Organization of Medical Support of Military Units During Combat Operations on the Basis of the Principle of "Golden Hour"

The overloading of emergency services is an urgent public health problem that affects all countries of the world, and despite numerous efforts in this field, significant progress has not yet been achieved. Against the background of the military invasion of muscovites to the territory of Ukraine with constant air attacks on cities with a high population density, the load on the emergency medical service has increased many times, which requires the fastest possible improvement of its structure and work organization. The one of the important factors driving the increase patient admissions to emergency departments is often non-urgent calls or visits, that is, visits by patients with conditions that do not require urgent attention or complex medical interventions and can be safely treated by primary medical aid. The consequences of overloading the emergency medical service negatively affect patients and medical personnel. So, low medical care quality leads to mortality among the patients, the numerous of medical errors and financial costs, and there is "burnout" of medical staff. The key to success is the correct organization of medical triage. Some countries have their own system of medical triage, although it is not different fundamentally. In the triage process, there are three options for evaluating the decision on the urgency category of assistance: expected result, excessive level or undersorting. Resource overspending occurs when the assigned triage category has a higher level of urgency than necessary. This so-called medical re-sorting is a reassessment of the severity of an illness or injury. Despite the progressively increasing load on the emergency medical service in Ukraine against the background of the moscow invasion and the increase in its funding in recent years, only a quantitative indicators of its work have significantly increased without much improvement in the quality of care due to absent of the any changes in the organization of the work of the emergency service which is based on outdated Soviet management principles.

Section: стаття є фрагментом ндр кафедри анестезіології та інтенсивно...unclassified

Principles of Medical Triage for Patients in Ukraine and Abroad

Mohylnyk,

Suprunenko

2024

“…Так, при вивченні наслідків ядерного бомбардування Хіросіми та Нагасакі було встановлено, що психічні розлади відзначалися у всіх, хто вижив. Війна як психотравмуючий фактор поєднує майже всі патогенні впливи на людину, властиві стихійним лихам і катастрофам, завдає величезної фізичної, психологічної, духовної та соціальноекономічної шкоди [24].…”

Section: історія проблемиunclassified

Post-Traumatic Stress Disorder as Pressing Issues of Our Time

Mohylnyk,

Zhyvotovska,

Tarasenko

et al. 2023

The issue of combat-related psychological trauma and the development of post-traumatic disorders during wartime are of great significance now. The ongoing conflict with the invasion of neighbouring forces and the large-scale war against Ukraine poses a threat that could extend for years, if not decades, and potentially affect other regions. The constant shelling of border areas, missile attacks, and the dire social, humanitarian, and epidemiological conditions in occupied territories of Kherson, Zaporizhzhia, Donetsk and Luhansk regions have resulted in profound psychological distress among not only military personnel but also the entire population of Ukraine. This situation has led to a complex and diverse development of post-traumatic stress disorder in the contemporary context. However, despite these tragic events, this topic is of interest due to its scientific, practical, epidemiological significance, among other aspects. There is still no universally accepted theoretical framework defining approaches to the study of the psychological and biological mechanisms underlying post-traumatic stress disorder. Several pathogenetic models of the development of this disorder are currently under development. This disorder is characterized by a wide range of symptoms, including asthenia, anxiety, affective, behavioural, and psychotic disorders, which often present challenges in therapy. The most effective approach involves the use of combined pharmacological and psychotherapeutic interventions, with antidepressants being the only pharmacological agents endorsed in international clinical guidelines as first-line treatments. While experimental treatment methods exist, they require further investigation. Nonetheless, only about half of the patients achieve remission. Consequently, symptomatic therapy, placebo medications, and polypharmacy have become common in clinical practice, as clinicians attempt to address various comorbid psychopathological symptoms. This approach, to some extent, reflects the lack of well-established effective therapeutic methods and often results in prolonged illness, the development of treatment resistance, and the occurrence of side effects. In general, the efficacy of comprehensive therapy is insufficiently studied and necessitates further representative placebo-controlled and comparative clinical studies, as well as the development of more suitable and effective experimental approaches to investigate novel treatment methods.

Characteristics of the Epidemiological Situation in Areas of Military Conflicts and Anthropogenic Disasters

Mohylnyk¹,

Tarasenko²,

Sonnik³

et al. 2023

Self Cite

This article presents an overview of the characteristics pointing out the deterioration of the epidemiological situation during military conflicts and anthropogenic disasters drawing form the latest literature. There are particular conditions that can provoke emergencies, among them military conflicts, natural disasters, humanitarian crises, man-made disasters, the use of biological weapons, particularly within the context of the Russian military invasion of Ukraine. The emergency conditions according to the principles of the sanitary and epidemiological service involve sudden and often unpredictable disruptions to normal everyday circumstances. These disruptions stem from disasters, natural calamities, and their aftermath, resulting in significant human casualties and widespread illness. The most important factors affecting the development of epidemiological circumstances include violations of the water supply system, contamination of food products, washing away various chemicals into water bodies, flooding of natural biocenoses, crowding, stress, increased sensitivity to infections, intensive migration processes. The complete or partial destruction of the material and technical base of health care and the sanitary-epidemiological service with disruption of the activities of medical and preventive institutions in the occupied territories also significantly affects the epidemiological situation. Given the eastern and southern regions in Ukraine, the emergency situation with severe epidemic complications has been observed for a year in the cities and villages occupied by Russians. As a result of serious violations of living conditions in disaster areas, war zones, and occupied territories, the epidemic situation regarding intestinal infections, including typhoid, paratyphoid, viral hepatitis, dysentery, and salmonellosis, has sharply worsened. Moreover, the increase in the incidence of them occurs in the first weeks after the action of the extreme factor. Crowding of people contributes to the intensification of aerosol contamination. Particularly dangerous in this regard are meningococcal disease, viral pneumonia, diphtheria and other contagious diseases. In addition, the high risk of critical deterioration of the epidemiological situation in Ukraine causes a high probability of the use of chemical and biological weapons by russians.