2. Peculiarities of organization of the medical help to children.

At failures, accidents and acts of nature the significant number of victims is made by children. So, at chemical accident in Arzamas (1988) and railway accident in Bashkiria (1989) they have made accordingly 13,7% and 24,3%.

In an extreme situation at children such kind of the medical help, as the self-help, and in most cases - mutual aid is excluded. Therefore salvors, medical workers should render the first medical help first of all to children. At an identical degree of weight of injury children have advantage before the adults at rendering assistance both in the center of an affect, and at stages of medical evacuation.

The injuries at children are connected to anatomic-physiological features of child’ organism. First of all, it is necessary to mention such points:

• The diffusive and generalized reaction of nervous system in reply to various kinds of stress - pain, temperature (overcooling, overheating of organism), burns etc. Even at small stress influences the child has changes of activity in the cardio-vascular systems, respiratory system, the convulsive syndrome arises;

• The sensitivity of children, especially of younger age, to loss of blood even in small quantities. So, at a newborn child the loss of 50 ml of blood is equivalent to loss of 600-1000 ml of blood by the adult. Thus it is necessary to remember, that at children the arteries are wider and their ratio to a vein’s lumen is 2 times as large, than in adult. Rather labile arterial pressure promotes faster development of shock condition;

• inclination of mucous environments of the top respiratory ways to hydropses, the intensive renal work, that raises danger of development of the lung edema, hyperhydratation or dehydratation of organism;

• The high elasticity of the bone system, that reduces frequency of bone fractures at children and at the same time causes damages, typical of children's age, breaks, subperiostal fractures, fractures of a “green branch" type, etc.

Taking children out from places of an affect and evacuation of them to the medical establishments will be carried out with the support of the relatives (friends). It is advisable to take out children in the age below 5 years from places of accident in hands, if it allows a condition of an injured, character and localization of injury. It is advisable not to keep children’s casualties too long at the first stage of evacuation or to escape it with the aim of their fastest hospitalization to the special type of the medical institution. But in such cases the continuity in rendering assistance should be provided.

At the first stage of medical evacuation with the purpose of creation of conditions for temporary hospitalization 20-25 places from every 100 places should be allocated for children. At rendering the medical help medical property, equipment, subjects of care used in children's clinics are applied.

The special urgency is the questions of protection of children in zones of radioactive and chemical pollution. Not only the application of individual means of protection, but all opportunities for shelter of children in collective means of protection, including those from adverse atmospheric conditions (heat, cold, smoke etc.) are used.

In the chemical centers all affected children, irrespective of degree of severity, should be considered as litter ones. The urgent medical assistance should be rendered as much as possible closer to a border of a zone of pollution. First of all the aid must be rendered to most severely wounded and nursing babies, providing their fast evacuation.

At a significant part of children, who have got ill by infectious diseases, the answer-back organism’ reaction on an identical doze of the activator is more expressed, than at the adults. At children convulsive and hyperthermal syndrome develop rather quickly, as well as the infringement of respiratory activity, cardio-vascular and excretory systems, also endotoxic shock, septic conditions, vomiting, alimentary tract dysfunction may appear, many kinds of metabolism are disturbed. This features require fast aimed sorting of the children and their urgent evacuation to the specialized medical establishments with realization of reanimation measures in a way.

During the usage of drugs and special means (antidotes) while rendering assistance at children it is necessary to take into account the recommendations worked out for pediatrician practice.

It is necessary to take into account psychoemotional a condition of an injured child. Besides, the uncontrollable behavior of children of younger age (2-3 years) complicates the rendering of the medical help.

The organization of rendering of the qualified (specialized) medical help to children is under the constant control of the chief doctors and heads of the children’s therapeutic institutions. The organization-methodical management of such help is carried out by the main children's surgeons, traumatologists, pediatricians and other experts of the pediatric type.

The qualified (specialized) medical help for injured children in medical establishments is provided with the usage of the appropriate medical equipment (children beds, tables for swaddling etc.). The allocation of rooms for expansion of additional children's departments and chambers for children should be carried out at the rate of not less than 3 м2 of the area on one children bed. In children's chambers, as a rule, there are children of one age group. For children in the age before 7 years there are organized general chamber for boys and girls, and for the more senior age – separate ones.

In structure of children's department it is necessary to have 10% of beds for children in the age before 1 year, and 30% each for children in the age of 1-3 years, 4-6 and 7-10 years.

In children's department there are medical inspection point, resuscitation hospital wards, dressing-room, room for applying gypsum etc. Surgical intervention is carried out in department of the urgent help, and clinic-diagnostic, X-ray and other kinds of inspection - in the appropriate departments.

Difficulty of definition of a degree of injury severity and volume of medical measures at children with combined traumas and affects requires participation of the doctors of various specialties in inspection and treatment (surgeon, neurologist, traumatologist, ophthalmologist etc.), and also application of the special diagnostic equipment. At realization of a complex of cure-and-diagnostic measures all divisions of versatile hospital should serve children first of all. The stationary treatment of injured children after stabilization of conditions will be carried out in a combination with pedagogical work. The supply of children's department by medicines, antibiotics, preparations of blood and blood-substitutes, other preparations and disinfectants will be carried out by the appropriate divisions of hospital where it is.