1. Introduction Characteristic of the main injury factors in catastrophes.

The character of losses (amount and structure) among the population in catastrophes, the degree of injury and damage of local (territorial) forces and means of health services, presence or absence of locality pollution in the disaster area, the size of the focus of destruction, etc. constitute the notion of the medico-tactical characteristic of catastrophes.

These conditions influence greatly on the forces and means of urgent medical aid service in extreme situations, the forms and methods of their work in order to liquidate the medical consequences of the catastrophe.

The main injury factors both of natural, and technological catastrophes are:

- Dynamic (mechanic) influences on the organism of an air blast, collapses, throwing action, secondary shells, falling from height, pressing down by the destroyed buildings, mines and other heavy objects;

- Thermal effect (high or low temperatures, radiation energy);

- Radioactive radiations;

- Harmful chemical substances (highly active toxic agents-HATA), in particular chlorine, ammonia etc.;

- Biological (bacteriological) substances.

These factors are identical or almost identical with the effect of modern weapon on the human by a number of parameters. They quite often can influence simultaneously or in succession bringing about various multiple, combined traumas of a different degree of severity.

2. Characteristic of the amount and structure of population losses in catastrophes.

The size of losses and number of the dead varies in wide range depending on the kind of catastrophe and a number of conditions: from intensity of the effect of the injury factors, density of the population in the disaster area, character of dwellings, the degree of protection and readiness of the population, etc. For example, at earthquakes 22,5%-45% of traumas occur due to falling buildings and 55% - because of wrong behaviour of the people (panic, inability to hide, falling from height, etc.).

At a tornado in Ivanovo 48% of traumas were caused by flying and falling objects. And it is not accidental that a number of the countries of the world (Mexico, USA, Japan) have special practical classes to work out skills of hiding, e.g. in earthquakes and giving first aid among adults and pupils. It promotes decrease of losses among the population.

The high severity of affection with prevalence of cranio-cerebral trauma is observed in mechanic injury. According to the findings of V.A. Polyakov, in road-transport accident traumas of a head make 50,9%, traumas of the limbs- 20,4%. The limbs’ traumas take actually the second place in a number of cases.

During the last wars they never conceded of the first place. The limb traumas are less dangerous to life, than traumas of a head, chest, stomach and pelvis. Such patients stand the better chance of life and returning to duty, to their work. At earthquake an often trauma of a head is the scalping of a skin of a skull by the objects flying down from the height, by the constructions of the destroyed buildings.

In Ashkhabad at earthquake in 1948 such trauma has made 15 % from all traumas of a skull. In Armenia they also met frequently.

In structure of losses the densities of complex and multiple trauma is high also. As is known, these traumas are often complicated by a shock, bleeding, suppuration, they are mutually severe and require longer treatment. The outcomes are often less favorable.

The high frequency among the injuries of the long-term crash-syndrome deserves the special attention. In Armenia it was observed at 23,8 % of victims; in Italy - 21,8 %, in Hiroshima - 20%.

The wounds are usually lacerated, polluted by sand, ground, splinters of glasses on large depth. It was observed in all the victims at the tornado in Ivanovo, at explosion in Arzamas, at all earthquakes. High mortality rate was marked among the victims: in Ivanovo - 8,6 %, in Arzamas - 8,3%, in medico-prophylactic establishments of Bashkiria - 20,3 %, and in Chelyabinsk-44,0%.

The structure of losses among the children's population due to localization differs less than the same in the adults and there also prevail multiple and complex traumas.

The significant part of injureds perishes from inopportuneness of rendering of the medical help, though also trauma was not fatal.

It is known, that the shock may be irreversible in 1 hour. Antishock measures carried out at the first 6 hours reduce the mortality rate on 25-30%.

Among lost 1/3 dies slowly (in the first 6 hours it is possible to save them). According to WHO’s data, 20% among the victims who are lost as a result of accidents of the peace time could be rescued, if the medical help had been rendered on a place of incident.

In Ivanovo from 57 corpses delivered from a place of incident, there were 9 corpses (16 %)of people which have died from a shock due to fractures of a shoulder and lower limbs and a not stopped bleeding and asphyxia.

In structure of losses from accidents the significant part often is made by women and children. The special attention must be paid to the problem of attitude to the pregnant women got into accident. There are such women in the world on the average at a different stage of pregnancy at the range of 2,5-5,0%. The accident frequently interrupts the duration of their pregnancy.

So, at earthquake in Ashkhabad (1948) from 25 pregnant women the two of them had premature birth, at 8 occurred abortions. In Ivanovo and Sverdlovsk at 10-25 % of the pregnant women within 5 days after accidents there were spontaneous abortions. Only 15 pregnant women out of 100 ones could carry a child among those suffered from stress in the earliest terms of pregnancy due to explosion in Sverdlovsk. At the majority of them premature deliveries have occurred and half of children was lost.

It was, as well as at the women in Hiroshima after American nuclear explosion in 1945. From 177 pregnant Japanese women at 45 of them the premature deliveries and abortions have occurred, i.e. at 25 % or in every 4^th person. Almost 25 % of the women of Hiroshima with the interrupted pregnancy have died. While before nuclear explosion the abortion was observed only at 6 % of Japanese women. One of the reasons of such phenomenon at the Japanese women till now is considered the factor of their radioactive irradiation, but the women of the mentioned above cities of USSR didn’t acquire such irradiation. Probably, here the main reason were psychoemotional stress, mechanic influence of an explosive wave extending in organs and tissues of the human as a wave of instant compression and instant expansion, the impacts by flying objects, falling down of the women and injuries.

There is one more pathology during the accidents, about which the doctor must know. It is psychoneurological stress, shock, stunning condition, etc. In Arzamas and Ivanovo from 10 up to 13 % of injureds required treatment in conditions of specialized psycho-neurological establishment and up to 64 % - the out-patient treatment. At earthquake in Tashkent (1966) the acute reactive states were marked at 14 % of the patients by duration within day and at 10 % of patients for a longer time.

The significant number of cases of acute cardio-vascular diseases, of hypertension crisis, endocrine infringements (complications and deterioration) is observed. The earthquake in Armenia also was accompanied by frequent psychoneurological trauma.

The pathology of the population’s affection has its peculiarities during disasters on atomic power stations, nuclear-power producing reactors. Affection of the chemical toxins is possible at the objects of highly active toxic agents.