Organization of Modern Medical Evacuation (ME)

Medical evacuation is a multi-stage process and it consists of several connected stages, one of such is medical transportation (MT) by ground, water, or airmobile transport to the medical institution. ^{Reference Goncharov, Bystrov and Bobij10–Reference Kasimov, Makhnovskiy and Loginov13} The patient’s diagnostics and treatment results in unspecialized institutions have significantly lower marks compared to the trauma centers, and the death rate becomes higher than 30%. ^{Reference Hurd and Jernigan14–Reference Shatalin, Agadzhanyan and Kravtsov17} Thus, ME cannot be considered as a decisive factor for the patient’s health. Usually, it is a forced action, and MT is the most unprotected of its stages. ^{Reference Tulupov, Besaev and Sinchenko18,Reference Kuvshinov, Sushilnikov and Yakovlev19}

Can be picked out three stages of ME: preparatory, transportation, and after-transportation stabilization (Figure 1). ^{Reference Goncharov, Bystrov and Bobij10,Reference Shatalin, Agadzhanyan and Kravtsov17} Each stage has its organizational peculiarities which depend on the place and circumstances, but there are some common principles that are used on each stage.

Figure 1. Stages of Medical Evacuation.

The preparatory stage includes:

• Reception, registration, and injured sorting;

• Special treatment of the sufferer, decontamination, degassing, and disinfection of their clothing and equipment; and

• First aid and preparation for further transportation.

Medical transportation can be provided by different kinds of transport depending on the accident type, location, or weather conditions. The MT stage is the most unprotected because of various suddenness types may arise. As usual, it happens because of the equipment fault. Also, many different complications occur in body position changing. So, all precautions should be intensified in the patient’s transfer.

The stabilization stage is provided in the closer medical institutions to the disaster. It’s important these institutions must have conditions and equipment to provide special treatment. Such medical institutions are:

• Hospitals of the disaster medicine service;

• Diversified, specialized hospitals, clinics, and centers of the Ministry of Health and Social Development of RF, and medical forces of the Ministry of Defense of RF;

• Medical institutions of the Ministry of Railways of Russia, the Ministry of Internal Affairs of Russia, the border troops of Russia, and the Federal Security Bureau of Russia; and

• Staff and the medical service of the Civil Defense. ^{Reference Sahno, Zaharov, Karlin and Pilik20}

Current Problems in Health Crew Creation

The total or partial deficiency of paramedics in health crews is one of the global problems for providing ME. The interstate research of the dependence of the health crews’ effectiveness in their staffing and competency level shows that a part of the medical crews would like to be equipped by an extra doctor or a doctor assistant. At the same time, the necessary condition for a successful ME improvement is additional training of the MT crew’s specialists to constantly increase their qualifications. ^{Reference Goncharov and Sahno21,Reference Rasmussen, Røislien and Sollid22}

The decreasing of MT crews is another important and often unresolved problem. Important problems are bad roads, the fuel limit, and non-working vehicles. But it must be remembered that the correct chosen transport remains necessary to avoid the complications in time and after transportation. ^{Reference Rasmussen, Røislien and Sollid22–Reference Homma, Niiyama and Sonoda24} For example, the height rising in aircraft flight leads to the atmosphere pressure reducing that may cause hypoxia and the gas expansion in the patient’s body cavities, ^{Reference Kashani and Farmer25,Reference Parsons and Bobechko26} which can cause dangerous physiological reactions for the patient. ^{Reference Poulton, Worthington and Pasic27}

One more is the undesirable usage of aircraft for ME purposes in places of biological, chemical, or nuclear weapons usage because of the possible infection or poisoning of the crew. It is impossible to guarantee the security of air transport and to control crew’s health and life safety. ^{Reference Joshi and Sharma28–Reference Yanagawa, Ishikawa and Takeuchi30}

The problem of foreign citizens’ evacuation in rescue operations in RF regions is caused by the communication barrier. It also demands organization and quick interstate interaction with the patient’s relatives, lawyers, and the insurance agents to solve the question of medical service payments, especially on occasion its cost is not covered by the compulsory health insurance fund sources. ^{Reference Logunov31} The other side is ME of citizens from aboard. It is consisting of the international legislative regulation of the issue of workflow, the improvement of the medical insurance system, and the solving of the technical questions of the ME. ^{Reference Kachanova32}

Finally, ME from the oil and gas extraction places has critical problems caused by the high injury risk for the workers and by the significant distances between extraction places and medical institutions. The implementation of new technologies of telemedicine is a necessary condition for providing high-level health care in this field. ^{Reference Evjemo, Reegård and Fernandes33,Reference Norman, Ballantine and Brebner34}

World Experience

According to the international rating results, RF refers to the middle-risk category countries that are providing quality ME and further medical care (Table 1). ^{Reference Toner, Andrée Wiltens and Berg35,Reference Wynberg, Toner and Wendt36}

Table 1. Level of Medical Evacuation Risk in Countries that have Evacuation Services

Abbreviation: UAE, United Arab Emirates.

The reasons of the ME necessity are:

• Limited capabilities of medical units in the cure for injured people at the location of the disaster or near to it;

• Necessity of the emergency cure;

• Impossibility of enough medical forces’ concentration at the CS location;

• Necessity of specialized medical care rendering; and

• Presence of the real risk repeating and the secondary injuries danger for people in the CS center. ^{Reference Yanagawa, Anan and Oshiro29,Reference Yanagawa, Ishikawa and Takeuchi30,Reference Wynberg, Toner and Wendt36}

The primary factors to better ME’s actual problems, according to Russia’s conditions, are:

• Optimized conditions creation for the availability, timeliness, and higher quality of the medical care achievement for the sufferers in the CS;

• Realization steps of long-term program health care infrastructure optimization; and

• Medical care system organization and development (with emergency and first aid) using new information technologies and telemedicine.

So, analysis of medical-sanitary CS consequences liquidations results shows that ME is the required and independent, diverse, and complex component event in treatment and evacuation activities. It is conducted by the special medical forces for life-saving and preserving the health of the injured. ^{Reference Starodubtseva and Shepina4,Reference Kulnev, Bobrov and Soldatov7}