2. Road - transport accidents.

For the last years on the roads of Ukraine annually occur tens thousands car accidents and failures. In 1990 as a result of RTA 53 thousand of people were was heavy wounded, more than 9 thousand were lost. Now in Ukraine every 10 minutes the RTA occurs, every 50 minutes perish 1 man, 2 children perish daily, up to 30 men perish daily in auto accidents and 170 men receive heavy traumas and thermal burns. The significant part of injured perishes from inopportuneness of rendering UMA, though the traumas in a number of cases are not of fatal severity.

The world experience of rendering UMA at traumatic damages testifies that anti-shock measures which have been carried out at first 6 hours after the trauma, reduce the mortality on 25-30%. It is known also, that in a number of cases in 1 hour the shock can become irreversible. On the WHO data 20 % from lost could be rescued, if the medical help was rendered to them at once on a place of accident. At the same time, if RTA has taken place far from the occupied area, the rendering of UMA in most cases is delayed. Among the traumas which have arisen in result of RTA, most frequently are marked the following ones: cranial-brain, chest and stomach wound, fractures of long tubular bones of limbs, extensive wounds of soft tissues. The mechanical wounds can be complicated by thermal burns. Wounds are usually fragmentary, frequently are polluted with ground, as a rule deep. The traumas among the children (which make 8-14 % among injured) on localization do not differ from those at the adult, but the injured children, as a rule, more often are in a condition of a shock. The special attention must be paid to the pregnant women who have got in accident. The world statistics testifies that 5 % of the women has infringements of normal pregnancy in different terms.

The timeliness of UMA in many respects depends on a place of car accident. If it has taken place in the city (settlement) or near to it, the representatives of traffic police service have an opportunity in the shortest terms to request a UMA team.

At the RTA far from the occupied areas the time of a beginning of rendering UMA, as a rule, delays and in many aspects depends on distance to medical establishment, readiness of a UMA team for immediate departure to the place of accident. In a phase of isolation (before arrival of the medical staff) a basis of rescue of life of the people, which have got in car accident, is the first medical help rendered in the order - and mutual aid, and also organization of transportation of injured to the nearest medical establishment.

The notification of medical establishment about the RTA is carried out by the traffic police, less often –by the witnesses of accident. The time of departure of a UMA team to a place of accident and well-organized work increase the chances of injured for a survival. It is known, that the mortality among received a trauma is increased by 0,5 % for each hour of a delay of surgical intervention. In this connection the quantity of medical teams directed on a place of incident should be - one brigade on 1-2 injured. The doctors of UMA teams should well be guided in realization of sorting and medical evacuation of injured, in questions of emergency diagnostics of various kinds of affections, in engineering and sequence of realization of the urgent medical help. After the arrival on a place of RTA the chief of a medical brigade defines a place of the gathering of injured. The doctor can spend for primary survey of an injured no more than 40-60 sec, for which he can use the certain algorithm of survey including the following manipulations:

• Revision of oral cavity and upper respiratory ways with simultaneous removal of foreign bodies and restoration of function of external breath. Priority of measures is determined by danger of respiration disorder to the life of an injured;

• Estimation of frequency and character of respiratory movements, decision of a question on the indications for realization of the elementary measures (breathing "from mouth to a mouth", "from mouth to a nose", indirect massage of heart);

• Definition of an integrity of blood vessels and simultaneous stop of an external bleeding, first of all the arterial one;

• Estimation of a condition of cardiovascular system by calculation of pulse rate. The absence of pulse testifies to reduction a BP below than 80 mm of mercury column, that orients medical staff on realization of the appropriate measures of the urgent medical help;

• Establishment of speech contact with an injured, and also check of presence or absence of active and passive limbs’ movements;

• Estimation of a condition of sense organs, first of all organs of vision. The severity of a condition can be defined by the fact how he opens his eyes: by order, or at pain irritations, or does not react to external influences at all;

• Survey of external damages.

The estimation of severity of condition at the end, is based on two integrated parameters - condition of the basic functional systems of an organism (respiratory, cardiovascular, central nervous system) and extensiveness of local damages. The basic purpose of UMA on a place of incident is the rescue of life of an injured and his fastest evacuation to the medical establishment. At significant number of injured (10-15) doctors of the urgent medical help team will carry out assortment of injured, one medical assistant fills in a primary medical card, second - carries out urgent measures according to the instructions of the doctor, first of all to that with the insufficiency of blood circulation and breath. The doctor defines the sequence (first, second) and way of evacuation (laying, on a stretcher or sitting) and allocates the medical assistance for support of the evacuated.

At the much greater number (more than 15) of injured the circuit of action of medical teams may change. On a place of the injured gathering two sorting brigades work, which basic task is the establishment of the preliminary diagnosis and degrees of severity of injureds, and also filling of nameplate data and kind of an affect in a primary medical card. The urgent measures, first of all, under the vital indications are carried out by other UMA teams. After a mark in a primary medical card about the taken measures the injured prepares for evacuation to the medical establishment. The transportation of injured is carried out in view of sequence and situation in the machine (laying, sitting) under the control of doctor’s assistant. While admitting the injured in medical establishment the assortment of them is carried out with allocation of the following groups:

1 Group - persons with disorders of the vital organism’ functions.

2 Group - persons in a heavy condition and in a condition of an average severity.

3 Group – lightly injured persons.

4 Group - persons who do not require stationary treatment.

Rendering of urgent medical aid begins in reception room and continues in medical departments, and in lightly injured - in polyclinic.

The duties of all doctors and medium-level medical staff are to be well defined in the plan of work of any medical establishment as to urgent medical aid during accidents.