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PernOHaJlbHoe OKP() OXOTHO ynoBneTBOPReT TaKHe npOCbObl. 06o3HaqeHHR, Hcno.rn,3yeMb1e B HaCTO.RllleM H3naHl1H, H nPHBO.llHMhle B HeM MaTepHaJlbl 1-lli B KoeM cnyqae He Bblpai,;aJOT MHeHHR CeKpeTapHaTa BceMHpHOH op,aH113aUHH 3.npaaooxpaHeHHR 0 IDPHJJHqecKOM CTa-ryce KaKOH-JlHOO CTpaHbl, TeppHTOPHH, ,opona HJlH paHoHa, HX o p,aHe BnaCTH H.l1H o(5 HX ,ocynapcTBeHHbl X .paHl•!UaX. YnoMHHaHHe HeKOTOPblX KOMnaHHH HJlH nponyKI..IHH OTne.rn,Hb(X H3,0TOBHTeneH He 03HaqaeT, qTO BceMHI)HaR op,aHH3aUHR 3,IlpaBOOxpaHeHHR OT,DaeT HM npe,III10qTeH1-1e no cpaBHeHJ1ID C .npyrnMH, He ynOMRttyTblMH B TeKCTe, H.l1H peKOMeHnyeT HX K HCnOJll,3 0BaHHID. KaK npaBHno, naTeHTOBaHHble HaHMeHOBaHHR BbinenRIDTCR HaqaJlbHblMH npoITHCHblMH 6 yKBaMH , 9 Ta ny6 .11HKaUHR OTPai,;aeT B31nR.Ilbl yqacTHHKOB naHHOH Pa6oqeH .pynrn,1 H Heo6R3aTeJll,HO npencraBnReT pelileHHR HJlH af)HUHaJll,HyID nOJlHTHKY BceMHPHOH o p,aHH3aUl1H 3.npaBooxpaHeHHR. J,13)lAHO B )lAHJ,111 ISBN 978 92 890 7342 4 ISSN 0250-8729 1. 2. 3. 4. 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Ecn11 npe.nnonaraeTcR, qTO napaMe.IIHUI-IHCKHH nepco ttan 6y.neT MaKCHMaJlbHO 11CCTOJlb3OBaThCR npH OKa3attJ,fJ,f HeOTflOllHOH nOMOfilH, OH ,UOJDKeH nonyqJ,tTb COOTBeTCTBYIOUIHH CTaTYC. 3TOMy 6y .IIYT cnocOOCTBOBaTb qeTKO COCTaBneHHble nporpaMMbl no.nrOTOBKH H aTTecTailllfl. nomKHoe BHHMaHHe cne.nyeT TaKJle y.nenRTh cnylle6HOMy npo.nBHJleHHIO npe.ncTaBHTeneH napaMe.IlJ,tUHHCKOro nepcoHana. B HeKOTOPblX paHOHaX CWA OTMeqeHO CHHJleHHe CMepTHOCTH HeKOTOPblX KaTeropHH OOJlbHblX, 17 nony-.:rnBIIIHX noBpell\,lleHHR, H PYKOBO.IIHTenH cnyi,;O C"IHTalOT, "!TO qaCTifllHO 3TO M0111J-10 o6DRCHHTb npHBneqeHHeM n apaMe,IlHIJHHCKOro nepcoHana K paOoTe cnym HeOTnomoH noMoruH. 5.3 Bpa"!H nepBH"IHOH nOMOIUH 8 TeX CJTY"laRX, KOr,Ila -rpeOyeTCR HeOTnomaR Me.DHUHHCKaR noMODlb, no0nH30CTH 3aqac-ry10 He ooaaeT apaqa. 0.llHaKO ecnH apaq OKa3b!BaeTCR Ha MecTe npoHcrueCTBHR, OH oC5R3aH OKa3aTb nepeylO nOMQDlb. 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B CIIIA, HaflPHMep, TaKOMY Bpaqy B <IHcne JIHU, npe~HHHMaKl]lHX CQarBeTCTBylOUlHe ,lleHCTBHR B <Jpe3Bbl<laHHblX CHT}'aUHRX, arBO~TCR UleCToe MeCTO, a Bblpa<1aM-cne1..1HaJ1HCTaM - ce.m,Moe.a B Coe.mrneHHOM KoponeBCTBe Bpa<I HearnO»iOH nOMOIIIH HMeeT nonHblA CTaTYC Bpa<1a-cne1..1HaJ1HCTa, H B HaCTOfllllee BpeMR pa3pa6oTaHa nporpaMMa no.uroTOBKH cneUHaJlHCTOB no OKa3aHHIO nOMOIIIH npH Hec<1aCTHblX cny<IaRX H <Jpe3Bbl<laHHblX CHT,'a.I.IHRX Ha TaKOM i,;e YPOBHe, <ITO H B nporpaMMa.X nonraroBKH cneUHaJIHCTOB no .opyrnM ~CUHnJIHHaM (cM. npHnOllteHHe III). 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OcHOBHaR uem, cnyi,;Ob1 HeoTnO:uiOH Me~UHHCKOH nOMOIJIH COCTOHT a nepBoe MecTO arBO~TCR <1aCTHblM nHuaM, BTOpoe - nOJIHl..lHH HJIH cny;iii:Oe nparHoonoi,;apHOH Oe3onacHOCTH, TPeThe - TaK Ha3blBaeMLIM TeXHHKaM HeoTnO»iOH nOMOIIIH, <1eTBePToe napaMe~UHHCKOMY nepcoHany H mnoe - 6oJU,HH<JHblM Me~UHHCKHM cecTpaM ( 0 t te n , J •, nH<IHoe coo(5111eHHe) . 19 B TOM, tITOO,I Bpatrn npHCTYffi{.llH K OKa3al-lH!O nOMOIIIH 6om,HoMy KaK Mo n-io CKopee nocne nonyqemm cooTBeTCTBylOIIlero CHniana, XOTR 3Ta o6R3aHHOCTb qacro BblTIOJil-iReTCR KOCBeHl-lblM nyTeM Ha paHHeH CTa)lHH OKa3aHHR nOMOl!lH . .IlnR nna.HHPOBaHHR cnyi,;0!,1 npei,;,ne acero Heo6XO.JIHMO onpe,neJIHTb ace ee <l>yHKUHH . 3aTeM Heo6XO.l]HMO onpe,ne.llHTb ee KOMllOHeHTbl, Ka.K TeXHJ,NecKHe, Ta.K H Ka,npoBble. Cne,nyeT y,ne.llHTb ,OOJIJPJioe BHHMaHHe KaqecTBY 3THX KOMllOHeHTOB H xapaKTepy CBR3H Mei,;,ny 1-!HMH. HaKOHeu, Heo6XO.l]HMO TIOMHHTb, qro moa,1e H3MeHeHHR, HanpaaneHl-lbie Ha ynyqrueHHe .neRTeJtbHOCTH cnyi,;61,1, 3aBHCRT OT COUHaJtbl-lblX (f>a.KTOpoB, CBR3aHHblX CO cnyi,;6ofl, H MO[YT Cl.lTb B IIIHpoKOM nnaHe KaTeropH3OBal-lbl Ka.K KJPH.l]H'IecKHe HJIH a,llMHHHCTpaTHBHble. I..ITO KacaeTCR Ta.Koro KOMllOHeHTa, Ka.K nepcoHan, TO 3.0ecb aan-io no.n.oepllGfBaTh HHTepec apaqefl K TOMy, trro npe.nnpHHHMaeTCR Ha acex CTa.l]HRX noManH B qpe3 Bbl'IaHHblX orryaUHRX. BpatIH He acer.na np1-1.naaa.11H ,no.lmioe 3HatieHHe nOTeHUHaJlE,HOH nOJib3e nepBOH noMOIIIH, OKa3WBaeMOH npe,ncraBHTeJIJIMH HaceneHHR. KpoMe Toro, oHH Mano c.nena.11H .Il]1R Toro, qToC'bl npo:l>ecCHOHaJibl-lble paoorHHKH, yqaCTBylOlllHe B OKa3aHHH nOMOlllH Ha paHHHX CTa.l]HRX B qpe3Bb(qaHl-lblX orryaUHRX, npOll1JIH COOTBeTCTBYIOlllYlO no.nrOTOBKY B npHHRTHH Mep, Heo6XO.l]HMblX JlJIR coxpaHeHHR JP;J.13HH TIOCTPa.oaBl!lHX H.11H o6nertieHHR HX CTpa,Ila.liHH. Ha COBpeMeHHOM 3Tane OTHaneHHe apaqefl K cnyi,;C>aM HeOTnomoH Me.l]HUHHCKOH TIOMOIIIH o6ycnoBneHO BeCbMa HH3KHM ypoBHeM HX co6cTBeHHOH no,nrOTOBKH B ,llaHHOH o6.naCTH. nOCKOJibKY B 6o1tblllHHCTBe c-rpaH apaqefl, KaK npaBHno, He OKa3blBaeTCR Ha MecTe npoHCl!lecTBHR, .Il]1R HHX a.mo a,1 BecbMa none3HblM yqacTBOBaTb He TOJtbKO B no.nroTOBKe napaMe.l]HUHHCKOro nepcoHana , HOH npoBO.l]HTb TipaKTH'IecKoe Ha6mo,neHHe 3a BblTIOnHeHHeM HM CBOHX <l>YHKt.n-!H- KpoMe roro, napaMe.llHUHHCKHH nepcoHan cnyi,;a,i HeOTnomofl noMomH .noni,;eH HMeTb B03MOJP;HOCTb Bbl3BaTb apaqa Ha MecTO npoHClllecTBHR B TeX cny<IaRX, ec.llH OH CTOJil-<HynCR C K.llHHH'IeCKHMH npo6neMaMH, neJP;3lllHMH BHe c<l>ePbl ero KOMlleTeHUHH. npH 3TOM aamo, trro6bl BpaqH, npoH3BO.llRIIIHe BMelllaTeJtbCTBO B Ta.KHX ci-rrya.uHRX, HMe.llH no,nrOTOBKY B o6naCTH HeoTnomoH Me.l]HUHHCKOH nOMOIIIH. noRBneHHe napaMe.JIHUHHCKoro nepcoHana, npruemero xopauy~ no,nrOTOBKY B o6nacTH HeOTnomoH TIOMOIIIH, RBnReTCR BecbMa Ba)P;Hb(M .IIOCTHJP;eHHeM. 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B octtoae HaH6onee nernoro nyTH ,oocTH1teHHR KOOp,IlHHaUHH, OCClOeHHO ecnH ,onR 3TOro npHHHM.alOTCR a,nMHHHCT!)aTHBHhle Mept,I, nel\HT HeOOJlbllloe 'IHCno areHTOB, PYKOBO,llflllIHX pa3mNHblMH KOMnOHeHTaMH cnyll6bi. O,IlHHM H3 nyTeH C03,IlaHHR ynpomeHHOH a.llMHHHCTpaTHBHOH CTPYKTYPhl RBnReTCR o6ecnet1eHHe ycnoeHH .onR Toro, t1To0bi Me,IlHKO-CaHHTapHaR nOMOIIIb OKa3hlBanaCb nepcoHanoM 3,IlpaBOOxpaHemtR; Heuenecoo6pa3HO HCTTOJlb3OBaTb pa6oTHHKOB cny1te'.l.1 npOTHBOnOllapHOH Oe3onacHocrH ,onR nepeBO3KH noc-rpa,oaBlllHX. <t>parMeHTapHblH x:apaKTep cnyl!.C'.1.1 HeO'rnOllO-iOH Me,IlHUHHCKOH nOMOIIIH MOl\eT noMemaTb ,IlOCTHl\eHHIO em BblCOKHX craH,IlaPTOB OOCnylPJ.iBaHHR, a ecnH CHCTeMa TaKHX cnyllO cyroecTByeT 3a C'leT o6atecrBeHHblX <t>OH,IlOB, Hea,oeKBaTHoe <t>HHaHCHpoBaHHe TaKl\e MOl\eT craTb npH'IHHOH CHHl\eHHR CTaH,IlapTOB paOOTbl Cny)IQ,I B pe3yJlbTaTe nORBneHHR MHOf'O'IHCneHHhlX conepHH'laKl!JlHX qacrHblX cnyl\6. 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B KOHTPOJ!bHOM JlHCTe .0O.mt.Hbl ('.°J,ITI, YKa3aHbl ycraHosneHHbte craH.napn.1, H O.IIHHM H3 3neMeHToB cpasHeHHR C Ccx::TaBneHHblM nepe~eM Oy .neT creneHb, B KO'rQ\'.)OH KOMnOHeHTI,t CHCTeMbl COOTBeTCTByITT craH,DapTaM. BeCbMa none3HO npoBO,llHTh KaK MO)f;I-1O blHPe KOJIH't:/eCTBeJrnoe onpe.neneHHe Hl-ft>opMal..lHH, a He nonaraThcR npocro Ha KaqecrBeHHbte cpaBHeHHR. YTO KacaeTCR .npyrnx cnocoOoB oueHKH, BeCbMa ueHHblMH MOryT OKa3aThCR HeKO'rOpt,le HaUHOHaJibHble PYKOBO.llRlllHe npOHHUHilhl H3yqe1-D-fR TaKOH Hm>opMal..lHH. Cne.nyta11eH cryneHbID oueHKH RBJIReTCR aHaJIH3 paOOI'bl CHCTeMbt, H.rtH ee pe3y11bTaTHBHOCTH. 9TO 03HaqaeT H3MepeHHe TaKHX napaMeTPOB, KaK BpeMR, qepe3 KO'ropoe Cl,tna BbtcnaHa MalJIHHa CKopoH nOMOIIIH HJIH KO'rOpoe npomoo .no roro, KaK Obtna OKa3aHa <t>aKTH't:/eCKaR ne't:/eOHaR noMOllib. HMeJIBO B 9TOM nna.He OCOOOJIBO ueJIBOH MO~eT OKa3aTbCR TeXHOnOnf4eCKaR nOMOlllb, HanpHMep B HeKO'ropblX PaffOHaX ClilA; pernCTPaUHR H aHaJIH3 Bhl3OBOB H ,O'rBeTHhlX .neHCTBHH CO cropoHbl cny~Ci,t HeO'rnQ)f;I-IOH Me.DHUHHCKOH noMOIIIH RBJIReTCR B HaCTORblee BpeMR KOMnOHeHTOM npouecca oueHKH. Cei'iqac B Oo11bllIHHCTBe cnyqaeB oueHKa cny~ HeoTnO)f;I-IOH Me)lHUHHCKOH nOMOlllH npoBO.DHTCR B COOTBeTCTBHH C npHBe.neHHhlMH 3,lleCb npHl-lUHllaMH, O.DHaKO Bee B03paCTaeT Heo6XO.DHMOCTh B aHaJIH3e pe3y11bTaTHBHOCTH TaKHX cny~r:5 B nnaHe 3a6oneBaeMcx::TH H CMePTHOCTH H B ocor:5eHHOCTH B aHa.11H3e 3aTpaT H Bblro.O, CBR3aHHblX co cny~OoH onpe.neneHHOH CTPYKTYpt,I . O.DHaKO TOT <t>aKT, qTO cny~('.'J,1 HeoTnO)f;I-IOH Me)lHUHHCKOH nOMOIIIH COCTORT H3 MHorotrncneHHh!X 9neMeHTOB, 3aTPy.DHReT BbtnOnHeHHe 3TOH 3a,oaqu. BecbMa ueHHOH OCHOBOH .DJ1R Hay't:/Hb(X HCCne.noBaHHH no onpe.neneHHJO 9¢xt>eKTHBHOCTH H pe3yJ!bTaTHBHOCTH cny~r:5 MOryT cTaTb KOHTPQnupyeMbte HCTlblTaHHR ( 6 ) . 22 7. BblBO,Ilhl H PEKOMEHJJ.Al..lilll 7.1 8b1BO,llbl no pa3,neny 2: Knacc!il>HKaUHR qpe3BblqaHJ-ib(X Me,llHUHHCKHX ci,rryal..lHH a) BOJJee ~eKTHBHble nyTH Knaccm>HKaUHH qpe3.B1,1qaHJ-ib(X Me.l]HllHHCKHX cwryaUHH, KOTopble MOl!HO Oblno a,i pa3paooran,, oOnel""IaT oueHKy cnyJKO. 0) BeCbMa none3HblM C:1,ino C'l,i KomNecrBeHHoe oope,neneHHe BMet:daTeJlbcTBa no THnaM paoorHHKOB cnyllCibl HeOTnOJKHOH Me,llHUHHCKOH nOMO!UH, npe,nnpHHHMaIOl!IHX HeoOXO,llHMble ,neHCTBHR B OTBeT Ha nOCTYnHBmHH CHnian. no pa3,neny 3: OpraHH3aUHR cnyJKO HeOTnOl!HOH Me,llHUHHCKOH nOMOMH BHe OOJlbHHU a) OblymaeTC.FI Heo0XO,llHMOCTb B TeXHffqeCKH pe3YJlbTaTHBHOH CHCTeMe Bb130Ba. 0) TaM, r.ne cpe,llCTBOM Bbl30Ba RBnReTCR Teneq,oH, H,IleaJlbHblM C'l,in O>l e,llH'.HblH HOMep OecnnaTHOro Bbl30Ba. B) Cne.nyeT noompnn, no,nroTOBKY HaceneHHR B o6naCTH OKa3aHH.FI nepBOH nOMOmH. r) HeoOXO,llHMO npe.nnpHH.FITh ncribiTKY aHanH3a 3aTPaT H Bblr'O.Il, ocoOeHHO ecnH 3TO OTHOCHTC.FI K peaHHMaUHOHHblM MeponpH.FITH.FIM npH cep,netrno-nero~IX COCTO.RHH.FIX . .n) Mo;,;eT npHHeC'rH nOJlb3Y BOBneqeHHe Bpaqefl B KOHTPQnHpoBaHHe cnyir-0 fl,(CblnKH MaMHH CKopoH nOMOlllH, a TaJ<;ti;e B no.nrOTOBKY nepcoHana .onn TaJ<HX cnyir-6. e) Cne.nyeT oOecneqHTI, B03MO;ti;HOCTb ,nn.FI COCTaBneHH.FI nepeqHR Me;ti;.nyHapO,llHblX CTaH,napTOB MamHH CKOpoH nOMOlllH H OOOpy,nOBaHH.FI TaJ<HX MamHH. 23 no pa3,oeny 4: Opra.HH33UHfl cny;,;0 HeOTnOlfJ-IOH Me.IIHUHHCKOH noMOIIIH B OoJlbHHuax a) BOJlbHW-!Hbie OT,OeneHHR HeoTnomoH nOMOIIIH, npOH3B0.llRlllHe ouel-D<y COCTORHHfl OoJlbHblX H Ha<IaJlbHoe ne<IeHHe, RBJIRJOTCR Ba!Oih!M cpe.ocrBOM ,um><t>epeHUHaUHH cneUHaJIH3HPQBaHHOH H nepBH'lHOH MeJIHUHHCKOH noMOIIIH. 0) JleRTeJlbHOCTb TaJ<HX OT.oeneHHH .oon;,;Ha OblTb HHTerpHPQBaHa C paOoToH BpatieH nepBH'lHOH nOMOIIIH C TeM, tITo6br nOBblCHTb 3M>eKTHBHOCTb H pe3yJlbT3THBHOCTb cny;,;a,i B uenoM. B) CneUHamcT, paOOTa KOToporo B nepByio oqepe.m, CBR33Ha C OKa3a.HHeM nOMOIIIH npH Hec<IacrHbIX cny<Ia.RX H KOTOPbIH RBJlReTCR qneHOM nepcoHana OT.oeneHH.R HeOTnOlfJ-IOH noMOlllH, MO;!.eT co.oeAcrBOBaTb nOBblllleHHIO CT3H.03PTOB oOcnymBaHH.R. r) Bamo, tITOCi.I OoJlbHH'IHble OT.oeneHHR HeOTnOlfJ-IOH nOMOIIIH Cl,(JIH o6ecnetieHbl Heo6XOJIHMbIMH noMemeHHRMH H nonyqam no.o.oep;!,Ky co CTOpoHbl COOTBeTcreyl()DlHX HayqHb!X yqpe;,;,neHHH H cneUHaJIH3HPOBaHHblX OoJlbHH'lHblX cny;,;(5 • .0) UeHHbIM cpe,OCTBOM CBR3H Me;,;,ny OoJlbHH'lHLIMH OT.oeneHH.RMH HeOTnomoA noMOIIIH H cny;,;OQA pacnpe.oeneHHR Mal!IHH CKopoH nOMOIIIH RB1lReTCR paJIHOTenecl>oH. no pa3,oeny 5: nepcoHan cny;,;O HeOTnomoA MeJIHUHHCKOH nOMOblH a) napaMeJIHUHHCKHH nepcoHan, npCllle,IlblHH cneUHaJlbHYIO no.oroTOBKY B oOnacTH CKa3aHHR HeOTnomoA MeJIHUHHCKOH noManH, 3a.HHMaeT Bee Oonee oomoe MecTO B paOOTe 24 TaJ<OH cny;,;a,1, ocoOeHHO Ha paHHHX CTaJIHRX OK33aHHR noMOblH. 6) EcJIH Bpa<IH nepBH'lHOH noMOIIIH npaiinH cneUHaJlbHYIO no.oroTOBKY B oOnacrH HeOTnomoH Me,llHUHHCKOH noMOlllH , HX 3H3HHR MOryT npHHecTH CT0Jlb3Y cnylltOe HeOTnomoA Me.llHUHHCKOH nOMOIIIH, oco6eHHO B OT,OaneHHbIX paHOHax. B) Bee npot>eccHOHaJlbHbie paOoTHHKH .00~1 npoATH COOTBeTcrBYIOl!IYIO no.orOTOBKY no OK33aHHIO nepBOH noMOlllH. no pa3,neny 6: nnaHl-fPOBaHHe H oueHKa cny!tO Hearno!tHoH Me.IIHUHHCKOH nOMOIIIH a) nnaHHpoaaHHe pe3y.TlbTaTHBHOH cny!tObi Oy,neT oOner"leHO, ecJU.1 BCe ee sneMeH'll>I OyJXYT HaXO.llHTbCR B Be.lleHHH o,llHoro opratta. 6) OueHKa CJiy'll.6 HearnomOH Me,llHUHHCKOH nOMOlllH 3aTPy,llHeHa, nOCKO.TlbKY OHH COCTORT H3 MHOrot01cneHHblx sneMeHTOB, H TeM He Mettee Otta HeoOXO,llHMa. B) nepBhIMH C'I'YTleHRMH oueHKH CJiy'11.6bI ffBJlfllOTCR SnH,neMHonorw1eCK11e 11ccne,noBaHHR H HHBeHTap113aUHR cnyi,;Obl. r) Heooxo,llHMbl 11ccne,noBaHHR no onpe,neneHHIO pe3y.TlbTaTHBHOCTH H 9'1>¢eKTHBHOCTH cnyi,;6. 1. OC'¥i!ecTBeHHhle opraHbl ,llOJDIHbl rapaHTHpoBaTb K~OMy rpall,Ila.HHHy npaBO Ha nonyt1eHHe KaK Momo oonee pe3yJlbTaTHBHOH nOMOIIIH H KaK MO!tl-1O B oonee KCJPOTKHH cp<)K nocne npOHClllecTBHR; He HapyniaR npH 9TOM CyniecTBYKXllHe nono'll.eHHR, rapaHTffPylQllHe yBa'll.eHHe ,llOCTOHHCTBa H 3aIIIHTY CBOOO.ll>I mNHOCTH, 2. Me.IIHUHHCKaR nOMOlltb 00.TlbHblM H nOCTpa,llaBIIIHM B Hec'laCTHblX cnyqaRX J1HUciM OTHOCHTCR no 00.TlbllleH 4aCTH K ol>epe Me,llHUHHhl, n09TOMy HeO6XO,llHMO pa3BHBaTb KOHUem.IHIO HeOTnOllliOH Me,llHUHHCKOH nOMOlllH KaK KOMllOHeHTa nepBH'IHOH Me,llHKO-CaHHTapHOH nOMOIIIH. 3. Bbl3OB CJiyl!C'.:bl Me,llHUHHCKOH nOMOblH ,llOnl!eH ocymecTBJIRTbCR no e,llHHOMy .ll1lR BCeH CTPaHbl Tenel>OHHOMy HOMepy. 3a Tenel>OHHblH Bbl3OB He ,llOnl!Ha B3HMa.TbCR nnaTa HH B BH,lle MOHeT, HH B BH,lle l!eTOHOB. KpoMe Toro, Tenel>OHHaR CBR3b ,llOnl!Ha npepblBaTbCR TO.TlbKO onepaTopoM npHHHMalOIIJero nyHJ<Ta, a He JU.1UOM, c.nenaBIIIHM Bhl3OB, HaKOHeu, Tenel>OHHblH HOMep nocne.IIHero ,llOn'll.eH no B03MOJ!HOCTH aBTOMaTH'leCKH H,lleHTl-fl>HUHP<)BaTbCR npHHHMaJOII!HM nyHKTOM, 4. Heo6XO.IIHMO o6ecne'IHTb COBMecTHMOCTb pa3nH'IHblX CHCTeM Bbl3OBa, 25 5. OpraHH3aUHR HeornOJ!QiOH MeJlHW1HCJ<OH OOMOillH .llOnJ!Qia COOTBeTCTBOBaTb cyniecTBYIOllleH opraHH3aI..IHH nepBH\fHOH Me.mn<O-CaHHTapHOH OOMOIIIH H B c.nyqae Heo6XOJlHMOCTif ee YJ<penmrn,. 6. OpraHH3aW1R HeoTnOJ!QiOH MeJlHW1HCKOH noMauH He WnJ!Qia 0.1Tb OpHeHTHP()BaHa HCJUO'-lliTeJlbHO Ha .nopoJ!QiO-TpaHCOOPTHble np()HCllleCTBHR, a .llOJmia oOecnetrnBaTb B03MOJ!QiOCTb npe.nOCTaMeHHR noMOiaH npH ~3BLl'IaHHblX XHPYPn,rqeCJ<HX H MeJlHWiHCKHX CHTYaUHRX. 7. CneJlYeT oC5ecnetrnTb KOOPnHHaUJ,flO HeoTJJOJ!QiOH MeJlHW1HCKOH noMOMH Ha YPOBHe perHOHOB. 8. ¢yHKI..IIDf Bpa<IeH nepBH<IHOH noMODIH Heo0XO,llHMO HHTerpHP<)BaTb C CHCTeMOH HeoTnOJ!QiOH Me,llHW1HCJ<OH noMomH. 9. Bbl30B Cny;t;C':l,i .llOn;t;eH nepe.naBaTbCR B e,llHI-D,IH UeHTP, Ha KOTOPblH B03J10;!.eHa OTBeTCTBeHHOCTb 3a BCe ~3Bbl<IaHHble Me.IIHUHHCJ<He CHTYaWiH, npH 3TOM pe3yJlbTantBHOCTb OOMOIIIH H cnaceHHe noc-rpa.naBlllHX 6yJlYT B onpe.neneHHOH Mepe 3aBHCeTh OT BOMetieHHR BpatieH B KOHTPOJlb Bbl30BOB. 10. CneJlYeT OTMentTb HeoOXOJlHMOCTb COTPY.llHH'IecTBa B o6naCTH OKa3aHHR HeoTnOJ!QiOH MeJlHUHHCJ<OH noMauH Me;!(JlY BCeMH OoJlbHHuaMH H BHe0oJlbH1-fqHb[MH Me,llHUHHCKHMH cny;t.6aMH, KaK rocy.naPCTBeHHblMH, TaK H qaCTHb(MH. 11. .IlM OOBbll!leHHR BKna.na Me,llHW1HCJ<Oro H napaMe,llHUHHCJ<Oro nepcoHana B paOoTY cny;t;~ HeornOJ!QiOH Me,llHUHHCKOH noMaitH 3TOMY nepcoHany cneJlYeT npoHTH cneUHa11bHYIO 00.nrOTOBl<Y B oonacTI! HeOTnOJ!QiOH OOMODIH. 12. Cny;t.6a HeoTnOJ!QiOH Me,llHUHHCKOH noMODlH .llOJmia Q,(Tb ooecne<IeHa pa,llHOTene¢OHOM, tIToe:t,l MOJ!QiO 6binO Bl,(3BaTb ManrnHY CJ<OpoH nOMODlH HnH Bpatia OO!leH npaKTHKH, <ITO oco6eHHO BaJ!QiO B ceJlbCJ<HX paHOHax. 13. B OoJlbHHUax mn;!(Hb( HMeTbCR noMeDteHHR H oOopy.nOBaHHe .llM CBR3H .npyr C .npyroM H BCeMH .llPYrHMH 3BeHbRMH, yqaCTBYIOMHMH B OKa3aHHH HeornOJ!QiOH OOMOlllH. 26 14. Cne,oyeT npoBeCTH a.Ha.JIH3 npaBHJl ,IIBHJ,;eHHR TpaHcnopTa , npe,oyCMaTJ)HBalO!lll-OC npeHMY!UecTBO MaJIIHH CI<opoH OOMOIIIH nepe.n .IlPYrHMH TpaHCTlOPTHl>IMH cpe.ncTBaMH. 15. Cne,oyeT COBepDJeHCTBOBaTh YCTPOHCTBO MaDJHH CKOpoH OOMOIIIH H npe,llHa3HatreHHoro .l1JlR HHX o6opy.noBaHHR. 16. BepToneT cne,oyeT paccMaTJ)HBaTh Ka.K BaJ,;Hoe H mmr.na He3aMeHHMoe TpaHCllopTHoe cpe.ncTBO, nOCKOJlbKY ero HCllOJib30BaHHe B trpe3BbltraHHhlX CHTYal..GiRX noMOraeT C3KOHOMHTh apeMR H OOBbllilaeT Oe3onacHOCTh nocTJ)a,naBDJl-0{, 17. HeoOXO,IlHMO pacnpoc-rpaHRTb HHl>opMaUHIO O cny;,p;Oa,x HeOTJIO)f;HOH Me,llHUHHCKOH OOMOlllH, BK.Tll()t{aJ'I pe3yJlbTaThI HCCJle.llOBaHHH B 3TOH o6nacTH, ocoOeHHO 3TO OTHOCHTCR K pa3BHBalOl!lHMCR CTpaHaM, 18. TTOCTYOaIOl!lHX B 6oJibHHl..lbl .mru, nOCTpa.naBDJHX B pe3yJlbTaTe trpe3BbltraHI-lblX OOCTORTeJlbCTB, cne,oyeT pa3,l1e.lIHTh Ha 4 KaTeropHH: i) 6oJibHble BblCOKOro PHCI<a C yrpOllCalOIJlHM .l1JlR Jp;J.i3HH COCTORHHeM, T, e. 6oJlbl-lble B trpe3Bl,[t{aHH0 TRJ,;eJIOM COCTORHHH: ii) OOJlbl-lble C nOTeHUHaJibHO onacHblM .l1JlR )p;H3 HH COCTORHHeM, HY)f;.llaIOl!lHecR B cpotrHOH OOMOIIIH (TepaneBnrtrecKOH, XJ.iPyprntreCKOH, OCHXHaTJ)HtreCKoH); iii ) 6oJlbHble, COCTORHHe KOTOPblX He TJ)eCiyeT cpotrHOH noMonm, T, e . mrua c MeHee cePbe3HblMH HapyroeHHRMH; i V) 6oJlbHble, COCTORHHe KOTQPblX Tpe(jyeT TDJaTeJlbHOro aHaJIH3a, Cne.noBaTeJlbHO, npH OQCTYOJleHHH B 6oJlbHHuy nOCTJ)a.naBDJI-OC cne,oyeT HCXO,IlHTh H3 .llBYX OCHOBI-lblX KaTeropHH 6oJlbl-lblX: i) 6oJlbl-lble, HY)f;.llal<l!JHecR B m-rreHCHBHOM netreHHH HJlH HenpepblBHOM Ha6rno.neHHH: Ta.KHM 6oJlbl-lblM .neHCTBHTeJlbHO Heo6XO,IlHMa HeoTJIOJ,;HaJ'I nOMOlllb ( 6oJlbl-lble C yrpOJ,;aJODJHM .l1JlR ni3HH COCTORHHeM, 6oJlbHble C nOTeHUHaJlbHO onacl-lblM .l1JlR )p;H3HJ.i COCTORHHeM) : 27 i i ) OOJibHhle, KOTopble npelt,lle BCero ,llOJlJIQibl CbiTb OCMQTPeHhl, np()KOHcyJibTI!p()BaHbl H OTITpaBneHbl ,nOMOH .ll,llR npoxolt,lleHHR neqeHHR no.n Ha6mo.neHHeM co CTOpoHhl OOJibHHtfiiblX 5paqeH (TepaneBTOB, XHPYPrGB, ncHXHaTPOB HnH .npyrnx cneUHanHCTOB) HIM HanpaBneHbl Ha KOHcyJibTal.lHH K cneUHanHCTaM no COUHaJibHO-Me,llHUHHCI<HM oonpocaM. Cne.noBaTeJibHO, Heo6XO,llHMO CTHMyJMpoBaHHe HHTerpal.lHH nepB~OH H OOJibttHqHOH TTOMOl!lH B O,nHOH H TOH ~e CHCTeMe. 19. npH nnaHHpoBaHHH HOBOBBe.neHHH B OOJibHH<fHYJO npaKTHKY cne.nyeT yt{HTblBaTb TO, 'ITO YCTpoHCTBO npHeMHhlX OT.neneHHH ,llOJIJfJ-1O no B03MO!O-IOCTH COOTBeTCTBOBaTb Pa3flHqHhlM rpynnaM OOJibHhlX. 20. O6yqeHHe B oonaCTH HeOTnO!O-IOH Me.IIHUHHCKOH nOMOlllH .nonmo npoBO,llHTbCfl Ha 5 ypoBWOC: 28 i) npocBellleHHe HaceneHHR, oOyqeHHe B 11u<0ne; OHO ,nOfl!0-1O Q,iTb OrpaHJNeHO npHBHTHeM HaIIJKOB OKa3aHHR caMOH npocTOH TTOMOl!lH, pacc~TaHHOH Ha Bbl~BaHHe OOJibHOro (o6ecneqeHHe 6e3onacHoro nono~eHHR .ll1lR 6oJibHoro, cB06o.nttoro nona.naHHR ao3.nyxa B aepXHHe OT,neJJ,1 pecnHpaTopHoro TPaKTa, opaJibHble MeTO.nbl HCI<YCCTBeHHoro )lblxaHHR, OCTaHOBKa BHeruHero KpoBOTeqeHHR), a TaK~e ooecneqeHHR 3a.JllHThl .H Bbi3OBa COOTBeTCTByl<llleH cny~a,1; ii ) o6yqeHHe nepcoHana, pa6oTaKlllero B ruKonax (HaqaJibHblX H cpe,nHHx), H HaUHOHaJibHblX HHCTPYKTOpoB B o6naCTH OKa3aHHR nepBOH TTOMOl!lH, KOTOpble MOryT H ,nOJlJIQibl npoBO,llHTb ooyqeHHe nepooro YPOBHR; iii ) o6yqeHHe npol>ecCHOHaJibHblX pa6oTHHKOB nepBOH TTOMOl!lH; iv ) o6yqeHHe napaMe.IIHUHHCI<Oro nepcoHana (B OCHOBHOM Me.nHUHHCI<HX ceCTep) ; v) no.nroTOBKa apaqeu B o6nacTH HeoTflO!O-IOH nOMOlllH B nepHo.n yHHBepcHTeTCI<oro o6yqeHHR H .naJibHeH1I1ero nom.1111eHHR KBa.mt1>HKaLU-IH; TaKaR no,nroTOBKa .nom1CHa npQBO.llHTbCR apa-qaMH, 3HaKOMblMH C Ham.1KaMH OKa3aHHR HeOTnoimoH noMOMH. 21. Bpa"qH, HMeKlli[He KBa.mt1>HKaUHIO B oonacTH peaHHMaUHOHHOH H HeoTnoimoH nOMOMH, .llOJmibl B3RTb Ha ce6R OCHOBHYID Ol'BeTCTBeHHOCTb 3a npeno.naaaHHe 9THX .IlHCUHnnHH. QOy-qeHHe B 9TOH oOnaCTH MO)P;eT B nepayro o-qepe.m, OXBaThlBaTh npeno.naaaTeneH H HaUHOHaJibHl,IX HHCTPYJ<TopoB no OKa3aHHm nepBOH nOMOlJlH. TaKoe o6y-qeHHe .llOJmiO BKnm-qaTh npol>HnaKTHKY. Ero .l]OJllmbl npoBOJIHTh KBa.TMl>HUHPOBaHl-lhle pa60THHKH, KOM!leTeHTHble B ne.naronNecKHX H Hay'!HldX OOJJaCTRX, OCOC">eHHO B ol>epe Me.llHUHHbl. 22. Cnyi,;a,i 3.npaBOOxpaHeHHR .non»lbl CTPeMHTbCR K TOMy, 'qTOObl napaMe,IIHUHHCKHe pa60THHKH nocne cneUHaJtbHOH no.nroTOBKH MOrnH OKa3blBaTh HeOTno;,myro nOMOlllb. 23. OcHOBHl,le yCHnHR cne.nyeT HanpaBHTb Ha npoae.neHHe HenpepblBHOI'O o6y-qeHHR apa-qeH OOl!leH npaKTHKH, KOTOpblM -qacTO npHXOJIHTCR OKa3b1BaTb nepeyro nOMCXllb , OC06eHHO Tex, KOI'Opble pa6oTaIDT B ycnoBHRX ceJll>CKOH MecTHOCTH. 24. BcnoMoraTeJll>HbIM pa6oTHHKaM npHHa.nne)P;HT aamoe MecTo B OKa3aHHH HearnomoH nOMOIIIH 3a npe.nenaMH 6oJll>HHU. OHH ,OOJI)P;Hbl KOHTPOJIHPOBaThCR opraHH30BaHHOH cnylKOoH HeoTnomoH Me.IIHUHHCKOH nOMOlllH, HanpaBJIRIOOleH HX pa6oTy H npoBO.llRllleH oueHKy HX .neRTeJll>HOCTH Ha MecTe. 25. )leRTeJll>HOCTb PYKOBOJIHTeneH 3.JlPaBOO:xpaHeHHR, HanpaaneHHaR Ha Koop,llHHaUHIO TaKHX MOMeHTOB, KaK C03.llaHHe H opraHH3aUHR cnyi,;6 HeoTJ!OlmOH nOMOlllH, .JlQJIJICHa 6b1Th nOCTaaneHa Ha oonee npo'lffiYJO ocHoey . 26 . B nporpaMMax Hay-qHhlx Hccne.noaaHHH, nocBRMeHHl>IX cnyi,;6aM 3.npaBOOxpaHeHHR, Heo6XOJIHMO y .nenflTb ocoooe BHHMaHHe H3y-qeHHJO npo6neM HearnoimoH Me,IlHUHHCKOH nOMOlllH. 29 JlliTEPATYPA 1. Technical discussions on the organization of resusci- tation and casualty services. Copenhagen, WHO Regional Office for Europe, 1963 . 2 . The organization of resuscitation and casualty services: report on a Seminar. Copenhagen, WHO Regional Office for Europe, 1968 (EURO 0256). 3. Bull, J.P. Measures of severity of injury. Injury, 9 (3) (1978) . 4. Laymen may outscore physicians in cardiopulmonary resuscitation . Journal of the American Medical Association, 239(5):391-392( 1978 ). 5. Giroud, M. La collaboration entre le SAMU du Val d'Oise et les medecins practiciens du secteur de Pointoise. Techniques hospitalieres, sociomedicales et sanitaires, 398 (1978). 6. Cochrane, A.L. Effectiveness and efficiency. In: 30 Random reflections on health services. London, Nuffield Provincial Hospitals Trust, 1972. npHJIOJr(eHHe I fIPE,llBAP11TEJibHA.s:! l<JIACCHcfJI.Il<AI.nrn lfPE3Bbl4A 11HblX CHTY AUHH npo1>eccop M. Ca raa Kottuem..IHFI HeoTJIOJPJiOCTH HJIH cpotU-IOCTH (ar JJaTHHCKOr'O cnoaa urge ns ) onpenenetta ttenocTaTOtfi-lO 4eTKO, a HMeHHo: TO, 4TO OODFIBJIF!eTCFI cpO'lliblM, no]llr(HO 0.1Tb cneJiaHO 6e3OTJiaraTeJU,HO. O,miaKO nOCKO.llbKY .00 npHHJITHFI KaKHX-JIHOo Mep acerna npoxo.m-rr KaKOe-TO BpeMFI, Heo6XO,IIIDIO ycraHOBHTh npHeMJieMblH apeMeHHOH HHTepaan. OueHKa TaKOr'O HHTepaana HeH36eJKHO BaPbHPYeTCFI B 3aBHCHMOCTH O'r TOr'O, HllleT JIH KTO-JIHOo nOMOlllH H nOOTOMy c-rpeMHTCFI noJiy4HTh ee HeMeMeHHo, HJIH ;,r;e npennaraJOT JlH HaM CTPHCTYnHTb K OKa3aHHIO nOMOIIlH, H nOOTOMy HaM HY)r(HO KaKoe-TO apeMFI nepen :3THM, 4TO, KCTaTH, CibiaaeT HHOr')la onpaB,lla.HHhlM. Pe3ym,TaTbl XHPYPI"'H4ecKHX onepaI..IHH, npoOO,llHBlllHXCFI B nepHon BOeHHblX neHCTBHH, noKa3a.JIH, HaCKOJU,KO BeJIHKa 3aBHCHMOCTb CMepTHOCTH O'r apeMeHH, npC11JeJ]!llero C MOMeHTa patteHHR no onepaLnrn. B 3TOM nJiaHe cTaTHCTH4eC1rne na!-ilil,1e SANTY(!) ocooeHHo aneqaTmoor. 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HMeeM .[leJlO C orcpoqeHHOH HeoTJlOllHOCThlO B OTHOb.leHHH XJ,fpypra, HO He peaHHMaTOpa, KOTopblH .[IOJlllteH c.oenan, BCe OT Hero 3ae11cR1I1ee HeMe.IlJleHHo. ,llaHHaR KJJaCCI-Jl>HJ<aUHR npe.[ICTaBJlReTCR ceAqac HecKOJibKO ycrapeEl!leA; OHa oOR3aTeJibHO JlOJlllHa Cb!Th .[IOOOJlHeHa TaKHM OOHRTHeM, KaK HeoTJlOllHOCTh, OCO3HaHHaR KaK TaKOBaR qeJlOBeKOM, HlllYIIIHM OOMOIIIH, B cpaBHeHHH C ee oueHKOH, JlaHHOH epaqoM. B CaMOM )lene, TPe0oBaHHR HaceneHHR C Ka!t.IlblM ro.ooM yee.lJH'01Bal<l'l'CR. B 1945 r. B yronOBHb!H KO)leKC <t>paHUHH C':t.Jn BHeceH nyHKT (CT. 63, n.2) oO o6R3aTeJibHOM OKa3aHIDI OOMOIIIH, a B COOTBeTCTBIDI co CTaTheH 5 KO)leKca Me,IlHUHHCKOH 3THl<H BCe epaqH He3aBHCHMO OT HX o0R3aHHOCTeH H KBalMPHKaUHH JlOJlllHbl B qpe3BblqaHHblX CHTYaUHRX OKa3blBaTh OOMOlllb JlHl..laM, HaXO.llfllJlHMCR B Henocpe.[ICTBeHHOH onacHOCTH, npH OTcyTCTBIDI ,opyroH Me,IlHUHHCKOH OOMObJH. nooTOMY Mb! 0oJibb.le He MO!teM nonaraThCR Ha TTPHHRTYIO KJJaCCI-Jl>HKaUHIO, H B 1973 r. HaMH C':t.Jn BBe,IleH TepMHH "yrpO!taIOl!lee" JlJ1R xapaKTepHCTifl(H COCTORHHR, KOTOpoe MO!teT C':t.JCTPO 3aKO~TbCR CMepn,10, ecJll.1 He npHHRTb Heo0XO,IlHMblX Mep (3). HaM npe.ocTaBJlJ'ieTCR, 'ITO TePMHH "qpe3BblqaHHaR CHTYaUHR 11 MO!teT OTHOCHThCR TOJibKO K TaKHM COCTORHHRM, KOTOpt,le MOf'YT npHBeCTH K CMePTH HJll.1 B03MOllHOH yTpaTe KaKOH-Jll.10o BallHOH <llYHKUHH, HanpHMep 3peHHR. TaKHe qpe3Bb(qaHHb(e CHTYaUHH 32 cne,llYeT pacueHHBaTh Ka.J< "yrpo;,r;a1011me", trroa,i OTJJH'IHTh HX OT .llPYrHX qpe3Bbl<JaHHblX cwryal.lHH, KOTOPble MOryT ~!Tb BTOPOH HJlH TPeTbeH CTeneHH. t{TOO,J oonee nOJIHO OC:BeTHTb npo6neMy 'JPe3Bbl<JaHHblX CHTYaUHH, Kpafuie Ba;,J-10 paccMOTpeTb noc:ne,UOBaTeJibHOC:Tb naTc:4>H3HOnOrH'lecJ<HX MOMeHTOB noc:ne roro, KaK npQH3cmno Ka.J<oe-TO TpaBMaTH<JecJ<oe HJJH <l>H3HOnorHtJecJ<oe HapyroeHHe (4). 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BOnbHbie B TaKHX CHTy'aUHRX .non~I OCMaTpHBaTbCR Bpa'-!aMH B nepByJO O'-!epe,llb, '-!To6bl nocne,DHHe MOrnH ycTaHOBHTh, ,neHCTBHTeflbHO nH OHH OTHOCRTCR K '-IHCny trpe3Bbl'-laHI-H,IX. npH yrpo~aia!Il1X ~3HH COCTOHHRX TPe6yeTCR HeMe,nneHHaR nOMOMb Me.IIHUHHCKOro H napaMe.IIHUHHCKOro nepcoHana (B 3aBH- CHMOCTH OT opraHH3al.lHH CHCTeMbI TTOMOIIIH). npH qpe3 Bbl'-laHHblX Me.IIHUHHCKHX CHTy'aUHRX Heo6XO.IIHMbl no- MOMb Bpa'-!a, KOTOPbIH .non~eH 6b(Tb BbICnaH Ha MecTO, HnH roc- nHTanH3aUHR OOflbHOro. npH OCO3HaHHbIX trpe3Bbt'-laHHblX CHTy'aUHRX Heo6XO.OHMbl Tl!laTeflbHoe paccne.noBaHHe TaKHX CHTyaUHH H HHCTPYKTa~ no rene<l>OHY. BOnbHbie B TaKHX cnyqaRX .non~I HanpaBnRThCR Ha OCMOTP B aM6y naTOPHIO B '-laCbI ee pa60Tb1 HnH ~e HX .non~eH noceTHTb Bpa'-1 BHe O'-!ePe.nH, ecnH OHM He XOTRT HnH He MOryT H,llTII B Me.IlHUHHCKHH ueH-rp. I. 3. 4. 5. 6. JIHTEPATYPA SANTY. Le traitement du choc chez les grands blesses . In : Congres de chirurgie mterallie . Lyon chinirgica/, 14: 54 ( 1917) - quoted in (4). Brocq et al . Trairement des urgences en chirurgie. Paris, Masson . 1956. Cara . M. & Poisvert , M. Premiers secours clans /es derresses respiratoires. Paris, Masson . 1963 . Creyssel, J. & Suire, P. Oroc traumatiqut!. Paris, Masson , 1944 . INSERM. Secvurs d'urgence: recherr:he operatiormelle. Paris , 1970 (report). Cara, M. L'achamement therapeutique . Gesrions hospiralieres, 162: 17-26(1977). 41 np1mollleHHe II OOWOTOBKA B OBJIACTH f!EPBOH TTOMOIIIH: OCHOBHblE ACfIEKTbl r-H J. 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OCilnaR npaKTHKa B Kaqecrae cTaproero pernc-rpaTopa ar.neneHHR HearnoJP.HoH nOMOIIUi npH HecqaCTHbJX cnyqanx H qpe3BblqaHHbJX CHTYauHRX yqaJUHXCR cne.nyeT nOJJK.Jil()qaTb KO BCeM BH.llaM .neRTeJibHOCTH Hanpni,;eHHo paooraJ0111ero ar.neneHHR, a TaK;,te K yqacnno Bero opraHH3aUHOHHOH .neRTeJlbHOCTH. Ha np()TR;,iteHHH BCeH no.nroTOBl<H OH .nonJP.eH caMOCTORTeJlbHO BhlnOJU-lRTb Kmi~eo:yID paoory, o0y'IaTh Mna.lllllHH nepcoHan MeJJHUHHo:oro ar.neneHHR H KOHTPOmipoBaTb ero H B TO i,;e BpeMR HaXO)lHTbCR no.a Ha6JilO.lleHHeM KOHcyJlbTaHTa, npHKpenneHHoro K 9TOMY ar.neneHHID, npH'leM ypoaeHb OTBeTCTBeHHOCTH yqamerocn JlO.11Jl(eH HeYKnOHHO nOBbllllaTbCR. B. CneUHaJlbHaR npaKTHKa 3a BpeMR, OTIJYllleHHoe Ha cneUHaJibHYID no.nroTOBKY, yqamHecR .llOnJP.Hbl npHo0pecTH OrihlT no TeM pa3.ne.naM pa3.J1HtnihlX cneUHaJlbHOCTeH, KOI"opble HaHOonee Omi3KH K o:l>epe Me.llHUHHbl, CBR3aHHOH C OKa3aHHeM nOMOIUH npH Hec'IaCTHblX cnyqaRX H qpe3BblqaHHblX CHTyaUHRX. 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MeTO.l]HKa a.neKBaTHOH nonrOTOBKH KaAUlOro OTne.TibHOro y'-lamerocR no yKa3aHHbIM o6nacTRM 6yneT 3aBHCeTb OT HMelOlllHXCR o6opynoBaHHR H noMemeHHH. 6) 3HaHHR no YKa3aHHhIM HHJite oonacTRM npenCTaBJlRIOTCR !q)aHHe BalltHblMH H MOryT C'.!,(Tb npHo6pereHbl B OTneneHHH nOMOlllH npH Hec'-!aCTHblX cny'-!aRX H qpe3Bbl'lfiliHh!X CH'ryaUHRX: noBpellJleHHR H HHt>eKUIDI MRrKHX TKaHeH; OlltOrH: noBpell.lleHHR qepena; HHt>eKUIDI H noBpellJleHHR PYK (TO.TibKO nepBOHa'la.TibHoe ne'leHHe); nepe.nOMb1 {pacno3HaBaHHe H HeMenneHHoe ne'leHHe); noBpellJleHHR rna3 (B OCHOBHOM yMeHHe CTaBHTb JlHarnoo); noapellJleHHR yxa, ropna H HOCa (B OCHOBHOM yMeHHe CTaBHTb )lHarH03): a6nOMHHa.1IbHble COCTORHHR (yMeHHe cTaBHTb )lHarH03 H npoBO,llHTb OUeHKY COCTORHHR); COCTORHHR, TPe6Yl(JlllHe rHHeKonorH'-!ecKOH HnH aKYlllePCKOH noMOlllH (yMeHHe CTaBHTb JlHarH03 H npoBOJlHTb oueHKy COCTORHHR) : MHOlitecTBeHHb1e TI)aBMbl ( yCTaHOBneHHe oqepe,ID-IOCTH npouenyp y orne.Tlbttoro OO.TibHOro H oqepe.m-iocTH OKa3aHHR nOMOlllH npH HaJJH'-IHH HeCKO.TibKHX 00.Tibl-lbIX, a TaKlite yMeHHe npHMeHRTb peaHHMaUHOHHbie MeTO.llbl); MeTO,IJ,I MecTHOro o6e300nHBaHHR. 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MOJI\HO TaKJl\e npOBecTH oOy'4eHHe Me,llHUHHCKHX cecTep H nepcoHana cnyll\61,1 CKOPOH noMOJnH . 49 YrnyOnettHe 3HclHHH Y y<1aiueroc:R, paOoTalallero B KaqecTBe cTaP111ero perHC-rpaTopa, MOl!eT nORBHThCR ocoObIH HHTepec K ol>epe a<a3aHHR noMOll!H npH ttecqaCTHhlx cnyqaruc H qpe3ewqaHl-lblX CHTYaUHRX, qTQ Oy.neT cnocoOc:TBOBaTh yrnyOneHHIO 3HclHHH B 3TOH oO.nacTH. TaKOMy Y'{ailleMyCR HeoOXO.IlHMO npe.nocTaBHTh B03MO!\HOCTb 3aHHMaThCfl Hccne.noeaTeJlbCKOH paOoTOH B O,llHOM H3 OT,IleneHHH. OCDC'J,1H HHTepec K :3TOMy pa3.neny Me,IlHUHl-lbl oqeHb eaacett, n<Y.3TOMy ero cne.nyeT BCRqecKH no.Il,IlepmeaTu. 50 OpHJJO!teHHe IV Cill!COK Y1-IACTHHKOB COBEl!\AHl-Ul BpeMeHHb[e KOHcy JlbTfill'Thl npo:1>. T. Alaoui, .IlHPeKTop TeXHJ.NeCl<HX c.ny:110, MHHHC- TepcrBO oOinecTBeHHOI"O 3..QPaBOOxpfilleHHR, PaCiaT, MaPoKKO ,Il-p G. Alba, Mel!CMHHHCTePCl(HH KOMHTeT no .llQPO:l\HOH Oe3onacHocrn, napH!t, ~paHUHR ,Il-p A. 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Khater, nHPeKToP Cny~6 HeOTnOJPJ--IOH Me.IIHUHHCKOH nOMOWH, MHl-!HcTepcTBO 3.DPaBOOxpaHeHHR, renHono.TMc, KaHp, EnmeT n-p 0. Landa, Pyt<OBO.IIHTeJib OTnena cny~6 HeOTnOJPJ--IOH noMauH, MHHHCTepcTBO 3,DpaBOOxpatteHHR 4e111CKOH CoUHa.TMCTH'{eCKOH Pecrry6.TMKH, Tipara, 4exocnOBa.J<HR Tipo:t>. L. Lareng, BHUe-npe.nce.oaTeJib, YHHBepcHTeT TionR Ca6aTbe, Tyny3a, <t>paHUHR Tipol>. C. Manni, nHPeKToP HHCTHTy'Ta aHeCTe3HOnonrn H peaHHMaUHH, KaTOmNeCKHH yHHBepcHTeT, PHM, HTaJIHR n-p M. Miskiewicz, 3aMeCTI!Te1Ib ~eKToPa, OTnen Me.IIHUHHCKHX cny~6, MHHHCTepcTpBO 3,DpaBooxpaHeHHR H coUHaJibHOro o6ecneqeHHR, BaruaBa, TioJlbllJa (BHUe-npence.naTeJib) n-p W.J. Modle, MHHHCTepcTBO 3,DpaBOOxpatteHHR H coUHaJibHoro oCiecneqeHHR, JloHnoH, Coe.IIHHeHHoe KoponeBCTBO (COCTaBHTeJib OMeTa) n-p M. Murtomaa, Me.IIHUHHCKHH a.DMHHHCTPaTIIBHl,IH pa6oTHHK, nHPeKTOpaT 3,DpaBOOxpaHeHHR, XeJibCHHKH, ¢HHnRHnHR n-p J. Otten, BOJibHHUa CB. ¢paHUHCKa, TieopHR, l!ITaT HJIJIHHOHC, CIIIA n-p A. Piga Rivero, MHl-lHCTepcTBO 3,DpaBOOxpatteHHR H COUHaJibHOro o6ecneqeHHR, Ma.np11n, HcnaHHR Tipo:t>. L. Serre, nHPeKTOP S .A.M. U. , B01IbHHUa CB. 3.nya, MrnmeJibe, <f>paHUHR n-p P . Todorovic, nHPeKToP HHCTIITYTa rnrnel-lbI H oxpaHbl OKPY~aJOllleH cpe.Ilbl, HHCTHTYT OOl!IeCTBeHHOro 3,DpaBOOxpaHeHHR CoUHaJMCTJ,fqeCKQH Pecrry6.TMKH Cep6HH, Benrpa.n, Droc.naBHR r-H J. Weyand, KoHcyJibTaHT no OKa3aHHJO nepooH noMomH, J111ra oOmecrB KpacHoro Kpecra, leHeBa, ~BefluapHR .U-p H. Zoelli ck, PYKOBO,mITe.Tlb ar.nena Me.IIHUHHCKOH nOMOlllH npH TPaHCTJOPTHblX npoH<:lllecTBHRX H tiP€3Bbl'-laHHblX orryammx, <i>e.nepa.ra,Hoe MHHHCTepcTBO no .Ue.naM Mono.nem, ar.nen no .nenaM ceMbH H 3.npaBOOxpaHeHHR, BoHH, <i>Pr EBponei:ta<oe pernoHa.TlbHoe 010po 803 .U-p C . J . Romer, PernOHaJlbl-lblH carpy ,llHHK, ITporpaMMa npe.nynpe~eHHR Hec'-lacnn,oc cnyqaeB (CeKpeTapi,) 53
Organisation mondiale de la santé (OMS) · Publications
Планирование и организация служб неотложной медицинской помощи: отчет о совещании ВОЗ, Тулуза, 24–28 февраля 1979 года
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Organisation mondiale de la santé