evacuation and transition to S.'s creation of l. - aa. the lake on the basis of evacuation to destination. The need of such reorganization was indicated by B. K. Leonardov though organizational forms for this purpose at that time were not developed yet.
In «The charter of military public health service of RKKA» (1933) the first attempt of change of an order of S. of l was made. - aa. the lake on the basis of stage treatment with nek-ry elements of evacuation to destination (fig. 1). But implementation of the principle of evacuation proclaimed in this Charter to destination was not organizationally provided with creation on the battlefield specialized to lay down. institutions, need to-rykh began to be felt even during World War I of 1914 — 1918. From the general flow of wounded and patients allocated in essence only inf. patients. Rendering specialized medical aid by other wounded and patient in the army back was not provided by the Charter. Concerning them the former «drainage» type of evacuation remained that inevitably resulted in multistaging in rendering medical aid to them. Besides use for evacuation of lightly wounded return flights of transport of transportation caused need of their overload on divisional and case exchange offices. The collection points developed here lightly wounded and field evacuation receiving stations were capable to give only the first medical assistance and did not provide performance of necessary surgical interventions. Insufficient security of medical service with an automedical ambulance (as of May 1, 1935 it made only 6,6% of requirement) excluded an opportunity to evacuate wounded and patients, passing buffer stages of evacuation, on that stage, «where the qualified medical care which will be defined by the nature of a disease or defeat» (UVSS — 33, § 9) can be provided to evacuated.
Need of creation of network specialized to lay down. institutions as the major condition providing a possibility of evacuation to destination it was especially visually confirmed during fighting of Red Army in 1939 against the Japanese imperialists on the river Halkhin-Gol and during the Soviet-Finnish military conflict of 1939 — 1940. Based on this fighting experience of medical providing troops, and also on real assessment of development a wedge, medicine on the way of its specialization, E. I. Smirnov specified: «... since the maxillofacial surgery, neurosurgery, treatment of damages of bones of extremities and a chest cavity were allocated in independent disciplines, that situation for hospital when each doctor-surgeon was a doctor for all wounded ceased to exist, and any wounded was a patient of any doctor-hi-rurga».
Thus, by the beginning of the Great Patriotic War of 1941 — 1945 generally there were conditions and the principles providing further development of system of stage treatment (see) were defined on the basis of evacuation to destination. In its formation and the subsequent practical implementation the big role was played by E. I. Smirnov. The field medical doctrine which is put forward by it, a being a cut it was formulated in premilitary years, and then it is fullestly opened on the 5th plenum of Academic medical council at the chief of the Head military and sanitary department of Red Army in February, 1942, was a theoretical basis of system of stage treatment with evacuation to destination. The essence of this doctrine is made by the following provisions: 1) uniform understanding of an origin and course of a disease, and also the principles of surgical and therapeutic work in field conditions; 2) existence of uniform school and uniform view of methods of prevention and treatment of wounds and diseases; 3) succession in performance of medical actions at various stages of evacuation; 4) obligatory existence of the short, accurate medical documentation allowing to make full sorting of wounded and patients and providing succession and the sequence of performance of lechebnoevakuatsionny actions.
In premilitary years the Sanitary management of Red Army made for theoretical and organizational formation of S. of l much. - aa. the lake of fighting of troops on the basis of stage treatment with evacuation to destination. The doctors taken on staff a dignity. platoons of battalions, in 1940 were replaced by paramedics as full medical work on the IFV was impossible. The divisional hospital was withdrawn from a division and included in structure of forces and means of medical service of army, two types of field mobile hospitals — army (at the rate of one on the case) and army, included in structure of the head evacuation point (HEP) and the hospital base of army (HBA) were provided in structure a cut. In army and in the front companies of medical strengthening were created, the state to-rykh provided a number of the specialized groups intended for specialization of field mobile hospitals. Thereby the foundation of rendering specialized medical aid since hospitals of army subordination was laid and basic data are developed for specialization to lay down. institutions of hospital bases of the front and back of the country. However by the beginning of the Great Patriotic War a row planned by Sanitary management Red was not realized And rmiya about rganizatsionno-regular transformations, in particular were not created hospital for treatment lightly wounded and classifying sections hospital.
The Great Patriotic War exerted exclusively great influence on S.'s development by l. - aa. lake. The adversity at the beginning of war forced to concentrate rendering the qualified surgical help preferential in army (front) hospitals and to reduce volume it in a divisional first-aid post to the urgent actions providing a possibility of further evacuation of wounded and patients. For the same reason medical sorting of wounded and patients for the benefit of their evacuation to destination and rendering main types of specialized medical aid were carried out in the reception and sorting bases of the center organized by the Head military and sanitary department on the major operatsionnostrategichesky directions. Absence as a part of army and front to lay down. institutions of hospitals for treatment of lightly wounded led in the first months of war to evacuation of a considerable part lightly wounded and easily sick to the deep back that interfered with timeliness of their specialized treatment and bystry return. Therefore in the middle of the Smolensk battle in July, 1941 on the Western front at the initiative of Sanitary management of the front according to the instruction GVSU the foundation was laid for formation of «hospitals camps» for treatment lightly wounded and easily sick on 1000 places everyone. This experience quickly became property of other armies and fronts, and in December, 1941 was fixed by creation of regular hospitals for lightly wounded (see. Hospital for lightly wounded ).
Transition of the Soviet Army to counterattack near Moscow, and then and in the general approach was caused by a possibility of creation of full-fledged GB of the armies and fronts (due to re-evacuation to lay down. institutions from the back of the country) providing rendering all main types of specialized medical aid, including and therapeutic. It allowed to create therapeutic field mobile hospital (see) in armies. They were entered into structure of GB And at the end of 1942, and PPG are transformed in surgical field mobile hospital (see). As a result of the held events each general army began to have 2 infectious PPG (see. Infectious field mobile hospital), 2 therapeutic PPG, 2 hospitals for treatment lightly wounded and several surgical PPG. The last by a pridacha to them specialized groups of companies of medical strengthening turned in specialized hospital. Except the specified field hospitals, GB of armies incorporated evacuation hospital (see), one-two classifying sections (see. Sorting hospital), and also the EDS (see. Evacuation receiver ). The total regular bed capacity of hospitals in the general armies conducting fighting fluctuated ranging from 4000 to 7000 beds and more depending on tasks of army, its structure and conditions of a situation.
The main part to lay down. institutions of front subordination EG of various bed capacity and a profiling (surgical, therapeutic, specialized), by hospitals for treatment lightly wounded and sortirovochnoevakuatsionny hospitals was presented. During war need to have in structure to lay down came to light. institutions of the front also PPG entering field evacuation point of front subordination.
Thus, on the basis of broad specialization army and front to lay down. institutions and significant increase in power of GB of armies and fronts during the Great Patriotic War there was a final registration of more perfect organization of medical and evacuation providing field army — system stage, treatments to evacuation to destination (fig. 2). The essential role in its formation was played by the scientific and methodical management from GVSU, a dignity. managements of fronts and dignity. departments of armies, and also managements of evacuation centers. At the same time especially plenums of Academic medical council at the chief of GVSU were important for establishment of unanimity of views on implementation of the principles of this system.
The fundamental principles of system of stage treatment with evacuation to destination were: echeloning of medical aid; its approach to wounded and patients; timeliness of rendering; an organic combination of actions for rendering medical aid and to treatment with evacuation; succession and the sequence in performance to lay down. actions; implementation of evacuation to destination since DMP and HPPG of the first line; specialization of medical aid in to lay down. GB institutions. For implementation of the specified principles C. of l. - aa. lake. The Soviet Army provided consecutive expansion on the ways of medical evacuation of a number of first-aid posts and to lay down. institutions. At the same time they depending on the place in system of stage treatment with evacuation to destination, a fighting and medical situation provided rendering certain types of medical aid by the wounded and patient. So, on regimental medical aid stations (see) it appeared first medical assistance (see), on divisional first-aid posts and in surgical PPG of the first line — the qualified medical care (see). For rendering to wounded and patients of specialized medical aid (see. Specialized medical care ) were provided specialized to lay down. GB institutions of army and front.
The principles of stage treatment with evacuation to destination completely were repaid during the Great Patriotic War, having provided high activity during the rendering medical aid to the heaviest contingents of wounded and patients that allowed to return up to 72,3% of total number of wounded and 90,696 patients in a system. Experience of the Great Patriotic War at the same time confirmed again exclusively big dependence of specific forms of the organization of medical and evacuation providing on a fighting, rear and medical situation. Such dependence concerning contents and the volume of medical aid at stages of medical evacuation found accurate reflection in «Instructions on field surgery» where it was told that in the conditions of field medical service the volume of work and the choice of a method of surgical intervention and treatment are defined by hl. obr. a fighting situation, the number of arriving wounded (patients) and their condition, number of doctors, especially surgeons, at this stage, existence of vehicles, field to lay down. institutions and medical equipment, season and condition of weather. Experience of the past war also clearly revealed decisive dependence of quality of medical and evacuation providing troops on degree of readiness of the managerial personnel of medical service. Lack of purposeful preparation of such shots in premilitary years caused a number of serious gaps in medical and evacuation providing troops, especially in the first period of war that caused need of reorganization during war of system of preparation of military-medical shots (see. Army medical college ).
At all the advantages of S. of l. - aa. lakes of the period of the Great Patriotic War were not always completely realized that depended on a number of the objective reasons. Including quite often there was a need of repeated rendering the surgical help to wounded that was caused by impossibility of carrying out exhaustive surgical interventions at army stages of medical evacuation and in HPPG of the first line. It was often interfered by a situation and lack of necessary special equipment in medical and sanitary battalions (see) divisions and in HPPG of the first line. At that time still there were also no effective remedies detaining development of an infection in a wound, timely use to-rykh allows to make the delayed surgical treatment in specialized to lay down. institutions. Page of l. - aa. the lake of the period of the Great Patriotic War was characterized by excessive multistaging at evacuation of wounded (patients) and rendering medical aid to them. Their most part at that time passed consistently not only all army stages of medical evacuation (PMP, DMP or HPPG of the first line), but also a number of echelons of GB of the armies and fronts which was carrying out approximately same volume of specialized medical aid. Such situation developed in connection with objective conditions, but sometimes depended on insufficient readiness of medical heads.
The main means of transportation of wounded and patients in the front back and in the back of the country was. - transport. At the same time there were its various types (military and sanitary short meetings, temporary and constant military and sanitary trains — see. Railway medical ambulance ), working at different sites. that, certainly, led to a consecutive overload evacuated from one look. - of transport on another and to need to develop the corresponding groups in places of this overload to lay down. GB institutions of army or front. The medical service during the Great Patriotic War had insufficient number a dignity. airplanes that limited a possibility of mass evacuation tyazheloporazhenny directly in the GB located at a great distance from the front line, passing the echelons preceding them.
Multistaging of evacuation had an adverse effect on results to lay down. process, promoting increase in duration of treatment and deterioration in outcomes that was a subject of discussion on the 6th and 7th plenums of Academic medical council at the chief of GVSU. E. I. Smirnov on the 6th plenum (on August 26 — 30, 1942), noting defects of work of field public health service, specified: «Stage treatment with evacuation to destination is the cornerstone of lechebnoevakuatsionny ensuring fighting of troops of our Red Army. All know well that this system accepted by us — the best, the most advanced. But not all know that the most advanced system can have negative sides. What weaknesses stage treatment can have? Multistaging. What harm is done by multistaging? As a rule, extends terms of treatment of wounded, reduces efficiency of timely rendering the specialized surgical help wounded in a skull, jaws, a thorax, a stomach, the wounded with injury of big tubular bones and large joints» (Works of the sixth plenum of UMS at the chief of GVSU, M., 1942, page 21).
Further development and S.'s improvement of l. - aa. the lake during the post-war period was connected not only with need of elimination of the specified reasons of its organizational incompleteness, but also with the changed natures of fighting of troops and conditions of their medical providing. Acceptance on arms of modern armies of means of mass defeat, new types of firearms, incendiary mixes like napalm involves change of character and structure a dignity. losses, and also emergence of new types of fighting pathology.
For the organization of medical and evacuation providing the new conditions of activity of medical service generated by a possibility of use of different types have special value nuclear weapon (see). At the end of World War II of the atomic bombs dropped on the Japanese cities of Hiroshima and Nagasaki, and the subsequent scientific researches the major factors exerting the defining impact on the organization of medical and evacuation providing allowed to establish studying of effects of unjustified use of the USA. Treat these factors: possibility of single-step emergence of the numerous centers mass dignity. losses both on the battlefield, and in the back of the country (see the Center of mass defeats); irregularity dignity. losses and essential change of their structure (increase of specific weight burned, emergence of radiation defeats, increase in weight of defeats, their combined character); infection with radioactive materials of extensive territories; possibility of epidemics as a result of sharp deterioration a dignity. - a gigabyte. conditions of regions of an arrangement or fighting of troops and decrease immunol. resistance of an organism at the persons which were affected by ionizing radiation; sharp discrepancy of the available forces and means of medical service to the volume of the forthcoming work on rendering medical aid, evacuation and treatment struck and patients, the complication of medical sorting caused by difficulties of forecasting of weight of radiation defeats and their outcomes; essential increase in possible losses of staff of medical service in all its links. Value of a rational combination of medical and evacuation, sanitary and hygienic and anti-epidemic actions increases in these conditions in a bigger degree, than in the period of the Great Patriotic War.
Along with the specified complications of conditions of activity of medical service the great influence on the organization of medical and evacuation providing is rendered by success of medical science achieved during the post-war period, especially in its such sections as medical radiology, immunology, anesthesiology and resuscitation, toxicology. Use of antibiotics will allow to make if necessary (e.g., at mass losses or at impossibility under the terms of a fighting situation quickly to give surgical help) surgical interventions in later terms, than it was allowed in the period of the Great Patriotic War, i.e. to solve a problem of rendering the single-step exhaustive surgical help struck in specialized surgical hospitals. The combined character of a considerable part of defeats in result of possible use of new types of weapon and difficulty of definition of the leading syndrome of defeat (disease) will cause need to involve in rendering specialized medical aid and the subsequent treatment of the struck representatives of various medical specialties. The need for the therapeutic help (including in surgical hospitals) will increase as among fighting defeats radiation defeats (radial illness) and the gas poisonings which are combined with various injuries can take an important place. Very perspective for improvement of evacuation to destination, and in particular for elimination of multistaging of evacuation, it is necessary to consider broad use of the air transportation. It will allow to disperse also much more widely flows evacuated struck and patients on to lay down. to the institutions developed on the battlefield.
New conditions of activity of health service resulted in need of reorganization of S. of l. - aa. the lake of troops which provides the following main stages of medical evacuation (fig. 3): PMP, MB of a division or separate medical group to lay down. GB institutions, hospital of the back of the country. Also the IFV in cases when it is developed can be carried to number of stages of medical evacuation and works on site (e.g., in defense). Certain features in the organizations of work depending on their tasks and the place in the general S. of l are inherent in all stages of medical evacuation. - aa. the lake of troops, and also from a fighting and medical situation. This system the principles of stage treatment with evacuation to destination are the cornerstone of the period of the Great Patriotic War. But it contains also a number of new provisions, such as the maximum restriction of multistaging in medical and evacuation process; aspiration to rendering single-step exhaustive medical aid; promotion of first-aid posts also to lay down. institutions by the boundaries (areas) mass a dignity. losses (if it allows a situation) with the subsequent organization here treatments of those contingents struck and patients, to-rye are not subject to evacuation out of borders of the front; broad maneuver not only by the volume, but also types of medical aid; perhaps early dispersal of evacuation flows between GB; need of a constant combination of the medical and evacuation actions to actions for protection struck and patients, and also forces and means of medical service from weapons of mass destruction.
In military medicine there are two concepts determining content to lay down. - the prof. of the actions held to S. by l. - aa. the lake during the rendering medical aid struck and the patient — a type of medical aid and volume of medical aid. Under the guise of medical aid understand a certain list (complex) to lay down. - the prof. of the actions held by staff of troops and medical services in the battlefield (in the centers mass a dignity. losses) and stages of medical evacuation. The type of medical aid is defined by the place of its rendering, level of training of the persons rendering it and existence of the corresponding equipment. The volume of medical aid is a set to lay down. - the prof. of actions in the borders of a specific type of medical aid which are carried out at stages of medical evacuation concerning the certain categories struck and patients according to medical indications and according to a fighting and medical situation.
Page of l. - aa. the lake of troops provides the following types of medical aid now: first aid (see), the pre-medical help (see), the first medical assistance (see), the qualified medical care (see), specialized medical care (see). A certain (standard) type of medical aid is inherent in each stage of medical evacuation. However at medical ensuring fighting there will be conditions, at to-rykh number struck, needing this or that type of medical aid inherent in a certain stage of medical evacuation, will significantly exceed possibilities of its rendering. Therefore the existing S. of l. - aa. the lake provides group of actions of the first medical and qualified medical aid for urgency of its rendering and corresponding changes of volume of medical aid. These changes are defined by specific conditions of a fighting situation; size and structure dignity. losses; security of divisions, parts and institutions of medical service with forces and means allowing to render this or that type of medical aid; a possibility of timely delivery struck and patients on the subsequent stages of medical evacuation, etc. Change of volume of medical aid towards its reduction at this stage of medical evacuation leads to change at the subsequent stage not only volume, but also a type of the medical help. So, e.g., reduction of volume of medical aid on PMP will lead quite often to what in MB and OMO it is necessary to render to a row arriving the struck not only qualified medical aid, but also the first medical assistance.
In system of medical and evacuation providing special value have succession in carrying out to lay down. actions, i.e. observance of uniform methods of treatment of the struck both patients and consecutive building to lay down. - the prof. of actions at stages of medical evacuation. Lack of uniform system of such actions (the uniform field medical doctrine) will lead to serious violation of all process of treatment struck and patients. Characteristic feature
of S. of l. - aa. the lake at the present stage of its development will be rendering main types of specialized medical aid since to lay down. GB institutions. Specialization of medical aid is provided with existence to lay down. the institutions having the corresponding specialists and necessary equipment for rendering this help to certain groups struck and patients. The solution of the specified task is reached by creation of constant regular specialized hospitals, e.g. neurologic field mobile hospital (see), hospital for lightly wounded, or by temporary strengthening of field hospitals by the corresponding specialized groups.
Differentiation of the specialized medical aid rendered in the GB developed on the battlefield will depend in many respects on existence of forces and means necessary for this purpose. In case of war at first, especially at use of means of mass defeat, a possibility of the organization of specialized medical aid will be sharply limited, and the list of its types will be minimum. However and expansion of specialized hospitals or specialized departments in multi-profile hospitals for the following contingents is provided in this period: wounded in the head, a neck and a backbone; the nek-ry categories burned in particular with heavy burns of an organ of sight; lightly wounded and easily sick, and also inf. patients. In process of arrival in structure of medical service of field army of the main part put by it to lay down. institutions the list of types of specialized medical aid will extend. At the same time depending on quantity struck and the patients needing this or that type of specialized medical aid, and the number available at present to lay down. institutions entirely specialized on one profile or specialized departments as a part of multi-profile specialized hospitals can be created hospital.
In case of use by the opponent of weapons of mass destruction the medical service should carry out to extremely short time medical and evacuation actions, a part to-rykh will be directly held in the center of mass defeats. In this regard timely information of medical service on the arisen centers, constant readiness for holding actions for mitigation of consequences of use by the opponent of weapons of mass destruction, existence of a special reserve of forces and means are necessary. The major condition defining activity of medical service at use by the opponent of means of mass defeat will be character of a fighting situation, and first of all existence or lack of threat of an exit of the opponent to the region of the center of mass defeats. In the presence of such threat of the main objective of medical and evacuation providing troops there will be a bystreyshy evacuation struck from the region of the center. The volume of medical aid at stages of medical evacuation in these conditions will as much as possible be reduced. In the absence of threat to both a favorable radiation and chemical situation first-aid posts and medical institutions can be brought closer directly to the center of defeat; medical care will be provided at the same time in wider volume. An important task will be collecting struck, evacuated from the center or leaving it independently, and rendering pre-medical and first medical assistance to them. For this purpose on the main ways of an exit or export of the mass defeats struck from the center first-aid posts will be developed (most often PMP), to-rye in the past in military-medical literature quite often were called as collection points struck or temporary collection points for struck. At mass receipt struck and patients on stages of medical evacuation value of medical sorting especially will increase (see Sorting medical), the cut will depend on the clearness and efficiency success of activity of any first-aid post and to lay down. institutions.
Organic component of S. of l. - aa. lake. The Soviet Army medical evacuation is. For evacuation struck and patients in the Soviet Army there are various sanitary vehicles. The greatest difficulties are represented by evacuation struck from the battlefield, carried out by means of various vehicles or manually (see Carrying out and export of struck). The carrying out of struck is assigned to staff of divisions of collecting and evacuation of medical service, and also the soldiers allocated for this purpose by the order of commanders of parts and divisions. Export struck from the battlefield is assigned to a regular dignity. transport of the IFV, division of collecting and evacuation of PMP and MB, and also general transport; use for this purpose of armored personnel carriers considerably will facilitate the organization of export struck under fire of the opponent. Further transportation struck and patients is planned on automobile a dignity. transport, to-ry is the main means of medical evacuation on the site between army stages and hospital base now. Possibilities of use of lungs a dignity increase in modern conditions. airplanes and helicopters for evacuation struck and patients, since MB and OMO. Railway and water dignity. transport will be applied to medical evacuation on the battlefield and in the territory of the country. Combination of ways of medical evacuation with delivery roads will allow to use the return flights of transport of general purpose (automobile and aviation) for evacuation struck and patients. The motor transport of general purpose shall serve preferential for evacuation easily struck and easily patients. The return flights of military transport aircraft can be used at evacuation of all categories struck and patients. Use of the return flights of transport of general purpose for medical evacuation will be organizationally provided with placement of first-aid posts and to lay down. institutions near delivery roads (evacuation) and preliminary planning of its use. Evacuation struck and patients from first-aid posts and to lay down. institutions it will be organized by the higher chief of medical service and it is carried out by the vehicles subordinated to it. The way, on Krom is made carrying out and transportation struck and patients to the back, received the name «way of medical evacuation». Set of the ways of evacuation located on them stages of medical evacuation and the working sanitary vehicles, providing certain usually large, group of troops, is called the evacuation direction.
See also Hospital base , Meditsina military , Health service of Armed Forces of the USSR , System of sanitary and hygienic providing , System of anti-epidemic providing , Sorting medical , Evacuation medical , Stage treatment .
Medical and evacuation providing Navy will be organized on the basis of the principles, uniform for all types of AF of the USSR. However the specific features which are defined by peculiar conditions of their fighting activity are inherent in forms and methods of medical and evacuation ensuring fighting of forces of the fleet. Decisive impact on the organization of medical and evacuation providing is exerted by structure of the fleet and its technical equipment, forms and ways of conducting combat operations, system of basing and logistic support, an originality of medico-geographical conditions of districts of swimming and military operations. Considerable remoteness of districts of swimming of ship forces from stationing sites, dissociation of the ships and connections operating in various districts of the seas and oceans, complexity of implementation of maneuver on transfer struck and patients from the ship on the ship in the sea interfere with bystry and their systematic evacuation for timely rendering necessary medical aid and treatment. Struck and patients by force during more or less long time remain by the ships on care of the regular medical service having limited opportunities.
Experience of medical and evacuation ensuring forces of the fleet in last wars demonstrates that in system of actions for rendering wounded and sick to medical aid, their evacuations and treatment the evacuation principle always prevailed. On dressing points of the ships medical aid by regular structure was the wounded, and upon return of the ships in base they were evacuated in sea hospital or infirmary where were treated, most often till a final outcome. During the Russian-Japanese war of 1904 — 1905 and World War I of 1914 — 1918 medical and evacuation providing the fleet gained further development. For reception, rendering medical aid and treatment in bases along with coastal to lay down. institutions used the floating infirmaries and hospital vessels (see) serving intermediate, and in some cases as final stages of medical evacuation for the wounded and patients evacuated from the ships operating in small removal from the coast. For evacuation of wounded from the large ships on the coast groups of watercrafts of the small tonnage were created.
During the Great Patriotic War medical and evacuation providing the fleet was carried out on the basis of system of stage treatment, uniform for AF of the USSR, with evacuation to destination. By the ships of willows coastal parts medical aid by the wounded and patient appeared according to qualification of medical structure and equipment of posts (points) of medical aid: by the ships IV of a rank — the first medical aid, by the ships II and III of ranks — pre-medical; on leaders, large kanonersky boats, coastal and depots of connection of the ships, in divisions of coastal artillery, battalion first-aid posts of marines — the first medical; by the ships I of a rank, in infirmaries of aerotechnical bases, brigade first-aid posts of marines — the qualified medical aid. From the ships and connections operating, as a rule, in insignificant removal from the coast, wounded and patients were evacuated in multi-profile stationary hospital of naval bases where it were it qualified and separate types of specialized medical aid and treatment within 1 — 2 month was performed. Seriously wounded were evacuated in rear hospital of the country or GB of the Soviet Army. An important role in system of medical and evacuation providing the fleet was played medical - a dignity. the groups incorporating surgical, sanitary and epidemiologic, ship, radiological and other maneuverable groups, and also the medical motor transport. For evacuation of wounded and patients on the fleet divisions of sea, air and land egresses were created. Thanks to the accepted S. of l. - aa. the lake in a system from naval hospitals was returned to 86% of wounded and 95% of patients (without the result of treatment of the seriously wounded evacuated to the back of the country and GB of the Soviet Army). At the same time essential difficulties for implementation of system created: insufficiently developed network of institutions for rendering specialized medical aid and treatment of wounded; low-power of means of specialization of institutions (departments); limited possibilities of maneuverable use of forces and means of medical service of the fleet (flotilla).
Basic changes of forms and ways of armed struggle at the sea in the conditions of possible use by the opponent of means of mass defeat, probability of emergence mass a dignity. losses and emergence of new types of defeat, achievement of medical science caused need of further development and S.'s improvement of l during the post-war period. - aa. lake of the fleet. The principles of stage treatment with evacuation to destination containing a number of new important provisions are its cornerstone: approach of medical aid to the centers a dignity. losses by promotion of mobile forces and means of medical service, creation of conditions for rendering the single-step exhaustive medical aid, rendering qualified and separate types of specialized medical aid by ship forces in remote areas of the seas and oceans, a combination of medical and evacuation actions to actions for protection against weapons of mass destruction.
In system of medical and evacuation providing the fleet with the main stages of medical evacuation are: posts of medical care of the surface ships and submarines, points of medical care of coastal parts and coastal bases, medical institutions of naval bases, hospital vessels and GB of the fleet.'
At the specified stages of medical evacuation there are following types of medical care: pre-medical — on posts of medical aid of the ships III of a rank; the first medical — on points of medical aid of coastal parts; qualified — on posts of medical aid of the I—II ships of a rank and points of medical aid of coastal bases. In medical institutions of naval bases (naval hospital, basic infirmaries) and on hospital vessels it appears qualified and some types of specialized medical care, and in GB of the fleet — specialized medical care.
In the organizational relation medical and evacuation providing consists of the events held by medical service by the ships in the sea and the events held ashore. By the ship forces operating in the sea (ocean), timely rendering qualified and nek-ry types of specialized medical aid can be provided, along with use of regular medical service of the ships and connections, depending on specific conditions of a situation the next ways: preliminary strengthening of connections by groups of the qualified (specialized) medical aid; the direction of these groups on the ships after fight by high-speed sea and air types of vehicles; by evacuation struck and patients in coastal to lay down. institutions or on the vessels of medical providing which are near the area of actions of ship forces. For evacuation struck and patients vessels of medical providing rescue service and court of the back, the fighting ships, basic watercrafts, seaplanes and helicopters will be used (see. Water medical ambulance , Sanitary aircraft ). The air transportation is planned to be used first of all for evacuation of tyazheloporazhenny.
On the coast for reception struck and patients from the ships EDS will be developed. The seamen needing the urgent qualified medical aid from the EDS will go in to lay down. institutions of naval base, and all others — in GB of the fleet. Evacuation struck and patients from the EDS, points of medical aid of coastal parts, connections in medical institutions of naval base and GB of the fleet it is supposed to carry out sanitarnotransportny parts of health service, the motor transport of the GB medical institutions, the motor and air transportation allocated by command.
At use by the opponent of weapons of mass destruction the major feature defining activity of medical service in the centers mass a dignity. the losses arising in areas of basing of forces of the fleet rather small probability of an exit of the opponent in the centers will be that will allow to bring closer to them forces and means of medical service and to provide rendering medical aid in necessary volume. Medical and evacuation actions in the centers mass a dignity. losses provide search, rendering the first medical aid, evacuation struck and
patients on points of medical aid for rendering the first medical assistance, and then in medical formations and to lay down. the institutions which are put forward to the centers mass a dignity. losses for rendering the qualified medical aid. At the same time it is supposed to make maneuver not only by the volume, but also a type of medical aid. In the subsequent struck will be delivered in GB (its department) for rendering specialized medical aid and treatment. Struck and patients with the terms of treatment exceeding established for GB of the fleet it is planned to evacuate railway, marine and air transport in GB of the back of the country.
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A.S. Georgiyevsky, O. S. Lobastov; A. A. Ermakov (military pestilence.).