Organization of aeromedical evacuation of patients by helicopters at combat conditions in Eastern Ukraine
Introduction. Aeromedical evacuation is one of the key methods of evacuation, which ensures mobility and quality medical care during transportation. At the same time, this method of evacuation requires constant improvement, in accordance with the quantitative and qualitative composition of the wounded, study of optimal and economically justified evacuation routes, prompt change of the number and structure of wounds in accordance with changing military - political situation and methods of hostilities.
The purpose: to study the quantitative and qualitative indicators of the aeromedical teams of intensive care, which carried out the evacuation of patients from the ATO / JFO zone for 2015-2018.
Materials and methods. Observations and retrospective analysis of the organization of patient transportation for the period from January 2015 to July 2018 were conducted. Maps of transportation of patients highly dependent on medical care for the period from March 2018 to April 2019 were studied. The total number of patients transported by helicopter is 5820. The average age of patients with high dependence on medical care was 30.6 ± 8 years. In each of the 82 patients, the leading syndrome was identified according to the reason for its transportation.
Results. In Ukraine, aeromedical evacuation has achieved significant success due to the interaction of various structures and constant painstaking work to improve the technique of its implementation. It should be noted that the number of wounded depends on the military - political situation, and there is a tendency to reduce the total number of transported patients in 2015 - 2018. However, in 2018 - 2019 the proportion of patients with high dependence on medical care increased, which may indicate changes in approaches to treatment and selection of patients for aeromedical evacuation. Among the transported patients, the majority were patients with mine injuries (45%), with gunshot wounds 28%, 10% of those transported had acute cardiovascular diseases such as acute myocardial infarction, acute coronary syndrome or acute cerebrovascular accident. Also, 10% of patients had non-combat injuries, 5% had infectious diseases and so on. During transportation, 83% of patients in the high category of dependence on medical support underwent artificial lung ventilation, 68.3% of patients underwent medical sedation to adapt to mechanical ventilation, which was carried out at the rate of propofol 87.5%, sodium oxybutyrate 8.9%, ketamine 1 , 8%, and sodium thiopental 3.6%. 12.2% of patients had unstable hemodynamics.
Conclusions. Critical role in the rational use of forces and means of air medical evacuation is played by organizational processes, careful approach to patient selection, proper formation and equipment of air medical evacuation teams, as well as planning of evacuation routes taking into account the tactical combat situation and the actual level of medical care. assistance. The structure of diagnoses among transported patients with high dependence on medical support is dominated by patients with mine injuries - 45% and gunshot wounds - 28%. The vast majority of patients (82.9%) in this category require artificial lung ventilation, medical analgesia - 68.3%, and 12.2% of patients need vasopressor hemodynamic support. Studying the actual results of aeromedical evacuation, their analysis and improvement based on previous experience will improve the efficiency of the use of forces and means of aeromedical evacuation.
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