Organization of sanitary and anti-epidemic support in emergency situations. Organization of anti-epidemic measures in emergency situations Sanitary standards for the organization of work in emergency situations

The organization and implementation of sanitary and hygienic and anti-epidemic measures in the general system of liquidating the medical and sanitary consequences of emergencies have a very essential. In the emergency zone, this work is carried out by the territorial centers of the State Sanitary and Epidemiological Supervision Russian Federation(TsGSEN).

To ensure a quick response, specialized formations are being created on the basis of the Central State Sanitary and Epidemiological Service and other institutions of the sanitary-epidemiological service.

In order to prevent and eliminate the medical and sanitary consequences of emergencies, sanitary and epidemiological institutions and formations carry out the following main activities:

Carry out control over the sanitary and epidemiological situation, organize the examination of food raw materials, food products, drinking water, external environment for contamination with radioactive substances, poisonous and chemically hazardous substances, pathogenic microorganisms;

Interact with departmental medical and sanitary services on the issues of providing assistance to the population in the lesions;

Carry out special training employees of sanitary and epidemiological institutions and units for work in emergencies;

The territorial centers of the State Sanitary and Epidemiological Supervision, the formations and institutions of the Sanitary and Epidemiological Service, the forces and means of research institutes operating in the RSChS are supported in a high degree of readiness;

Carry out the accumulation, storage, refreshment, accounting and control of medical property necessary for the work of units and institutions of the sanitary and epidemiological service in emergencies;

Carry out control over the observance of sanitary rules, hygienic standards in the event of an emergency in a peaceful and war time;

Organize the work of a network of observation and laboratory control for the timely detection and indication of biological (bacteriological) contamination (pollution) of drinking water, food and fodder raw materials, food, objects the environment in emergency situations of peace and wartime;

Forecasting the possibility of epidemics on the territory of the Russian Federation.

For the operational management and coordination of the activities of organizations and citizens to prevent massive infectious diseases and human poisoning and eliminate the consequences of emergencies by local authorities executive power permanent sanitary and epidemiological commissions... The structure of these commissions includes the heads of the services of the administrative territory, and the working body of the commission is the headquarters, which is created from employees of the civil defense services, health care and anti-epidemic institutions.

In the institutions that are part of the state sanitary and epidemiological service (TsGSES, research institutes of the sanitary and hygienic and epidemiological profile, anti-plague institutes and stations, etc.), management bodies are created to work in emergencies - headquarters for Civil Defense and Emergencies object. The composition of the headquarters is determined by the order of the chief of the civil defense of the object, depending on the structure of the institution, its capabilities and tasks to be solved.

The order of work of the headquarters for civil defense of the object is determined by the functional duties of its officials. State sanitary and epidemiological supervision in the emergency zone (area) includes a set of measures for sanitary and anti-epidemic provision of the population.

Sanitary and hygienic provision in an emergency is understood as a set of measures carried out in the emergency zone (area) in order to preserve the health of the population and personnel involved in the elimination of the consequences of an emergency by:

Medical monitoring of their state of health; sanitary supervision over the conditions of accommodation (outside the places of permanent residence), food, water supply, sanitary condition of the territory, disposal of sewage, burial of the corpses of dead people and animals;

Assessment of the sanitary and hygienic state of the emergency zone (area);

Predicting the influence of unfavorable factors on the health of the population and personnel involved in the elimination of emergencies, and developing proposals to improve this influence;

Hygienic education.

The Sanitary and Epidemiological Service organizes and conducts the following sanitary and hygienic measures:

Organization and conduct of an assessment of the sanitary and hygienic state of the territory and determination harmful factors affecting public health and the environment;

Organization of sanitary and hygienic measures to protect the personnel of emergency facilities, participants in the liquidation of the consequences of the accident and the population;

Organization and participation in sanitary supervision over the conditions of accommodation of the population in the emergency area, its food, water supply, bath and laundry services;

Organization of sanitary supervision at hygienically significant facilities that ensure the livelihoods of the population in the emergency area;

Medical control over the state of health of personnel of formations and institutions participating in the elimination of the consequences of emergencies, their provision with special clothing, protective equipment and their correct use;

Participation in the control over the sanitary state of the territory, its timely cleaning, disinfection and supervision over the burial of the dead and the dead;

Organizational and explanatory work on the regime and rules of behavior of the personnel of emergency facilities, participants in the liquidation of the consequences of the accident and the population in the emergency zone.

When carrying out sanitary and hygienic measures, it is necessary take all hygienically important objects under strict control- both destroyed and damaged at the source of the disaster, and continuing to function.

Such objects include:

1. water supply and sewerage systems;

2.enterprises Food Industry, Catering and trade;

3. preschool and school institutions;

4. utilities;

5. injured and uninjured housing stock;

6. medical and prophylactic institutions, in which the injured and sick from the area of the disaster are hospitalized;

7. places of temporary resettlement of the evacuees;

8. locations of rescue teams, detachments;

Organization of sanitary and anti-epidemic measures in emergency situations

In Kazakhstan, the development and improvement of sanitary and epidemiological assistance to the population in the event and elimination of emergency situations (ES) caused by natural disasters, accidents, man-made disasters and epidemics are becoming increasingly important. This is due to an increase in the incidence of such dangerous infectious diseases as cholera, hemorrhagic fevers, acute viral intestinal and other infections, in addition, for recent decades in various regions of the world, a number of new viruses have been identified - the causative agents of dangerous infections.

In case of natural disasters - earthquakes, floods and others - first of all, the scale of destruction, the size of the flooded area, the number of people who find themselves homeless, drinking water and food, exposed to cold water, wind and other meteorological factors are important, which determines the massive appearance of infectious and non-infectious diseases.

A particular danger is posed by major catastrophes, accompanied by massive injuries, death of people and animals, environmental pollution, violation of sanitary and epidemiological well-being, significant material and economic damage.

Successful prevention and control of infectious diseases in natural disasters and man-made disasters can only be carried out on the basis of a single organizational system for the whole country, which should provide for the activities of clinical and preventive medicine specialists, as well as activities carried out by other special services, taking into account general and special aspects of the development of the epidemic process in disaster areas.

Let's try to formulate a definition of this branch of disaster medicine. Epidemiology of disasters is an independent scientific direction of disaster medicine and an area of practical activity. She studies the epidemic process that manifests itself in specific social and natural conditions of emergencies, develops the principles and organization of sanitary and anti-epidemic support for eliminating the consequences of emergencies. Epidemiology of disasters in its practical activities carries out sanitary and epidemiological supervision, is engaged in planning, preparation and implementation of preventive and anti-epidemic measures to eliminate the medical and sanitary consequences of emergencies.

Epidemiological methods are used to study the effect of various emergency factors. A study of the impact of specific emergency conditions on human health, an analysis of the risk factors of the side effects of the environment in an emergency on the health and social status of the population, an assessment of the effectiveness different types sanitary and epidemiological care, measures for organizing sanitary and epidemiological surveillance aimed at restoring the state of health of the population, which was before the disaster.

In case of accidents, catastrophes and natural disasters, the sanitary-hygienic and epidemiological situation in the emergency situation (ES) area is significantly complicated. This is due to the following reasons:

* destruction of residential and public buildings;
* failure of water supply, sewerage and treatment facilities, utilities and industrial enterprises;
* intensive migration of various contingents of people;
* changes in people's susceptibility to infections;
* the failure of sanitary-epidemiological and medical-preventive institutions in the disaster zone;
* the presence of a large number of corpses of people and animals;
* mass reproduction of rodents, the appearance of epizootics among them and the activation of natural foci of zoonotic infections.

All of the above reasons significantly worsen the sanitary and hygienic situation and significantly exacerbate the epidemic situation for many infectious diseases.

For this reason, sanitary and hygienic and anti-epidemic measures are one of the constituent parts of the national system of disaster medicine, an important section of medical support for the population and the elimination of the consequences of emergencies.

Sanitary and anti-epidemic support in emergencies includes a set of organizational, legal, medical, hygienic and anti-epidemic measures aimed at preventing the occurrence and elimination of infectious diseases, maintaining the health of the population and maintaining its ability to work.

In the process of eliminating the medical and sanitary consequences of emergencies, the sanitary and epidemiological provision of the population is carried out in three directions:

* sanitary and hygienic measures;
* anti-epidemic measures;
* environmental control.

Sanitary and hygienic and anti-epidemic measures are one of the most important activities of authorities, health care and other services, as in Everyday life, and in the event of an emergency in peacetime and wartime. They are aimed at solving the following goals:

* preservation and strengthening of public health, disease prevention;
* prevention of the occurrence of infectious diseases among the population;
* the fastest elimination of infectious diseases in case of their appearance.

anti-epidemic emergency decontamination

Sanitary and hygienic measures are a set of measures carried out in the emergency zone in order to preserve the health of the population and participants in the liquidation of the consequences of emergency situations. The main ones are:

* medical control health conditions;
* sanitary supervision of accommodation conditions;
* sanitary supervision of food and water supply;
* sanitary supervision of bath and laundry service;
* control of the sanitary condition of the territory. The Sanitary and Epidemiological Service organizes and conducts

the following sanitary and hygienic measures in the emergency area:

* organizing and assessing the sanitary and hygienic state of the territory and determining the harmful factors affecting the health of the population and the environment;
* organization and participation in sanitary supervision over the conditions of accommodation of the population in the emergency area, its food, water supply, bath and laundry services;
* organization of sanitary and hygienic measures to protect the personnel of emergency facilities, participants in the liquidation of the consequences of the accident, as well as the population;
* organization of sanitary supervision at hygienically significant facilities that ensure the livelihoods of the population in the emergency area;
* medical monitoring of the health status of personnel of formations and institutions involved in the elimination of the consequences of emergencies, their provision with special clothing and protective equipment, their correct use;
* participation in the control of the sanitary state of the territory, its timely cleaning, disinfection and supervision over the burial of dead and deceased people and animals;
* organizational and explanatory work on the regime and rules of conduct for the personnel of emergency facilities, participants in the liquidation of the consequences of the accident and the population in the emergency zone.

In the event of a failure of water supply facilities and networks, measures are determined to provide the population with good-quality water. If it is impossible to restore the centralized water supply, they decide on the organization of its supply to the emergency zone. Experts take part in the selection of a water source, give permission to use vehicles for the supply of water, if necessary, organize the disinfection of water in tankers, carry out selective control of the content of residual chlorine in drinking water and its quality.

In case of failure of sewage, treatment facilities and networks, the flow of wastewater to land areas and in open reservoirs, emergency measures are determined for carrying out repair and restoration work and stopping the discharge of untreated wastewater, daily bacteriological control of the quality of water in the reservoir is carried out at control points.

At food facilities, events are organized to exclude the possibility of contamination of food. In agreement with the specialists of the sanitary and epidemiological teams, temporary food points are organized in the emergency zone and they are landscaped.

Particular attention is paid to the implementation of measures among the population for the prevention of acute intestinal diseases transmitted by water and food.

In places of temporary resettlement of residents and personnel of formations, preventive measures are taken to create appropriate conditions for living, drinking regime, and public services.

Anti-epidemic measures - a set of measures to prevent the emergence and spread of infectious diseases and the fastest elimination in case of their occurrence.

Anti-epidemic measures are divided into two groups:

* measures to prevent the emergence and spread of infectious diseases;
* measures aimed at eliminating epidemic foci among the population in the emergency area.

To assess the degree of epidemic danger of infectious diseases in emergency zones, a method is proposed that takes into account the most significant factors:

* pathogenicity of an infectious agent;
* mortality;
* contagiousness (expressed by the contagious index);
* the number of cases and the number of expected sanitary losses;
* the number of contact persons and the need for their isolation (observation);
* the size of the epidemic zone (levels: local, local, territorial, regional, federal).

In an emergency, the epidemic process has a certain specificity, and its inherent patterns of development may be violated. First of all, this concerns the source of the causative agent of the infection, its type and place of natural activity (habitat, reproduction and accumulation) In disaster zones, the source of infection is often difficult to establish, since the forms of preserving the place of vital activity of the pathogen change, and its habitat is expanding. For this reason, several epidemic foci of different nosological forms may appear simultaneously in the disaster zone.

The main anti-epidemic measures in the event of an epidemic focus are as follows:

* registration and notification;
* epidemiological examination and sanitary and epidemiological reconnaissance;
* identification, isolation and hospitalization of the sick;
* regime restrictive measures;
* general and special emergency prevention;
* disinfection of the epidemic focus (disinfection, disinsection, deratization);
* identification of bacteria carriers and enhanced medical monitoring of the affected population;
* sanitary-explanatory work.

Registration and notification. All identified patients and persons suspicious of the disease are taken on special accounting... The chief physician of the center of state sanitary and epidemiological surveillance of the district (city) must be immediately notified of the detection of infectious patients. Upon receipt of data on the occurrence of highly contagious infections, the population of the disaster area and adjacent territories is also notified with an explanation of the rules of conduct.

Epidemiological examination and sanitary and epidemiological reconnaissance. Each case of an infectious disease should be subjected to a thorough epidemiological examination in order to identify the alleged source of infection and to carry out basic measures aimed at preventing the spread of infection.

Epidemiological examination of the focus includes the following sections of work:

* analysis of the dynamics and structure of morbidity by epidemiological signs;
* Clarification of the epidemiological situation among the remaining population in the disaster zone, its locations;
* questioning and examination of sick and healthy;
* visual and laboratory examination of the external environment;
* determination of objects that economically worsen the sanitary-hygienic and epidemiological situation in the center of the disaster;
* survey of medical (veterinary) workers, representatives of the local population;
* inspection of the sanitary condition of settlements, water sources, utilities and food facilities, etc.;
* working out the collected materials and establishing causal relationships in accordance with the available data on the type of epidemic in a specific infection.

Sanitary and epidemiological reconnaissance - collection and transmission of information about the sanitary and hygienic and epidemiological situation in the emergency zone. The tasks of sanitary and epidemiological intelligence include the following:

* identification of the presence and localization of patients, the nature of the outbreak and the prevalence of infectious diseases;
* establishing the presence and activity of natural focal infections in emergency zones, epizootics among wild and domestic animals;
* Inspection of the sanitary and hygienic state of the emergency zone, its settlements and water sources, economic facilities, communal and sanitary, medical and sanitary and epidemiological institutions;
* assessment of the possibility of using forces and means for work in epidemic foci local authorities health care preserved in emergency areas.

The group of sanitary and epidemiological intelligence includes a hygienist, an epidemiologist (or infectious disease specialist), a bacteriologist, a laboratory assistant, and a driver.

Sanitary and epidemic condition of the area. Based on the data obtained, the state of the area is assessed. It can be assessed as prosperous, unstable, dysfunctional, and extreme.

* Good condition:
- - absence of quarantine infections and group outbreaks of other infectious diseases;
- - the presence of isolated infectious diseases that are not related to each other and that have appeared over a period exceeding the incubation period of this disease;
- - the epizootic situation does not pose a danger to people;
- - satisfactory sanitary condition of the territory, water supply facilities;
- - communal amenities.
* Unstable condition:
- an increase in the level of infectious diseases or the emergence of group diseases without a tendency to further spread;
- the emergence of isolated infectious diseases related to each other or having a common source of the disease outside the given territory with a satisfactory sanitary condition of the territory and high-quality implementation of a set of measures for anti-epidemic support.
* Unfavorable condition:
- - appearance group cases dangerous infectious diseases in the emergency zone or epidemic foci of especially dangerous infections in neighboring territories if there are conditions for their further spread;
- - numerous diseases of unknown etiology;
- - the occurrence of isolated diseases by especially dangerous infections.
* Emergency condition:
- a sharp increase in a short period of time in the number of dangerous infectious diseases among the affected population;
- the presence of repeated or group diseases of especially dangerous infections;
- activation of natural foci of dangerous infections in the emergency zone with the appearance of diseases among people. Identification, isolation and hospitalization of the sick. The team in which the first case of the disease is discovered should be the object of careful observation. With a number of diseases (dysentery, typhus, scarlet fever, etc.), it is necessary to organize daily rounds and interviews of the served contingents, and in case of suspicion of an infectious disease, isolate and hospitalize the sick.

Timely early withdrawal of the patient from the team serves as a cardinal measure to prevent the spread of infection.

Restrictive measures. In order to prevent the introduction of infectious diseases and their spread in the event of epidemic foci, a complex of regime, restrictive and medical measures is carried out, which, depending on the epidemiological characteristics of the infection and the epidemiological situation, are divided into quarantine and observation. The organization and conduct of these events are entrusted to the responsible heads of the administrative territories and the sanitary and anti-epidemic commission.

Quarantine is a system of temporary organizational, restrictive, administrative, economic, legal, treatment-and-prophylactic, sanitary-hygienic and anti-epidemic measures aimed at preventing the removal of the causative agent of a dangerous infectious disease outside the epidemic focus, ensuring the localization of the focus and their subsequent elimination.

Quarantine is introduced when patients with especially dangerous infections appear among the population, group diseases with contagious infections with their increase in a short time. When even isolated cases of plague, Lassa, Ebola fevers, Marburg disease and some other contagious diseases, as well as mass diseases of anthrax, yellow fever, tularemia, glanders, myeloidosis, typhus, brucellosis, and psittacosis are established, a quarantine regime should be introduced.

Observation - regime-restrictive measures, providing, along with the strengthening of medical and veterinary supervision and the implementation of anti-epidemic, treatment-and-prophylactic and veterinary-sanitary measures, restricting the movement and movement of people or farm animals in all administrative territorial entities adjacent to the quarantine zone, which create the observation zone.

Observation is introduced in areas with an unfavorable or emergency sanitary-epidemic condition, i.e. with the appearance of group non-contagious diseases or isolated cases of contagious infections.

Observation and quarantine are canceled after the expiration of the maximum incubation period of this infectious disease from the moment of isolation of the last patient, after the final disinfection and sanitization of the service personnel and the population.

Emergency prophylaxis is a set of medical measures aimed at preventing the occurrence of diseases in people in case of infection with pathogens of dangerous infectious diseases. It is carried out immediately after establishing the fact of bacterial infection or the appearance among the population of cases of dangerous infectious diseases, as well as massive infectious diseases of unknown etiology.

Unlike vaccine prophylaxis, emergency prophylaxis provides quick protection for those infected.

Emergency prevention is divided into general and special. Before establishing the type of microorganism that caused the infectious disease, carry out general, and after establishing the type of microbe-pathogen - special emergency prevention.

As means of general emergency prophylaxis, antibiotics and chemotherapy drugs of a wide spectrum of action, active against all or most of the causative agents of infectious diseases, are used. The duration of the course of general emergency prophylaxis depends on the time required to identify, identify and determine the sensitivity of the pathogen to antibiotics and averages 2-5 days.

As means of special emergency prevention, antibacterial drugs are used that have a high etiotropic effect on the pathogen isolated from infectious patients in the epidemic focus, taking into account the results of determining its sensitivity to antibiotics. The duration of the course of special emergency prophylaxis depends on the nosological form of the disease (the duration of the incubation period, calculated from the day of infection) and the properties of the prescribed antimicrobial drug.

The order to carry out emergency medical prophylaxis is given by the sanitary and anti-epidemic commissions.

Simultaneously with the beginning of emergency prophylaxis in the foci of infection, it is recommended to carry out active immunization (vaccination or revaccination) of the population.

Disinfection of foci is carried out by the forces of the state sanitary and epidemiological service through current and final disinfection.

Disinfection is the destruction of infectious disease pathogens in the environment. It can be carried out by physical, chemical and combined methods. Disinfection is carried out by disinfection groups. One such group, consisting of a disinsector, a disinfector and two orderlies, is capable of treating 25 apartments with an area of 60 m 2 each during a working day.

Disinfection of the territory, buildings and sanitization of the population is carried out by the communal service.

Disinsection - the destruction of insects (carriers of infectious diseases). It is carried out by physical and chemical methods. The chemical method is considered the main one - the treatment of objects with insecticides.

Deratization - the destruction of rodents (as a source of pathogens of infectious diseases). It is carried out by mechanical and chemical methods.

Disinfection of food is carried out by the trade and nutrition service, and water by the water supply service. Quality control of food and water disinfection, as well as their sanitary examination is carried out by the State Sanitary and Epidemiological Surveillance Service.

test questions

1. Definition and objectives of sanitary and epidemiological provision of the population.
2. The main provisions of sanitary and hygienic measures to preserve the health of the population and participants in the elimination of the consequences of emergencies.
3. The main anti-epidemic measures in emergencies.
4. Features of the appearance of epidemiological foci of infectious diseases among the population.
5. The goals of sanitary-hygienic and anti-epidemiological measures in the epidemic focus.
6. Factors of the epidemiological danger of the occurrence of infectious diseases in the emergency zone.
7. The sequence of the epidemiological examination of the bacteriological focus.
8. Sanitary and epidemiological reconnaissance of the epidemic focus.
9. Determination of the sanitary and epidemiological state of the emergency area.
10. Quarantine and observation. Definition and content of activities.
11. Emergency prevention of infectious diseases.
12. Tasks and organization of a network of observation and laboratory control.

9.1. Tasks, goals and definition of sanitary and anti-epidemic provision of the population in emergency situations.

9.2. Organization of sanitary and hygienic measures in emergency situations.

9.3. Organization of anti-epidemic measures in emergency situations.

9.4. Objectives and organization of a network of observation and laboratory control.

9.1. OBJECTIVES, PURPOSES AND DEFINITION OF SANITARY AND EPIDEMIC SUPPORT OF THE POPULATION IN EMERGENCY SITUATIONS

Destruction of residential and public buildings;

Failure of water supply, sewerage and treatment facilities, utilities and industrial enterprises;

Intensive migration of various contingents of people;

Changes in people's susceptibility to infections;

Failure of sanitary-epidemiological and treatment-and-prophylactic institutions in the disaster zone;

The presence of a large number of corpses of people and animals;

Mass reproduction of rodents, the appearance of epizootics among them and the activation of natural foci of zoonotic infections.

All of the above reasons significantly worsen the sanitary and hygienic situation and significantly exacerbate the epidemic situation for many infectious diseases.

In the process of eliminating the medical and sanitary consequences of emergencies, the sanitary and epidemiological provision of the population is carried out in three directions:

Sanitary and hygienic measures;

Anti-epidemic measures;

Environmental control.

To determine specific sanitary and hygienic and anti-epidemic measures, it is necessary to take into account the peculiarities of various types of disasters, natural disasters and the influence of the entire complex of factors and consequences of emergencies both on the nature of the sanitary-epidemic situation and on the dynamics of the epidemic process in one or another nosological form of an infectious disease.

The solution of these tasks is of great importance and is entrusted to the territorial centers of the State Sanitary and Epidemiological Supervision and the institutions of the sanitary and epidemiological service.

Sanitary and hygienic and anti-epidemic measures are one of the most important activities of authorities, health care and other services, both in everyday life and in the event of an emergency in peacetime and wartime. They aim to address the following goals:

Preservation and strengthening of public health, disease prevention;

Prevention of the occurrence of infectious diseases among the population;

The fastest elimination of infectious diseases in case of their occurrence.

9.2. ORGANIZATION OF SANITARY AND HYGIENIC MEASURES IN EMERGENCY SITUATIONS

Sanitary and hygienic measures- a set of measures carried out in the emergency zone in order to preserve the health of the population and participants in the liquidation of the consequences of emergency situations. The main ones are:

Medical monitoring of health status;

Sanitary supervision of accommodation conditions;

Sanitary supervision of food and water supply;

Sanitary supervision of bath and laundry services;

Monitoring the sanitary state of the territory. The Sanitary and Epidemiological Service organizes and conducts

the following sanitary and hygienic measures in the emergency area:

Organization and conduct of an assessment of the sanitary and hygienic state of the territory and the determination of harmful factors affecting the health of the population and the environment;

Organization and participation in sanitary supervision over the conditions of accommodation of the population in the emergency area, its food, water supply, bath and laundry services;

Organization of sanitary and hygienic measures to protect the personnel of emergency facilities, participants in the liquidation of the consequences of the accident, as well as the population;

Organization of sanitary supervision at hygienically significant facilities that ensure the livelihoods of the population in the emergency area;

Medical monitoring of the health status of personnel of formations and institutions participating in the elimination of the consequences of emergencies, their provision with special clothing and protective equipment, their correct use;

Participation in the control of the sanitary state of the territory, its timely cleaning, disinfection and supervision over the burial of dead and deceased people and animals;

Organizational and explanatory work on the regime and rules of behavior for the personnel of emergency facilities, participants in the liquidation of the consequences of the accident and the population in the emergency zone.

source, give permission to use vehicles for the supply of water, if necessary, organize the disinfection of water in tankers, carry out selective control of the content of residual chlorine in drinking water and its quality.

When sewerage, treatment facilities and networks fail, wastewater flows into land areas and open water bodies, emergency measures are determined for carrying out repair and restoration work and stopping the discharge of untreated wastewater, daily bacteriological control of the water quality of the reservoir is carried out at control points.

Particular attention is paid to the implementation of measures among the population for the prevention of acute intestinal diseases transmitted by water and food.

In places of temporary resettlement of residents and personnel of formations, preventive measures are taken to create appropriate conditions for living, drinking regime, and public services.

9.3. ORGANIZATION OF ANTI-EPIDEMIC ACTIONS IN EMERGENCY SITUATIONS

Anti-epidemic measures in the area of action and nearby areas should be aimed at neutralizing sources of infection, breaking the pathways and mechanisms of transmission of pathogens, increasing the immunity of residents, reducing the possibility of developing certain forms of infectious diseases, weakening the effect of various extreme factors on people. Depending on climatic and geographical conditions, time of year, type of accident, catastrophe or natural disaster among the population, one can expect the spread of viral hepatitis, typhoid fever, dysentery and other acute intestinal infections, as well as natural focal diseases (plague, anthrax, tularemia, leptospirosis, etc. etc.). The possibility of the occurrence of other diseases is not excluded, for the prevention of which special measures are needed.

Anti-epidemic measures- a set of measures to prevent the emergence and spread of infectious diseases and the fastest elimination in case of their occurrence.

Anti-epidemic measures divide into two groups:

Measures to prevent the emergence and spread of infectious diseases;

Measures aimed at eliminating epidemic foci among the population in the emergency area.

The main anti-epidemic measures are as follows:

Sanitary and epidemiological reconnaissance of the proposed areas of dispersal and placement of evacuated residents in the suburban area;

Epidemiological surveillance, including the study of the sanitary and epidemiological state of settlements;

Timely identification of infectious patients, their isolation and hospitalization;

Accounting and remediation of carriers of pathogens and persons suffering from chronic forms of infectious diseases;

Prevention of infectious diseases through the use of vaccines, serums, antibiotics and various chemicals;

Vector-borne disease and rodent control.

The most difficult situation in terms of medical and sanitary consequences of emergencies arises when epidemic foci of infectious diseases appear among the population. They are characterized by the following features:

The presence of infectious patients among the victims and the possibility of an accelerated spread of infection;

Activation of mechanisms of transmission of infectious agents in emergency zones;

The duration of the contaminating effect of undetected sources and the appearance of long-term foci;

The complexity of the indication and diagnosis of infectious foci;

The presence of a minimum incubation period as a result of constant contact with undetected sources of infection, a decrease in resistance and a large infectious dose of pathogens.

To assess the degree of epidemic danger of infectious diseases in emergency zones, a method is proposed that takes into account the most significant factors:

Pathogenicity of an infectious agent;

Mortality;

Contagiousness (expressed by the contagious index);

The number of cases and the number of expected sanitary losses;

The number of contact persons and the need for their isolation (observation);

The size of the epidemic zone (levels: local, local, territorial, regional, federal).

The main anti-epidemic measures in the event of an epidemic focus are as follows:

Registration and notification;

Epidemiological examination and sanitary and epidemiological reconnaissance;

Identification, isolation and hospitalization of the sick;

Restrictive measures;

General and special emergency prevention;

Disinfection of the epidemic focus (disinfection, disinsection, deratization);

Identification of bacteria carriers and enhanced medical monitoring of the affected population;

Sanitary explanatory work.

Registration and notification. All identified patients and persons suspicious of the disease are taken on a special account. The chief physician of the center of state sanitary and epidemiological surveillance of the district (city) must be immediately notified of the detection of infectious patients. Upon receipt of data on the occurrence of highly contagious infections, the population of the district is also notified.

on disasters and adjacent territories with an explanation of the rules of conduct.

Epidemiological examination and sanitary and epidemiological reconnaissance. Each case of an infectious disease should be subjected to a thorough epidemiological examination in order to identify the alleged source of infection and to carry out basic measures aimed at preventing the spread of infection. Epidemiological examination of the focus includes the following sections of work:

Analysis of the dynamics and structure of morbidity by epidemiological characteristics;

Clarification of the epidemiological situation among the remaining population in the disaster zone, its locations;

Interview and examination of sick and healthy people;

Visual and laboratory examination of the external environment;

Identification of objects that economically worsen the sanitary-hygienic and epidemiological situation in the disaster focus;

Interviewing medical (veterinary) workers, representatives of the local population;

Inspection of the sanitary state of settlements, water sources, communal and food facilities, etc.;

Working out the collected materials and establishing causal relationships in accordance with the available data on the type of epidemic in a specific infection.

Sanitary and Epidemiological Intelligence- collection and transmission of information about the sanitary-hygienic and epidemiological situation in the emergency zone. IN tasks sanitary and epidemiological intelligence includes the following:

Revealing the presence and localization of patients, the nature of the outbreak and the prevalence of infectious diseases;

Establishment of the presence and activity of natural focal infections in emergency zones, epizootics among wild and domestic animals;

Inspection of the sanitary and hygienic state of the emergency zone, its settlements and water sources, economic facilities, communal and sanitary, medical and sanitary and epidemiological institutions;

Assessment of the possibility of using the forces and means of local health authorities, preserved in emergency zones, for work in epidemic foci.

The group of sanitary and epidemiological intelligence includes a hygienist, an epidemiologist (or infectious disease specialist), a bacteriologist, a laboratory assistant, and a driver.

Sanitary and epidemic condition of the area. Based on the data obtained, the state of the area is assessed. It can be assessed as prosperous, unstable, dysfunctional, and extreme.

Well-being:

Absence of quarantine infections and group outbreaks of other infectious diseases;

The presence of isolated infectious diseases that are not related to each other and that have appeared over a period exceeding the incubation period of this disease;

The epizootic situation does not pose a danger to people;

Satisfactory sanitary condition of the territory, water supply facilities;

Communal livability.

Unstable state:

An increase in the level of infectious diseases or the emergence of group diseases without a tendency to further spread;

The emergence of isolated infectious diseases related to each other or having a common source of disease outside the given territory with a satisfactory sanitary condition of the territory and high-quality implementation of a set of measures for anti-epidemic support.

Unfavorable condition:

The emergence of group cases of dangerous infectious diseases in the emergency zone or epidemic foci of especially dangerous infections in neighboring territories if there are conditions for their further spread;

Numerous diseases of unknown etiology;

The emergence of isolated diseases with especially dangerous infections.

Emergency condition:

A sharp increase in a short period of time in the number of dangerous infectious diseases among the affected population;

The presence of repeated or group diseases of especially dangerous infections;

Activation of natural foci of dangerous infections in the emergency zone with the appearance of diseases among people. Identification, isolation and hospitalization of the sick. The team in which the first case of the disease is detected should be closely monitored. With a number of diseases (dysentery, typhus, scarlet fever, etc.), it is necessary to organize daily rounds and interviews of the served contingents, and in case of suspicion of an infectious disease, isolate and hospitalize the sick.

Timely early withdrawal of the patient from the team serves as a cardinal measure to prevent the spread of infection.

Restrictive measures. In order to prevent the introduction of infectious diseases and their spread in the event of epidemic foci, a complex of regime, restrictive and medical measures is carried out, which, depending on the epidemiological characteristics of the infection and the epidemiological situation, are divided into quarantine and observation. The organization and conduct of these events are entrusted to the responsible heads of the administrative territories and the sanitary and anti-epidemic commission.

Quarantine- a system of temporary organizational, regime-limiting, administrative and economic, legal, treatment-and-prophylactic, sanitary-hygienic and anti-epidemic measures aimed at preventing the removal of the causative agent of a dangerous infectious disease outside the epidemic focus, ensuring the localization of the focus and their subsequent elimination.

Quarantine is introduced when patients with especially dangerous infections appear among the population, group diseases with contagious infections with their increase in a short time. When even isolated cases of plague, Lassa, Ebola fevers, Marburg disease and some other contagious diseases, as well as mass diseases of anthrax, yellow fever, tularemia, glanders, myeloidosis, typhus, brucellosis, psittacosine should be introduced, the quarantine regime should be introduced ...

Observation- regime-restrictive measures, providing, along with the strengthening of medical and veterinary supervision and the conduct of anti-epidemic, medical and preventive and veterinary-sanitary measures,

the movement and movement of people or farm animals in all administrative territorial units adjacent to the quarantine zone, which create the observation zone.

Observation is introduced in areas with an unfavorable or emergency sanitary-epidemic condition, i.e. with the appearance of group non-contagious diseases or isolated cases of contagious infections.

Observation and quarantine are canceled after the expiration of the maximum incubation period of this infectious disease since the isolation of the last patient, after the final disinfection and sanitization of the service personnel and the population.

Emergency prevention- a set of medical measures aimed at preventing the occurrence of human diseases in the event of their infection with pathogens of dangerous infectious diseases. It is carried out immediately after establishing the fact of bacterial infection or the appearance among the population of cases of dangerous infectious diseases, as well as massive infectious diseases of unknown etiology.

Unlike vaccine prophylaxis, emergency prophylaxis provides quick protection for those infected.

Emergency prevention is divided into general and special. Before establishing the type of microorganism that caused the infectious disease, carry out general, and after establishing the type of microbe-pathogen - special emergency prevention.

As means of general emergency prophylaxis, antibiotics and chemotherapy drugs of a wide spectrum of action, active against all or most of the causative agents of infectious diseases, are used (Table 9.1). The duration of the course of general emergency prophylaxis depends on the time required to identify, identify and determine the sensitivity of the pathogen to antibiotics and averages 2-5 days.

The order to carry out emergency medical prophylaxis is given by the sanitary and anti-epidemic commissions.

Simultaneously with the beginning of emergency prophylaxis in the foci of infection, it is recommended to carry out active immunization (vaccination or revaccination) of the population.

Disinfection of foci carried out by the forces of the state sanitary and epidemiological service by conducting current and final disinfection.

Disinfection- elimination of pathogens of infectious diseases in the environment. It can be carried out by physical, chemical and combined methods. Disinfection is carried out by disinfection groups. One such group, consisting of a disinsector, a disinfector and two orderlies, is capable of treating 25 apartments with an area of 60 m 2 each during a working day.

Disinfection of the territory, buildings and sanitization of the population is carried out by the communal service.

Disinsection- destruction of insects (carriers of infectious diseases). It is carried out by physical and chemical methods. The chemical method is considered the main one - the treatment of objects with insecticides.

Deratization- destruction of rodents (as a source of pathogens of infectious diseases). It is carried out by mechanical and chemical methods.

An extremely important event - identification of bacteria carriers. If during epidemiological examination and laboratory research carriers (typhoid-paratyphoid infections, cholera, diphtheria, etc.) are identified in epidemiological foci, then measures are taken in relation to them to protect others from infection.

In addition, there are measures for enhanced medical supervision of the personnel of the rescue teams.

To conduct a wide and effective health education radio, television, print should be used. It should be aimed at strict implementation by the entire population general recommendations according to the rules of conduct, observance of sanitary-hygienic rules and other measures of personal protection.

To ensure a quick response and conduct urgent sanitary and hygienic and anti-epidemic measures in the emergency area, on the basis of the institutions of the sanitary and epidemiological service, hygienic and anti-epidemic teams of constant readiness and epidemiological reconnaissance groups, from which sanitary and epidemiological detachments can be created. The profile and composition of the teams depend on the capabilities of the institution and the nature of the main activity.

9.4. OBJECTIVES AND ORGANIZATION OF THE OBSERVATION NETWORK AND LABORATORY CONTROL

Observation and laboratory control is organized and carried out in pursuit of the following goals:

Timely detection and indication of radioactive, chemical and biological contamination of drinking water, food, air, soil and environmental objects;

Taking emergency measures to protect the population, food, water and socially important facilities from AOKhV and bacteriological agents.

The surveillance and laboratory control network (SNLK) is an integral part of the forces and means of surveillance and control of the RSChS. SNLK has three levels:

Federal;

Regional;

Local.

The list of permanent readiness forces of the State Sanitary and Epidemiological Service of Russia at the regional and territorial level includes the centers of the State Sanitary and Epidemiological Surveillance in the territories of the constituent entities of the Russian Federation, anti-plague institutions, the Anti-Plague Center in Moscow and 11 anti-plague stations. All these institutions can form more than 70 sanitary and epidemiological teams and about 20 specialized anti-epidemic brigades (SPEB) based on anti-plague institutions to work in the emergency zone.

The head offices of the SNLK (the most prepared to perform tasks) are high-alert units with a readiness period of 8 hours.

The main task of the Federal Center for State Sanitary and Epidemiological Supervision of the Ministry of Health of Russia- participation in the development and implementation of measures to ensure laboratory control and examination of food, drinking water and food raw materials for contamination by pathogens of infectious diseases, as well as providing methodological assistance to institutions of sanitary and epidemiological supervision in emergencies in peace and wartime.

On republican, regional, regional, port, city, district 1st category TsGSEN of Russia and the corresponding TsSEN on railway transport of the Ministry of Railways of Russia, centers of sanitary and epidemiological surveillance and medical and sanitary units of the Federal Directorate of Biomedical and Extreme Problems under the Ministry of Health of Russia are entrusted with the following measures:

Conducting sanitary and epidemiological reconnaissance in the outbreaks of mass destruction by forces created on the basis of the TsGSEN (TsSEN) formations (epidemiological reconnaissance groups, sanitary and epidemiological detachments, etc.);

Establishing the type of microbiological agents for combat formulations in wartime and pathogens of infectious diseases in peacetime emergencies in samples taken from environmental objects, food, drinking water, food raw materials, as well as in materials taken from sick and corpses of people (specific indication);

Identification of isolated strains of microorganisms and toxins (only for republican, regional and regional CGSES);

Conducting a sanitary examination of food, drinking water and food raw materials contaminated with radioactive substances, OB, AOXB and infected BS, with the issuance of an opinion on their suitability for intended use;

Determination of the specific and volumetric activity of radionuclides in food samples, drinking water and food raw materials at controlled facilities;

Establishment of the radionuclide composition of the samples under study (except for the regional TsGSEN);

Determination of contamination of food, drinking water, food raw materials at controlled objects of OM and AOKhV;

Management of the work of lower levels of the Central State Sanitary and Epidemiological Service on the territory under their jurisdiction and providing them with methodological assistance.

The main tasks of city, district TsGSEN of the 2nd and 3rd categories of the State Sanitary and Epidemiological Supervision of Russia and the corresponding CSEN on railway, water and air transport are as follows:

Conducting sanitary and epidemiological reconnaissance in the served area;

Establishing the presence (on the basis of indirect signs) in environmental objects of microbiological agents of combat formulations in wartime and causative agents of infectious diseases of people in emergencies in peacetime;

Investigation of samples taken from environmental objects, food, drinking water and food raw materials for contamination with known pathogens;

Measurement of the dose rate of radioactive radiation on the ground in the area of the institution;

Establishing the presence of OB, AOXB in environmental objects, carrying out their preliminary identification;

Sampling from environmental objects, food, drinking water and food raw materials contaminated with radioactive substances, OM, AOKhV and infected BS, their delivery to the head CGSEN for laboratory research and sanitary examination.

The main task of the Anti-Plague Center of the State Sanitary and Epidemiological Supervision of Russia- methodological guidance of the activities of anti-plague stations on the issues of especially dangerous natural focal infectious diseases in emergencies in peace and wartime.

The main tasks of anti-plague stations and their branches are as follows:

Conducting sanitary and epidemiological reconnaissance in foci of bacterial contamination;

Identification of strains of microorganisms of the bacterial group isolated from various samples as a result of specific indication;

Upon receipt of dubious results, delivery to the appropriate center of specific indication of samples taken from environmental objects, food, drinking water, food raw materials, as well as materials taken from patients and corpses;

Measurement of the dose rate of radioactive radiation on the ground in the area of the institution;

Establishing the presence of OM in the environment and carrying out an indication.

Institutions of hydrometeorological stations included in SNLK, agrochemical laboratories, facility laboratories of some ministries and departments carry out the following activities:

Determination of the level of gamma radiation on the ground in the area of their placement sites;

Quantitative and qualitative laboratory control of the contamination of the AOKhV soil, plants and crop products, open water bodies;

Conducting reconnaissance in areas of chemical and radioactive contamination at agricultural facilities;

Revealing the nature of the epidemic focus.

In the departmental laboratories of the ministries responsible for the food, meat and dairy industry, fisheries, and others, they carry out monitoring and laboratory control of the contamination of state resources of grain and products of its processing, food raw materials, foodstuffs hazardous to humans and animals, state reserves food products manufactured, processed and stored at subordinate enterprises, warehouses and bases. The same laboratories civil defense carry out radiation, chemical, nonspecific bacteriological reconnaissance in areas of contamination (contamination), indication of OM, AOKhV, including rocket fuel components, participate in the training of specialists of production (facility) laboratories included in the SNLK.

The readiness of SNLK institutions to solve the tasks assigned to them is ensured by the relevant ministries and departments of the Russian Federation by training (training) specialists in peacetime and equipping departments, laboratories, stations and posts

the necessary equipment, instruments and techniques. The heads of SNLK institutions are responsible for the training (retraining) of specialists.

Sanitary and hygienic and anti-epidemic measures are one of the constituent parts of the national system of disaster medicine, an important section of medical support for the population and the elimination of the consequences of disasters and natural disasters.

test questions

1. Definition and objectives of sanitary and epidemiological provision of the population.

2. The main provisions of sanitary and hygienic measures to preserve the health of the population and participants in the elimination of consequences

3. The main anti-epidemic measures in emergencies.

4. Features of the appearance of epidemiological foci of infectious diseases among the population.

5. The goals of sanitary-hygienic and anti-epidemiological measures in the epidemic focus.

6. Factors of the epidemiological danger of the occurrence of infectious diseases in the emergency zone.

7. The sequence of the epidemiological examination of the bacteriological focus.

8. Sanitary and epidemiological reconnaissance of the epidemic focus.

9. Determination of the sanitary and epidemiological state of the area

TOPIC 10 MEDICAL SUPPLY OF FORMATIONS AND INSTITUTIONS DESIGNED FOR HEALTH CARE FOR THE POPULATION IN EMERGENCY SITUATIONS

TOPIC 11 MEDICAL SERVICE OF THE ARMED FORCES OF THE RUSSIAN FEDERATION IN EMERGENCIES

TOPIC 12 ORGANIZATION OF MEDICAL SUPPLY TO THE POPULATION IN LOCAL ARMED CONFLICTS

Sanitary and anti-epidemic provision of the population in emergency situations begins directly in the disaster zones, in the emerging epidemic foci and continues along the evacuation routes up to the places where the affected population is located.

Sanitary and anti-epidemic support is a complex of organizational, legal, medical anti-epidemic measures aimed at preventing the emergence and elimination of infectious diseases, as well as compliance with sanitary rules and regulations in the event of a sharp deterioration in the sanitary and epidemiological state in disaster zones and other emergencies.

5.1. Features of the formation of epidemic foci in an emergency and a general set of measures to prevent the spread of infection in the disaster zone

Epidemic foci in emergency situations:

A sharp deterioration in the social and living conditions of people in connection with the destruction of residential and other buildings, disruption of water and energy supply, deterioration in catering, the work of bath and laundry facilities, etc .;

One-time pollution of large areas of the territory, water sources, food raw materials;

The appearance of a large number of affected people who need to be hospitalized;

Aggravation of the epidemic situation for infections characteristic of the area;

Infection of people and animals through the use of contaminated water and food, mass migration of sources of infectious agents;

Decrease in the level of natural resistance of the organism in victims, which facilitates the formation of epidemic strains of pathogens and infection of various groups of the population;

The formation of many epidemic foci, the absence of their clear boundaries;

Accommodation of infectious patients in adapted rooms and at home due to the impossibility of evacuation or for medical reasons;

Re-profiling of medical and prophylactic institutions, re-equipment of public buildings and structures for the deployment of observators, hospitals and other medical units; - transportation, opening and burial of a significant number of the deceased, incl. and from infectious diseases;

The lack of a sufficient number of forces and means of the sanitary-epidemiological service and health care, which complicates the organization of the timely detection and isolation of infectious patients, laboratory diagnostics and the provision of medical care;

Late referral of patients, concealment of the disease during interviews and examinations of the affected population, refusal of hospitalization after the diagnosis has been established, which necessitates the participation of representatives of the executive power (police officers, riot police, etc.) in taking measures to timely isolate infectious patients who are dangerous to the surrounding area.

It should be borne in mind that sanitary and anti-epidemic support depends on the nature of the emergency, the volume and sequence of measures to eliminate the medical and sanitary consequences of specific local conditions, which include:

Utilities and amenities of the victims' accommodation;

Sanitary condition of settlements;

Availability and equipment of evacuation routes for infectious patients;

Infectious morbidity among the affected population;

Immune status of the population;

Staffing of medical personnel in medical and sanitary-preventive institutions;

Bed network of infectious diseases hospitals, including reserves for its additional deployment;

General set of measures to prevent the spread of infection in the disaster zone

- Registration. All sick and suspicious persons are registered at the sanitary-epidemiological institution, therefore, the dynamics of the admission of infectious patients is reported to the headquarters of the sanitary-anti-epidemic commission (SEC) at least twice a day, and in case of quarantine infections - every 2 hours.

- Epidemiological examination. When infectious patients appear among those who have entered the stage, a thorough epidemiological examination is carried out in order to identify the source of infection and the route of transmission of the pathogen, the number of people who communicated, and also to determine the volume of laboratory examination and indications for antibiotic prophylaxis or the use of immunotherapy.

- Hospitalization. Timely hospitalization of an infectious patient is a cardinal measure to prevent the spread of infection. The evacuation of infectious patients from epidemic foci in disaster zones is carried out by a special or adapted transport vehicle, which must be disinfected after each transportation. First of all, patients with highly contagious forms of infection are evacuated. If police officers, riot police, etc. are involved in escorting a patient, it is necessary to provide measures for their medical protection(clothes, protective mask, antibiotic prophylaxis, etc.).

- Strengthening sanitary and epidemiological surveillance: additional examination of water sources, food supplies, accommodation of evacuees, unscheduled examination of decreed contingents, etc.

- The use of means of general and special emergency prophylaxis or specific prophylaxis measures for epidemiological indications according to existing schemes.

- Widespread sanitation awareness campaign is carried out in order to increase the level of sanitary culture of the population, clarify the rules of behavior of infectious patients and carriers in disaster areas before their isolation, the procedure for using water sources, food, placement rules, rules of personal and public hygiene.

Requirements for the evacuation of injured and infectious patients

Among the affected population, active identification of patients with various infectious diseases arising due to the "mixing factor", which are subject to evacuation, should be carried out. The evacuation of such patients can be carried out both outside and inside the emergency zone. When planning the evacuation of infectious patients, their number, sequence and timing of removal, routes to hospitalization points or intermediate points are determined.

The main sanitary and anti-epidemic evacuation requirements affected and infectious patients are:

Organization of epidemiological surveillance;

Identification of infectious patients and those suspected of infectious diseases at the gathering places of the evacuated population, their isolation and referral to an infectious diseases hospital;

Conducting emergency prophylaxis (according to indications);

Equipment on the evacuation routes and in the places of resettlement of the affected infectious isolators, observators and monitoring the sanitary treatment of the population;

Control over the organization of food, water supply and bath and laundry services along the evacuation routes and in the places where the evacuees are located;

Monitoring compliance with sanitary and hygienic rules for the supply of drinking water and storage of food products intended for evacuated infectious patients;

Organization of control over the maintenance of a satisfactory sanitary condition of places and premises for temporary stay of the evacuees;

Fight against insects and rodents, control over the removal and disinfection of sewage and food waste along the routes. Evacuation is supervised by the headquarters of civil defense and emergency situations (GOChS) of the administrative territories. For practical implementation evacuation measures to help the headquarters of the Civil Defense and Emergencies, special evacuation bodies and formations are being created.

Health authorities and the sanitary-epidemiological service organize medical support evacuated population, representing a complex of medical and evacuation, sanitary and hygienic and anti-epidemic measures. These events are carried out at the gathering points, at the points of loading of the evacuation and disembarkation means at the places of destination, along the route and at the places of resettlement.

Sanitary and anti-epidemic support of evacuees is assigned at places of departure, arrival and placement, as well as on the route along highways and dirt roads - to local health departments, centers of sanitary and epidemiological surveillance of regional, regional, city, district, and along the route along railways- to the medical and sanitary authorities of MGTS, by waterways - to the medical and sanitary authorities of water transport.

The sanitary and epidemiological service of the republic, which is part of the Russian Federation, region, district, city bears full responsibility for sanitary and anti-epidemic support and allocates doctors from the composition of sanitary-preventive institutions to organize activities for health care evacuated groups. The duties of the above specialists include:

Clarification of the medical and sanitary conditions for the placement of evacuees;

Participation in the selection and equipment of places of departure, arrival and final placement of victims, as well as sanitary and epidemiological supervision over them;

Organization of medical examinations of evacuees, carrying out unitary processing measures for epidemic indications;

Organization and implementation of sanitary and epidemiological surveillance while traveling on trains, ships, on highways, on airplanes;

Conducting emergency special and specific prophylaxis for evacuees on epidemic indications;

Implementation of sanitary and epidemiological supervision over the organization of water supply and food.

When evacuating from disaster areas, the local sanitary and epidemiological service must have information about the contingent of evacuees. Persons responsible for the sanitary and anti-epidemic support of the evacuees must have constant communication with the executive authorities carrying out the evacuation.

Anti-epidemic measures along the route

Includes identification, isolation and hospitalization of infectious patients in nearby hospitals located on the evacuation routes of the population;

Sanitary supervision of food places,

Provision of good quality drinking water;

Disinfection measures.

Each train, ships and aircraft must have medical personnel appointed by the leadership of the territorial health care at the points of departure and simultaneously performing the functions of sanitary supervision (doctor, paramedic, nurse, epidemiologist assistant, disinfector - depending on the number of evacuees).

When evacuating the affected population on passenger trains medical personnel carry out:

Periodic inspection of all cars;

Identifying patients and providing them with medical care;

Notification of health authorities about existing cases of infectious diseases;

Isolation of patients with infectious diseases;

Preparation for evacuation and transportation of patients to inpatient healthcare facilities;

Supervision of the sanitary condition of wagons;

Keeping a sanitary diary;

Registration of documentation if it is necessary to remove sick or deceased from the train along the route.

Each train has separate compartments and carriages for temporary accommodation of patients. The medical staff of the train must have a medical box with medicines, incl. antibiotics for emergency prevention, disinfectants. All restaurants and buffets at railway stations should be reoriented to supply evacuees with hot water, food and milk for children.

If sick and suspicious of especially dangerous infections are found on the way, they are removed from the train at the nearest station that has a health care facility or an isolation checkpoint. Hospitals are required by telegraph notification from those responsible for the evacuation to prepare for the reception of infectious patients. When 20 or more infectious patients appear on the train or a case of a particularly dangerous infectious disease, the train is quarantined or monitored.

In this case, it is necessary to carry out:

Medical examination of all evacuees to identify, isolate and send to educational institutions all patients and suspected of having an infectious disease;

Emergency general, and when a diagnosis is made, special prophylaxis with antibiotics and other drugs; complete sanitization of evacuees, disinfection of their belongings and carriages (if necessary).

In case of evacuation by motor transport on highways and dirt roads, territorial health authorities organize medical, and sanitary and epidemiological institutions - sanitary and anti-epidemic measures in groups of evacuees (based on the availability of forces, means and conditions).

In places of arrival of evacuees the sanitary and epidemiological service carries out the following activities:

Participates in the selection of the territory and settlements of districts that are safe in terms of the sanitary and epidemic state;

Carries out sanitary and epidemiological supervision over the deployment and organization of work of reception centers for temporary accommodation (tent camps, dugouts and other places of stay), temporary infectious diseases hospitals for food, water supply of victims;

Organizes the sanitization of the arriving people and the disinfection of their belongings in the presence of epidemic indications in the medical facilities in the places of arrival of the affected population,

Provide for medical examination, first of all, the children's contingent, the provision of the necessary outpatient and inpatient care infectious patients,

Emergency prevention.

Anti-epidemic measures in temporary accommodation

Requirements for the place of accommodation of migrants.

Dry, not flooded, flat area with a natural slope for the removal of atmospheric precipitation;

Low groundwater table and clean, well-filtering soil;

Good sun exposure and ventilation;

Location close to sources of drinking and food supply, energy and heat supply, access roads;

Subdivision into two zones: residential (household) and service area;

Sanitary protection gaps between places of accommodation of people and objects that have a harmful effect on the evacuees;

When choosing a location, you must take into account the local seasonal wind rose;

The temporary site should not include natural foci endemic for especially dangerous infectious diseases, zones of sanitary protection of sources of drinking water supply, landfills and burial grounds of industrial waste, as well as be safe from landslides, mudflows, avalanches;

The territory must be landscaped in advance and subsequently kept clean and tidy;

Solid household waste should be collected in containers with a closed lid installed on hard-surfaced sites, which should be removed when they are filled to no more than 0.9 useful volume; the storage period for garbage in containers should not exceed 3 days in winter and 1 day in summer, washing and disinfection of containers should be carried out regularly, with the same frequency;

Septic tanks and cesspools should be filled no more than 2/3 of their volume, outdoor latrines should be cleaned and disinfected daily, should be lit in the dark, windows should be closed with a fine mesh;

Sanitary and hygienic requirements for premises and other facilities

The evacuated population is provided with housing, taking into account the deployment and construction, if necessary, of temporary dwellings (tents, yurts, dugouts, prefabricated or mobile homes, etc.), at the rate of 6 m 2 per person. The most acceptable prefabricated panel structures of residential buildings of domestic factory assembly (small houses), if during their construction and operation, the functioning of the necessary engineering equipment (ventilation, electricity, heat, water supply) is ensured. It is also possible to use the surviving housing stock (residential buildings, holiday homes, sanatoriums, boarding houses, military towns, children's camps).

The air temperature in rooms where there are infectious patients should not be lower than 18 ° C with an average relative humidity of 35-65%. In order to avoid excessive cooling, the victims should be placed on mattresses, beds, mats, bunks, etc., no closer than 0.5-0.8 m from the outer walls.

The rates of water consumption for the needs of infectious patients entering treatment are not less than per day: 75 liters for 1 patient being inpatient, and 45 liters for washing. To carry out sanitization, city baths or mobile disinfection and shower installations (DDA, DDP, bath and laundry trains, etc.) should be used.

It is necessary to have drying rooms for drying clothes and shoes, at the rate of 18 m2 of drying room area per 100 people. The air temperature for drying woolen and cotton clothes should be maintained at 60 ° С, for drying shoes and fur clothes - 40 ° С.

At a distance of 50-100 m from the living area, you should place: washbasins, at the rate of no more than 20 people. for 1 tap; outdoor toilets, at the rate of one toilet - for 20 women, one toilet - for 40 men.

Wet cleaning of living quarters using disinfectants should be carried out daily, general general cleaning of all premises is carried out at least once a week. Wash basins and toilets are cleaned and disinfected at least 2 times a day.

The distance from the place where people are accommodated to outdoor latrines is 50-100 m; cesspools - at least 5 m; waste bins - at least 20 m; pigsties and other livestock facilities - at least 200 m; open warehouse with coal - not less than 300 m; filtration fields - not less than 500 m; sewage fields - at least 1 km; landfill (landfill) - at least 3 km.

When deploying a campus in a tent version, it should be borne in mind that the period of living in tents is considered in hygienic terms as temporary (up to 6 months), since it is difficult to create stable and normal sanitary and hygienic living conditions in them.

Study questions:

1. Tasks, principles and main measures of sanitary and anti-epidemic support in emergencies. BSEC Criteria.

2. Organization and tasks of the observation and laboratory control network.

3. Organization of sanitary examination and protection of food products, food raw materials, water in emergencies.

4. Epidemics of infectious diseases and group poisoning.

5. The main sanitary and hygienic and anti-epidemic measures taken during evacuation measures in places of temporary settlement.

Introduction

The study of the history of various SB, catastrophes and wars that occurred both in the distant past and in the present period shows that in emergencies, epidemics often occur or the level of infectious diseases among the affected population rises sharply.

In the period and after the SB, accidents, catastrophes, during the conduct of hostilities, there is a sharp deterioration in the social conditions of life and everyday life of the population, a large number of mechanical injuries, burns and other injuries appear, in which the natural resistance of the body is significantly reduced, stress conditions arise and other phenomena. The population is deprived of housing, electricity, drinking water, the sewage system is destroyed, the work of bath and laundry facilities is disrupted, and the organization of food is deteriorating. All this significantly worsens the sanitary and hygienic situation, significantly aggravates the epidemic situation for a number of infections, a situation is created when potential sources of infection are not isolated for a long time, have numerous contacts with those around them.

In case of violation of ecological systems, it is possible to "revive" natural foci of especially dangerous infections (tularemia, plague, anthrax, etc.) and their spread.

The presence in laboratories and the accumulation by some countries of bacterial agents as biological weapons gives reason to assume the possibility of their use in war, as well as the likelihood of dispersion in the form of an aerosol in peacetime.

The organization and implementation of sanitary and hygienic and anti-epidemic measures along with medical and evacuation measures in the general system of liquidating the medical and sanitary consequences of emergencies is very important in preserving the life, health and working capacity of the population affected by emergencies and during the conduct of hostilities.

Question number 1

Tasks, principles and main measures of sanitary and anti-epidemic support in emergencies. BSEC Criteria.

Sanitary and anti-epidemic support in emergencies - this is an integral part of the medical and sanitary provision of the population, includes a complex of organizational, legal, medical, hygienic and anti-epidemic measures aimed at solving the following main tasks:

Prevention of the emergence of mass infectious diseases among the population in emergency situations of peace and wartime, and in case of occurrence, for their quickest elimination.
Preserving and strengthening the health of the population, maintaining its working capacity by ensuring sanitary well-being and eliminating the unfavorable sanitary consequences of emergencies or the use of weapons of mass destruction by the enemy in wartime.
Control over the observance of sanitary rules and norms in the emergency zone and in the places of resettlement of the affected population.

Sanitary and anti-epidemiological support is based on the following principles:

state and priority nature of the sanitary and epidemiological service;
a unified approach to the organization of sanitary and anti-epidemic measures;
compliance of the content and scope of measures, the sanitary - epidemic situation;
a differentiated approach to the formation of forces and means of service, taking into account regional characteristics, the level of potential danger of territories;
constant readiness of its forces and means, their high mobility;
interaction of the sanitary and epidemiological service of the Ministry of Health with the bodies and institutions of other departmental medical and sanitary services.

In order to prevent and eliminate the medical and sanitary consequences of emergencies, SES carries out the following main activities:

monitors the sanitary and epidemiological situation in and around the emergency zone;
organizes the examination of food raw materials, food products, drinking water, for contamination with radioactive substances, poisonous and chemically hazardous substances, pathogenic microorganisms;
conducts special training of employees of sanitary-epidemiological institutions and units for work in emergencies;
supports in a high degree of readiness the territorial centers of the State Sanitary and Epidemiological Supervision, the formations and institutions of the Sanitary and Epidemiological Service, the forces and means of research institutes functioning in the RSChS;
carries out the accumulation, storage, refreshment, accounting and control of medical property necessary for the work of units and institutions of the sanitary and epidemiological service in emergencies;
monitors compliance with sanitary rules, hygienic standards in the event of an emergency in peacetime and wartime;
organizes the work of a network of observation and laboratory control for the timely detection and indication of biological (bacteriological) contamination (pollution) of drinking water, food and fodder raw materials, food, environmental objects in emergencies in peace and wartime;
forecasts the possibility of epidemics on the territory of the Russian Federation.

In emergency areas, due to the deterioration of the sanitary-hygienic and epidemiological situation, epidemic foci often arise.

The epidemic focus is:

Place of stay of people with an infectious disease.

Or the territory within which people or farm animals were infected with the causative agents of infectious diseases.

The characteristic features of the epidemic in the emergency areas are:

The mass infection of people and the formation of multiple foci;

The duration of the focus due to unidentified sources;

Shorter incubation period due to constant contact with undetected sources of infections;

The presence of a large infectious dose of pathogens;

Lack of protection of the population and the affected from contact with infectious patients due to untimely isolation of infectious patients and untimely diagnosis.

The Epidemiological Emergency (BSEC) is assessed according to the following criteria :

the risk of the introduction and spread of infectious diseases among the population;
the progressive increase in infectious morbidity among the population in the epidemic.
the threat of a significant number of infectious patients with different etiology due to the "mixing factor";
possible social and economic damage;
the emergence of severe forms of infectious diseases that impede the timely evacuation of patients from the emergency zone to medical institutions;
impossibility territorial bodies fully cope with the epidemiological situation;
7. the risk of transmission of infection outside the emergency zone.

Upon arrival in the emergency zone, specialists of the sanitary and epidemiological service conduct a thorough epidemiological investigation, assess the epidemic state of the territory, formulate a hypothesis about the nature of the pathogen, the ways of its transmission and the possibility of further development of the epidemic.

The sanitary and epidemic state of the emergency area can be assessed as favorable, unstable, unfavorable and emergency:

Well-being characterized by:

The presence of isolated infectious diseases that are not related to each other;

Satisfactory sanitary condition of the territory, water supply facilities;

Communal livability.

Unstable state characterized by :

An increase in the level of infectious diseases or the emergence of group diseases without a tendency to further spread;

The presence of epizootic foci of zoonotic infections that pose a threat to humans;

The emergence of isolated infectious diseases related to each other with a satisfactory sanitary condition of the territory.

Unfavorable condition characterized by :

- the emergence of group cases of dangerous infectious diseases in the emergency zone in the presence of conditions for their further spread;

Numerous diseases of unknown etiology;

The emergence of single diseases of the OOI;

Extraordinary condition characterized by:

- a sharp increase in a short period of time in the number of dangerous infectious diseases among the affected population;

The presence of repeated or group diseases of AOI;

Activation of natural foci of dangerous infections in the emergency zone with the appearance of diseases among people.

Question 2

Organization and tasks of the observation and laboratory control network.

The SNLK system includes monitoring and laboratory control services of various ministries and departments, including the State Sanitary and Epidemiological Service. She is part of forces and means of observation and control of the RSChS. It has three levels: federal, regional, local and operates in three modes of activity. The general management of SNLK is entrusted to the Ministry of Emergency Situations of Russia.

The service has three main tasks:

1. Observation for objects of the external environment. This ensures the timely detection of contamination of environmental objects (food, food and feed raw materials, drinking water) RV, OV, AOKHV and BS using technical means.

2. Laboratory control- detection in samples from environmental objects (food, food and feed raw materials, water) of the desired agent, namely RV, OM, AOKhV, BS.

3. Indication agent - confirmation of the fact of contamination (pollution) and determination of the type of radioactive substances, ОВ, AOKhV, BS.

The fulfillment of these tasks by the SNLK system makes it possible to take urgent measures in time to protect the population, agricultural production from RV, AOKHV (OV), pathogens of infectious diseases.

SNLK system includes:

All-Russian Center for Monitoring and Laboratory Control of the Ministry of Emergencies;

Academic and industry research institutions;

Departments (laboratories) of a number of universities (hydrometeorological, chemical, toxicological, veterinary, agrochemical and other profiles);

Territorial centers for hydrometeorology and environmental monitoring;

Aviation and hydrometeorological stations and posts;

Specialized plants "Radon";

TsGSEN on air and water transport (basin TsGSEN);

Territorial TsGSEN;

TsGSEN on the railway transport of Russia.

Plague control institutions;

Plant quarantine border posts;

Veterinary laboratories;

Radiation and chemical observation posts;

Chemical and radiometric laboratories of civil defense;

Chemical and radiometric laboratories of civil defense carry out radiation, chemical, nonspecific bacteriological reconnaissance in contamination zones, indication of OB (AOXB), including propellant components, participate in the training of specialists at facility laboratories, including in SNLK.

The posts of radiation and chemical observation carry out the observation of the external environment and timely detection of radioactive substances, ОВ and AOKhV in environmental objects and their indication by technical means.

In accordance with the scheme of laboratory studies in institutions and formations of the Central State Sanitary and Epidemiological Service, up to 30 microbiological samples, 50 - toxic-chemical and up to 100 - radiological samples can be examined daily.

After the delivery of samples from the epidopic, the type of bacteria is determined, and a preliminary response is given in 1-3 hours, and the final response in 12-48 hours.

Question 3

Organization of sanitary examination and protection of food products, food raw materials, water in emergencies.

When the enemy uses weapons of mass destruction or in a number of technogenic emergencies in peacetime, food, food and water can be contaminated with radioactive substances, OM, BS. The degree of food contamination depends on the type of food product, the degree of sealing, the type of container, the quality of the packaging, the exposure time and the resistance of the acting agent.

Densely consistency and bulk foodstuffs are mainly contaminated superficially, and liquid ones - throughout the entire volume.

PB they can penetrate into grain to a depth of 30 mm, and into bakery products - up to 10 mm. FOV They penetrate in the form of vapors into bread to a depth of 20 mm, into meat - up to 70 mm, into pasta - up to 160 mm. Contamination of food and water BS can occur when aerosols with microbial formulations settle on them, contact with infected insects, rodents, sick people.

Most food products are a good breeding ground for the development and accumulation of pathogenic microorganisms. (the causative agent of cholera persists in oil for up to 30 days, in black bread - up to 4 days, in white bread - up to 26, on vegetables and fruits - 8 days; the dysentery microbe lives in water - up to 92, on bread - up to 20, on fresh vegetables and fruits - up to 6 days.

Overall responsibility for carrying out measures to protect food and drinking water rests with the heads of the corresponding administrative territories, in wartime, with the heads of civil defense. Direct responsibility for the implementation of these activities rests with the heads of the respective enterprises and facilities.

Protection of various types of food and water is carried out in the following main areas:

a) organizational;

b) engineering and technical;

c) sanitary and hygienic.

Organizational direction includes :

Dispersal of food stocks in the suburban area with the threat of emergencies;

Preparation of workers and employees of food facilities to carry out measures to protect food and water, as well as to carry out work on their disinfection;

Lab preparation. CSEN and formations for the indication of radioactive substances, AOKhV, OV, BS, sanitary examination and laboratory control over the contamination of food and drinking water;

Accumulation of disinfectants.

b) Engineering and technical direction includes :

Construction of new food warehouses, elevators in the countryside and reconstruction of old ones;

Carrying out works on sealing warehouse and industrial premises;

Introduction of hermetic equipment and containers for food storage;

Constant maintenance of water intake points and water supply network in a technically sound condition, as well as the creation of sealed containers for storing drinking water.

in) Sanitary and hygienicdirection includes :

Compliance with sanitary standards and requirements for storage, transportation of food, the maintenance of water sources in accordance with sanitary and hygienic requirements;

Carrying out works on the destruction of insects and rodents on the territory of objects;

Compliance by workers and employees of food facilities with the rules of personal hygiene;

Strict observance of sanitary norms and rules for technological and culinary processing of food products at catering establishments and at enterprises processing food raw materials.

Measures for the disinfection of food and drinking water at bases, warehouses, trade, industrial enterprises and water pumping stations are organized by the heads of these facilities and are carried out by the forces and means of object formations.

Control over the quality of disinfection of food and water is carried out by the Sanitary and Epidemiological Surveillance Service.

Disinfection is divided into: natural and artificial.

Natural disinfection carried out by leaving contaminated food and water for a certain period, during which the product is self-disinfected. Foodstuffs, fodder and water supply sources left for self-disinfection are marked with “Infected” signs, they are monitored and laboratory controlled. Food and drinking water contaminated with BS are not subject to natural disinfection.

Artificial disinfection produced in various ways:

washing containers with water or soap solutions,
treatment with disinfectants,
wiping the container with a rag,
transferring products to clean containers,
removal of the contaminated (contaminated) layer of the product,
settling of liquid products (when contaminated with radioactive substances), etc.

Decontamination of food and water includes decontamination, degassing and disinfection.

You went through these questions in detail in the course of general hygiene.

In the event of a focus of pollution (infection), the trade and catering service organizes its work in the next sequences:

I

At the food facility, food warehouse, by the facility medical service and the control units of the facility, a survey of the territory, storage facilities, food transport, packaging, inventory is carried out with the preparation inspection report.

II

Inspection of food products and their sorting on the:

Obviously contaminated (contaminated);

Suspicious for pollution - having no external signs of pollution (infection), but located near contaminated (contaminated) premises or areas.

Uncontaminated (non-contaminated) products are stored in safe and undamaged shelters and containers.

Only food and foodstuffs suspicious of contamination (contamination) after their neutralization are subject to examination.

III

After examining and sorting food and water, proceed to sampling.

Samples of water and liquid products are taken after thorough mixing. Samples of dry products are taken from the most suspicious places for contamination from the surface layers.

The samples taken are placed in jars, bottles, bags, which are packed in a rubberized bag and, as soon as possible, are delivered to the laboratory along with an accompanying note, which indicates the type of object, the conditions of the product, the state of the container, the type of product (name of the water source) , purpose of the study, date of sampling.

Sampling persons must wear protective clothing and use respiratory protection, and after completion of work, undergo complete sanitization.

Suspicious food and drinking water, until the results of laboratory analysis are obtained, must be safe, considered conditionally contaminated (contaminated) and cannot be used for food.

IV

The release of food products suspicious of contamination is carried out only after a sanitary examination.

As a result of the examination by a sanitary expert, the following decisions can be made:

1. The product is allowed for use without any restrictions(no pollution or contamination);

2. The product is usable by healthy people within a certain period, if the amount of radioactive substances (concentration of AOXV, OM) does not exceed the maximum permissible norms. This product cannot be sent to childrens and LUs. IN accompanying documents and on the container is marked "D-RV" or "D-AOKHV" (permissible contamination of RV or AOKHV). Products contaminated with BS must be completely decontaminated.

3. The product is usable, but to be sold through the communal system, if there is confidence that after culinary and technological processing, the amount of RS (concentration of AOXV, OM) will not exceed the permissible limits, and BS will be completely absent. This conclusion, the sanitary expert gives after the control cooking. After it, the finished product is subject to re-examination.

4. Product to be neutralized with re-examination.

5. Product not suitable for human consumption, but can be used for technical needs(handed over for recycling);

6. Product not usable and subject to destruction.

The destruction of contaminated (contaminated) food is carried out by burning or burying at a depth of at least 1.5 m with preliminary denaturation with oil, lysol, bleach, kerosene, etc.

Products to be disposed of or destroyed are transported in specially equipped closed vehicles. Transport after transportation of contaminated (contaminated) products is subject to decontamination.

Question 4

Infectious epidemics diseases and group poisoning. Measures for the localization of foci of mass infectious diseases in the OBZ.

Epidemic- This is a massive infectious disease of people within a certain region, when the level of infectious morbidity in a given territory is significantly higher than the usually recorded level of morbidity for this territory.

The emergence of epidemics can be associated with

ü Natural factors,

ü Climatic factors,

ü Material and household factors,

ü Social conditions,

ü as well as with biorhythms of macro- and microorganisms.

Conditional epidemics can be divided into: natural and artificial.

The emergence of an epidemic of infectious diseases in emergencies and in wartime contributes to:

A sharp deterioration in the social conditions of life and everyday life of the population (overcrowding, loss of housing stock, lack of electricity, drinking water, destruction of sewage systems, disruption of bath and laundry facilities, deterioration in catering).
Intensive migration of people.
The emergence of a large number of people with radiation sickness, mechanical injuries, burns, stressful conditions, which significantly reduce the body's resistance and increase susceptibility to infections.
Frequent non-isolation of sources of infection.
Mass reproduction of rodents, the appearance of an epizootic among them is possible, and there can also be an activation of natural foci of AOI (tularemia, plague, anthrax, etc.).
Possible use by the enemy of BW in wartime.
Deterioration of the sanitary and hygienic state of the territory due to the destruction of industrial enterprises, the presence of corpses of people and animals, rotting products of animal and plant origin.
Failure or disruption of the network of sanitary-epidemiological and health care facilities as a result of emergencies or the conduct of hostilities.

Measures to eliminate epidemiological foci (foci of infection with biological agents) are carried out in accordance with the anti-epidemic protection plan, which is compiled by the Central State Sanitary and Epidemiological Service in conjunction with the health management body and approved by the relevant executive authority or local government.

The decision to introduce a plan for the anti-epidemic protection of the population is made by the sanitary-anti-epidemic commission (SEC) in peacetime or by the head of the civil defense of the region, city in wartime.

The SEC is created at all levels of administrative and executive power. It is headed by the Head of Administration or his deputy. The deputy chairman of the SEC is appointed by the chief state sanitary doctor administrative territory. The composition of these commissions includes the heads of the services of the administrative territory (representatives of the governing bodies and institutions of the medical service, the Department of Internal Affairs, military units, spruce economy, transport links, trade, etc.).

The main anti-epidemic measures in the elimination of the epidemic focus (OBZ):

registration and notification;
epidemiological examination and sanitary and epidemiological reconnaissance;
identification, isolation and hospitalization of the sick;
carrying out regime - restrictive measures (quarantine, observation);
emergency non-specific and specific prophylaxis;
disinfection of the epidemic focus (disinfection, disinsection, deratization);
identification of bacteria carriers and enhanced medical monitoring of the affected population;
sanitary-explanatory work.

* When detecting patients with AOI or group diseases with acute infectious diseases or if there is an established fact of the use of BS by the enemy, the population is alerted.

* A sanitary-epidemiological reconnaissance or epidemiological investigation of the alleged area of infection is carried out, with sampling from the external environment, catching suspicious insects, rodents, etc. For this, ERTs are created.

* Active identification of patients, their isolation and hospitalization is organized.

(Timely and early isolation of the patient with final disinfection is a cardinal measure to prevent the spread of infection).

When patients with especially dangerous infectious diseases are identified, no later than 6-8 hours later, yard bypasses are organized according to the precinct principle of supervision, with the division of the site into micro-sections. Work at the micro-site is carried out by a medical team consisting of: a doctor, two nurses, two disinfectants and several people-activists (authorized) from the local population.

For such a brigade, a site with a population of up to 2000 people is allocated. It is provided with packing for the collection of material from patients, drugs for emergency prophylaxis, disinfectants (1.5 l), special forms, it can be attached to vehicles.

In addition to identifying patients and those suspected of having a disease, household visits are carried out to check the implementation of hospitalization of patients, mass vaccinations, to monitor the state of dwellings and territory, and to carry out sanitary-explanatory work.

It should be emphasized that the work of the brigade is carried out in a strict anti-epidemic regime, i.e. the personnel of the brigade work in protective clothing. Sets of these clothes are kept in the medical facility.

Each team draws up a door-to-door list of the population living in the area, including visitors.

Household visits are carried out at least twice a day with the obligatory measurement of the body temperature of all residents (thermometry is carried out by the residents themselves). Thermometry results are recorded in a special journal.

In the apartment, measures are organized to isolate the patient and carry out the current disinfection.

Patients with fever are hospitalized in the provisional department, and patients with symptoms characteristic of this disease are admitted to an infectious diseases hospital.

At the end of the day, each team fills out a special reporting form. The head of the brigade summarizes the information received and transfers it to the polyclinic, from where it is sent to the district health department.

* Depending on the characteristics of the infection and the epidemiological situation, quarantine or observation can be organized.

Quarantine is a complex of strict regime-restrictive, isolation and anti-epidemic measures aimed at preventing the removal of the causative agent of a dangerous infectious disease both outside the epidemic and its spread inside the focus.

The organization of quarantine includes:

Complete isolation of the epidemic with the establishment of an armed guard (cordon) in the adjacent territories. Barrage posts are set up on all roads leading to the epidemiological focus zone (OBZ).
Strict control over the entry and exit of the population and the removal of property from the quarantine zone. It is forbidden to travel through the center of contamination of vehicles and stops outside the designated areas when passing through transit railway and water transport;
Organization of checkpoints on the main routes along which the delivery is carried out additional forces and funds for the elimination of the outbreak. For material and technical supply, receiving and transfer points are organized through which raw materials, food products, property, equipment are delivered to the quarantine zone; through them is the export of finished products.
Creation of observators for persons leaving the quarantined zone;
Early detection of infectious patients, their isolation and hospitalization in a specially designated LU;
Restriction of communication between certain groups of the population, termination of the activities of entertainment establishments, educational institutions, markets, etc .;
Protection of infectious diseases hospitals, water sources, food warehouses, organization of commandant service.
Establishing an anti-epidemic mode of operation of medical institutions located in the outbreak;
Conducting emergency and specific prophylaxis and other measures.

When quarantining large administrative and industrial centers, the boundaries of quarantine include the adjacent settlements associated with it by local transport, common system supply and trade, as well as production activities. In the conditions of evacuation and dispersal from quarantined cities, the boundaries of quarantine expand to include settlements where the evacuated population is located.

The introduction of quarantine is accompanied by the simultaneous introduction of the observational regime in all administrative territories adjacent to the quarantine zone.

Observation - This is a set of restrictive measures that provide for the strengthening of medical supervision in order to timely detect cases of the appearance of infectious diseases, take emergency measures to localize them and eliminate the causes that contribute to their spread.

Observation includes:

Restriction of exit, entry and transit of all types of transport through the monitored territory. For this, adjusting posts are set up;
Conducting emergency prophylaxis among contact persons (vaccination);
Strengthening medical control over the state of the territory, catering, water supply, trade rules.
Surveys and thermometry of the population for the purpose of active and timely detection of infectious patients and their hospitalization;
Strengthening sanitary and educational work;
Restriction of movement and displacement of the population;
Decontamination of contaminated objects of the external environment and a number of other measures.

Observation and quarantine are canceled after the expiration of the maximum incubation period of a given infectious disease from the moment of isolation of the latter, final disinfection and sanitation of the service personnel and the population.

Removal of quarantine or observation is carried out by order of the chairman of the SEC, on the recommendations of health authorities and can be carried out gradually in separate settlements or in the entire zone at once.

In the epidemiological center, crowding of people is unacceptable, including in polyclinic institutions, therefore, medical care approaches the population and turns out to be at home or at enterprises and institutions.

In the medical unit and the MP of industrial enterprises and institutions located in the outbreak, medical workers transfer their activities to workshops and departments in order to avoid contact of persons seeking medical care. At the same time, the forces of medical posts and sanitary assets are actively identifying patients, thermometry of workers and employees at least twice a shift.

The personnel of formations, institutions and divisions at the end of the working day undergo a complete sanitization with a change of clothes. Depending on the specific conditions, these persons are accommodated in places permanent residence or go to the "barracks" position.

At all stages of the provision of medical care to infectious patients, the necessary anti-epidemic regimen must be provided.

* Disinfection of epidemic foci (disinfection, disinsection, deratization)

Disinfection of the territory, buildings and complete sanitization of the population is carried out by the municipal and technical service.

Disinfection of apartment epidemiological foci of infection, clothing is organized by the forces of the state sanitary and epidemiological service through the current and final disinfection. Disinfection - carried out by disinfection groups. One group, consisting of a disinfectant, a disinfector and two orderlies, is capable of operating 25 apartments with an area of 60 m 2 each during a working day.

* Carrying out emergency non-specific and specific prophylaxis to the population. The duration of the course of emergency nonspecific prophylaxis is determined by the time required to identify and identify the pathogen, on average 2-5 days.

* Identification of bacteria carriers and enhanced medical monitoring of the affected population, personnel of rescue teams.

* Strengthening sanitary and educational work. For this, radio, television, and print are used. This work is aimed at strict implementation by the entire population of general recommendations on the rules of conduct, compliance with sanitary and hygienic rules and other personal protection measures.

Question 5

The main sanitary and hygienic and p / epidemiological measures carried out during evacuation measures and in places of temporary resettlement.

Organization and implementation of sanitary - hygienic and anti-epidemic measures during the period of dispersal and evacuation of the population will present significant difficulties.

These events are organized and carried out by the Central State Sanitary and Epidemiological Service, the Research Institute of Sanitary and Hygienic and Epidemiological Profiles, anti-plague institutions, as well as the MSGS units created on their basis (SEO, SEB, SPEB, GER).

Sanitary and hygienic and anti-epidemic measures are organized and carried out at prefabricated evacuation points, intermediate evacuation points, reception centers, embarkation and disembarkation points, along the route, in areas of temporary and permanent accommodation of the evacuated population and include:

Constant control over the sanitary and hygienic conditions of accommodation in the places where the evacuees are accommodated.

Wherein:

The sanitary condition of the territory is monitored, its timely cleaning and disinfection. To accommodate the population during evacuation in hostels and other temporary premises, in tent camps, the minimum area norm should be 4.0 - 4.5 m 2 per person. Washbasins are installed at the rate of one nipple for 10 - 15 people. Toilets are equipped on the basis of one seat for 34-40 men and one seat for 25-30 women. When placing the population in a tent camp, field ditches are equipped (instead of bathrooms) at the rate of one ditch 0.3 m wide, 0.5 m deep and 1 m long for 20 people. Toilets and field ditches should be located at a distance of 50-60 meters from the place of residence of the population. Roviks should be located below water sources and at a distance of at least 200 m from them. Sewage in ditches must be disinfected and covered with a layer of earth. Sewage is collected in special containers. One container 50-100 liters for 50 people.

2. Control over water supply to the population.

Water supply is the most pressing problem during evacuation and in areas of settlement. When calculating the need for water, one must proceed from the fact that to meet the most basic needs, 10 liters of water will be required per person per day, and for sanitizing one person - 40-45 liters, for one patient being treated - 75 liters. water. Health authorities, as well as san-epid personnel. institutions and formations Special attention applies for control over the equipment of water intake points or the organization of the supply of drinking water on the routes. SES organizes laboratory control over the quality of water, its chlorination.

3. Nutrition control, compliance with sanitary and hygienic rules when storing food, preparing food at food facilities.

Timely identification of infectious patients, their isolation and hospitalization.

To this end, infectious isolation wards are being deployed at all medical centers along the evacuation routes.

Constantly held surveillance of the epidemic situation and information of the population about the epidemic situation.

Depending on the sanitary and epidemiological situation at the final settlement points, it may be necessary to provide the population with emergency prophylaxis of infectious diseases with antibiotics, mass vaccinations.

To carry out vaccinations for the evacuated population in all LUs, medical units, medical units, GO are organized vaccination teams composed of:

1 doctor and 2 paramedics

Or 1 paramedical worker and 2 sanitary workers (in this case, 1 doctor is allocated for 3-4 such teams).

It is also envisaged to organize, in a short time, mobile and temporary vaccination centers, created by the forces of health care facilities.

During the period of dispersal and evacuation of the population, it becomes very important sanitary enlightenment work among the evacuees, taking into account the situation.

Control over the organization of bath and laundry services for the population in the places of its accommodation.

If necessary, disinsection measures are organized (chamber treatment of linen and bedding).

6. Disinfection and deratization measures.
When organizing medical and sanitary evacuation, you should take into account climatic - geographical conditions.

In the cold season, for medical units, rescue teams and gathering points for the population, it is necessary to have warm rooms for heating people and drying rooms for clothes and shoes with an area of 15-18 m 2 per 100 people. Victims should be placed on mattresses, beds, mats, plank beds at a distance of at least 0.3-0.5 m from the outer walls.

When evacuating the population in winter, it is especially important prevention of frostbite in persons injured with blood loss.

To warm the affected, medical centers should provide them with blankets, heating pads, thermoses with hot tea.

When evacuating in hot climates, all measures must be taken to prevent heat and sunstroke, morbidity, gastrointestinal disorders.

When carrying out the evacuation of infectious patients, the necessary anti-epidemic regime is observed (patients are evacuated on special vehicles in accordance with the schedule for using the roads allocated for their movement).

Conclusion:

For the sanitary and epidemiological service, as well as for the entire health care system, abrupt, often unforeseen changes in the usual environment resulting from a natural disaster, catastrophe, accidents can be accompanied by numerous human casualties, mass diseases and injuries of people, a sharp deterioration in the sanitary and hygienic situation and extreme complex epidemiological situation.

In this regard, one of the main tasks of the VSMK and MSGO is to prevent the emergence and spread of massive infectious diseases among the population, to ensure the sanitary well-being of the population. The organization and conduct of emergency sanitary and anti-epidemic measures in emergency situations of peace and war are based on general principles health protection, medical care to the population, prevention of the emergence and spread of infectious diseases.

Art. Lecturer of the Department of MPZ and MK