CIVIL DEFENSE AND EMERGENCY PROTECTION AT THE FACILITY
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Training program for workers and employees
Topics
Civil defense as a system of national measures to protect the population from the dangers arising during the conduct of military operations or as a result of these actions
Dangers arising during the conduct of military operations or as a result of these actions.
Organization of the unified state system of prevention and liquidation of emergency situations (RSChS) Actions of employees of organizations in emergency situations of a natural nature Actions of employees of organizations in emergency situations of a man made nature The main measures of civil defense and the unified state system of prevention and liquidation of emergency situations for the protection of the population First aid.
Basics of Patient care Actions on Civil Defense Alert Signals
Briefing on civil defense
Summary of the GOChS briefing Journal of the GOChS briefing
TOPIC 7.
Providing first aid.
Basics of patient care.
QUESTION No. 1 The basic rules of first aid in emergency situations.
Rules and techniques of artificial respiration and indirect heart massage.
First aid is a complex of urgent measures aimed at preserving the life and health of victims of injuries, accidents and sudden illnesses.
The time from the moment of injury, poisoning to the moment of receiving help should be extremely reduced.
The provider of assistance is obliged to act decisively, but deliberately and expediently.
First of all, it is necessary to take measures to stop the impact of damaging factors(remove the drowning person from the water, extinguish burning clothes, take the victim out of the burning room or from the zone of infection with toxic substances, etc.).
It is important to be able to quickly and correctly assess the condition of the victim.
With osmiotra, it is first established whether he is alive or dead, then the severity of the lesion is determined, whether the bleeding continues.
In many cases, a person in trouble loses consciousness.
The person providing assistance should be able to distinguish loss of consciousness from death.
SIGNS OF LIFE: the presence of a pulse on the carotid artery.
To do this, the index and middle fingers are applied to the recess on the neck in front of the upper edge of the sternoclavicular mastoid muscle, which stands out well on the neck; the presence of independent breathing.
It is established by the movement of the chest, by moistening the mirror attached to the mouth and nose of the victim; the reaction of the pupil to light.
If the open eye of the victim is covered with a hand, and then quickly take it aside, then there is a narrowing of the pupil.
If signs of life are detected, it is necessary to start providing first aid.
It is necessary to identify, eliminate or weaken life threatening manifestations of the lesion – bleeding, respiratory and cardiac arrest, violation of the patency of the respiratory tract, severe pain.
It should be remembered that the absence of a heartbeat, pulse, breathing and the reaction of the pupils to light does not mean that the victim is dead.
Providing assistance is pointless with obvious signs of death: - clouding and drying of the cornea of the eye; - when squeezing the eye from the sides with your fingers, the pupil narrows and resembles a cat's eye; - the appearance of cadaverous spots and rigor mortis.
In all cases of first aid, it is necessary to take measures to deliver the sufferer to a medical institution or call an ambulance.
the call of a medical worker should not suspend the provision of first aid.
It should be remembered that providing assistance is associated with a certain risk.
In contact with the blood and other secretions of the victim, in some cases, it is possible to become infected with infectious diseases, including syphilis, AIDS, infectious hypatitis, electric shock, drowning when captured by the victim, as well as receiving traumatic and thermal injuries.
This does not in any way exempt from the civil and moral responsibility for providing medical assistance to victims, but it requires knowledge and compliance with the simplest security measures.
If contact with blood and other secretions is necessary, it is necessary to wear rubber gloves, in their absence, wrap the hand in a cellophane bag.
When removing a drowning person from the water, you need to swim up to him from behind and extremely carefully.
It is better to remove a person with a stick, belt, rope or other object.
In case of a fire, it is necessary to take measures to prevent poisoning of the combustion product, for which it is urgent to remove or remove it from the danger zone.
When providing assistance in a car accident, the victim is taken out of the roadway and the accident site is marked with clearly visible signs.
RESUSCITATION TECHNIQUES
INDICATIONS FOR RESUSCITATION: a weak fading pulse or its absence; dilated pupils that do not respond to light; rare shallow breathing or its absence.
PREPARATION FOR RESUSCITATION.
Lay the victim on a hard base, unbutton the collar on it, loosen the tie (women have a bra).
Quickly and carefully feel the back of the neck to see if it is smooth.
The presence of bone protrusions indicates a fracture of the cervical vertebrae or damage to the skull.
TO TILT YOUR HEAD BACK, take a place to the side of the victim.
Place your hand on his forehead so that the thumb and index finger are on both sides of the nose.
Put your other hand under your neck.
With multidirectional movements of the hands, straighten the neck, throwing the head back until it stops.
Excessive effort should not be used.
After throwing back the head, the victim's mouth usually opens.
If this did not happen, proceed in one of three ways:
1) place the thumbs with the emphasis on the chin, and the rest – under the lower jaw.
With the palms and partially with the help of the forearms, tilt the head back over the sufferer and fix it.
With your thumbs, move the lower jaw slightly up and forward – so that the lower front teeth slightly protrude above the upper ones;
2) put your hand on your forehead, tilt your head back.
The thumb of the other hand is inserted into the victim's mouth by the base of the front teeth; the index finger is wrapped around the chin.
With the remaining fingers closed, support it in this position.
With a downward movement, open your mouth and at the same time slightly push out the lower jaw; the mouth will open;
3) open the mouth by gripping the lower jaw from the side.
If the victim's airways are blocked by foreign bodies, turn him on his side and make 3-5 sharp pushes between the shoulder blades with the base of the palm.
When the victim is lying on his back, place the hands one on top of the other in the upper part of his stomach and apply 3-5 sharp pushes towards the esophagus.
Then they start artificial respiration (artificial lung ventilation – ventilator).
If after 2-3 test breaths the air does not enter the lungs, turn the head of the sufferer to the side, open the mouth, fixing the jaws with crossed thumb and forefinger.
Wrap the index and middle fingers of the other hand with a handkerchief or bandage and put it in your mouth.
Thoroughly, in a circular motion, clean the oral cavity (remove broken teeth, dentures, vomit, etc.).
ARTIFICIAL LUNG VENTILATION (IVL) is the first part of resuscitation.
According to the "mouth to mouth" method – with the thumb and forefinger of the hand fixing the forehead of the victim, tightly clamp his nose.
Take air into your lungs, press your mouth tightly to your mouth ( complete tightness!) and sharply blow air into your lungs.
after inflating the lungs – inhaling the victim the mouth is released and an independent passive exhalation is monitored.
Without waiting for it to end, spend another 3-5 breaths.
You can not use gaskets – gauze, shawls – you can not!
According to the "mouth to nose" method, fix the victim's head with one palm, and grab his chin with the other.
Push the lower jaw a little forward and close it tightly with the upper one.
Hold your lips with your thumb.
Take some air into your lungs.
Wrap your lips tightly around the base of the victim's nose, but so as not to pinch the nasal openings, and vigorously blow air into it.
After freeing the nose, follow the passive exhalation.
With a regular ventilator,1-1.
5 liters of air should enter the lungs every time.
To do this, the rescuer must take a sufficiently deep breath.
The frequency of inflating the lungs should be 10-12 times per minute (one breath per 5 seconds).
If the chest walls of the victim did not rise during ventilation, it means that the air did not get into the lungs, but into the stomach.
Quickly turn the victim on his side and press on the stomach.
The spirit will come out and you can continue to provide assistance.
Errors during ventilation: lack of tightness between the rescuer's mouth and the victim's mouth or nose; with the "mouth to mouth" method, the victim's nose is not sufficiently clamped; the victim's head is not fully tilted back, and air enters the stomach.
If after 3-5 artificial breaths the pulse of the victim on the carotid artery does not appear, immediately begin external heart massage.
EXTERNAL HEART MASSAGE is the second part of resuscitation.
It includes a cycle: a blow to the heart area - checking the effectiveness – massage thrusts.
The blow is struck with a fist in the middle part of the sternum.
Immediately check the pulse.
When performing massage pushes, the rescuer should straighten his arms at the elbows.
At the end of each
push compression is delayed from 0.7-0.8 s.
The deflection of the chest should be
4 cm, and the massage rate is 60-70 thrusts per minute.
It is necessary to constantly monitor the pulse!
MASSAGE THRUSTS are performed with crossed palms.
The base of one of them is located on the lower half of the sternum (retreating two fingers above the xiphoid process), the fingers are bent upwards.
Another one
the palm is placed on top and quick pressure pushes are made.
The RESUSCITATION CYCLE "VENTILATOR+MASSAGE" is performed in the ratio of 2:15, i.e. after two breaths, 15 massage pushes follow.
With the participation of two spas in the resuscitation, this ratio is 1:5.
You can not take an artificial breath at the same time with a massage push!
RESUSCITATION BY TWO RESCUERS.
The first (the leader) kneels near the victim's head, the second at the chest.
The first performs diagnostics, preparation for resuscitation, ventilation with a frequency of 12 breaths per day
minute, monitors the pulse and condition
pupils.
The second in command of the first begins an external heart massage, which alternates with a ventilator performed by the first rescuer.
If necessary, the second rescuer is instructed to check the bleeding or call a doctor.
SIGNS OF RESTORATION OF BLOOD CIRCULATION: the pulse is well felt, the pupils narrow, the skin turns pink.
In the absence of these signs, resuscitation is stopped within 30 minutes.
After the recovery of the victim's vital activity, it is necessary (from the supine position) to turn him over on his right side.
Otherwise, the tongue sinks and strangulation itself occurs.
The coup is done quickly and in a strict sequence: 1 bend the right leg at the knee; 2 pull the foot up to the knee of the other leg; 3 bend your left arm at the elbow and put it on your stomach; 4 straighten the right arm and press it to the trunk; 5 pull up the left brush to the left; 6 take the victim by the left shoulder with one hand, and by the pelvis with the other and roll him to the right side in a reclining position on his stomach; 7 tilt your head back, and place your left hand comfortably under it; 8 put your right hand close to the trunk from behind, bend it slightly at the elbow.
The victim continues to be monitored.
Periodically monitor the pulse and the condition of the pupils.
QUESTION #2 TEMPORARY STOP OF BLEEDING FROM THE ARTERIES.
EXTERNAL ARTERIAL PRESSURE.
Signs: the blood is bright red, often gushing with a pulsating jet.
to temporarily stop the bleeding, pinch the artery above the wound site with your finger or apply a pressure bandage.
The second rescuer at this time is preparing funds for the final stop of bleeding.
You can also fix the limb to squeeze the vessels.
According to the sufferer, you need to quickly roll up a sleeve or a trouser leg and make a roller out of any material, put it into the hole formed when bending the joint located above the injury site.
Then, strongly to the point of failure, bend the joint over this roller.
In this position, the bent leg or arm should be tied or tied to the torso of the victim.
If there is severe bleeding, apply a tourniquet.
This is a forced, very responsible measure.
Use standard Esmarch rubber harnesses, tape harnesses, cloth harnesses, or improvised means; a rubber tube, a belt, a scarf, etc.
The tourniquet is applied above the wound site, on the upper third of the shoulder (you can not put it on the middle third!) or on any part of the thigh.
It is mandatory to monitor the pulse on the periphery of the limb.
Expose the limb, lift it up, put a bandage made of a bandage or a soft pad made of clean cloth (without lumps, bumps, irregularities) on it.
Bring the tourniquet under the limb, stretch it moderately and fix one move on the bandage.
The initial section of the harness remains free.
Make another 2-3 moves, and each subsequent overlay is next to the previous one close, but not on top of it.
A tourniquet is applied until the bleeding stops, constantly monitoring the pulse.
The last 1-2 moves are made on top of the previous ones.
Tie the end of the ribbon bundle to the initial segment.
Fasten the chain of the Esmarch harness for the hook.
The pressure from the tourniquet should be sufficient to stop the bleeding, but not cause complete exsanguination of the limb.
The time of the tourniquet on the limb is not more than 1.5-2 hours, and in winter and in the cold up to 1 hour.
Every half an hour or an hour, the tourniquet should be dissolved for a few minutes (at this time, the vessel above the tourniquet is squeezed with a palm).
Lightly massage the furrow from the tourniquet on the skin.
Then apply the tourniquet again, slightly above the previous position.
Hospitalize the victim.
A memo indicating the date, time of application, and the name of the rescuer must be attached to the harness.
EXTERNAL VENOUS.
Signs: the blood is dark red, flows out in a sluggish stream from the peripheral part of the vessel.
Neck injuries are especially dangerous due to the possible ingress of air into the veins (leading to paralysis and death).
To temporarily stop the bleeding, bring the ends of the wound closer and squeeze the tissues.
Apply a sterile cloth to the wound, and on top of it, along the axis of the limb, a dense roller made of
matter.
After stretching the bandage a little, put it on the roller and make fixing moves.
If the neck is injured, the compression bandage is sealed with oilcloth or poly ethylene.
INTERNAL.
Occurs with head injuries , chest, abdomen, with peptic ulcer of the stomach, intestines.
Symptoms: dizziness, shortness of breath, rapid fatigue, tinnitus, thirst, darkening of the eyes.
Possible loss of consciousness.
With abdominal injuries (ruptures of the stomach, intestines, esophagus) and peptic ulcer disease sharp pains, vomiting with blood.
In case of chest injuries pain when breathing, shortness of breath, cough.
The victim needs complete rest.
For various internal bleeding, the following assistance is provided:
- in the abdominal cavity – lay the victim on his back, put the"cold" on his stomach;
- into the chest cavity, as well as from the nose – the position of the victim should be semi sedentary;
- from the oral cavity lay the victim on his stomach, turn his head to the side;
- from the nose put the "cold" on the nose closer to its base and on the sides; squeeze the nostrils for a time from 2 to 20 minutes.
ACUTE MASSIVE BLOOD LOSS.
It occurs as a result of external bleeding in severe injuries: open fractures of large bones, wounds of large arteries; as well as internal bleeding.
The victim's blood supply to the brain and heart deteriorates sharply, severe shock and terminal conditions develop.
Help with shock;
- complete rest, bed rest; lift the victim's legs at an angle of about 150, it is convenient to lean them on pillows.
Place the head horizontally.
Stop the blood flow;
- in the absence of abdominal injuries and vomiting,periodically give 1-1.
5 hundred kans of warm drink (according to ? a teaspoon of salt and soda per 1 liter of water); 1-2 tablets of crushed analgin under the tongue;
- apply bandages to the wounds.
In case of bone fractures – transport immobilization.
Warm up, urgently hospitalize.
OPEN WOUNDS.
It is impossible to touch wounds with your hands or with any tool, to remove foreign bodies from their surface!
Dirt from the skin areas surrounding the wound is eliminated in the direction from the wound; the skin is treated with a 5 % alcohol solution of iodine.
The wound is covered with a sterile napkin or a piece of sterile bandage, a cotton gauze bandage is applied and bandaged.
PENETRATING WOUND OF THE ABDOMINAL CAVITY.
It is forbidden to set the fallen organs, to touch them!
It is necessary to apply a sterile napkin, then a cotton gauze bandage and loosely bandage the wound.
PENETRATING WOUND TO THE CHEST.
Carefully remove the dirt from the skin around the wound, apply a sterile cloth on it.
At a distance of about 5 cm from the edges of the wound, apply a not wide strip of vaseline or neutral cream.
Put a piece of clean oilcloth on top of the napkin so that its contour covers a strip of vaseline.
At the exit, apply wide passages of the bandage that secure the bandage.
QUESTION #3 First aid for fractures.
Techniques and methods of immobilization with the use of service and improvised means.
Methods and prvila of transportation and carrying of victims.
There are isolated fractures (of one bone), multiple fractures (of two or more), combined fractures (of one or more bones with simultaneous damage to internal organs), as well as closed and open fractures.
ATTENTION!
In case of an open fracture, it is necessary to expose the limb, stop external bleeding, treat the edges of the wound and apply a sterile bandage on it.
It is impossible to touch the wound, set bone fragments, remove fragments and foreign bodies!
Any type of transfer requires the delivery of the victim to the hospital.
This should be preceded by transport immobilization, i.e. immobilization of the damaged area of the body.
THE PURPOSE OF TRANSPORT IMMOBILIZATION is to create peace for the damaged part, to immobilize bone fragments, to exclude secondary damage to blood vessels, nerves, and soft tissues.
The following technical means are used:
- standard Kramer wire ladder tire with dimensions of 10x110 and 10x60 cm.
Previously, it is covered with cotton wool and secured with bent moves;
- wooden splint of Dieterichs ( with a fracture of the lower limb);
- a wooden shield (for fractures of the spine and pelvic bones).
In the absence of standard tires, any improvised means are used – narrow boards, skis, sticks, and for fixing – strips of dense fabric, harnesses, ropes.
In the absence of other means, the immobilization of the upper limb is achieved by fixing it to the trunk, and the lower one to the healthy leg.
Fix at least two joints on both sides of the fracture.
On the humerus and femur – at least three.
Joints and bone protrusions in all cases are covered with cotton gauze pads or rags, avoiding folds and irregularities, and fix them with a bandage.
Then they apply tires.
With a closed fracture, the splints are applied directly to the clothes, straightening the folds on it and freeing the pockets.
In cold weather, it is necessary to insulate the victim, especially his limbs.
For anesthesia, crushed 1-2 tablets of analgin are given under the tongue.
UPPER LIMBS, SHOULDER GIRDLE
FRACTURES OF THE BONES OF THE ARMS, SHOULDER GIRDLE, RIBS.
Fix the forearm at an angle of 900.
The victim's hand should be slightly deflected to the back, the fingers are half bent.
Put a thick cotton gauze roller in the brush.
In case of multiple fractures, place the forearms bent at an angle of 900, right in front of the left, on paired splints fixed in front and behind and suspended from the neck on cross bandages.
Both tires are fixed with a third, horizontal tire located just above the middle third of the shoulder.
After applying a splint, a limb with an isolated fracture is fixed with a scarf, a strip of fabric, a jacket hollow, a trouser belt or a Dezo bandage.
To fix a broken COLLARBONE, make two rings from dense cotton gauze or cloth bundles with a thickness of 3 cm and a length of 70 cm.
Put the rings on your forearms through the armpits.
The victim should straighten up, straighten his shoulders, turning them slightly outward.
In this position, tie the rings firmly in the inter scapular area.
Put cotton wool under the knot.
In case of a fracture of the SCAPULA, the limb is fixed on the kerchief.
The victim of a RIB fracture should exhale, and at this moment apply a circular bandage made of a wide bandage, a hard towel or a scarf to the lower part of the chest.
You can use a Band Aid (adhesive tape) with a width of at least 10 cm.
In case of a fracture of the upper ribs, additionally apply a vertical strip of a wide bandage (plaster, tape) through the forearm on the side of the injury.
LOWER LEG, ANKLE JOINT, FOOT
FRACTURE OF THE SHIN BONES.
In case of a fracture of both bones of the lower leg, 3 Kramer splints or 3 slats are used.
If one bone is broken, one splint is applied on the back surface.
The foot is fixed at an angle of 90gr..
FRACTURED BONES, SPRAINED LIGAMENTS OF THE SHIN AND FOOT JOINT, FOOT.
Apply splints on the outer and inner surfaces of the lower leg from the knee joint to the heel and 5-10 cm further.
Fix the tires, the shin and the foot (under the weight of 90 gr.).
FRACTURE OF THE FEMUR.
Three joints are fixed – the hip, knee and ankle.
Three tires are required:
- external – from the armpit to the foot and a little further (from two to three Kramer tires);
- back from the gluteal fold along the back of the thigh to the foot and then with a turn of 900 to the foot a little further than the fingers;
- internal – from the groin area along the inner surface of the thigh to its outer edge.
The external tire is fixed to the trunk in several places.
All three splints are fixed to the thigh and lower leg in the upper parts and in the vicinity of the ankle joint.
The foot is bandaged to the tires crosswise.
To immobilize the hip, you can also use strong slats, poles:
- two external ones (4-5 cm wide) - from the armpit 5-6 cm further than the edge of the foot;
- two internal ones from the groin to the same level;
- two rear ones from the gluteal fold to the foot.
In the absence of bandages, they are replaced with 8-9 ribbons or strips of strong fabric.
You can use belts and cords (always with a pad made of soft fabric).The top of the outer and inner tires are also protected with a soft cloth roller.
The foot is placed at an angle of 900 to the axis of the limb and is fixed to the shin and splints with cross strokes of a tourniquet or strips of fabric.
In case of multiple hip fractures, the principle of tire lining is the same.
FRACTURE OF THE BONES OF THE KNEE JOINT.
Apply three Kramer splints or three slats along the back surface of the leg – from the upper third of the thigh to the ankle joint.
With a fracture of the patella, incomplete fractures of other bones, you can limit yourself to one splint.
THE SPINE
FRACTURES OF the SPINE require especially careful treatment of the victim.
When moving and laying it, the spine should not sag in the area of the fracture, otherwise a spinal cord injury or paralysis is possible.
the victim tilted his head forward.
The rescuer acts with an assistant.
The bandage is covered with cotton wool along the entire length and carefully applied with circular overlapping loops, creating a cotton gauze collar.
It is impossible to allow displacement of the vertebrae and compression of the carotid arteries.
The victim is placed on a wooden shield and transported, observing his condition.
The victim of a fracture of the THORACIC OR LUMBAR SPINE is placed on a shield or immobilized by improvised means using:
- two strong slats with a width of 8-10 cm are 15-16 cm longer than the height of the victim;
- three slats long about 1/4-1/3 of the first;
-12 strips of strong fabric, harnesses or ribbons.
Short straps are attached to a pair of long ones at the level of the upper arms, pelvis and feet.
The victim is carefully placed on this crosspiece and fixed with cloth strips in the chest, abdomen, thighs, shins, and ankle joints.
The pelvis is fixed to the middle crossbar by the strokes of the strips through the perineum, and the upper arms and hands are fixed to the upper one, in oblique strokes.
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