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ORGANIZATION OF SPECIALIZED MEDICAL ASSISTANCE FOR THE AFFECTED ENT SPECIALIST

Let us consider the organization of specialized ENT care by the example of the ENT department of SVPNhG.

As mentioned above, VPN / hG has an independent otolaryngological department, which can be strengthened (with a mass flow of wounded on the basis of HPLC by strengthening it with a neurosurgical group from the OSMP. The ENT department of SVPCH is deployed on the basis of one of the medical departments of the HPLC using the otolaryngological team of the neurosurgical group. The tasks of the department include:

1. Reception, sorting and placement of ENT for the wounded and sick.

2. The provision of specialized medical care and treatment in full.

3. Hospitalization of the wounded and sick after surgery and treatment within 60-90 days.

4. Preparation for the evacuation of the wounded in need of treatment for a period of more than 60-90 days, as well as those subject to dismissal from the army.

5. Providing specialized ENT care for combined head and neck injuries and advisory work in other departments of SVPHG and medical institutions of the GBF.

6. The provision of specialized medical care for organs wounded in the ENT and the evacuation of them to the HPLR.

7. Military medical ENT examination.

The department employs 8 people: the department head is an otolarynoglog surgeon, an intern surgeon, an operating nurse, three nurses and two orderlies. The set of UL mentioned above is designed for the operation of one surgical team of two medical staff. The main expendable medical property (painkillers, suture material, needles, drainage tubes, dressings, etc.) The ENT department receives from the pharmacy VPHG.

In addition to the UL LOR kit set available in the department, the department additionally receives the following sets of VPHG funds: V-1 (dressing room large), G-7 (operating room small), G-12 (ward room), G-13 (care items), B-1 ( sterile dressings), a special set (NSp) from the G-1 set (general medicines), 5 sets for blood transfusion, a field operating table (SOP), two dressing field tables (SPPU), portable anesthesia machine (Narcon-2), shadowless lamp, etc. Books and forms of medical records and reports (medical history, dressing journal, blood transfusion register, evacuation envelopes, certificates of illness, etc.) are written out from the hospital pharmacy (set BK-2).

The stock of medicines and other consumable medical property of the VPNhG allows us to provide medical care and subsequent treatment to 30 ENTs for the wounded for 15 days. The expended medical property from the UL kit is also replenished from the hospital pharmacy.

Special medicines for ENT of the wounded and sick (ointments in the nose, for the ears, anesthetic solutions for the mucous membranes, etc.) are prepared by the hospital pharmacy.

Upon admission to the SVPKhG those affected in battle in the reception and sorting department, intra-point and evacuation sorting is organized. It is carried out with the removal of dressings. An otolaryngologist is involved in the sorting. For endoscopy of ENT organs, which may be required in the sorting room, diagnostic dressing room and diagnostic room, you must have a portable open electric lamp. For examination in the diagnostic dressing room, you should deploy a separate table with the property necessary for a tracheotomy (sharp tracheotomy hook, tracheotomy dilator, scalpel, two tracheotomy tubes) and nasal swabs (5% cocaine solution, 3% hydrogen peroxide solution, gauze tampons 15 cm long and 2 cm wide, soaked in liquid paraffin, cotton wool, tightly rolled up and tightly dressing gauze rollers with double silk thread, rubber catheter, spatula, nose forceps, tweezers, scissors), as well as an ENT examination kit, inst Items for which you should get at the hospital pharmacy from the G-1 kit.

The ENT department of the VPNhG is deployed as part of the following functional units: preoperative, dressing, operating and hospital wards.

In the preoperative, the wounded are prepared for surgery (subjectification, cleaning of the wound circumference by washing with a jet of disinfectant solution, shaving the surgical field with subsequent skin treatment with gasoline), and preparing the hands of surgeons and operating sisters for surgery. There is a utility table, a drawer for uniforms, a table for medical records, a nurse’s table, goats for three stretchers, a sterilizer, a wash basin, hand basins, and a bench for the wounded. A pre-operative nurse and a nurse from the staff of the Institute for the Management of Chronic Diseases work.

The operating ENT department is deployed in the ward of USB-56 in conjunction with the operating room of the maxillofacial department. The anesthesiologist working here, if necessary, simultaneously carries out anesthesia with ENT and a dental wounded. Approximately 30-40% of ENT operations can be performed under general anesthesia. In the operating room, 5 operating tables are deployed: 2 otolaryngological and 3 dental (Fig. 6.7.1). The distribution of tables may vary depending on the number of incoming organs and maxillofacial area injured in the ENT. Over ENT operating tables reinforce pendant lamps with open light.

When moving to the operating room, they place a table with tools and a table lamp for endoscopy and performing simple manipulations on ENT organs in a wounded sitting position.
Since ENT operations are performed in a darkened room, it is advisable to ENT the operating tables with a curtain from the operating tables of the maxillofacial department, since the powerful light of the operating lamps of the maxillofacial operating room can interfere with the ENT surgeons, and the open light above the ENT table of the surgeon - the dentist.

In the operating ENT department on one of the tables, the surgeon prepares the operating field, performs anesthesia, finishes the operation with primary or provisional sutures, and performs tamponade. ENT surgeon on another operating table performs special endoscopic stages of ENT operations. It should be said that such a two-stage treatment of wounds is not always optimal.

A study of the medical histories of the past war and peacetime shows that the surgical treatment of the ENT of a wounded person with damage to the middle and inner ears takes 3-5 hours, with damage to the paranasal sinuses, pharynx, larynx, esophagus - 2.5-3.5 hours, when processed superficial ENT wounds - approximately 0.5 hours (with the experience of the ENT surgeon - 3-5 years). On average, it is believed that 1-1.5 hours may be required for the surgical treatment of one ENT wound.

The dressing ENT department is deployed in the tent UST-56, docked with either the operating room or the hospital tent. In the dressing room there is a dressing table, a table for sterile material and instruments, a table for sterile solutions and ampoules, a table with equipment for blood transfusion. During the filling of the hospital, the dressing room, docked with the operating room, can serve as a preoperative one. In the second period of the hospital’s work in the dressing room, outpatient reception of the wounded and sick can be carried out.

The ENT department department is deployed in a tent USb-56 with 30 beds. After the ENT hospital is loaded, the UST-56 tent can be handed over to the department by partially curtailing the other departments of the hospital (reception and sorting, CCA), in which a second hospital ward is being deployed. The hospital has two nurses and one nurse. For better monitoring of the ENT condition of the wounded, they are placed in bunks with the head end to the aisle. In the hospital ward they deploy a post of a nurse, equip a place for storing care items for the wounded, dishes, place tables for eating, a wash basin. In the hospital, there should be a portable electric lamp for endoscopy of the wounded.

Otolaryngological forces and means are differently represented quantitatively and qualitatively at various stages of medical evacuation, which is associated with the peculiarities of the organization of medical support for ENT patients affected at these stages.

During the period of hostilities, the front has 8 hospital bases. In the rear hospital base (TGB), 17,500 beds are deployed; in the front line (PHB) - 9300 beds. The staff of each hospital base has one unit of specialized medical care (OSMP), which includes 15 groups of specialized medical care. The otolaryngologist is included in the neurosurgical group (senior resident), which also includes two neurosurgeons, a maxillofacial surgeon, an ophthalmologist, a neuropathologist, as well as two senior operating nurses, three operating sisters. OSMP groups are sent to strengthen specialized specialized military field hospitals (and not to profile them, as was previously envisaged). OSMP equipment has an ENT otolaryngological kit, which provides specialized ENT care and is designed for the work of one surgical team of two doctors.

In each GB there are 18 medical institutions. Of these, otolaryngologists are on the staff of the following institutions:

- VPN / hG-for 300 beds (two otolaryngologists in the ENT department for 50 beds);

-VPOZHG - for 300 beds (three otolaryngologists in the position of senior coordinators - one in each of the three burn departments);

-VPGLR - 2 hospitals with 750 beds each (in each hospital - one otolaryngologist in the surgical department as a resident);

-VPMG - 2 hospitals with 300 beds each (in each hospital - one otolaryngologist in the burn department as a resident);

- VPPNG - 2 hospitals with 300 beds each (in each hospital - one otolaryngologist-therapist in the neurological department as a resident).

Thus, each GB has 12 otorhinolaryngologists for specialized medical care.

In peacetime, specialized otorhinolaryngological care is also provided starting from the hospital stage. In the garrison VG with a bed capacity of 50 to 150 beds, one ENT doctor is provided as a resident of the surgical department according to the staffing table. With a bed capacity of more than 150 beds, it is planned to deploy an ENT department, which employs two ENT specialists, as well as secondary and junior medical personnel.
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ORGANIZATION OF SPECIALIZED MEDICAL ASSISTANCE FOR THE AFFECTED ENT SPECIALIST

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