scholarly journals Conceptual principles of the wounded combatants’ evacuation, suffering military surgical trauma on the medical support levels

2020 ◽  
Vol 87 (5-6) ◽  
pp. 60-64
Author(s):  
I. P. Khomenko ◽  
I. A. Lurin ◽  
S. O. Korol ◽  
V. Yu. Shapovalov ◽  
B. V. Matviichuk
Keyword(s):  
Traumatic Shock ◽  
Statistical Investigation ◽  
Unstable State ◽  
Surgical Trauma ◽  
Medical Support ◽  
Shock State ◽  
Trauma Severity ◽  
Medical Evacuation ◽  
Joint Forces ◽  
Severity Degree

Objective. To improve the results of treatment of the wounded persons, suffering a combat surgical trauma, elaborating and introducing of objective scales of the trauma severity estimation into the medical evacuation system while conduction of Antiterroristic operation / Operation of Joint Forces. Materials and metods. Complex medical-statistical investigation was performed, in which 684 wounded persons, suffering a combat surgical trauma were included. Dynamical medical control and determination of the trauma severity degree in accordance to AdTS (Admission trauma Scale) were applied on all levels of medical support. Results. In the beginning of conduction of Antiterroristic operation / Operation of Joint Forces a mortallty have had occurred during transportation of wounded persons in unstable state (more than 9 points) to military-medical clinical centers. The wounded persons in a traumatic shock state were transported on forth level of medical support, what have been considered an organization defect in the help deliver process, which leaded to death of military persons. At the same time an unjustified delay of transportation of servicemen, suffering wounds of the wrist and foot (up to 5 points), on the first and second levels of medical support, leading to development of severe complications, have occurred. Taking into account the above mentioned, the authors have provided a differentiated approach for medical evacuation of wounded persons, suffering a combat surgical trauma, depending on its severity degree. Conclusion. Evacuation of wounded persons, suffering a combat surgical trauma, constitutes an integral part of the medical support system of Antiterroristic operation/Operation of Joint Forces, closely connected with a medical support process during transportation. Medical evacuation of wounded persons with injuries of the vision organ, the wrist and foot must be accomplished urgently to specialized clinic of the fourth level of medical support.

scholarly journals Anatomical-functional scale of estimation of the trauma severity in wounded persons with thoracoabdominal injuries in environment of conduction of The Joint Armed Forces Operation

2020 ◽  
Vol 87 (1-2) ◽  
pp. 3-7
Author(s):  
Ya. L. Zarutskyi ◽  
S. A. Aslanyan ◽  
O. I. Zhovtonozhko ◽  
Yu. M. Oliinyk ◽  
P. P. Forostyanyi ◽  
...  
Keyword(s):  
Armed Forces ◽  
Abdominal Injuries ◽  
Functional Scale ◽  
Trauma Severity ◽  
Medical Evacuation ◽  
Severity Estimation ◽  
Level Ii ◽  
Joint Forces ◽  
Thoracoabdominal Injuries ◽  
Gun Shot

Objective. To determine the trustworthiness of the elaborated anatomic-functional scale for the trauma severity estimation (Admission trauma scale) in the wounded persons with thoraco-abdominal injuries, evacuated on the level II medical service. Materials and methods. Retrospective analysis was conducted, concerning 123 wounded persons with the gun-shot thoraco-abdominal injuries, obtained while conduction of The Joint Forces Operation. The trauma severity was determined in accordance to anatomic-functional scale (Admission trauma scale). Results. Statistical analysis was conducted concerning the point characteristic estimation in accordance to anatomic-functional scale of the general massive of the observation. Estimation in accordance to anatomic-functional scale for the wounded persons, who have survived, constituted at average (6.9 ± 2) points, while for the wounded persons, who have died, – (12.4 ± 15) points. Then, a value of the confidence interval was determined in accordance to formula M ± 3δ. Of 123 wounded persons with thoraco-abdominal injuries in 107 (87%) the state of severity estimation in accordance to anatomic-functional scale did not cross the interval of trustworthiness borders. Conclusion. Anatomic-functional scale for the trauma severity estimation permits to determine the organization of treatment peculiarities in the surgical help delivery on initial stages of medical evacuation, and, taking into account of this procedure simplicity, its application is possible without application of additional methods of examination.

scholarly journals Pathophysiological substantiation of medical evacuation of the wounded persons, suffering injuries of the extremities on the levels of medical support

2019 ◽  
Vol 86 (6) ◽  
pp. 25-29
Author(s):  
І. P. Khomenko ◽  
S. О. Коrol ◽  
B. V. Маtviychuk ◽  
L. А. Ustinova
Keyword(s):  
Statistical Analysis ◽  
Severe Trauma ◽  
Combat Trauma ◽  
General State ◽  
Medical Support ◽  
Trauma Severity ◽  
Medical Evacuation ◽  
Circulatory Disorders ◽  
Cardio Vascular

Onbjective. To determine the optimal scheme of medical evacuation for the wounded persons, suffering the combat trauma of the extremities, bаsing on clinic-statistical analysis of changes in the homeostasis indices. Маterials and methods. Complex pathophysiologic investigation, concerning 378 wounded persons, suffering a combat traumas of the extremities in accordance to 26 indices of homeostasis, was conducted. Dynamic physician’s control with determination of the trauma severity in accordance to the AdTS (Admission trauma Scale) on all levels of medical support was accomplished. Results. There was established, that in a case of organization of a consequent delivery of traumatological help to the wounded persons, suffering severe and extremely severe combat trauma of the extremities, estimated by the AdTS as 5 points and more, on levels of medical support due to timely conducted antishock measures and the operative interventions performed a severe respiratory-circulatory disorders - (5.2 ± 0.6) standard units - have had changed steadily towards moderate - (7.7 ± 0.2) standard units. Меdical evacuation of a wounded persons through one or two levels leads to development of definite respiratory-circulatory disorders - (2.8 ± 0.9) standard units, significant lowering of a one-time and a minute productivity of the heart with tendency for cardio-vascular and respiratory insufficiency occurrence: a power іndex - (19.0 ± 4.1) ml/m2, the heart іndex - (2.1 ± 0.3) l/min/m2. In a wounded persons, suffering nonsevere trauma, estimated using a AdTS lesser than 5 points, the shortening of quantity of the medical support levels do not influence the patients’ general state, аnd a respiratory-circulatory disorders owes a moderate character - (8.16 ± 1.37) standard units. Conclusion. Меdical evacuation of wounded persons, suffering nonsevere trauma (lesser than 5 points in accordance to AdTS) must be conducted in accordance to a shortened scheme; while in a severe one (5-9 points in accordance to AdTS) and in extremely severe trauma (more than 9 points in accordance to AdTS) - after conduction of the antishock measures and stabilization of state on every level of medical support.

In memory of Georgiy Nicolaevich Tsibulyak

2020 ◽  
Vol 22 (4) ◽  
pp. 249-252
Author(s):  
I. M. Samokhvalov ◽  
V. I. Badalov ◽  
N. A. Tiniankin ◽  
P. P. Liashedko ◽  
K. P. Golovko
Keyword(s):  
Research Laboratory ◽  
Traumatic Shock ◽  
Gold Medal ◽  
Clinical Findings ◽  
Terminal State ◽  
Surgical Trauma ◽  
Senior Lecturer ◽  
War Surgery ◽  
Scientific Papers ◽  
Surgery Department

The biography of colonel of Medical Corps, professor Georgiy Nicolaevich Tsibuliak (19322020) is presented. In 1956 G.N. Tsibuliak graduated from the Kirov Military Academy being awarded with gold medal. When being a cadet, he got actively engaged in research. In 1961 G.N. Tsibuliak defended candidates dissertation on the injury treatment in casualties damaged by ionizing radiation, took part in the study of multiple injuries occurring in atomic tests. After graduating from the medical residency he stayed in War Surgery department of the Academy, was eventually assigned as a senior lecturer, the head of the research laboratory carrying out the study of shock and terminal state. In1966 he defended a doctorate in pathogenesis, clinical findings and treatment of tetanus. G.N. Tsibuliak became one of the leading advocates for the concept of traumatic shock in individuals. This fact that at present emergency physicians and surgeons dealing with traumatic shock consider to be an axiom, is scientifically based, and was gained through hard routine work in treating severely injured casualties. From 1976 to 1982 Georgiy Nicolaevich was Surgeon-in-Chief in Group of Soviet Forces in Germany. In 19901993 he was in charge of research laboratory dealing with combat surgical trauma in the Academy. Since 1993 G.N. Tsibuliak had retired from active duty, holding the position of a professor at the War Surgery department. He is the author of more than 200 scientific papers, including 7 monographs. G.N. Tsibuliak was closest associate of A.N. Berkutov in studying traumatic shock in casualties, took an active part in formation of a new clinical specialty resuscitation.

Resuscitation of Traumatic Shock

2006 ◽  
Vol 17 (3) ◽  
pp. 317-326 ◽  
Author(s):  
Christine A. Cottingham
Keyword(s):  
Hemodynamic Monitoring ◽  
Traumatic Injury ◽  
Clinical Signs ◽  
Traumatic Shock ◽  
Vantage Point ◽  
Compensatory Mechanisms ◽  
Shock State ◽  
Frequent Complication ◽  
Tissue Hypoperfusion ◽  
Innate Ability

Shock, or tissue hypoperfusion, is a frequent complication from traumatic injury. Despite the etiology of the shock state, there is always some component of hypovolemia. The body’s innate ability to compensate for impaired perfusion may mask clinical signs, leading to delays in treatment. This article presents an overview of these compensatory mechanisms and resuscitation strategies from the vantage point of routine hemodynamic monitoring.

scholarly journals The first domestic devices for intraosseous infusion - is the great advance of military medicine in pre-hospital stage enhancement

2018 ◽  
Vol 20 (4) ◽  
pp. 106-112
Author(s):  
I M Samokhvalov ◽  
K P Golovko ◽  
A V Denisov ◽  
S Yu Telitsky ◽  
N A Zhirnova ◽  
...  
Keyword(s):  
Blood Volume ◽  
Medical Devices ◽  
Limited Liability ◽  
Traumatic Shock ◽  
Infusion Therapy ◽  
Volume Resuscitation ◽  
Limited Liability Company ◽  
Circulating Blood Volume ◽  
Medical Evacuation ◽  
Intraosseous Infusion

Traumatic shock is considered to be the most common clinical form of a severe patient’s condition (63%). Timely and adequate blood volume resuscitation is one of the most important procedures in providing medical care to critically injured casualties and patients at the forward medical evacuation stage. The key to this problem, especially when the infusion therapy is needed at the pre-hospital stage, is the development of alternative (extravascular) techniques of plasma volume expander administration. The article presents the results of testing of the first domestic medical devices for intraosseous infusion in critically injured casualties and patients. At present, on commission of the Russian Ministry of Defense and with the scientific support of Kirov Military Medical Academy, domestic enterprises developed test samples of medical devices to provide intraosseous infusions: a «Disposable device for intraosseous infusion of solutions if there is no intravenous access, which was designed on the basis of a spring drive» - the index «VKI-P», developed by limited liability company «Novoplast-М» and a set for intraosseous infusion using an electric drive - the index « VKI-E», developed by limited liability company «Research engineering company «Spetsproekt». Assessment of performance of test samples of the medical devices for intraosseous infusions «VKI-P» and «VKI-E» was carried out using pathophysiologic model of traumatic shock in 14 experimental animals (pigs) by creating artificial blood loss of medium severity, 25% of circulating blood volume (in average 440 ml), followed by its resuscitation with intraosseous infusion of 0,9% solution of NaCl. As a result of the performed tests it was found that the device «VKI-P» and the set «VKI-E» provide for NaCl infusion in major vessels (with an intraosseous infusion), 750 ml of volume during 45-50 min, and can be used as an alternative access to provide infusion as a part of anti-shock therapy, which solves the problem of volume resuscitation when giving care to severely injured casualties and patients at the forward medical evacuation stages. These samples may be recommended for inclusion into the medical service list of complete supplies and the Medical Corps supply support, the Armed Forces of the Russian Federation.

scholarly journals Modern approaches to rehabilitation of military men with a gun-shot polystructural woundings of upper extremity

2019 ◽  
Vol 86 (5) ◽  
pp. 34-38
Author(s):  
I. V. Roy ◽  
N. О. Borzykh ◽  
L. D. Каtіukova ◽  
О. V. Borzykh
Keyword(s):  
Upper Extremity ◽  
Outcome Measure ◽  
Rehabilitation Program ◽  
Military Hospital ◽  
Trauma Severity ◽  
Results Of Treatment ◽  
Standard Procedures ◽  
Gun Shot ◽  
The Individual ◽  
Severity Degree

Objective. To improve the results of treatment in the patients with polystructural gun-shot woundings of the upper extremity, using elaboration and individualization of the rehabilitation program, depending on the trauma severity degree. Маterials and methods. The restorational treatment course to 52 injured persons was conducted in accordance to elaborated individualized program in the Institute of Traumatology and Orthopedics NAMS of Ukraine, 168 military men - in accordance to standard procedures in the Іrpin Military Hospital with periodical monitoring of the state and correction measures. The extremities function was estimated in accordance to two procedures, which have added one another: DASH (Disability of the Arm, Shoulder and Hand Outcome Measure) and AOOS in modification of І. М. Кurinnyi. Results. Expediency of differentiated approach and elaboration of individual programs of rehabilitation and achievement of a maximally searched definite results of the specialized help delivery to the injured persons, suffering a gun-shot polystructural woundings of upper extremity. Conclusion. Enhancement of the upper extremity function in military men, who obtained rehabilitation in accordance to the individual programs elaborated, was essentially bigger - (61.7 ± 12.1) points and achieved during shorter by (65.0 ± 14.0) days, than in the wounded persons, who obtained rehabilitation in accordance to standard procedures, the function enhancement have constituted (48.1 ± 11.2) points.

scholarly journals Clinical and Epidemiological analysis of the structure of combat surgical injury during Antiterrorist operation / Joint Forces Operation

2021 ◽  
Vol 2 (2) ◽  
pp. 5-13
Author(s):  
I. P. Khomenko ◽  
S. O. Korol ◽  
S. V. Khalik ◽  
V. Yu. Shapovalov ◽  
R. V. Yenin ◽  
...  
Keyword(s):  
Medical Care ◽  
Armed Conflict ◽  
Pleural Cavity ◽  
Abdominal Cavity ◽  
Armed Conflicts ◽  
Pelvic Cavity ◽  
Surgical Trauma ◽  
Epidemiological Analysis ◽  
Civilian Population ◽  
Joint Forces

I Introduction. In generalizing the experience of providing medical care to the wounded in armed conflicts, a special place belongs to the analysis of the magnitude and structure of casualties, which depend on the conditions, forms and methods of hostilities. The purpose. Conduct a clinical and epidemiological analysis of the proportion of gunshot and mine injuries in the structure of combat surgical trauma during the Anti-terrorist operation / Joint Forces operation. Materials and methods. The total number of wounded as a result of the armed conflict in eastern Ukraine in the period from 2014 to 2019 was more than 41 thousand people, from them killed among the civilian population – 3350 people and 4100 – servicemen. Results. It was proved that the wounded with non-severe combat surgical trauma are 36.5%, severe – 48.9%, extremely severe – 14.6%. Shrapnel wounds were received by 35.3%, bullet wounds – 48.3%, mine injuries – 16.6%. Isolated combat surgical trauma was found in 16.8%, multiple – in 34.3%, combined – in 48.9% of the wounded. Impenetrable combat surgical trauma was diagnosed in 63.7% of the wounded, penetrating into the pleural cavity – in 17.2%, in the abdominal cavity – in 16.0%, in the pelvic cavity – in 3.1%. Conclusions. In the structure of sanitary losses of the surgical profile during the ATO / OOS, the wounded with injuries of the extremities are 56.7%, with injuries of the chest – 10.1%, abdomen – 5.1%, pelvis – 3.0%.

scholarly journals Main Results of Activities of All-Russian Centre for Disaster Medicine Zashchita of Federal Medical Biological Agency in 2020 and Tasks for 2021

2021 ◽  
pp. 10-17
Author(s):  
S.F. Goncharov ◽  
◽  
I.G. Titov ◽  
B.V. Bobiy ◽  
A.V. Akin’shin ◽  
...  
Keyword(s):  
Disaster Medicine ◽  
Information Modeling ◽  
Health Consequences ◽  
Medical Support ◽  
Analysis And Evaluation ◽  
Medical Evacuation ◽  
Emergency Situations ◽  
Materials Research ◽  
Observation Method ◽  
Methods Analytical

The objective of the study based on the analysis and evaluation of key performance indicators of the all-Russian center for disaster medicine "Zaschita" FMBA Rossii (WCMC "Protection" in the Center) and disaster medical Service (QMS), Russian Ministry of health to develop proposals and to identify priority areas for further development and improvement of the system of medical support of the population in emergency situations (es). Materials and methods of research. Materials research: normative and methodical documents governing the organization and operation of the all-Russian service for disaster medicine (VSMK), medical aid to victims in emergency and medical evacuation; records of the regional centers of emergency medical care and disaster medicine (SMP RC and IC), the territorial centers of emergency medicine (TSMC) and WCMC "Protection" on the activity of the elimination of the health consequences of emergencies in 2020 etc. Research methods: analytical, statistical, direct observation method, logical and information modeling. The results of the study and their analysis. In 2020, 2108 emergencies with health consequences occurred in the Russian Federation, excluding the COVID-19 pandemic, which is almost 25% less than in 2019. This situation can be explained by a decrease in the intensity of transport operations and the activity of the population during the pandemic. In order to further develop the system of medical support for the population in emergencies, the main tasks for 2021 are formulated.

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