Basic principles and periods of care provision
The fundamental rule of emergency medicine states: comprehensive medical care must be provided to the victim in the shortest possible time.
In an ideal situation (optimal scenario), the patient must be delivered immediately to a specialized inpatient facility right after sustaining the injury. However, the harsh reality is that first aid almost always has to be provided directly at the scene of the incident. At this moment, qualified medical personnel are typically absent, and conditions for proper diagnosis are completely lacking.
In standard situations, excluding mass casualties or global disasters, the entire rescue process is clearly divided into two main periods:
- Pre-hospital period — encompasses all out-of-hospital interventions.
- Hospital period — treatment directly within an inpatient facility.
The pre-hospital stage includes absolutely all types of medical care provided outside a hospital: this can happen on the street, at the patient's home, inside an ambulance, or at an outpatient clinic.
Specialists at this stage face four main tasks:
- Directly saving the victim's life.
- Stabilizing and maintaining vital body functions.
- Prevention of severe complications that may threaten life and health.
- Careful transportation to a medical facility where specialized care will be provided.
Classification of types of care at the pre-hospital stage
The scope and nature of medical interventions strictly depend on who is providing the care and what equipment they have. Several successive levels are distinguished:
- First aid. Provided directly at the scene as self-care or peer care (by bystanders). There is no specific equipment; exclusively improvised materials are used. The use of medications at this stage is not provided for, and the nature of actions is purely symptomatic.
- Primary pre-medical health care. This task is performed by a nurse or paramedic. Their arsenal already includes special medical kits. A crucial feature of this stage: the medical worker does not make a diagnosis. Their goal is to identify life-threatening disorders, so the care is syndromic in nature.
- Primary physician health care. Provided by general practitioners, which include family doctors and district general practitioners of polyclinics.
- Emergency medical care. Provided by personnel of frontline EMS crews. During the examination, the physician or paramedic of the crew must establish a preliminary diagnosis. At the same time, there are strict limitations: any surgical operations, reposition (reduction) of bone fragments, and additional examinations such as radiography are strictly excluded.
- Primary specialized health care. Provided by traumatologists in trauma centers. Here, opportunities arise to perform additional instrumental studies (primarily radiography). The main tasks of the traumatologist are to clarify the diagnosis and determine clear indications for referring the victim to a specialized inpatient facility.
Medical and sanitary support in chemical accidents
Disasters accompanied by the release of chemical substances require special tactics. The basic principle of work in such conditions is continuous medical and evacuation support for the casualties. People must be evacuated from the hazard zone as quickly as possible to a safe medical facility. Inpatient treatment within the focal point itself, outpatient follow-up at the place of residence, or immediate evacuation outside the region without rendering aid are unacceptable.
Key measures in a chemical accident include:
- Rendering first medical aid to the casualties in the shortest possible time.
- Emergency evacuation of victims from the hazardous zone.
- Performing special sanitary processing of the casualties to stop the action of the chemical agent.
- Moving the "primary physician care" stage closer to the borders of the hazard zone.
- Clear organization of qualified and specialized medical care at subsequent stages.
For the successful elimination of medical and sanitary consequences, absolutely all medical-preventive, sanitary-hygienic, anti-epidemic, and pharmacy facilities located in the emergency zone are utilized. Their departmental affiliation does not matter in this case — all resources are pooled. If the accident is of a local or municipal nature, the elimination of its consequences is fully provided by the forces and means of the territorial disaster medicine service, as well as local-level medical institutions.
To remember the types of care in order of increasing complexity, use the chain: Self (first aid) → Paramedic (pre-medical) → General Practitioner (physician care) → Ambulance (preliminary diagnosis) → Trauma Center (specialized).
Class and exam questions
Does an ambulance paramedic have the right to make a definitive diagnosis at the scene?
No. At the stage of primary pre-medical care, a diagnosis is not made at all (care is syndromic), and the ambulance crew establishes only a preliminary diagnosis.
Can an ambulance crew reduce a fracture before arriving at the hospital?
Categorically no. At the emergency medical care stage, any operations, reposition of bone fragments, and X-ray examinations are excluded.
Where should victims of a chemical accident undergo inpatient treatment?
The basic principle in disasters is the evacuation of casualties from the hazard zone to a medical facility. Inpatient treatment is not performed directly in the disaster zone.
What else to study on this topic
- Algorithms for providing first aid (self- and peer care) at the scene
- Composition and rules of using medical kits for pre-medical care
- Syndromic therapy of life-threatening conditions at the pre-hospital stage
- Rules for carrying out special processing of casualties in chemical accidents
- Organization of a trauma center's work and indications for hospitalization
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Prepared by WhiteCoat Pro faculty in accordance with the medical school curriculum. For educational purposes only.