The content of sanitary hygienic events in the emergency area. Organization of anti-epidemic events in emergency situations

The organization and conduct of emergency sanitary and anti-epidemic activities in emergency situations (emergencies) are built on general principles for health protection, providing medical care to the population in distress areas, preventing and distributing infectious diseases.

Sanitary-anti-epidemic support in emergency Includes a complex of organizational, legal, medical, hygienic and anti-epidemic measures aimed at preventing the emergence and elimination of infectious diseases, compliance with sanitary rules and norms with a sharp deterioration in the sanitary and epidemic state, preserving the health of the population and maintaining its working capacity.

The main principles of the organization of sanitary and anti-epidemic support of the population in emergency are:

the state and priority nature of the sanitary and epidemiological service, the constant willingness of its forces and funds, their high mobility, clear functional purpose and formation, taking into account regional peculiarities;

a single approach to the organization of sanitary and anti-epidemic measures;

the compliance of the content and volume of measures of the sanitary and epidemiological situation, the nature of the activities and the possibilities of institutions and the formations of the service;

differentiated approach to the formation of forces and means, taking into account regional characteristics, level and nature of the potential danger of territories;

interaction of the Sanitary and Epidemiological Service of the Ministry of Health of Russia with the bodies and institutions of other departments and departmental health services.

The main purpose of the functioning of the Sanitary and Epidemiological Surveying Subsystem of the Sanitary and Epidemiological Survey is the organization of the activities of the State SeaPid Service, aimed at preventing and eliminating the adverse health and sanitary and epidemiological consequences of the emergency. Improving the organization and the increase in the availability of bodies and institutions of the state-poid service to the observation, assessment and forecasting of the sanitary and epidemiological situation are due to the emergence of a real or potential threat to the health of the population.

Types of situations that may be included in the category of emergency, unequal in different regions and depend on the two local factors: the initial state of endemicity of infection and the presence or absence of pathogen transmission paths.

When studying the epidemic, analytical methods should be used. A warning about a developing or epidemic that has arisen may proceed from various sources, in addition to the early warning system, they are not always reliable, so it is necessary to confirm the fact of the existence of the epidemic or its threat.

The first data confirming the existence of the epidemic should lead to the nomination of the preliminary hypotheses on the nature of the disease and its epidemiological picture, which will serve as a guide during field surveys. To identify cases corresponding to the preliminary (for the initial period), the definition of the disease (or "definition of the case") set tasks and choose the most suitable methods for this. Observed cases are further divided into suspicious, alleged or confirmed depending on the results of laboratory surveys using express methods.

Analysis of data collected by epidemiological brigades allows you to set the scale of the outbreak in time and in space. The incidence in various population groups is expressed by the indicators, the determination of which is carried out in terms of morbidity, prevalence, and mortality coefficients. Data on geographical distribution is applied to maps. Information on persons in contact with the patients allows to identify the features of transmission of infection and identify high-risk groups (they are subject to close epidemiological observation and require preventive and anti-epidemic activities).

Table 1

Emergencies associated with epidemics

or the threat of their occurrence

Infectious disease	Criteria for assessing the situation
Infectious disease	In non-hendemic	In endemic areas
	A single case confirmed discharge pathogen	1. Forest with several cases associated with the transfer of rodents or respiratory through 2. Epizeta among rodents
	Single confirmed local case	A sharp increase in incidence compared with the usual level, especially when multiple foci and deaths appear
fever	Single confirmed case among the population with the presence conditions of the pathogen (mosquitoes)	The emergence of new diseases, the absence of vaccination of the population, the activation of infection carriers and the epizootic process
Hemorrhagic fevers: Lasse, Marburg, Ebola, Argentinean, etc.	Single confirmed case among population	The emergence of new cases of diseases if there are conditions for further dissemination of infection

The organization and conduct of sanitary and hygienic and anti-epidemic measures in the overall system to eliminate the health effects of emergencies is very important. In the emergency area, this work is performed by the territorial centers of the State Sannepidnadzor of the Russian Federation (CGSAEN).

To ensure rapid response based on CGSAN and other institutions of sanitary and epidemiological services, specialized formations are created.

In order to prevent and eliminate the health consequences of emergency, sanitary and epidemiological institutions and formations are carried out by the following main activities:

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

interact with departmental health services on the issues of assistance to the population in the foci of the striking;

conduct special training of employees of sanitary and epidemiological institutions and formations for work in emergency;

maintained in a high degree of readiness the territorial centers of state-poypidezor, the formation and institutions of the sanitary-sanitary service, the forces and means of research institutes operating in the RSCS;

carry out accumulation, storage, refreshment, accounting and control of medical property necessary for the work of the formations and institutions of sanitary and epidemiological service in emergency;

monitor compliance with sanitary rules, hygienic standards in the emergence of emergencies in peaceful and wartime;

organize the work of the observation network and laboratory control on the timely detection and indication of biological (bacteriological) infection (pollution) of drinking water, food and forage raw materials, food, environmental objects in the emergence of peaceful and wartime;

exercise forecasting the possibility of epidemics in the territory of the Russian Federation.

For the operational guidance and coordination of the activities of organizations and citizens to prevent mass infectious diseases and poisoning of people and the elimination of the consequences of the emergencies by local executive bodies, permanent sanitary and epidemiological commissions. The executives of the administrative territory are included in these commissions, and the working body of the Commission is the headquarters, which is created from the employees of the GOCM services, health and anti-epidemic institutions.

When conducting sanitary and hygienic measures, it is necessary to take all hygienically significant objects under strict control - both destroyed and damaged in the disaster heat and continue.

These objects include:

Water supply and sewage systems;

food industry, catering and trade enterprises;

Children's preschool and school institutions;

Public service enterprises;

Affected and inflated residential fund;

Therapeutic and preventive institutions in which affected and patients from the catastrophe area were hospitalized;

Seats of temporary settlement of the evacuated population;

Location of rescue teams, detachments;

Industrial objects that can be sources of secondary striking AOCH, RV, BS, etc.

Principles and objectives of sanitary anti-epidemic support for emergency situations

Sanitary-anti-epidemic support in emergency includes a complex of organizational, legal, medical, hygienic and anti-epidemic measures aimed at preventing the emergence and elimination of infectious diseases, compliance with sanitary rules and norms with a sharp deterioration in the sanitary and epidemic state, preserving public health and maintaining its ability to work.

The Unified State System of Prevention and Emergency Elimination (RSCS) includes a functional subsystem of oversight of a sanitary-epidemiological situation involved in the elimination of the consequences of Natural and Technogenic CS.

The main principles of the organization of sanitary and anti-epidemic support of the population in emergency are:

the state and priority nature of the sanitary and epidemiological service, the constant readiness of its forces and funds, their high mobility, clear functional purpose and formation, taking into account regional characteristics;

a single approach to the organization of sanitary and anti-epidemic measures;

compliance of the content and volume of measures of the sanitary and epidemiological situation, the nature of the activities and the possibilities of institutions and the formations of the service;

differentiated approach to the formation of forces and means, taking into account regional peculiarities, level and nature of the potential danger of territories;

interaction of the Sanitary and Epidemiological Service of the Ministry of Health of Russia with the bodies and institutions of other departments and departmental health services.

The main purpose of the functioning of the Supervision Sanitary and Epidemiological Survey of the RSCS is the organization of measures of state -plain services aimed at preventing and eliminating the adverse health and sanitary and epidemiological consequences of emergencies. Improving the organization and the increase in the availability of bodies and institutions of the state-poid service to the observation, assessment and forecasting of the sanitary and epidemiological situation are due to the emergence of a real or potential threat to the health of the population.

The functional foundations of the subsystem determine the main tasks and provide for the main activities of sanitary and preventive institutions and formations for sanitary and hygienic and anti-epidemic support in emergency, namely:

adoption by the main state sanitary doctors of administrative areas of decisions mandatory for the executive authorities by federal executive authorities, the executive authorities of the constituent entities of the Russian Federation and local government, enterprises, institutions and organizations, regardless of their subordination and forms of ownership, officials and citizens in the event of the emergence of Sanitary epidemiological nature;

implementation of monitoring compliance with sanitary rules, hygienic standards and norms in case of emergency;

carrying out control over the conduct of specific and non-specific prevention of infectious diseases;

exercising control over the organization and conduct of the whole complex of sanitary-anti-epidemic activities;

ensuring the organizational and methodological guidelines to the activities of the Sanitary and Epidemiological Services of the Ministries and Offices of the Russian Federation on the Sanitary and Epidemiological Welfare Welfare of the Population in the event of an emergency;

education due to the allocations of the departmental reserve of financial and material resources allocated from the federal budget of the Russian Federation, including currency intended for financing sanitary and anti-epidemic activities in emergencies;

ensuring the constant readiness of the management system, forces and means to work in the emergencies, the implementation of the control of the creation and readiness of specialized formations of the State Sangeid Service (hygienic and anti-epidemic brigades, sanitary and epidemiological detachments and specialized anti-epidemic brigades) to include them in the grouping of forces and funds sent to liquidation Emergency;

ensuring controlling the readiness of the laboratory base of state -plain institutions as an integral part of the forces and means of observing and monitoring the state of the environment and potentially hazardous facilities in order to timely detect and implement operational control and measurements of radioactive and chemical pollution in emergency areas, as well as atmospheric air biological infection, drinking water, food and forage raw materials, food and other environmental objects;

presentation of the report to the Government of the Russian Federation on the sanitary and epidemiological situation in the emergency area;

participation in state expertise in the field of public protection and territories from emergency.

Sanitary and epidemiological supervision of sanitary-component is carried out at the federal, regional, territorial, local and object levels and solves the following tasks.

At the federal level:

development and implementation of the principles of a single state policy in the field of providing sanitary and epidemiological well-being, protection and promotion of the health of all categories of the population, reducing the negative impact of harmful environmental factors;

implementation of sanitary and epidemiological supervision for the development of new technologies and industries, the placement and operation of potentially dangerous objects;

scientific development and implementation of the most progressive methods of protection and hygienic education of the population, techniques and methods of work in the network of observation and laboratory control (SNLK), sanitary and epidemiological, radiation and chemical intelligence, as well as new directions to eliminate the health effects of emergencies;

development of the methodological foundations of the hygienic justification of the placement and logistics of the affected population;

study the possibilities of using the forces and means of the sanitary and epidemiological service and the development of the necessary recommendations on their work in emergency;

the interaction of bodies, institutions and formations of the Medicine Service of the disaster of various ministries and departments on assistance in conducting sanitary-anti-epidemic activities;

improving the automated information management system and training for work in a frequently changing sanitary and epidemiological situation;

the use of international experience in the prevention and elimination of health consequences of emergencies.

At the regional level:

implementation of sanitary and epidemiological supervision for the development of new technologies and industries, the placement and operation of objects on which regional emergencies may occur;

the introduction of progressive methods for individual protection and hygienic education of the population, receptions and methods of workshop of the SNLK in emergencies, exciting several territorial entities;

the interaction of bodies, institutions and formations of the Medicine Service of the disaster of various ministries and departments located in the region, on assistance in conducting sanitary-anti-epidemic activities;

improving the automated information and management system and training of personnel on the specifics of the territory and its impact on the conduct of sanitary and anti-epidemic activities in the emergency;

development of regulatory and methodological documents in the field of providing sanitary and epidemiological well-being of territories in the event of regional emercesum;

control over the execution of the sanitary legislation of the Russian Federation, participation in environmental monitoring and tracking the level of maintenance of toxic and radioactive substances, microorganisms in air, soil, water, food raw materials and food products; formation of regional reserves of forces and means of sanitary-epidemiological service;

the rational use of the forces and means of the RSCs located in the region, their timely maneuver with the organization and conduct of hygienic measures in the CS zones, in the territories contaminated with chemical and radioactive substances, in the foci of infectious diseases;

summary of the work experience of the management authorities, institutions and specialized formations to prevent and eliminate the sanitary-epidemiological consequences of the emergency.

In the territorial level:

control over the level of morbidity, the dynamics of specific and non-specific immunity, the accumulation of the absorbed dose, the consequences of the poisoning of emergency hazardous chemicals (AOCH), the implementation of measures to protect the population from radioactive and high-tech substances, strengthening immune and other protection of the population;

development of regulatory and methodological documents in the field of providing sanitary and epidemiological well-being, including behavior on those who suffered in the event of radioactive, chemical and epidemic foci in the emergency area and beyond; control over the execution of the sanitary legislation of the Russian Federation, participation in environmental monitoring and tracking the level of containing harmful substances in air, soil, water, food raw materials and food products;

development and implementation of emergency measures to improve the sanitary and epidemiological reliability of water supply, the organization of nutrition of the population, the collection and disposal of household and industrial waste;

conducting sanitary and epidemiological, sanitary and sanitary and radiation intelligence, organization of observation and laboratory control on chemically hazardous and other objects and in collectives that have been influenced by harmful substances;

control over the completeness and quality of sanitary and hygienic measures and sanitary processing of the population held by other departments and services; in compliance with the hygienic rules of the evacuation of the population and patients;

development and implementation of emergency measures to increase the sanitary and hygienic reliability of water supply and nutrition of the population, the collection and disposal of household and industrial waste;

introduction in all medical and preventive institutions at the stages of the medical evacuation of modern techniques and assistance methods for radiation and chemical accidents, a strengthened anti-epidemic regime;

control over the completeness and quality of deactivation, degassing, disinfection in the emergency area, as well as the sanitary processing of the population conducted by other departments and services;

preparation of general practitioners, therapeutors, pediatricians and emergency care doctors on the peculiarities of radiation lesions, poisoning and infectious pathology in emergency;

training to the public to protect against chemical and other harmful substances and behavior in pollution foci;

the creation and maintenance of special financial and material foundations, a reserve of laboratory equipment, personal protective equipment, reserves of diagnostic and other drugs, nutrient media, destroyers and other consumables;

conducting emergency (general and special) and antidonal prevention.

At the local level:

implementation of sanitary and epidemiological supervision of water supply facilities, catering enterprises, children's and other institutions located in the emergency area;

timely transition of medical and prophylactic institutions to work in conditions of enhanced, and if necessary and strict anti-epidemic regime;

targeted work of sanitary and toxicological, radiological and microbiological laboratories for mass research on indications;

training of the population behavior in the foci of chemical and radiological pollution;

issuance (by testimony) of radio protector and antidotes, the implementation of emergency (general and special) prevention.

Object level:

study of objects representing the potential hazard complication of the sanitary and epidemiological situation in the event of emergencies (objects of atomic, chemical, microbiological, food industry and water supply, sewage networks and sumps);

tracking the health and performance of working on the facility, their resistance to the effects of emergency factors in the conditions of a folding sanitary and hygienic situation;

establishing the necessary number of attracted forces and facilities of the object with the timing of their readiness and, if possible, the volume of measures performed;

protection of personnel, material tools and unique equipment, as well as laboratory and other animals, taking into account the projected environment (shelter in protective structures, evacuation, the use of personal protective equipment, including medical);

transfer of an object to the mode of operation in emergency conditions (management and communication, submission of reports and information sharing);

organization of the work of specialized formations of the facility, their supply of medical and special property, logistical and transport support.

From Natural and Technogenic Character for Sanitary and Epidemiological Service, there are greatest importance that have the greatest significance that most complicate the sanitary and epidemiological situation.

Characteristic signs of an emergency epidemic situation, taking into account primarily their importance and directions for the development of the epidemic process, it is necessary to evaluate the following primary criteria:

risk of drift and distribution of infectious diseases among the affected population;

the threat of the emergence of a significant number of cases of infectious diseases of different etiology due to the "mixing factor";

possible social and economic damage;

the emergence of infectious diseases with such a degree of severity, which leads to severe health violations that prevent the timely evacuation of patients from the emergency area to therapeutic institutions;

the impossibility for regional (territorial) bodies to fully cope with the emergency epidemic due to the lack of or lack of technical or specially trained personnel, as well as the necessary resources or equipment (drugs, vaccines, laboratory and diagnostic materials, means of combating insects, disinfectants and etc.);

danger of infection beyond the emergency area.

Upon arrival in the emergency area, Sanitary and Epidemiological Service Specialists are obliged to conduct a thorough epidemiological investigation to assess the epidemic state of the territory, formulate a hypothesis about the nature of the pathogen, the ways of its transfer and the possibility of further development of the epidemic.

The examples given in the table for non-hendemic and endemic areas illustrate situations that can be attributed to emergency in the distribution of listed diseases.

When studying the epidemic, analytical methods should be used. A warning about a developing or epidemic that has arisen may proceed from various sources, in addition to the early warning system, but they are not always reliable, therefore, it is necessary to confirm the fact of the existence of the epidemic or its threat.

The first data confirming the existence of the epidemic should lead to the nomination of the preliminary hypotheses on the nature of the disease and its epidemiological picture, which will serve as a reference when conducting field surveys. To identify cases corresponding to the preliminary (for the initial period), the definition of the disease (or "case definition"), set tasks and choose the most suitable methods for this. Observed cases are further divided into suspicious, alleged or confirmed depending on the results of laboratory surveys using express methods.

Emergencies related to epidemics or threat of their occurrence

Infectious disease	Criteria for assessing the situation
Infectious disease	In non-hendemic areas	In endemic areas
	A single case confirmed by excretion of the pathogen	1. Forest with several cases associated with the transfer of rodents or respiratory path 2. Epizeta among rodents
	Single confirmed locals	A sharp increase in incidence compared with the usual level, especially when multiple foci and deaths appear
Yellow fever	A single confirmed case among the population in the presence of the propagation conditions of the pathogen (mosquitoes)	The emergence of new diseases, the absence of vaccination of the population, the activation of infection carriers and the epizootic process
Hemorrhagic fevers: Lasse, Marburg, Ebola, Argentinean, etc.	Single confirmed case among the population	The emergence of new cases of diseases in the presence of conditions for further dissemination of infection

Analysis of data collected by epidemiological brigades allows you to set the scale of the outbreak in time and in space. The incidence in various groups of the population is expressed by the indicators, the definition of incidence, prevalence, mortality ratios. Data on geographical distribution is applied to maps. Information on persons in contact with the patients allows to identify the features of transmission of infection and identify high-risk groups (they are subject to close epidemiological observation and require preventive and anti-epidemic activities).

Sanitary and anti-epidemic (preventive) emergency measures

Studying the history of various natural disasters, disasters and wars, which occurred both in the distant past and in the present period, shows that epidemics often arise or sharply increases the level of infectious incidence among the affected population.

In the period and after the occurrence of natural disasters, accidents, disasters, during the conduct of hostilities, there is a sharp deterioration in the social conditions of life and life, a large number of mechanical injuries, burns and other lesions appear, in which the natural resistance of the body is significantly reduced, stressful states and other phenomena. The population is deprived of the housing stock, electricity, drinking water, the sewage is destroyed, the work of bath laundry institutions is disturbed, the organization of food is worse.

All this significantly worsens a sanitary and hygienic situation, significantly aggravates the epidemic situation in a number of infections, since the current situation leads to the fact that potential sources of infection are uninsulated and for a long time have numerous contacts with their surrounding persons for a long time. Extremely complex epidemic situations occur when in groups of unexplained cases of latent forms of dysentery, abdominal typhoids, diphtheria and some hazardous infectious high-precanti diseases in the collectives. In case of violation of environmental systems, it is possible "revival" of natural foci of specially dangerous infections (Tularemia, plague, Siberian ulcers, etc.) and their distribution. The presence of bacterial agent in laboratories and accumulates by some countries as biological weapons give reason to assume the possibility of using them in war, as well as the probability of dispersion in the form of an aerosol in peacetime.

To ensure rapid response based on CGSAN and other institutions of sanitary and epidemiological services, specialized formations are created.

In order to prevent and eliminate the health consequences of emergency, sanitary and epidemiological institutions and formations are carried out by the following main activities:

exercise control over the sanitary and epidemiological situation, organize the examination of food raw materials, food, drinking water, the external environment for pollution with radioactive substances, poisoning and chemically hazardous substances, pathogenic microorganisms;

interact with departmental health services on issues of assistance to the population in lesion foci;

conduct special training of employees of sanitary and epidemiological institutions and formations for work in emergency;

accumulate, storage, refreshments, accounting and control of medical property necessary for the work of the formations and institutions of sanitary-epidemiological service in emergency;

monitor compliance with sanitary rules, hygienic standards in the emergence of emergencies in peaceful and wartime;

organize the operation of the network of observation and laboratory control over the timely detection and indication of biological (bacteriological) infection (pollution) of drinking water, food and forage raw materials, food, environmental objects in the emergency room of peaceful and wartime;

exercise forecasting the possibility of epidemics in the territory of the Russian Federation.

For the operational guidelines and coordination of the activities of organizations and citizens to prevent mass infectious diseases and poisoning of people and the elimination of the consequences of the emergency, the local executive authorities are created by permanent sanitary and epidemiological commissions. The executives of the administrative territory are included in these commissions, and the working body of the Commission is the headquarters, which is created from the employees of the GOCM services, health and anti-epidemic institutions.

In the institutions that are part of the State Sanitary and Epidemiological Service (TSGSEN, research institutes of sanitary and hygienic and epidemiological profile, anticipate institutes and stations, etc.), management bodies are created for work in the emergency. The composition of the headquarters is determined by the order of the head of the object, depending on the structure of the institution, its capabilities and solved tasks.

The procedure for the work of the headquarters of the office of the object is determined by the functional responsibilities of its officials.

Organizational structure of headquarters for the Affairs of the Gochs Center of the State SanEpid Sannezor (option).

The State Sanitary and Epidemiological Supervision in the area (district) includes a set of activities of sanitary-anti-epidemic support of the population.

Under sanitary and hygienic support in emergency It is understood as a set of events held in the area (district) of the emergencies in order to preserve the health of the population and the personnel involved in the elimination of the consequences of the emergency, through: medical monitoring of their health; sanitary supervision over the terms of the placement (outside the places of permanent residence), nutrition, water supply, sanitary condition, the removal of uncleanness, the burial of the corpses of the dead people and animals; estimates of the sanitary and hygienic state of the Zone (district) of the emergency; predicting the influence of adverse factors on the health of the population and the personnel participating in the elimination of emergencies and the development of proposals for the improvement of this effect; hygienic education.

Sanitary and epidemiological service organizes and conducts the following sanitary and hygienic measures:

organization and conducting an assessment of the sanitary and hygienic condition of the territory and the determination of harmful factors affecting the health of the population and the environment;

organization of sanitary and hygienic measures to protect emergency facilities, participants in the elimination of the consequences of the accident and the population;

organization and participation in sanitary supervision over the terms of the population in the area of \u200b\u200bemergencies, its nutrition, water supply, bath-laundry service;

organization of sanitary supervision in hygienically significant objects providing the life of the population in the area of \u200b\u200bemergency;

medical monitoring of the health of the personal composition of the formations and institutions participating in the elimination of the effects of emergencies, its provision of special clothing, protection means and its correct use;

participation in controlling the sanitary condition of the territory, timely purification, disinfection and supervision of the burial of the dead and the dead;

organizational and explanatory work on the regime and rules of the behavior of personnel of emergency sites, participants in the elimination of the consequences of the accident and the population in the emergency area.

When conducting sanitary and hygienic measures, it is necessary to take all hygienically significant objects under strict control - both destroyed and damaged in a disaster area and continuing to function. These objects include: water supply and sewerage systems; Food industry, catering and trade enterprises; children's preschool and school institutions; public service enterprises; affected and inflated residential fund; Medical and preventive institutions in which affected and patients from the disaster area were hospitalized; seats of temporary settlement of the evacuated population; location of rescue teams, detachments; Industrial objects that can be sources of secondary destruction of AOCH, RV, BS, etc.

Taking into account the analysis of the situation under the emergency, the main sanitary and hygiene directions of the work of Sanitary and Epidemiological Supervision Specialists together with other interested organizations are the following.

When the water supply and networks are issued - participation in the choice of water source, the permit for the use of water, control the state of vehicles for the water supply (if necessary, the requirement to disinfect tank truck chlorination or other methods), carrying out sampling on bacteriological and chemical analysis.

At the failure of sewage structures and networks, wastewater flow into open ponds - daily bacteriological control over water quality of water bodies above the place of wastewater discharge and lower by the river in the places of economic and cultural and consumer water use.

Food facilities are an organization of activities that exclude the possibility of infection of food. At temporary power points - carrying out enhanced sanitary and hygienic control.

In places of temporary settlement of the population - participation in the creation of appropriate conditions for placement, drinking mode, nutrition, utility service. For large hostels and tent towns, if necessary, chamber processing of bedding is provided, using stationary and mobile disinfection chambers.

In permanent and temporal hospitals for affected - disinfection of operating, dressing and procedural; The implementation of laboratory control of the quality of disinfection and sterility of the material.

To accommodate the population at the time points of the collection, the area of \u200b\u200b3.75 m2 is given for each person at the rate of each person, taking into account the deployment of moving point points and moving points of water supply. To accommodate the population in hostels and other temporary premises, in tent cursories, the minimum area of \u200b\u200bthe area should be 4.0-4.5 m2 per person.

For medical formations, rescue detachments and in population points in the cold season, it is necessary to have warm rooms for heating people and drying rooms for clothing and shoes with an area of \u200b\u200b15-18 m2 per 100 people. In order to avoid excessive cooling of the victims, they should be placed on mattresses, beds, bedding, horses at a distance of at least 0.3-0.5 m from the outer walls.

Water consumption norms for the needs of the affected population are 10 l / day per person; per patient who is inpatient treatment (including drinking needs) - 75 l / day. On the washing of one person, including the personnel of working in the emergency formation, is 45 liters.

When placing the population in a tent or other camp type, the towns are equipped with roars (instead of bathrooms) at the rate of the calculation: one roar is 0.3 m wide, a depth of 0.5 m and a length of 1 m per 20 people. Rowliki is allowed to arrange parallel to each other at a distance of 1-2 m. They should be located below the water sources and at a distance of at least 200 m from them. Uncleans in Rowlov must immediately subjected disinfection and pour the layer of land.

Sanitary and epidemiological well-being is provided by a complex of organizational, legal, medical, anti-epidemic, reconcilitative measures aimed at preventing the emergence and elimination of infectious diseases, as well as compliance with sanitary rules and norms with a sharp deterioration in the sanitary and epidemiological state in the emergency area.

The main anti-epidemic activities in the occurrence of the epidemic focus are:

registration and alert;

epidemiological examination and sanitary and epidemiological intelligence;

identification, isolation and hospitalization of ill;

restrictive or quarantine measures;

general and special emergency prevention;

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

identification of bacteria carriers and enhanced medical observation of the affected population and the personnel of rescue formations;

sanitary and explanatory work.

Registration and alert. All patients and detected suspicious persons are taken for special accounting. The chief physician of the Center for State Sanitary and Epidemiological Supervision of the District (city) should be notified about the identification of infectious patients. Upon receipt of data on the occurrence of highly contagious infections, the population of the catastrophe area and adjacent territories with explanation of the rules of conduct is also noticed.

Epidemiological examination and sanitary and epidemiological intelligence. Each case of an infectious disease should be subjected to a thorough epidemiological survey in order to identify the intended source of infection and conducting basic measures aimed at preventing the spread of infection. The epidemiologist, conducting a survey, establishes on the basis of a survey of the patient and others, which objects of this situation are suspicious, which disinfection methods should be applied. At the same time, the epidemiologist selects material for laboratory research.

Sanitary and epidemiological intelligence is the collection and transfer of information about the sanitary and hygienic and epidemiological situation in the emergency area, which consists in obtaining data on epidemic foci, air quality, water and food, sanitary condition, residential fund, utilities and other objects affecting Conducting special and preventive measures organized and conducted by the sanitary and epidemiological service.

The tasks of sanitary and epidemiological intelligence includes:

identification of the presence and localization of patients, the nature of the outbreak and prevalence of infectious diseases, immune security among various contingents in areas of accommodation of the affected population;

establishing the availability and activity of natural focal infections in emergency areas, epizootic among wild and domestic animals;

the survey of the sanitary and hygienic state of the emergency area included in it in selenium points and water sources, facilities of the economy, utility and sanitary and sanitary and sanitary and sanitary and epidemiological institutions (sanitary leishers, bathrooms, laundry, sanitary and epidemiological and disinfection institutions, infectious hospitals and hospitals, bacteriological and virological laboratories, water treatment facilities, landfills and polygons of household and industrial waste, cemeteries, crematorium, etc.);

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

The group of sanitary and epidemiological intelligence includes: a hygienist, an epidemiologist (or infectious physician), a bacteriologist, a laboratory manner, driver.

Events on the organization of sanitary and epidemiological intelligence include:

clarification of the situation in the emergency area, the possible time of intelligence, the definition of routes of movement, the nature of the alert and means of communication;

survey of the emergency area (settlements, life support systems: centralized economic and drinking water supply and other drinking water sources, food supply bases and catering, public utilities, economy facilities as sources of potentially hazardous harmful substances, etc.);

collection and clarification of the data that local authorities and health care, institutions of veterinary and other services (the total number of residents in the village, the possible number of people remaining in the focus and the emergency area; area of \u200b\u200bextrusion of victims and ways of their evacuation);

obtaining information in the remaining territorial executive bodies and health institutions and veterinary medicine on the infectious incidence, the possibilities (vaccination) of the population, which produced in the hearth and the emergency area, as well as data on the naturalness of the territory, episodes;

sampling of soil and water surface reservoirs for microbiological control;

submission of reports on the results of exploration and relevant recommendations.

The sanitary and epidemic state of the area can be appreciated as a prosperous, unstable, unfavorable and emergency.

Promotional condition: no quarantine infections and group outbreaks of other infectious diseases; the presence of single infectious diseases that are not related to each other and emerged over the term exceeding the incubation period of this disease; The epizootic situation is not dangerous for people; Satisfactory sanitary condition of the territory, water supply facilities; communal landscading; Effective organization of sanitary and hygienic and anti-epidemic support; Lack of mass infectious diseases in adjacent territories.

Unstable state: an increase in the level of infectious morbidity or the emergence of group diseases without a tendency to further distribution; The emergence of single infectious diseases related to each other or having a common source of disease of the VIS area with a satisfactory sanitary condition of the territory and the qualitative implementation of a complex of measures for anti-epidemic support; The presence of epizootic foci of zoonotic infections representing a threat to people; The emergency area is located in close proximity to the focus of hazardous infectious diseases.

Difficult condition: The emergence of group cases of hazardous infectious diseases in the emergency area or epidemic foci of particularly dangerous infections in neighboring areas in the presence of conditions for their further distribution; numerous diseases of unknown etiology; The emergence of single diseases especially dangerous infections; Significant violations in organizing sanitary and hygienic and anti-epidemic support.

Emergency: sharp increase in the short term of the number of dangerous infectious diseases among the affected population; the presence of repeated or group diseases especially dangerous infections; Activation in the emergency area of \u200b\u200bnatural foci of hazardous infections with the emergence of diseases among people.

Identification, insulation and hospitalization of sick. The team in which the first case of the disease is discovered should become a subject of careful observation. With a number of diseases (dysentery, raw tit, Scarlatina, etc.), it is necessary to organize daily bypass and surveys of the services serviced by contingents, and in case of suspicion of an infectious disease, to isolate and hospitalize the diseased. Timely, early seizure of a patient from the team is a cardinal measure that prevents the spread of infection.

In order to identify patients with dangerous infectious diseases no later than 6-8 hours, it is necessary to organize the conduct of residential details. This event is held 2 times a day by employees of outpatient polyclinical institutions on the territorial principle; In cases of identifying patients with plates, it is anticipated suits of the appropriate type, after receiving prevention tools. The medical-nursing brigade allocate a plot with a population of 1000-2000 people. It is provided with styling for the fence of material from patients, preparations for emergency prevention, dissenters (1.5 liters), special blanks, pencils. The brigade must have lists of the serviced population.

In addition to identifying patients and suspected of diseases of persons with signal signs (temperature, diarrhea, rash, etc.), residential traversions are carried out to verify the implementation of hospitalization of patients, mass vaccinations, for monitoring the sanitary condition of dwellings and territory.

Transportation of infectious patients and suspicious infection is made by special transport separately. Accompanies the patient a nurse, chauffeur-sanitary and a santic porter. They should be in anticipated suits I or type II.

The nurse must have dishes for the collection of patient's discharge, lining oils, vessel, cotton wool, disinfecting solutions (3-5 l), necessary drugs to provide urgent assistance, oxygen. After the evacuation of the patient, transport is disinfected on a specially dedicated site for this. Disinfections are exposed to personal protective equipment after each flight.

Observation of the regime of infectious patients aims to prevent the dissemination of infection from a medical institution or a temporary infectious hospital where patients are hospitalized, as well as to prevent the nosocomial infection. It is necessary to strictly monitor the implementation of the rules of sanitary treatment during the admission of the patient, as well as for thorough observance of the rules of the current disinfection during the period of staying patient in the hospital. Special attention should be addressed to the deadlines for the discharge of the patient, since early extract can lead to penetration into carriers and further environmental interrogation.

Protective (observative) or quarantine events. In order to prevent the drift of infectious diseases and their distribution in the occurrence of epidemic foci, a complex of regime, restrictive and medical measures are carried out, which, depending on the epidemiological characteristics of infection and the epidemiological situation, are divided into quarantine and observation. The organization and holding of these events are assigned to the responsible managers of administrative territories and a sanitary-anti-epidemic commission.

Quarantine - a system of temporary organizational, regulatory, administrative and economic, legal, medical and preventive, sanitary and hygienic and anti-epidemic measures aimed at preventing the removal of the causative agent of a hazardous infectious disease outside the epidemic focus, ensuring the localization of the epidemic, episotic or epiphyototic focus and their subsequent liquidation.

Quarantine is introduced when patients with particularly dangerous infections among the population, group diseases with contagious infections with their increase in a short time. When establishing even single cases of diseases of the plague, lassis, ebol, ebola, and some other contagious diseases, as well as mass diseases of the Siberian ulcers, yellow fever, tularemia, sap, meloidosis, raped typhoid, brucellosis, prescription mode must be introduced.

Observation - regime-restrictive measures, providing for the enhancement of medical and veterinary observation and conducting anti-epidemic, medical and preventive and veterinary-sanitary measures, restricting the movement and movement of people or farm animals in all adjacent quarantine zone of administrative-territorial formations that create a observation zone ( GOST R.22.0.04-95).

The observation is introduced in areas with a disadvantaged or emergency sanitary and epidemic condition, that is, the emergence of group non-contagious diseases or individual cases of contagious infections.

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

General and special emergency prevention. Emergency prevention (preventive treatment) is a complex of medical measures aimed at preventing the occurrence of diseases of people in case of their infection by causative agents of hazardous infectious diseases. It is immediately held after establishing the fact of bacterial infection or the appearance of hazardous infectious diseases among the population, as well as mass infectious diseases of unknown etiology.

Unlike vaccine-philatics, emergency prevention ensures fast protection of infected.

Emergency prophylaxis is divided into common and special. Prior to establishing a type of microorganism, which caused an infectious disease, is carried out general, and after establishing the type of the pathogen, special emergency prevention.

As a means of general emergency prevention, antibiotics and wide-spectrum chemotherapy products are used, active in respect of all or most of the pathogens of infectious diseases. The duration of the course of general emergency prevention is determined by the time necessary for identifying, identifying and determining the sensitivity of the pathogen to antibiotics and averages 2-5 days.

Scheme of total extra prevention

A drug	Mode of application	One-time dose, g	Multiplicity of application per day	Medium dose for prevention rate, g	The average duration of the prevention rate, day *
Doxycycline
Rifampicin
Tetracycline

Notes: Doschokhlin is a basic means of general prevention; Rifampius, tetracycline, sulfaten - reserve facilities for general emergency prevention.

* The duration of the prevention rate can be reduced to 2-3 days in the presence of a specific indication results,

As a means of special emergency prevention, antibacterial drugs are used, which have a high etiotropic effect on the causative agent, isolated from infectious patients in an epidemic focus, taking into account the results of determining its sensitivity to antibiotics. The duration of the course of special emergency prevention is determined by the nosological form of the disease (the term of the incubation period calculated from the date of infection), the properties of the nominated antimicrobial drug.

The disposal of emergency medical prevention is issued by the Sanitary and Anti-Epides Commissions,

Responsibility for CE is assigned to managers of institutions, enterprises, medical and nursing brigades.

Methodological guidance and control over the implementation of emergency prevention measures is conducted by health authorities.

The order of emergency prevention is determined by local executive authorities (on the presentation of health authorities, which takes into account the epidemic situation in the region, the real reserves of antimicrobial funds and other factors). First of all, it is carried out in institutions and formations involved in the prevention or to eliminate outbreaks of infectious diseases; In institutions, institutions and enterprises located in the focus and continuing their work as well as in children's teams. Its organization and holding are assigned: in the first case - on the leaders of the formations and institutions, in the second - the heads of health care parts, departmental clinics and ambulatory, in the third - on managers and medical workers of institutions.

Emergency prevention among the other categories of the population is carried out by district polyclinics. For these purposes, the nursing brigades of medical care are formed on the territory of each microcuritus of the settlement, obliged to carry out the whole complex of medical and preventive measures - emergency prevention, medical observation of the population, early active identification of patients, their isolation, hospitalization, etc. In some cases, other medical and preventive institutions may be involved in the implementation of the measures mentioned.

In order to prevent the infection of medical professionals with causative agents of dangerous infections while working in the focus, they must strictly follow the rules of anti-epidemic regime.

The effectiveness of emergency prevention measures largely depends on the clarity of their implementation and the population coverage of their population. In this regard, each medical care team must have quarter lists of residents attached to them the micro-execution (microdistrict), indicating the main passport data of the observed people, including the place of work. The list indicates the name of the drug used, as well as the dose and the date of its issuance.

Similarly, with the start of emergency prevention in the foci of infection, it is recommended to conduct active immunization (vaccination or revaccination) of the population.

Among the methods of immunization, the most fully meets the requirements of anti-epidemic protection of the population, aerosol and oral administration.

Used immunization methods and the number of applicants

Immunization method	The number of vaccinations
		8 h (working shift)
BSZEGOLPY (BI-3, BI-4)
Overtoral
CabinetsNippet (Corger)
Subcutaneous (in I Fitzeva)
Vigram is accurate (syringe)
Imgrable

For immunization, vaccination brigades are created as part of one doctor and two nurses.

Calculation of vaccination brigades with mass vaccinations is carried out by the formula:

where X is the number of vaccination brigades, N is the total number of applicants, A - the number of persons inserted within one hour, T - working time of the vaccination brigade,

Disinfection of an epidemic focus of infection (disinfection, disinsection, deratization). Disinfection of apartment foci is carried out by the state sanitary and epidemiological service through the current and final disinfection.

Disinfection - destruction in the environment of pathogens of infectious diseases. It can be carried out by physical, chemical and combined disinfection groups. One disinfection group as part of the disinstructor, disinfector and two Sanitars during the working day is able to process 25 apartments with an area of \u200b\u200b60 m2 each.

Disinfection of the territory, buildings and sanitary processing of the population are carried out by the utility technology.

Disinsection - the destruction of insects (carriers of infectious diseases) is carried out by physical and chemical methods. The main one is considered the chemical method, which is to process objects insecticides.

Deratization - the destruction of rodents (sources of pathogens of infectious diseases). It is carried out by mechanical (caught) and chemical (use of poisoning bait) in ways.

Food disinfection is carried out by the sale and nutrition service, and the water is the water supply service. Control over the quality of disinfecting food and water, as well as their sanitary examination, the service of state sanitary and epidemiological surveillance is carried out.

Detection of bacteria carriers. If, with epidemiological examination and laboratory study, carriers (typho-paratyphoid infections, cholera, diphtheria, etc.) were revealed in epidemiological foci, then in relation to them, measures are being carried out that protect themselves from infection.

In addition, measures are being held on enhanced medical supervision of the personnel of rescue formations.

Sanitary and explanatory work. To conduct broad and efficient sanitary and explanatory work, radio, television, printing should be used. It should be aimed at strictly implementing the entire population of general recommendations on the rules of behavior, compliance with sanitary and hygienic rules and other personal protection measures.

Organization and objectives of the network of observation and laboratory control.

Network of observation and laboratory control (SNLK) is an integral part of the forces and means of observing and control of the RSCC.

The SNA system organizationally includes observation services and laboratory control of various ministries and departments, including state sanitary and epidemiological supervision.

The general leadership of the SNLK is assigned to the EMERCOM of Russia. The direct leadership of the subordinate institutions of the SNLK is carried out by ministries, state committees, departments and organizations included in the UNLC structure.

Observation and laboratory control in the Russian Federation is organized and carried out in order to:

timely detection and indication of radioactive, chemical, biological (bacteriological) infection (contamination) of drinking water, food and forage raw materials, food, environmental facilities (air, soil, water of open reservoirs, vegetation, etc.) in the emergence of peaceful and wartime;

emergency measures to protect the population, agricultural production from AOCH, biological (bacteriological) funds (BS) - causative agents of infectious diseases.

SNLK has three levels: federal, regional and local.

Federal Level SNLK is formed on the basis of academic research institutions, organizations and institutions of central subordination, whose actions in SNLK as a whole coordinate the EMERCOM of Russia.

Regional level SNLK is formed on the basis of institutions, organizations, industry research institutions, departments (laboratories) of higher educational institutions of the relevant profile operating in the territory of the republics as part of the Russian Federation, edges, regions decisive in the scale of the region. The coordination of the activities of the UNLCA institutions of this level carry out regional centers for the Affairs of the GOCC.

Local level SNLK is formed on the basis of institutions, organizations, profile centers operating in the relevant territory. Coordination of activities at the local level of SNLK is carried out by the relevant committees (commission) for emergency situations of the territorial executive bodies and territorial headquarters for the Affairs of the GOCC.

The functioning of the SNLK is carried out in three modes: daily activities, high availability and emergency mode.

SNLK system includes:

All-Russian Observation Center and Laboratory Monitoring of the Emergencies Ministry of Russia;

academic and sectoral research institutions;

departments (laboratories) of higher educational institutions of hydrometeorological, chemical, toxicological, veterinary, agrochemical and phytopathological profiles; territorial management and centers for hydrometeorology and environmental monitoring;

specialized inspections of analytical control;

aircraft and hydrometeorological stations and posts;

specialized Combines "Radon";

Russian republican information and analytical center of the State Sunchapide Service;

centers of state sanitary and epidemiological surveillance in air and water transport (basin TSGSEN);

territorial centers of state sanitary and epidemiological supervision;

centers of sanitary and epidemiological surveillance and health parties of the Federal Department of Medical and Extreme Problems under the Ministry of Health of Russia;

network, road, separated, linear centers of sanitary and epidemiological surveillance at the Railway Transport of the Ministry of Internal Affairs of Russia (CSSEN);

antician center, anticipated stations;

territorial veterinary laboratories;

design and survey centers and stations of agrochemical service, chemicalization centers and agricultural radiology, agrochemical laboratories;

plants protection stations;

paragraphs of signaling and forecasts of manifestations and development of pests and diseases of agricultural plants;

border points on plant quarantine;

production (object) laboratories of ministries, state committees, departments and organizations of the Russian Federation;

chemical radiometric laboratories of civil defense;

posts of radiation and chemical observation.

Head institutions of the SNLK (the most prepared for the fulfillment of tasks) are units of high readiness with a sentence of 8 hours.

The main task of the Federal Center for State Sanitary Eaters of the Ministry of Health of Russia is to participate in the development and conduct of measures to ensure laboratory control and expertise of food, drinking water and food raw materials for infectious diseases of infectious diseases, as well as the provision of methodological assistance to institutions of sanitary and epidemiological supervision in peace and wartime.

On republican, regional, regional, port, urban, district 1st category of TsGSEN Russia and the corresponding CSEN at the railway transport of the MPS of Russia, the centers of sanitary and epidemiological surveillance and medical and sanitary parts of the Federal Department of Medical and Extreme Problems under the Ministry of Health of Russia is assigned :

conducting sanitary and epidemiological intelligence in the foci of mass damage to the forces of the formations created on the basis of the CGSAN (CSSEN, MSH) of the formations (groups of epidemiological intelligence, sanitary and epidemiological groups, etc.);

establishing a type of microbiological means of combat recipes in wartime and causative agents of infectious diseases in the emergence of peacetime in samples selected from environmental facilities, food, drinking water, food raw materials, as well as in materials taken from patients and corpses of people (specific indication);

implementation of identification of selected strains of microorganisms and toxins (only for republican, regional and regional TSGSEN);

conducting a sanitary examination of food, drinking water and food raw materials contaminated with RV, OB, AOXB and infected BS, with the issuance of their conclusion about their use for use;

determination of the specific and bulk activity of radionuclides in food, drinking water and food raw materials on controlled objects;

establishing the radionuclide composition of the samples under study (except district TSGSEN);

determination on controlled facilities of food pollution, drinking water, food raw materials 0B and AOCH;

guide to the work of the understanding links of TsGSEN in the subordinate territory and the provision of methodical assistance.

The main tasks of urban, district TSGSEN 2nd and 3rd categories of state-poinnadzor of Russia and the corresponding TSEN on railway, water and air transport are:

conducting sanitary and epidemiological intelligence in the service area;

establishing the presence (based on indirect signs) in the objects of the environment of microbiological means of combat recipes in wartime and pathogens of infectious diseases of people in the emergence of peacetime;

study of samples selected from environmental facilities, food, drinking water and food raw materials for infection by famous pathogens;

measurement of power doses of radioactive radiation on the area in the area of \u200b\u200bthe establishment of the institution;

establishing the presence of OB, AOXB in environmental objects, conducting their preliminary identification;

sampling from environmental objects, food, drinking water and food raw materials contaminated with RV, OB, AOXB and infected BS, delivery of them to Head CGSEN for laboratory research and sanitary expertise.

The main task of the anticipated center of the StateSanePidnadzor of Russia is the methodological management of the activities of anticipate stations on particularly dangerous natural focal infectious diseases in the emergence of peaceful and wartime.

The main tasks of anticipate stations and their departments are:

conducting sanitary and epidemiological intelligence in the foci of bacterial contamination;

implementation of identification of strains of microorganisms of a bacterial group isolated from various samples as a result of a specific indication;

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

measurement of power doses of radioactive radiation on the area in the area of \u200b\u200bthe establishment of the institution;

establishing the presence in the Environment 0V and the indication.

Institutions of hydrometeorological stations included in SNLK, agrochemical laboratories, object laboratories of some ministries and departments are carried out:

determining the levels of gamma radiation on the ground in the area of \u200b\u200bits placement sites;

quantitative and high-quality laboratory control over the contamination of the soil, plants and crop products, open reservoirs;

reconnaissance in chemical and radioactive pollution areas at agricultural facilities;

detection of the nature of the epidemic focus.

In the departmental laboratories of ministries responsible for food, meat and dairy industry, fisheries, and others carry out observation and laboratory control over pollution dangerous for people and animals substances of state resources grain and products of its processing, food raw materials, food products, state reserves of food products manufactured, processed and stored in subordinate enterprises, warehouses and bases. The same laboratories issue a conclusion on their implementation. In addition, they determine the completeness of deactivation, degassing and disinfection of food raw materials, semi-finished products and food products.

Chemical-radiometric laboratories of civil defense are carried out radiation, chemical, non-specific bacteriological exploration in the zones of infection (pollution), the indication of OB, AOXB, including rocket fuel components, are involved in the preparation of specialists of production (object) laboratories included in SNLK.

Posts of radiation and chemical observation at the enterprises of ministries, state committees and departments are monitored to the emergence of peace and military time for timely detection in the objects of the RV, OB and AOCH and their indication by technical means.

If it is necessary to relocate the formations of the service of sanitary and epidemiological supervision in the places of their new placement in the emergency area, all laboratories must arrive in a short time and deploy functional units to work. To do this, it is necessary to provide in advance to allocate a tent fund or laboratories on vehicles. In case of the impossibility of deploying laboratories and organizing their work in the emergency zones, the indication should be carried out in the laboratory at its location or in the preserved fitness.

When the laboratory is recruited, specialists of local centers of sanitary and epidemiological surveillance and object laboratories can temporarily be used. To carry out microbiological studies, the laboratory must have: head of the laboratory - bacteriologist, 4-5 doctors-bacteriologists, 2 virology doctors, 6-7 laboratory technicians, 2-3 sanitary equipment (preparators), mechanical technique.

In toxic-chemical and radiological laboratories, an existing staff is used, but at least 2-3 doctors of the corresponding profile in each laboratory.

In accordance with the scheme of laboratory studies in institutions and formations of sanitary and epidemiological supervision centers, hygiene and epidemiology centers can be investigated daily to 25-30 microbiological samples, 48-50-toxic-chemical, 90-100-radiological.

After delivering samples from the epidemic focus, the type of bacteria is determined. This requires to give a preliminary response after 1-3 hours, and the final one - after 12-48 hours.

Institutions, including CGSAEN, SEA, SPB, should have the following documentation set:

departmental status (instruction) on the work of the SNLK;

plan to transfer institutions with peaceful martial law;

plan for the preparation and development of the institution of the SNLK for the current year and the prospect;

alert scheme, collecting the personnel of the institution in working and non-working time;

list of functional duties of specialists of institutions;

a list of particularly dangerous diseases and lesions of people, farm animals and plants;

the list of AOCHs produced in chemical enterprises and stored in the territory of the object and region;

a list of potentially dangerous objects in radiation, chemical and microbiological terms;

instructions on the procedure for maintaining radiation, chemical, biological (bacteriological) observation (intelligence) and the procedure for notification of infection (pollution) of environmental objects;

instructions on the procedure for transmitting information about infection (pollution) environmental objects with a communication scheme;

sampling methods and conducting research on pollution of RV, OS, AOCH and BS infection, determined by a list of particularly dangerous diseases and lesions of people, farm animals and plants;

the norms of permissible levels of radioactive contamination, maximum permissible concentrations of OV and AOKHV in air, drinking water, food, food and forage raw materials for peaceful and military time;

map (scheme) of a controlled area to display radiation, chemical and biological (bacteriological) environment;

the registration log of selected (received) samples and accounting for analyzing results;

magazine of radiation, chemical and biological (bacteriological) observation (intelligence);

instructions for safety measures when working with samples contaminated with RV, OV, AOCH and infected BS;

interconnecting tables, temporary reports for transmitting information on subordination and to the territorial headquarters for the Affairs of the GOCC.

The readiness of UNLCH institutions to solve problems assigned to it is ensured by the relevant ministries and departments of the Russian Federation by training (training) in peacetime and equipping departments, laboratories, stations and posts with necessary equipment, devices and methods. For the preparation (retraining) of specialists are responsible managers of UNLCA institutions.

Training and retraining of specialists is organized and carried out by ministries and departments of the Russian Federation according to plans and programs agreed with the EMERCOM of Russia. In order to improve its institutions, exercises and training and training are planned annually.

Organization of sanitary and anti-epidemic measures for the control and protection of food, food raw materials, water and the organization of their sanitary expertise in emergency situations

It is possible to prevent contamination (pollution) of food, water, food raw materials and medical supplements by conducting protective measures even during the occurrence of the threat of pollution of RV, AOCH, 0V and BS infection.

Protection of food (various types of food and water) is a difficult task, and nevertheless prevent their infection (pollution) is easier than to neutralize.

Under the protection of food and water, a complex of measures aimed at protecting them from pollution of the RV, AOCH, 0B and BS infection is understood.

The main source of radioactive contamination is radioactive substances dropping out of the radioactive clouds in the form of dust. The induced radioactivity for food and water does not represent much danger.

The fallout of radioactive precipitation (as well as AOCH and BS) entails infection (pollution) of open water bodies, water sources, unprotected reservoirs, pastures, agricultural crops and food reserves.

The degree of contamination of food RV, AOCH, 0V or BS infection depends on the type of food product, the type of medical property, the degree of sealing, the type of container, the quality of the packaging, the exposure time and the resistance of the acting agent.

Divorous and bulk food, medicines in packaging and containers are polluted (infected) mainly superficially, and liquid - throughout the volume. The depth of radioactive dust penetration into various types of unprotected food can fluctuate widely. Thus, the RV into a grain mound can penetrate to a depth of 30 mm, in flour - up to 15 mm, in millet and buckwheat croup - up to 20 mm, in bakery products - up to 10 mm. Unprotected liquid food (milk, vegetable oil) and drinking water are polluted to the entire depth. The duration of pollution depends on the rate of decay of the isotopes.

AOCH and 0B can enter the environment in the form of steam, gas, fog, smoke or drops. Some of them lose their poisonous properties under the influence of light, moisture and other natural factors, others retain toxicity for a very long time. The possibility of pollution of drinking water and food reserves by sabotage is not excluded. AOCH and 0B are well sorbed by food products and can remain in them in dangerous concentrations for a long time.

The penetration depth and degree of contamination depends on the type of AOCH and 0B, its concentration, the duration of exposure, the magnitude of the droplets, the chemical composition of the product itself and the nature of its packaging. For example, phosphorganic poisoning substances (FOB) penetrate in the form of vapors in bread, potato tubers to a depth of 20 mm, in meat - up to 70 mm, into solid fats - by 80-100 mm, in cereals and sugar - up to 80 mm, in Pasta - up to 140-160 mm. Liquid products can be contaminated with the entire depth of the container.

The degree of contamination of drinking water AOCH and 0B depends on a number of reasons, the main of which are: the type of substance, its physical condition, the ability to hydrolyolize, the amount of substance and the nature of water supply.

Infection of food and drinking water BS can occur when there is aerosols with microbial recipes on them, contact with infected insects, rodents, sick people. The predominant most food products is a good nutritional environment for the development and accumulation of pathogenic microorganisms. Many microorganisms are capable of retaining livelihoods for a long time and in water. For example, the pathogen of the plague persists in products up to 3 months, in water - 2-3 weeks; Asian cholera causative agent is saved in oil to 30 days, in black bread - up to 4, in white bread - up to 26, on vegetables and fruits -8 day, in water - up to several months; The causative agent of Brucellize lives in water up to 2 months; Tularemia causative agent - up to 3 months; The dysenteric microbe lives in the soil to 62 days, in water - up to 92, on bread - up to 20, on fresh vegetables and fruits - up to 6 days, the disputes of the Siberian ulcers and botulinum sticks are high resistance.

One way to prevent people's defeat is a reliable protection of food and water and timely detection of RV, AOCH, 0B, BS in the environment. Direct responsibility for protection is assigned to the leaders of the relevant facilities.

Large importance is the protection of local water sources. All sources with clean water should be protected and kept in proper sanitary manner. The most dangerous pollution (infection) of open water-sources - member, rivers, rods, Arykov. The means of their protection practically does not exist. After contamination (infection) of these water sources, use water from them is strictly prohibited before the permission of the sanitary and epidemiological service.

Responsibility for measures to protect food and drinking water is assigned to the heads of relevant administrative territories that plan these activities, identify material tools for this purpose and organize their implementation on time.

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

a) holding organizational events;

b) carrying out engineering and technical measures;

c) carrying out sanitary and hygienic events.

Organizational activities include:

dispersing food reserves in the country zone in the threat of emergence of emergencies;

preparation of workers and employees of food facilities to carry out measures for food protection and drinking water, as well as to carry out work on their disinfection;

preparation of laboratories of sanitary-epidemiological supervision centers and formations for indication of PB, AOCH, 0B, BS, conducting sanitary examination and laboratory control over pollution (infection) food and drinking water;

accumulation means of disinfection.

Engineering activities provide:

construction of new food warehouses, elevators in the country zone and the reconstruction of older;

carrying out work on sealing of warehouse and industrial premises, creating conditions for high-quality and efficient cleaning and disinfection of premises;

the introduction of hermetic equipment and containers for food storage;

the constant content of the places of water intake and the plumbing network in a technically sound state, as well as the creation of sealed containers for storing drinking water.

Sanitary and hygiene measures provide:

organization of storage and transportation of food, the content of water sources in accordance with sanitary standards and requirements;

carrying out work on the destruction of insects and rodents on the territory of objects;

compliance with workers and employees of food objects of personal hygiene rules;

strictly performing sanitary standards and rules of technological and culinary processing of food in enterprises processing food raw materials, and catering enterprises.

Protection of food and drinking water, as well as medicines, is achieved by sealing premises, the use of various types of containers, packaging and packaging materials, as well as with the help of sanitary and hygienic measures that contribute to the preservation of products. In the construction of warehouses, elevators, refrigerators for storing large food reserves, the maximum sealing of enclosing structures is envisaged. The windows are carefully customized in the premises, the windows are wedged, the window frames are covered with paper. We must not forget about ventilation devices. Regardless of the sealing of the premises, it is advisable to carefully pack and cover the finished products.

According to protective properties, Tara is divided into three categories.

The first category - protects against RV and BS completely and delays the penetration of AOCHs and OB (wooden barrels, wooden boxes with internal gaskets from polyethylene or foil, bags made of combined material, polyethylene bottles, kraft bags).

For the shelter of food and medical property, various materials are used: tarpaulin, polyethylene film, oilcloth, dense paper, etc. Technical equipment also applies: household and other refrigerators, well-closing cabinets, boilers, baths, pans with covers. Products having high energy value and for long-term storage are needed to be packaged in hermetically closing container (canned food).

In rural conditions, the simplest means of protection are used: to belazing with a tarpaulter with a subsequent snowing sand, soil, bordering of agricultural products.

It is necessary to draw attention to the protection of products, food raw materials during transportation. They should be carefully stolen by tarpauline or burlap. Inadequate products (meat in carcasses, bread, fish) are transported in van, containers, in special dense drawers, refrigerators, tank trucks.

For reliable food protection, it is very important to continue the development and production of sealed packaging for storing individual food reserves. Since these food reserves are not subject to laboratory research, it is possible to use them only with complete confidence in the absence of contamination (infection). Contaminated (infected) and suspicious pollution (infection) Individual food reserves are to be destroyed.

Events to disinfect food, food raw materials and drinking water at bases, warehouses, commercial and industrial enterprises and water stations are organized by the leaders of these objects and are carried out by the forces and means of object formations (controlling links, teams of disinfection, etc.). These works should be done directly in place or on specially equipped areas for neutralization. Control over the quality of activities is carried out by the Sanitary and Epidemiological Supervision Service and Departmental Services.

Disinfection is divided by natural and artificial.

Natural disinfection It is carried out by leaving the contaminated food and drinking water for a certain period for which the product itself occurs (natural disintegration of the RV, AOCH or s). This method can be used only when there is no need for urgent food and drinking water. The sources of water left for self-testing are indicated by the signs of "infected", observation and laboratory control is organized behind them. Food and drinking water, infected BS, are not subject to natural disinfection.

Artificial disinfection It is produced in various ways, the choice of which depends on the type of product, the type of pollution or infection (RV, AOKH, OV, BS) and a specific environment. At the same time, it is planned to wash with water or soap solutions, processing disinfectant, wiping the packaging of the rags, shifting products into a clean container, removing a contaminated (infected) product layer, upholding liquid products (with PB contamination) with the subsequent drainage of the upper (defined) part, thermal Processing (with contamination of AOCH, OS, BS infection), treatment with ultraviolet radiation (when infected by BS).

These methods of neutralization can be used both independently and comprehensively depending on the degree and nature of pollution (infection) and the type of food product. Chemical methods for food neutralization are not suitable, since chemicals used for neutralization, spoil the color, taste and sharply reduce the nutritional quality of products, and they themselves may be dangerous for a person due to toxicity.

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

Water deactivation is carried out in one of the following ways.

1. Settlement with preliminary coagulation and subsequent plums of the upper layer and filtration. Simplified modification of this method is the deactivation of water without filtering the precipitate, that is, the preparation and drain of the clarified layer.

2. Filtration of polluted water through ionites. This method consists in freeing water from PB, which are in ionized state, by filtration through ion exchange resins, absorbing cations and anions from water. Ion exchange resins (ionites) can be added to the tablet filters used to filter water.

3. Distillation of polluted water. The method is based on distillation of polluted water and condensation of its vapors in distillate.

POLLUTION OF FOOD RV FOOD PRODUCTS, as shown above, is superficial character and is due to the rv directly to the surface of the products or to the surface of the packaging material. The purification principle in these cases consists in removing and removing the surface layer of the product (most often it is sufficient to remove a layer with a thickness of 1.0-1.5 cm). With intensive pollution of liquid consistency products, the lattes are subject to chosen. The neutralization of products in hermetic packaging (canned) is reduced to deactivation of cans using special detergent decontamination compositions. Radiometric control is strictly obligatory.

Currently, sufficiently reliable methods of cleaning from radionuclides of meat, freshwater fish, mushrooms, rooteplood at home are developed.

It is known that the radioactive elements are washed away with an aqueous solution of cook salt ("extra" or iodized). Acetic essence or ascorbic acid can be added to the salt solution. In this case, proteins are not lost from the purified product. We present some methods for cleaning individual products.

Meat. After thawing, it is cut into pieces, put into an aqueous solution of the cooking salt: 40 g of salts are taken to 1 liter of water and 1.0-1.5 ml of 70% acetic essence. The solution is prepared in glass or enameled dishes. The ratio of meat and mortar 1: 2. The solution varies three times, mixing periodically. The total exposure time is 6-12 hours depending on the magnitude of pieces. The removal of nuclides from the equalone is carried out simply - with the help of cold water, which is replaced by pure every 3 hours at least three times.

A fish. Purified, without head and fins, fish are cut into pieces weighing 60-100 g, placed in a solution of the table salt (30 g per 1 liter of water in a ratio of 1: 1). The solution is replaced three times on fresh every 1.5 hours.

Mushrooms.Purified from garbage, three times boiled in a saline solution, washing with cold running water before each change of solution. Total boiling time 50 min. This way you can process and dried mushrooms.

Potatoes. It is released from nuclides by soaking the purified tubers in the cold salted to taste for 3-4 hours. In this case, up to 40% of radionuclides is washed, and during cooking until readiness is 60%. When cooking with a shift solution changed 15 minutes after boiling, up to 80% of radionuclides are washed.

Carrot. When cooking until prepared in fresh or salted water, up to 90% of radionuclides was washed.

For degassing water, the following methods can be used.

Boiling for at least 14 minutes. The method is unsuitable when the water is contaminated with the louction, since after boiling in the water, arsenic remains.

Filtration through special filters-absorbers, in particular with the help of a UNF-30 universal portable filter, allowing to clean from 0B and AOCHs up to 30 liters of water at an hour, tulk-coal filter TUF-200 and an upgraded autofilter station MafS-7500.

Chlorination with a brightened solution of chlorine lime or calcium hypochlorite with simultaneous coagulation by adding a coagulant - iron sulfate solution.

In practical terms, the combined method of water degassing is most reliable, for example filtering with subsequent chlorination. The extended water is allowed only to use after a thorough check of the completeness of the degassing by the indication method,

Degassing food is a very complex business. Food products, which are in a leakage container or in open form and strongly contaminated with drop-enjoyed 0V and AOCH, degassing are not subject to and destroyed. Food contaminated with separate drops 0V and AOCH, degassed if it is impossible to replace it ungubble. All food products from the point of view of choosing a degassing method and their future use is made to divide into 5 groups: ready-made food; Products that do not require culinary processing; Products in need of culinary processing; canned products; vegetables and fruits.

Food can be degassed in one of the following methods; mechanical removal of contaminated layers (main method); ventilation; culinary processing; Technological processing.

Thus, ready-made food, which is in a leakage container, is to be destroyed, and in a hermetic container can be recognized as suitable for use after degassing.

Canned foods can be recognized as suitable for consuming after degassing.

Vegetables and fruits contaminated with drip-liquid 0V and AOCHs are destroyed, contaminated by them are thoroughly and repeatedly washed with a jet of cold water, after which they are subject to culinary processing.

In bulk products, a layer of 3-7 cm thick is separated, in meat - 2-3 cm, then the products are ventilated or dragged. If after that the laboratory method is set by the absence of 0V and AOCHs in them, then they are suitable for use after culinary processing.

Ward degassed products should always be long - at least 2 hours, and the use can be allowed only after establishing the completeness of the degassing.

Contaminated fats can be used in soap, and grain, flour, potatoes - to generate technical alcohol, in cases where food cannot be neutralized or cannot be processed, it is subject to destruction of burning or, after mixing with chloro-lime casseurs, instillation in Earth.

The safe way of disinfection of food and water, infected BS, is long-term boiling. Individual water reserves in flasks are disinfected using special tablets. Water can also be disinfected by chlorine with elevated chlorine doses with subsequent dechlorination.

Conducting disinfecting food and water is associated with the danger of the defeat of people. Therefore, it is necessary to comply with certain security measures:

all work on degassing, deactivation and disinfection of food products should be carried out only in personal protective equipment;

the deactivation and disinfection area should be located aside from residential premises or population locations;

contaminated RV, OB, AOXB or infected BS Water should be drained in specially dumped waste wells;

during work on degassing, decontamination and disinfection, it is forbidden to remove the means of protection, smoking, eating and drinking;

when carrying out work on decontamination, it is necessary to control irradiation of working, using individual dosimeters;

upon completion of degassing, deactivational and disinfection works, it is necessary to undergo complete special processing.

After neutralization, bacteriological, chemical or radiometric control is carried out, responsibility for which state sanitary and epidemiological surveillance is carried. In all cases, when food is released for use with pollution not higher than the maximum permissible standards, in the accompanying documents and on the container is the mark "D-RV" or "D-AOCH" (permissible pollution of RV or AOCH). Products infected BS must be completely diskmed.

One of the events that contribute to the protection of food objects and water sources is intelligence. Well-organized reconnaissance, continuous implementation of laboratory control over contamination (infection) air, soil, water, food products are of paramount importance for the timely detection of RV, AOCH, OV, BS, and therefore, to reduce their affecting action. In the food objects, intelligence is conducted by intelligence groups of these objects.

In many cases, to determine the contamination (contamination) of drinking water and other products, it is necessary to make samples and deliver them to the laboratory to establish the type of BS applied and determining the degree of pollution of the RV, AOCH and OB.

In the event of a focus of pollution (infection), the sale and nutrition service organizes work to determine the degree of contamination (infection) in the focus of food reserves and the possibility of their use for nutrition. On each food facility, the food warehouse forces of the object medical service and control links of the object is being examined by the territory, food transport, warehouse, containers and inventory, which is drawn up with an act of examination.

After inspection, food products are sorted by explicitly contaminated (infected), suspicious pollution (infection) and unpolluted (unreleased).

Suspicious pollution (infection) are considered to be products that do not have external signs of pollution (infection), but located near contaminated (infected) premises or territories. Unpolluted (unimpressed) include products stored in reliable and intact shelters and containers.

Expertise is subject to only food, suspicious of pollution (infection), and food after its disposal.

Sanitary expense is called the establishment of suitability for the use of food and water.

Food Classification according to the degree of pollution of the RV, OS, AOCH and the BS infection is presented to 13.3. Organization of sanitary and anti-epidemic measures for the control and protection of food, cleaned raw materials, codes and organizing their sanitary expenses in Emergencies 393

Food Classification according to the degree of pollution

radioactive, poisoning, emergency chemicals and infection with bacterial media.

After the examination, proceed to the selection of samples. Samples of water and liquid products are taken after thorough mixing. Samples of dry products are taken with the most suspicious of pollution of seats from the surface layers. Each batch of products carefully inspect, examine the container, and then individual packaging open and take samples for laboratory control, and it is forbidden to mix the contents of the container.

Taken samples, depending on the type of products, are placed in glass or metal banks, bottles, paper or cellophane packages that are packaged into a rubberized bag and in the shortest possible time are delivered to the laboratory along with the accompanying note. The accompanying note indicates the type of object, the conditions of the product content, the state of the container, the type of product (the name of the water source), the purpose of the study, the test date of the sample. Persons who produce samples must be dressed in protective clothing and use respiratory protection tools, and after completing the work, complete sanitary processing.

Suspicious products and drinking water before obtaining the results of laboratory analysis should be in complete preservation, they are considered conditionally contaminated (infected) and cannot be used to power.

Eating food suspicious to infection is made only after the sanitary examination.

Sanitary expert its decision on the shelf life of food and water, on the basis of an act of examination of the food object, the results of laboratory analysis of samples, data on extremely permissible doses of PB, concentrations of AOCH and OV in ready-made foods that do not require further culinary and technological processing, as well as information Data headquarters for the Affairs of the Gochs district (city) about the radioactive, chemical, bacteriological focus of the defeat.

Sequence of actions of the sanitary expert:

get from the headquarters of the GOCC information about the fact of emerging emergencies;

get food samples;

require an act of the survey of the food facility;

require the accompanying note with the number of products, the conditions for their storage, place and time of the sample take;

determine the method and means of neutralization;

determine the procedure for the use, disposal, disposal or destruction of products;

give an expert opinion.

As a result of the examination, the following decisions may be taken:

the product is permitted for federal use without any restrictions (the product has no contamination or infection);

the product is beneficial to consuming healthy people during a certain period if the number of RV (concentration of AOCH, s) does not exceed the maximum permissible norms. This product cannot be sent to children's and medical institutions;

the product is suitable, but is subject to realization through a catering system, if there is confidence that after culinary and technological processing, the number of RV (concentration of AOCH, s) will not exceed the permissible norms, and the BS will be completely absent. Before issuing such a conclusion, a sanitary expert should provide an indication of the test cooking and obtain a description of the technology of preparation of the finished food product. After that, the finished product is re-examined in the appropriate laboratory. The conclusion is issued if the number of RV (concentration of AOCH, s) does not exceed the maximum permissible norms, and the BS is missing;

the product is subject to neutralization (deactivation, degassing, disinfection) or natural neutralization (accommodation), after which the re-examination is necessary, in the case of natural neutralization, the product must be stored separately, and its study should be carried out at least once every 3 months;

the product is not suitable for food, but can be used for technical needs (transferred to disposal);

the product is not suitable for use and is subject to destruction.

Food, which, after the neutralization activities, remain not suitable, are subject to disposal or destruction. Disposal of contaminated (infected) food is produced at existing recycling factories for secondary raw materials or in special enterprises. In the event that the products cannot be disposed of, they are to be destroyed.

The destruction of contaminated (infected) food is made by burning or instillation. Burn food in specially reserved places. In case the contaminated (infected) food cannot be burned, it is buried to a depth of at least 1.5 m with preliminary denaturation of oil, lizol, chlorine lime, kerosene, etc. Products to be disposed of or destruction are transported in specially equipped closed machines. Transportation after the carriage of contaminated (infected) products is subject to disinfection.

Food products are disposed of or destroyed according to the conclusion of a sanitary expert in the prescribed manner.

Control over the implementation of neutralization measures, the correctness of transportation of contaminated (infected) products, their storage, utilization and destruction is carried out by the Service of State Sanitary and Epidemiological Supervision. A number of events on the line of their department conducts a veterinary service.

Epidemics of infectious diseases and group poisoning

In a number of medical and sanitary consequences, the emergence of epidemic foci of infected areas, infected areas and epidemics occupies a significant place.

Epidemic in emergency - This is a massive and progressive distribution of an infectious disease within a certain territory, significantly exceeding the usually registered incidence in this area for the same period.

In the area of \u200b\u200bnatural disasters and other emergencies, the epidemic focus should be considered the place of infection and the residence of people with infectious disease or territory, within which in certain time and spatial boundaries, there has been infected with people and agricultural animals by the pathogens of infectious diseases and has taken a massive nature of the spread of infectious diseases.

The epidemic focus is determined by the temporary boundaries and is characterized by the following factors:

the presence of infectious patients among the affected population and the possibility of distribution by them of pathogens;

the presence of affected, in need of hospitalization, estimated from the point of view of the risk of infection;

the presence of a healthy population in contact with infectious patients in need of observation, observation, evaluated from the point of view of the risk of infection;

external environment representing infectious danger.

With a variety of infectious pathology, to determine the timing of the activity of the epidemic focus, the maximum incubation period of the propagated infectious disease is insufficient. When people with low susceptibility of the second peak of the propagation of infection may occur after 2-3 incubation periods after the first due to the transfer of the pathogen to persons in which the infection proceeded in asymptomatic form. Therefore, when determining the time limits of the epidemic focus, it is necessary to take into account the availability of carriers.

The characteristic features of the epidemic focus in the areas of emergencies should be considered:

mass infection of people and the formation of multiple foci by activating the mechanisms of transmission of pathogens of infections in the disaster zones;

the duration of the action of the focus (especially natural focal infections) due to the duration of the infectious action of non-identified sources;

reduction of the incubation period as a result of constant contact with non-detected sources of infection;

reducing the resistance of the body in emergency;

the presence of a large infamary dose of pathogens;

lack of protection of the population and affected by contact with infectious patients due to late insulation of infectious patients, the presence of various clinical forms of infectious diseases and the late diagnosis.

The above features determine the specifics of organizing measures for the localization and elimination of epidemic foci.

The territory of the spread of diseases is called nosoaryal; There are two types of infectious diseases ranges: ubiquitous and regional.

Ubiquitous infection is typical for most anthroponous and zooanthroponous infections, therefore, in the areas of emergencies, these infections can constantly create epidemic foci, since there is always a source of infection, as a rule, uninsulated. In addition, such infections are some domestic zoonoses, such as Siberian ulcers. The incidence of universal infections of unequal in different regions, which is explained by the peculiarities of the influence of social and natural factors on the development of the epidemic process. In emergency, these conditions are leveling.

Regional nosoaryals are limited areas of dissemination of the disease. These are areas where social and natural conditions favors the transmission of the pathogen. This distribution has some anthroponous and most zoonotic infections.

Natural phenomena and man-made catastrophes contribute to the reproduction of rodents, flies, other insects - keepers and carriers of pathogens. Knowledge of these features allows the doctor to imagine an epidemic situation and give a medical and tactical characteristic of possible epidemic foci in disaster zones.

The transmission mechanism of the infection will be maintained and acting in the focus during the term of the causative agent survival in the external environment and in the presence of infectious patients among the affected population. The intensity of the spread of infectious diseases, the degree of municipal and sanitary conditions of people in the emergency area and the placement of the evacuated population have significant impact. In addition, the unequal morbidity in various population groups is explained by the fact that some of them are exposed to greater danger of infection than others, as well as the peculiarities of the susceptibility of the body of people in extreme situations. So, mainly the child's incidence of scarlet, diphtheria, dysentery and other infections is due to a decrease in the intensity of immunity. The infectious incidence may appear in the cause of pathogens by rescuers who have arrived by the PA territory free from this infectious form, as well as in the activation of foci of endemic diseases.

As a result of serious violations of the living conditions and life of the population in the areas of the catastrophe, an epidemic situation in intestinal infections, including abdominal typhoids, paratims, viral hepatitis, dysentery and salmonellosis, sharply sharpened. Potential epidemic diseases in areas of destruction may include cholera, viral gastroenteritis, natural focal and other diseases.

The threat of the emergence of epidemic foci in the emergency areas depends on many reasons:

destruction of municipal objects (water supply, sewage, heating, dr.);

a sharp deterioration in the sanitary and hygienic state of the territory by the destruction of chemical, refineries and other industrial enterprises, the presence of corpses of people and animal, rotting of animal and plant origin;

mass reproduction of rodents, the appearance of epizootia among them and the activation of natural foci;

intensive migration of organized and unorganized people's contingents;

increasing people's susceptibility to infections;

violation of the network of sanitary and epidemiological and medical and preventive institutions, previously located in the disaster zone;

the need to assist local institutions in conducting activities among the population.

In emergency, the epidemic process has a specific specificity, and the inherent patterns of development may violate. First of all, this concerns the first level of the epidemic process - the source of the causative agent of infection, which is customary to be called an object; It serves as a place of natural vital activity, that is, habitat, reproduction and accumulation of pathogen. In the catastrophe zones, the source of infection is difficult to establish, since the forms of its preservation, the place of its livelihoods, reproduction is expanding, its habitat is expanding, etc. Therefore, in the disaster zone, several epidemic foci of different nosological forms may occur at the same time.

With stressful states, susceptibility to infection increases, as the immunological status is reduced, especially in children. A pronounced polymorphism of clinical manifestations of the disease is possible - from the hardest, lightning and fatal forms to the lightest, barely violating the common state of the disease.

The basis of epidemiological diagnosis in the areas of emergency is retrospective and operational epidemiological analysis and surveys of epidemic foci. The main method of identifying and evaluating the epidemic situation in the emergency area is sanitary-epidemiological intelligence.

The order of the epidemiological survey of the hearth includes the following sections of the work:

analysis of the dynamics and structure of morbidity in epidemiological features;

clarification of the epidemiological situation among the remaining population in the disaster zone, places of temporary placement of evacuated;

survey and examination of patients and healthy;

visual and laboratory surveys of the external environment;

determination of economy objects worsening sanitary and hygienic and epidemiological situation in a disaster area and in adjoining areas as a result of the destruction of structures, industrial and residential buildings, damage to water supply and sewage systems, environmental pollution;

survey of medical (veterinary) workers, representatives of the local population; survey of the sanitary condition of settlements, water sources, utilities and food objects, etc.;

treatment of collected materials and the establishment of causal relations in accordance with the available data on the type of epidemic under this infection.

Sanitary and anti-epidemic support of the population in emergency situations begins directly in disaster zones, in emerged epidemic foci and continues on evacuation paths up to the placement of the affected population.

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

5.1. Features of the education of epidemic foci at emergency and a common set of measures to prevent the spread of infection in the disaster zone

Epidemic foci at emergency:

A sharp deterioration in the socio-domestic living conditions of people in connection with the destruction of residential and other buildings, impaired water and energy supply, deterioration in the organization of nutrition, the work of bath laundry institutions, etc.;

One-time contamination of significant areas of the territory, water sources, food raw materials;

The appearance of a large number of affected, which must be hospitalized;

Aggravation of the epidemic situation on infections characteristic of this area;

Infection of people and animals when using infected water and food, mass migration of sources of pathogens of infection;

Reducing the level of natural resistance of the body 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;

The placement of infectious patients in adapted premises and at home due to the inability of evacuation or medical testimony;

Republication of medical institutions, re-equipment of public buildings and structures for deploying observants, hospitals and other medical units; - transportation, autopsy and disposal of a significant number of dead, incl. and from infectious diseases;

The lack of a sufficient number of forces and means of sanitary-epidemiological service and health care, which makes it difficult to organize the timely detection and insulation of infectious patients, laboratory diagnostics and medical care;

Late references of the disease, concealing the disease in surveys and surveys of the affected population, the refusal of hospitalization after the diagnosis is necessarily the need for representatives of the executive authorities (police officers, riot police, etc.) in taking measures to the timely isolation of dangerous for surrounding infectious patients.

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

Utility household equipping places of the affected by the victims;

Sanitary state of settlements;

The presence and equipment of ways to evacuate infectious patients;

Infectious incidence among the affected population;

Immune population population;

Staffing with medical personnel of therapeutic and sanitary and preventive institutions;

A kainy network of infectious hospitals, including reserves for its additional deployment;

Common set of activities to prevent the spread of infection in the disaster zone

- Check in. All patients and suspicious persons are taken for special accounting in a sanitary and epidemiological institution, therefore the dynamics of infectious patients reports to the headquarters of the Anti-Epidemic Commission (SEC) at least two times a day, and during quarantine infections - every 2 hours.

- Epidemiological examination. With the appearance of infectious patients among those affected by the stage, a thorough epidemiological examination is carried out, aimed at identifying the source of infection and path of transmission of the pathogen, the number of communicative, as well as to determine the volume of laboratory surveys and indications for the antibiotic pyrofilance or the use of immunopreparations.

- Hospitalization.Timely hospitalization of the infectious patient is a cardinal measure that prevents the spread of infection. The evacuation of infectious patients from epidemic foci in the catastrophe zones is carried out by a special or adapted transport for this purpose, which after each transportation must be disinfected. First of all evacuate patients with highly contagious forms of infection. In the event of an involvement of a patient police officers, riot police, and others. It is necessary to provide for the measures of their medical protection (clothing, protective mask, antibiotic pyroid, etc.).

- Strengthening sanitary and epidemiological supervision:additional examination of water sources, food reserves, placing placing evacuated, unscheduled surveys of decreated contingents, etc.

- Application of funds of general and special emergency prevention or specific prophylaxis measures for epidemiological indications according to existing schemes.

- Wide Deployment of Sanitary Operation It is carried out in order to increase the level of sanitary culture of the population, clarifying the rules of the behavior of infectious patients and carriers in the areas of the catastrophe prior to their isolation, the procedure for the use of water sources, food, placement rules, personal and public hygiene rules.

Requirements for the evacuation of victims and infectious patients

Among the affected population, the active identification of patients with various infectious diseases appearing due to the "mixing factor", which are subject to evacuation. The evacuation of such diseases can be carried out both beyond and within the emergency zone. When planning the evacuation of infectious patients, their number is determined, the sequence and timing of the exportation, routes to the paragraphs of hospitalization or intermediate items.

Basic Sanitary Anti-Epidemic evacuation requirements affected and infectious patients are:

Organization of epidemiological observation;

Identifying in places of collection of the evacuated population of infectious patients and suspicious to infectious diseases, isolation of them and the direction in the infectious hospital;

Conducting emergency prevention (according to indications);

Equipment for evacuation paths and in places of resettlement of affected infectious insulators, observator and monitoring of health care;

Control over the organization of food, water supply and bath-laundry service on the paths of evacuation and in places of placement evacuated;

Control over compliance with the sanitary and hygienic regulations for drinking water and the storage of food products intended for evacuated infectious patients;

Organization of control over maintaining the satisfactory sanitary condition of places and premises of the temporary stay of the evacuated population;

Fighting insects and rodents, control over the removal and disinfection of uncleanness and food garbage on routes of movement. The management of the evacuation is carried out by the headquarters of civil defense and emergency situations (GOCO) of administrative territories. For the practical implementation of evacuation measures to assist the headquarters of the Goches, special evacuation bodies and formation are created.

Health and Sanitary and Epidemical Management Authorities organize a medical support of the evacuated population representing a complex of medical and evacuation, sanitary and hygienic and anti-epidemic events. These activities are held at the boarding grounds, in the location points of the evacuation and landing in the place of destination, in the path and locations of the settlement.

Sanitary-anti-epidemic support of evacuated places are imposed in places of departure, arrival and accommodation, as well as on tracks on highway and dirt roads - to local health care departments, centers of sanitary and epidemiological surveillance regional, edge, city, district, and in the route of railways - on MGTS health authorities, on waterways of the message - to the organs of health management of water transport.

The Sanitary and Epidemiological Service of the Republic, which is part of the Russian Federation, Region, District, is fully responsible for sanitary-anti-epidemic support and allocates physician-preventive institutions to doctors to organize measures for medical care for evacuated groups. The duties of the above specialists include:

Clarifying medical and sanitary conditions of the placement of evacuated;

Participation in the choice and equipment of sending, arrival and final placement of victims, as well as sanitary and epidemiological supervision of them;

Organization of medical examinations evacuated, carrying out measures for unitary processing on epidemic testimony;

Organization and conducting sanitary and epidemiological supervision while following trains, courts, on highway roads, on aircraft;

Conducting emergency special and specific prophylaxis evacuated by epidemic testimony;

Implementation of sanitary and epidemiological surveillance of water supply and nutrition.

Sanitary and epidemiological service in places during evacuation from the districts of the disaster should have information about the contingent evacuated. Persons responsible for sanitary-anti-epidemic support are evacuated must have a permanent connection with the executive authorities that carry out evacuation.

Anti-epidemic events in the following way

Include identification, insulation and hospitalization of infectious patients to nearby hospitals located on the evacuation paths of the population;

Sanitary supervision of food,

Provision of benign drinking water;

Disinfective events.

Each train, marine and aircraft must have medical personnel appointed by the leadership of the territorial health in places of sending and performing simultaneously functions of sanitary supervision (doctor, paramedic, nurse, epidemiologist, disinfector - depending on the number of evacuated).

When evacuating the affected population on passenger trains Medical personnel carries out:

Periodic bypass of all wagons;

Identifying patients and providing medical care;

Notice of health authorities on cases of infectious diseases;

Isolation of patients with infectious diseases;

Preparation for evacuation and transportation of patients to stationary health care facilities;

Supervision of the sanitary condition of cars;

Sanitary diary;

Registration of documentation If you need to remove patients from the train or the deceased ones.

Each train highlighted separate coupe and wagons for temporary placement of patients. Medical train staff must have medical stamping with medicines, incl. Antibiotics for emergency prevention, disinfectants. All restaurants and buffets for railway stations must be reoriented to supply evacuated hot water, food and children - milk.

When detected in the path of patients and suspicious on particularly dangerous infections, They are removed from the train at the nearest station having a medical and prophylactic institution or an insulating checkpoint. Hospitals are required by telegraph notice from persons responsible for evacuation to prepare for receiving infectious patients. When 20 and more infectious patients or the case of a particularly dangerous infectious disease, a quarantine or observation is subjected to a quarantine or observation.

At the same time it is necessary to hold:

Medical examination of all evacuated to identify, isolation and sending in educational institutions of all patients and suspicious infectious disease;

Emergency total, and in establishing a diagnosis, special prevention of antibiotics and other drugs; Complete sanitary treatment of evacuated, disinfection of their things and wagons (if necessary).

In the event of evacuation by motor vehicles in highway and dirt roads, territorial health authorities organize medical, and sanitary and epidemiological institutions - sanitary and anti-epidemic activities in groups of evacuated (based on the presence of forces, means and conditions).

In the arrival places evacuated Sanitary and epidemiological service performs the following activities:

Participates in the choice of territory and settlements of districts, prosperous on sanitary and epidemic state;

Exercising sanitary and epidemiological supervision of the deployment and organization of the work-distributors for temporary placement (tent towns, dugouts and other residence sites), temporary infectious hospitals for nutrition, water supply of victims;

Organizes the sanitary processing of arrivals and disinfection of their things in the presence of epidemic testimony in the LPU in the arrival places of the affected population,

Provide medical examination, primarily a children's contingent, providing the necessary outpatient polyclinic and inpatient assistance to infectious patients,

Conducting emergency prevention.

Anti-epidemic events in temporary placement

Requirements for the placement of immigrants.

Dry, not sleeper smooth territory with a natural bias to drive atmospheric precipitation;

Low level of groundwater and clean, well filtering soil;

Good light illumination and ventilation;

Location near the sources of drinking and food security, energy and heat supply, driveways;

Division into two zones: residential (domestic) and service area;

Sanitary-protective gaps between the places of placement of people and facilities that have a harmful effect on evacuated;

When choosing a place, it is necessary to take into account the local seasonal rose of the winds;

The place of temporary should not not include natural foci, endemic in particularly dangerous infectious diseases, the sanitary protection zones of drinking water supply, polygons and graves of industrial waste, as well as to be safe from landslides, selent flows, snowy avalanches;

The territory should be well-designed well and subsequently contained in purity and order;

Solid household waste must be assembled into installed on platforms with a solid coating containers with a closing lid, which should be exported when filling them no more than 0.9 useful volume; Durations of storage of 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 grazers should be filled out of more than 2/3 of their volume, the outer restrooms should be removed daily, disinfected, should be covered in the dark, windows - closed with a fine-lined grid;

Sanitary and hygienic requirements for premises and other objects

The evacuated population is provided by housing, taking into account the deployment and structure, if necessary, temporary dwellings (tents, yurt, earthlings, prefabricated or mobile homes, etc.), at the rate of 6 m 2 per 1 person. The most appropriate collection structures of residential buildings of the domestic factory assembly (small houses), if during their construction and operation, the operation of the necessary engineering equipment (ventilation, electrical, heat, water supply) is functioning. It is also possible to use the preserved residential fund (residential buildings, holiday homes, sanatoriums, boarding houses, military towns, children's camps).

The air temperature in the premises where infectious patients are located, should not be below 18 ° C with an average relative humidity of 35-65%. In order to avoid excessive cooling of the victims, it should be placed on mattresses, beds, bedding, garages, etc., not closer than 0.5-0.8 m from the outer walls.

Water consumption norms for the needs of infectious patients arriving for treatment are at least at least: 1 patient located on inpatient treatment is 75 liters, 45 liters on the washing. Urban baths or movable disinfection and shower plants (DDA, DDP, bath laundry trains, etc. should be used for sanitary processing.

It is necessary to have drying premises for drying clothes and shoes, at the rate of 18 m 2 of the area of \u200b\u200bthe drying room per 100 people. The air temperature for drying woolen and cotton clothing should be maintained at 60 ° C, for drying shoes and fur clothing - 40 ° C.

At a distance of 50-100 m from the residential area should be placed: washbasins, at the rate of no more than 20 people. on 1 crane; Outdoor toilets, at the rate of one toilet - for 20 women, one toilet to 40 men.

Cleaning residential premises with a wet way using disinfectants should be carried out daily, the total general cleaning of all rooms is carried out at least once a week. Washbasins and toilets are cleaned and disinfected at least 2 times a day.

The distance from the place of placement of people to the outer restrooms - 50-100 m; Ubreb - at least 5 m; platforms for garbagers - not less than 20 m; pigsties and other livestock objects - at least 200 m; open warehouse with coal - not less than 300 m; Filtering fields - at least 500 m; fields of associate - not less than 1 km; Dusting landfill (landfill) - at least 3 km.

When deploying a town in a tent version, it is necessary to take into account that the period of accommodation in tents is considered in hygienic terms as temporary (up to 6 months), since they are difficult to create stable and normal sanitary and hygienic living conditions.

During catastrophes and natural disasters, water supply, sewage systems, folk facilities that use or producing chemical, bacteriological substances and radionuclides are destroyed. As a result, the catastrophes appear the corpses of people, animals, there is an intensive migration of the population. In these difficult conditions, epidemic foci occurs, the emergence and development of which contributes to the presence of infectious diseases of infectious patients or carriers of infectious diseases, as well as persons of risk groups (wounded and patients) and infected external environment, creating conditions for the rapid spread of infection. In disasters, natural foci are activated. As is known, the development of the epidemic process is possible in the presence of three factors: the source of infection, transmission paths, human susceptibility. Impact on any link of this chain can prevent an epidemic. Anti-epidemic activities used in the focus for the impact on the epidemic process include:

1) activities aimed at the destruction of causative agents of diseases: disinfection, disinsection, deratization, sanitary treatment;

2) activities aimed at terminating the possibility of implementing the mechanism of transmission of infection: protection of water and food from infection by causative agents of diseases, the use of individual means of protection and means of personal and social hygiene;

3) Activities aimed at reducing the susceptibility of the population to infection: an emergency non-specific (general) and specific prophylaxis.

The real boundaries of the focus, the intensity of the infectious process determine the organization of anti-epidemic activities in emergency. Often the boundaries of epidemic foci in emergency coincide with the borders of cities and settlements that have common economic and transport links. As a rule, the number of infectious patients in the focus increases sharply and suddenly, especially by infection, uncharacteristic for a particular territory.

The activity of the epidemic focus is calculated by two and three incubation periods of the infectious disease due to the presence among victims of susceptible people (wounded, burnt, persons with psycho-neurological disorders). The incidence of victims in an epidemic focus by one or another infection will depend on the sanitary and epidemiological conditions of the foci of the catastrophe (water supply, nutrition, cleaning of the territory), places of placement of the affected population, the work of medical and prophylactic and anti-epidemic institutions. As a rule, the number of illness exceeds 1/3 inhabitants of the village (city, district, settlement).

The greatest virulence, resistant to the external environment, long-term survival in food, water, the pathogens of particularly dangerous (quarantine) and natural infections are causative: plague (pulmonary form), Siberian ulcers, meloidoose, yellow fever, hemorrhagic fever. The greatest speed of development of the disease and severity is different cholera. However, in emergency situations and all other infectious diseases have a tendency to rapidly spread. In addition, the emergence of chronic, not a timely recognized infections is obstructed. This leads to the emergence of an epidemic focus and patients with combined infectious diseases.

When conducting anti-epidemic activities, the features of the education of epidemic foci in emergency (A.A.Shaposhnikov) are taken into account:

Symmetrosis of infected territories;

Infection of people and animals when using infected water and food, mass migration of infection sources;

The lack of clear boundaries of the lesion focus.

For the localization and elimination of the epidemic focus it is necessary to implement the following events:

1. Conducting general intelligence to establish the fact of the presence of an epidemic focus and its boundaries. Based on secondary signs (the appearance of insects and rodents in large quantities or their corpses, etc.), the assumption of epidochage is made. Immediately after receiving general intelligence data, special intelligence is carried out, in which, along with an epidemic survey of the alleged epidochage, includes selection of air, water, soil, as well as insects and animal corpses.

2. Alert population after receiving intelligence data to take measures to prevent contamination (sanitary processing, the use of collective and individual protective equipment).

3. Organization of quarantine and observation in order to locate an epidemic focus or preventing the spread of infectious diseases.

4. Conducting general and special prevention of the population is carried out by solving the sanitary and anti-epidemic commission of the territory. General prophylaxis is carried out before establishing the type of pathogen in the focus for 5 days by the antibiotics of a wide range of action: doxycylin 0.2 g per day, rifampicin - 0.6 g, tetracycline - 0.5 g, sulfaten - 1.4 g. Special prevention It is carried out after the determinant of the type of pathogen on the basis of a confirmed clinical diagnosis in infected patients. This type of prevention is carried out by vaccination brigades using vaccines, serums, anatoxins. It is also possible to use bacteriophages and antibiotics, subject to the determination of the contingent, which is carried out by immunization: children, adults, rescuers, medical staff Brigades.

5. Active identification of patients is carried out by survey (2 times a day) of the population and measuring the body temperature. Such an organization of work allows you to quickly take measures to isolation and hospitalization of sick.

6. Holding in the heart of disinfection, disinsection and deratization, disinfecting food and water. A very important section of work in the focus is an examination of an infected product or food raw materials. The conclusion of its suitability is issued according to data, with those under the table.

7. The organization of sanitary and educational work in emergency is necessary for the strict fulfillment by the population of recommendations on the rules of behavior in epidochage, compliance with sanitary and hygienic rules, individual protection measures.

In a technogenic disaster caused by mechanical, chemical and physical factors, the environmental parameters deteriorate. Therefore, a special importance is acquired by a set of sanitary and hygienic, anti-epidemic events.

Work on the organization and elimination of the consequences of man-made disasters is carried out both during the period of daily normal functioning of a potentially dangerous object and in emergency mode. Wherein the following tasks are solved :

Organization and implementation of environmental monitoring;

Creation and reliable operation of the information and alert system, reference service;

Analyzing the results of environmental control;

Creation and preparation of forces and means of ensuring the implementation of measures for man-made catastrophes.

The events held are the more effective than the more active and analyzes information about the environmental situation in the areas of accommodation of hazardous industries. This information is used in planning and conducting sanitary and hygienic activities in a specific region.

Sanitary and hygiene activities include:

Sampling followed by their direction to research to identify chemical, biological, radiological pollution;

Maintaining a proper sanitation in the area of \u200b\u200bthe area, an object that produced in the emergency area, as well as in the area of \u200b\u200bthe formations of the formations involved in the elimination of the consequences of emergencies, the placement of the dispersed and evacuated population;

Organization and control of nutrition and water supply of the population and persons involved in the elimination of the effects of emergencies;

Organization of chemical, bacteriological and radiological control of the quality of drinking water, food and food raw materials;

Control and organization of bath-laundry service;

Ensuring the population and rescuers with individual means of disinfection of water;

Monitoring the observance of sanitary-anti-epidemic activities of the population living on polluted territory, the formations involved in the elimination of the consequences of emergencies;

Organization of epidemiological observation, participation in the active identification of affected and patients;

Control of removal and disinfection of food waste on movement routes and in areas of settlement;

Organization of information support of the population (about sources of possible defeat, infection, ways to protect and assist);

Conducting sanitary processing, degassing and disposal of environmental objects, burial corpses.

In the case of air pollution in the emergency area, protective events or evacuation of the population from the pollution zone, prohibiting the use of garden crops, fungi, water use for drinking needs, as well as bathing, fishing, prohibition of pet contact, eating contaminated products animal husbandry. In the case of contamination of water sources, as well as water-seating systems, it is necessary to carry out measures to improve the quality of drinking water or organize water supply by imported drinking water based on the norm 50 to 60 l per day per person (see Table 29).

The urgent problem in emergency is to ensure the population and persons involved in the elimination of the consequences of disasters, food, safe for health, on the one hand, in sufficient quantities and the necessary set to maintain vital activity - on the other. Norms of the population in emergencies are the same as in the usual period of its livelihoods, because The deviation from them can lead to the pathological condition of the body. Therefore, in case of pollution of the environment in the cities and settlements of Russia, the creation of stocks of basic food products is provided - bread, milk, meat, sugar, etc.

The food reserves created in the regions allow us to ensure the need of a population affected with man-made catastrophes by only 40-75%. Therefore, some areas are not able to ensure the affected population due to public resources and then the help is provided in the prescribed manner at the expense of federal reserves.

In addition, the list of foods stored in the territories in case of emergency cannot be filled with a shortage of full-fledged proteins, ascorbic acid, vitamins B, RR, folic acid and carotene. It is important to remember when providing food products for pregnant women and children living in the territories of geochemical provinces whose diet should be rich in vitamins, iron-containing and other products.

The consequence of a technogenic catastrophe can be admissible to the environment of high concentrations of gaseous, liquid, dusty, dangerous substances for human health, which can lead to the impossibility of using local food raw materials and food. To establish their suitability. The examination is also determined by the procedure for the use of food depending on its pollution. Even in the usual period, the quality of food raw materials and food products often does not comply with hygienic standards for the bacteriological indicator and the content of heavy metals, nitrates, pesticides, radionuclides and other toxicants in them. It should be noted that the degree of food safety to a large extent depends on the safety of the technology of their processing, storage and implementation. The level of sanitary culture and technological discipline, as well as the equipment of the food industry enterprises, also affect the receipt of benign food.

Sometimes there are situations in which the use of food local resources (as in the case of the Chernobyl catastrophe) is impossible due to the content of chemical, biological and other substances in them. Thus, in canned products, lead, mercury, cadmium, tin, iron, copper, zinc, arsenic often exceed the maximum permissible concentration. The use of such products during the mannergenic emergencies increases environmental tension at the disaster site and will contribute to an increase in the incidence of the population and rescuers. Therefore, it is necessary to lay canned and other food products in case of emergency, the most pure, periodically carry out sanitary and hygienic examination and their refreshment. However, the presence of safe food is not yet a determining factor. Significant during this period is the problem of their timely delivery directly to the consumer. The organization of support for the population should be carried out simultaneously with the announcement of the emergency period, or no later than 10-12 hours.

The organization of protection and delivery of food to the population under the influence of chemical, biological, radiation factors of emergency is an important link in providing safe food and rescuers. The imperfection of the regulatory and economic support of the preparation of territories to functioning in emergency situations is a frequent cause of the incommodation of the delivery of high-quality food to the EFC area.

When organizing the supply of nutrition, it is also necessary to remember the national habits of the population and climate-geographical features of the territory on which a man-made catastrophe occurs, since a set of food products living in the northern regions of the country should differ from a set intended for the population living in the south.

A special place in medical and sanitary assistance to the population in emergencies is occupied by therapeutic and preventive institutions. The sanitary condition of therapeutic and preventive institutions is largely dependent on the type of water supply. The device of rational and centralized water supply is an important condition for the prevention of nosocomial infections, as well as the use of water for therapeutic purposes - conducting therapeutic hydrotherapy.

As a result, the emergencies are possible damage to water pipes, pumping stations and other engineering structures of the system of centralized water supply of medical and preventive institutions. In the case of maintaining local water supply and sewage and sewage in the hospital, a boiler room is built on the territory of the hospital. The temporary water supply of the hospital departments at emergencies can be ensured by installing water heating columns in bathrooms and titanium boiling rooms in the bofet rooms. With any organization of the Hospital Supply of hot water, its temperature must be no lower than 70 ° C. The calculation of the general water consumption of the hospital or the polyclinic is carried out on a bed or at visit. When calculating the water consumption of hospitals proceed from the norm of 400 l per day without taking into account fire safety, in an outpatient polyclinic institution - 15 liters per day per visitor. In this case, it is necessary to take into account that the greater the shank capacity of the hospital, the higher the level of water consumption.

If the centralized water supply is violated, other water sources whose water corresponds to the established sanitary requirements for drinking water can be used for the water supply targets of the hospital. Often in emergency selection of a water source is limited and its reliability in sanitation cannot be provided. Underground water sources are most reliable and, if possible, an artesian well is used to water the hospital. The question of the suitability of a water source for water supply the hospital is solved by a sanitary-epidemiological service, which issues a conclusion about the possible conditions for its use for the needs of the hospital. When solving the question of the use of water of open water sources, water intake places are examined, the conditions and methods of disinfection are selected.

In the event of the destruction of the water source or a distribution network and the impossibility of ensuring the medical and prophylactic institution (LPU) with water from open and underground water sources to their recovery, it is necessary to organize the actuators of water in the desired volume in special containers. LPU sewage must provide for mandatory wastewater treatment by installing local sewage treatment plants or joining a centralized sewage system. If hospitals in emergencies unfold on the territory of the countryside, the use of filtering fields or irrigation fields is possible to clean wastewater. However, the placement of large hospitals in the countryside requires, as a rule, cleaning wastewater on biological filters with subsequent disinfection of the waste fluid. At the same time, treatment facilities are located with a leeward side at a distance of at least 100 meters.

An important importance for the operation of the hospital in emergency is acquired by the issue of organizing washing and disinfection of hospital linen. In the case when LPU is located in large cities and the usual system of service is not broken, the washing of hospital linen is produced in a specially selected laundry located in the city. Lingerie is assembled from various types of LPU city, (hospital, clinic) and separations of various profiles: surgical, therapeutic, maternity, infectious, etc. However, it is necessary to pay attention to a significant difference in the technology of underwear: underwear from infectious hospitals (separations) at first to disinfect By pre-soaking in a disinfectant solution. Only after that it is washed with the usual method. When washing the linen from maternity, children's, surgical departments, detergent solutions with a neutral reaction are used.

For washing, the linen directly in the hospital is given separately standing laundry building. It is allowed to unite the laundry with boiler room and storage rooms. Often, the laundry is combined with the disinfection department of the hospital. The peculiarity of the processing of hospital linen requires a certain laundry plan. The dirty compartment adjoins the washable hall and the disassembly compartment. Washing machines are installed in the opening of the wall separating these rooms. Machines are loaded in a dirty compartment, at the end of the washing the laundry is unloaded in the washing room (conditionally clean half) laundry. Lingerie from noncommunicable branches comes directly into the disassembly separation of the laundry and after sorting is soaked, then erased and strokes. After the underwear passed through ironing machines, it is considered clean.

It is necessary to remember the timing of the survival of pathogens of certain diseases when infection with linen or clothing:

Abdominal typhoid - from 14 to 50 days;

Parathines A and B - up to 50 days;

Dieseneria - 1-2 weeks;

Cholera -12 days;

Difteria - up to 3 months;

Meningitis - 20-48 hours;

Brucellosis - up to 17 days;

Leptospirosis - up to 30 days;

SAP - 15 days;

Siberian ulcer - dozens of years.

The bandwidth of the laundry is calculated on the basis of the flow rate of the linen on one bed per month. So, for the therapeutic and neurological separation of the rate of consumption is 40 kg;

surgical, gynecological, children's, tuberculous and infectious -60 kg; Maternity (children's and women's underwear) - 80 kg. The expenditure rate of the linen as a whole in the hospital ranges from 50 kg per month for small hospitals, up to 60 kg - for large multidisciplinary hospitals. If a polyclinic unit is functioning in the hospital, then when calculating the linen, the necessary clinic, 10 outpatient rooms per bed of a mixed hospital are conditionally adopted.

When organizing laundry laundry from non-infectious and infectious departments is allowed to simultaneously take 30% of infected linen and 70%-high-infected. Regardless of emergency circumstances, the wicked underwear of therapeutic and preventive institutions must meet sanitary and hygienic standards.

Nutrition affected who are provided for medical assistance in the medical institution placed in the emergency area should be organized in such a way as to bring food cooking space as close as possible to the savings of the taste and food properties and remove odors, as well as dirty food in hygienic. . Therefore, there are two organizations of the organization: centralized and decentralized.

With a centralized system of nutrition, a single kitchen with a complete set of rooms is located in a separate building on the territory of the hospital. Such a device requires a good food transportation organization in the hospital branch: the presence of warm underground or terrestrial transitions, heat-resistant food storage containers, etc. With a decentralized system of nutritional organization of patients, a kitchen-preparation with storage rooms provided by refrigerators, cameras for separate storage of fish, meat , dairy products and fruits. It is necessary to equip a separate chamber for temporary storage of waste and garbage, which should have a separate output outward. If the hospital is located on the territory of the countryside, where there is a sufficient number of cellars, the glaciers are arranged for food storage.

When the device in the hospital is a decentralized power supply system in the kitchen-harvesting, primary processing of products is carried out, their storage. Prepared semi-finished products through the expedition are distributed over the housings in the kitchen-harvesting, where thermal processing of products is carried out. At the same time, the kitchens should be as isolated as possible from the hospital by a special device of walls, overlaps, doors, sluent fences. The kitchen-preparation is equipped with an independent supply and exhaust ventilation system and a grease system.

The main production facilities of the kitchen are arranged in accordance with the requirements of the technological process: premises (places) for primary product blanks, clean preparations for fish and meat, hot processing products, manufacture of cold dishes, issuing finished foods. For sink kitchenware, a separate room is given.

The described features of the technology relate to the work of the gearbox not only in the daily activities of the hospital, but are also preserved during the elimination of the consequences of the emergency.

The hospital is included for receiving, storing, identifying corpses, as well as conducting forensic examination and pathology studies. They can be independent institutions, but, as a rule, are an integral part of the pathologists of hospitals, research institutes, a special profile laboratories, a bureau of forensic examination, as well as the departments of pathological anatomy and forensic medicine. Morges are constructed, as a rule, according to typical projects, it is possible to place them or in the ground floors, or in the basements of the hospital's buildings directly. When the device in the basement, the morgue is isolated from other premises of the building, equipped with elevators or a special staircase for delivering corpses from offices. The morgue may include the following rooms: a room for receiving corpses, a storage room for one or more corpses, where camera safes (cooled cabinets) are installed in two or three tiers. In Morg, there are a sectional hall, a room for washing, embalming, dressing corpses. The morgue is also equipped with auxiliary premises: highlight rooms for storing fixed materials, clean clothing and coffins. Particular attention is paid to the equipment of the room intended for relatives, awaiting the issuance of the deceased, as well as the hall for conducting ritual ceremonies. The hall is provided by a separate yield and driveways. Departure from the morgue can be combined with a departure from the economic yard. For storage and issuing corpses of those who died from infectious diseases, isolated rooms with separate outlet to the street.

The main and auxiliary rooms of the morgue are placed in such a way that the flows have not intersected anywhere from the moment of receipt to the stage of issuing a corpse with personnel, relatives and research complex. The area of \u200b\u200bthe above-mentioned locations of the morgue is regulated by special regulatory documents and depends on the sick power of the hospital, the destination of the morgue, the service radius (urban, district, interdistrict).

The nature and volume of the work of the morgue depends on the type of emergency, the number of irretrievable losses, the medical institution profile. In multidisciplinary hospitals, the number of autopsy is much larger than in children's infectious hospitals. In the maternity homes, the overwhelming majority of pathology analytical studies are carried out on the dead premature and stillborn babies.

Morg must be equipped with cold and hot water, well-equipped with sewage, well-functioning ventilation. The floor and walls must satisfy sanitary and hygienic requirements, should wash and disinfect. The pathologist autopsy and identification of the dead and died in the emergence of emergencies can be carried out not only in the morgue, but also in fitted rooms, and the corpses can be stored in wagons-, refrigerator machines.

For the burial of the dead and the dead, cemeteries are satisfied. They have to

it is not closer to 300 meters from the nearby settlement, on elevated places, with low groundwater standing (not less than 0.5 m from the grave bottom) and with soil increasing for air. Usually, the graves are preparing the dock of a single burial of the dead in size 2x1 m, a depth of 1.5 m. The squeezing hill must be a height of at least 0.5 m, and it is necessary that its base will be at the edges of the grave.

Such a device limits the penetration of atmospheric waters into the grave, decomposition depends on the quality of the soil, moisture and air content in the grave. Complete decomposition occurs in about 10 years. Pathogenic vegetative forms of microorganisms are dying during the first year, and in wet and raw soils with poor air access decomposition takes place slower. The use of graves for re-burial is allowed not earlier than in 15-20 years, when the complete mineralization of organic substances is completed.

The burial in fraternal graves is carried out in compliance with the following conditions:

The size of the fraternal grave is determined at the calculation that 1.2 m area should be assigned to each corpse;

In one fraternal grave, no more than 100 corpses can be burned;

It is allowed to lay the corpses in 2 rows, while the lower row is falling asleep with a height of 0.5 m;

From the upper row to the surface of the earth, there must be a layer of at least 1 m;

The squeezing hill is made at no less than 0.75.

The use of disinfectants in the burial is impractical, since their disinfecting effect is reduced due to the large content of organic substances, and the processes of mineralization are inhibited by disinfectants.

When buried corpses infectiouspatients are required their disinfection. FROMthis trop is wrapped in fabric, impregnated with 5% Lizol solution or a 10% chlorine lime solution. A layer of chlorine lime with a thickness of 2-3 cm is poured onto the bottom of the densosococco tomb.

Requirements for burial in the conditions of the North, in the regions with low average temperatures and high humidity are tightened.

The burial of persons undergoing radioactive infection makes an additional requirement: the prevention of contamination by radioactive substances of the environment. To fulfill this requirement, burial should be made on specially designated places in cemeteries (Mitinskoye in Moscow), as well as equip the graves with special containers. At the same time, the depth of the graves and the distance between them should be so as not to become sources of increased radioactivity, i.e. The grave area should be quite large. After the burial of such dead, it is necessary to carry out periodic dosimetry control of the surface of the earth between the graves and the epchogical hill.

The crematoriums are designed for cremation of the dead and those who died, with the subsequent burial of their remains in specially designated places - Columbaria or graves. The premises of the crematorium consist of two parts: the ritual hall and a number of utility rooms, which includes the boiler room, the room where the bust for burning corpses, and personnel rooms equipped with shower and changing room are installed. In the crematorium, it is also necessary to release the premises for storing and issuing the remains of cremated. The crematorium is usually built on the outskirts of the settlement (taking into account the prospects for its development), are located with a leeward side and are equipped with good access roads and parking lots.

Planning and conducting measures for anti-epidemic and sanitary and hygienic protection of the population in emergencies are implementing institutions and formations of the Department of State Sanitary Sunsornezor, which is part of the Ministry of Health of the Russian Federation. The basic principle of the state of the State Epidemiological Service in emergency is continuous control over the solution of daily work tasks by performing supervisory functions. There are more than 2.5 thousand sanitary facilities and more than 150 specialized formations in the system of the State Sannepid Services of the Russian Federation. For the organization and conduct of sanitary and hygienic and anti-epidemic activities on the territory of the Russian Federation, 26 centers of state-poinnadzor of complete readiness and 190 head centers of state-poidnadzor are organized (the term of leadingness is 6-8 hours). The formation of specialized moving units, brigades and groups are caused by the need for an operational response. All the formations of the state-poid service are abnormal. The centers of state sanitary and epidemic oversight of all levels have sanitary and epidemic and bacteriological laboratories, radiological, toxicological and virological departments, departments of particularly dangerous infections. Republican anticipated center, 5 anticipated institutions, territorial anticipated centers. The central Research Institute of Epidemiology Organize and ensure the implementation of the necessary amount of anti-epidemic measures to prevent and eliminate particularly dangerous infections. Specialized formations of state -plain services are created on the basis of the centers of state-poindenzors of the constituent entities of the Russian Federation, anticipate institutions, the Research Institute of Epidemiological and Hygienic Profiles.

The Russian StatePid Services provides for the organization of the following types of formations:

Sanitary and epidemiological detachments (SEA);

Specialized anti-epidemic brigades (SPEB);

Epidemiological Intelligence Groups (GER).

Sanitary and epidemiological detachments (SEA) Formed by the centers of state-poinnadzor of the constituent entities of the Russian Federation on the basis of the staffing of the institution of the state -plain service and unite the radiological, sanitary and hygienic (toxicological) and epidemiological brigade. The centers of state-poidnadzor, not having the possibilities of the formation of SEA, form sanitary-andpidbrigades (SEB) consisting of radiological, sanitary-hygienic (toxicological), epidemiological groups. The composition of the SEA groups involved in the elimination of health effects of emergencies depends on the particular sanitary and epidemiological situation. GossenaPid Services on the territory of Russia 70 SEA was formed, the staff number of each of which is 21 people. Typical team of the brigade included in the SEA - 5 people. The creation time of SEA is 24 hours (SEB - 12 hours), after which the detachment is able to provide work offline on the territory of emergencies within 3 days.

The main activities of the SEA with different types of emergencies in the focus of the defeat of natural disasters:

organization of emergency non-specific and specific prevention of infectious diseases among the population, the personnel of emergency and rescue and other formations involved in the elimination of emergencies;

Control and provision of organizational and methodological assistance to ensure the sanitary and epidemiological regime of medical institutions, formations and departmental services;

Control over the organization of the sanitary and hygienic mode of work at catering establishments, water supply facilities and other livelihoods;

Monitoring the conduct of sanitary processing of an emergence in emergencies entering the medical institutions;

Tasks, principles and basic measures of sanitary contemporability in emergency situations.

Sanitary-anti-epidemic support in emergency includes a complex of organizational, legal, medical, hygienic and anti-epidemic measures aimed at preventing the emergence and elimination of infectious diseases, compliance with sanitary rules and norms with a sharp deterioration in the sanitary and epidemic condition, the preservation of public health and maintaining its working capacity.

Unified State System Prevention and Eliminate Emergency Situations ( RSChs.) Includes a functional subsystem of supervision of a sanitary and epidemiological situation involved in the elimination of the effects of Natural and Technogenic CS.

The main principles of the organization of sanitary and anti-epidemic support of the population in emergency are:

the state and priority nature of the sanitary and epidemiological service, the constant readiness of its forces and funds, their high mobility, clear functional purpose and formation, taking into account regional characteristics;
a single approach to the organization of sanitary and anti-epidemic measures;
compliance of the content and volume of measures of the sanitary and epidemiological situation, the nature of the activities and the possibilities of institutions and the formations of the service;
differentiated approach to the formation of forces and means, taking into account regional peculiarities, level and nature of the potential danger of territories;
interaction of the Sanitary and Epidemiological Service of the Ministry of Health of Russia with the bodies and institutions of other departments and departmental health services.

The main objectives of anti-epidemic support of the population in emergency are:

prevention and reduction of the infectious incidence of the population and preventing the spread of hazardous infectious diseases in the emergency area and beyond;
maintaining sanitary and epidemiological well-being in the emergency area and in areas of temporary placement of evacuated population, ensuring epidemic security of drinking water, food raw materials and food, utility and other objects.
Sanitary and epidemiological supervision of sanitary-component is carried out at the federal, regional, territorial, local and object levels.

From the emergency room of natural and technogenic nature for sanitary-epidemiological services, the highest significance of them are the greatest significance, which most of all complicate the sanitary and epidemiological situation.

Sanitary and preventive measures in emergency situations.

In the period and after the occurrence of natural disasters, accidents, disasters, there is a sharp deterioration in the social conditions of life and life, a large number of mechanical injuries, burns and other lesions, which are significantly reduced by the natural resistance of the body, there are stressful states and other phenomena. The population is deprived of the housing stock, electricity, drinking water, the sewage is destroyed, the work of bath laundry institutions is disturbed, the organization of food is worse.

To ensure rapid response to the CGSAN and other institutions of sanitary and epidemiological services, specialized formations are created.

In order to prevent and eliminate the health consequences of the emergency, sanitary and epidemiological institutions and formations are carried out by the following main activities:

exercise control over the sanitary and epidemiological situation, organize the examination of food raw materials, food, drinking water, the external environment for pollution with radioactive substances, poisoning and chemically hazardous substances, pathogenic microorganisms;
interact with departmental health services on issues of assistance to the population in lesion foci;
conduct special training of employees of sanitary and epidemiological institutions and formations for work in emergency;
maintained in a high degree of readiness the territorial centers of the state-poidnadzor of the formation and institution of the Sansepidservable, the forces and funds of research institutes operating in the RSCC;
accumulate, storage, refreshment, accounting and control of medical property necessary for the work of the formations and institutions of sanitary-epidemiological service in emergencies;
monitor compliance with sanitary rules, hygienic standards in the emergence of emergencies in peaceful and wartime;
organize the operation of the network of observation and laboratory control but the timely detection and indication of biological (bacteriological) infection (pollution) of drinking water, food and forage raw materials, food, environmental facilities in the emergence of peaceful and military time;
there is forecasting the possibility of the emergence of epidemics of the territory of the Russian Federation.

For the operational guidelines and coordination of the activities of organizations and citizens to prevent mass infectious diseases and poisoning of people and the elimination of the consequences of the emergency, the local executive authorities are created by permanent sanitary and epidemiological commissions. These commissions include the heads of administrative territories services, and the working body of the Commission is the headquarters, which will be created from the employees of the GOCM services, health care and anti-epidemic institutions,

In the institutions that are part of the State Sanitary and Epidemiological Service (CGSAEN, research institutes of sanitary and hygienic and epidemiological profile, anticipate institutes and stations, etc.), management bodies are created to work in emergencies - the headquarters of the headquarters of the headquarters are determined By order of the head of the object, depending on the structure of the institution, its capabilities and solved tasks.

The procedure for the work of the headquarters of the office of the object is determined by the functional responsibilities of its officials.

Under sanitary and hygienic support in emergency

it is understood as a set of events held in the area (district) of emergencies in order to preserve the health of the population and the personnel involved in the elimination of the consequences of the emergency, by: / medical monitoring of their health; sanitary supervision over the conditions of placement, 3 nutrition, (water supply, the sanitary condition of the territory, the removal of uncleanness, burial of the dead people and animals; estimates of the sanitary and hygienic state of the Zone (district) of the emergency; forecasting the influence of adverse factors on the health of the population and personnel, participating in the elimination of emergencies, and4 development of proposals for improving this influence; 'hygienic education.

Sanitary and epidemiological service organizes and conducts the following sanitary and hygienic measures:

organizing and conducting an assessment of the sanitary and hygienic state of the territory and determining the harmful factors affecting the public health and the environment;
organization of sanitary and hygienic measures to protect emergency facilities, participants in the elimination of the consequences of the accident and the population;
organization and participation in sanitary supervision over the terms of the population in the area of \u200b\u200bemergencies, its nutrition, water supply, bath-laundry service;
organization of sanitary supervision in hygienically significant objects providing the life of the population in the area of \u200b\u200bemergency;
medical monitoring of the health of the personal composition of the formations and institutions participating in the elimination of the consequences of the emergency
participation in controlling the sanitary condition of the territory, timely purification, disinfection and supervision of the burial of the dead and the dead;
organizational and explanatory work on the regime and rules of behavior of emergency personnel.

When conducting sanitary and hygienic measures, it is necessary to take all hygienically significant objects under strict control. These objects include: water supply and sewerage systems; Food industry, catering and trade enterprises; children's preschool and school institutions; public service enterprises; affected and inflated residential fund; medical institutions in which the affected and patients from the catastrophe area were hospitalized; seats of temporary settlement of the evacuated population; location of rescue teams, detachments; Industrial objects that can be sources of secondary destruction of AOCH, RV, BS, etc.

Sanitary and epidemiological well-being is provided by a complex of organizational, legal, medical, anti-epidemic, production activities, aimed at preventing the emergence and elimination of infectious diseases, as well as compliance with sanitary rules and norms with a sharp deterioration in the sanitary and epidemiological state in the emergency area.

The main anti-epidemic activities in the occurrence of the epidemic focus are:

registration and alert;
epidemiological examination and sanitary and epidemiological intelligence;
identification, isolation and hospitalization of ill;
restrictive or quarantine measures;
general and special emergency prevention;
disinfection of an epidemic focus.
identification of bacteria carriers and enhanced medical observation of the affected population and the personnel of rescue formations; sanitary and explanatory work.

Sanitary and epidemiological intelligence and organization and conduct, assessment of the sanitary and epidemic condition of the emergency area.

Sanitary-epidemiological intelligence is the collection and transfer of information about the sanitary and epidemiological situation in the emergency area, which consists in obtaining data on epidemic foci, air quality, water and food, sanitary condition, residential fund, utilities and other objects affecting Conducting special and preventive measures organized and conducted by the sanitary and epidemiological service.

The tasks of sanitary and epidemiological intelligence includes:

identification of the presence and localization of patients, the nature of the outbreak and prevalence of infectious diseases, immune security among various contingents in areas of accommodation of the affected population;
establishing availability and activity in emergency zones, epizootic among wild and domestic animals;
the survey of the sanitary and hygienic state of the emergency area of \u200b\u200bhuman settlements and water sources, economy facilities, utilities and sanitary and health, medical and sanitary and epidemiological institutions.
evaluation of the possibility of using for work in epidemic foci of forces and means of local health authorities, preserved in the disaster zones.

The group consists of three: Head - Epidemiologist, Assistant Epidemiologist (Feldsher-Laberant), Driver. If necessary, other specialists, a hygienist, an infectious physician, a bacteriologist may be included in the group. The group selects samples in the environment and conducts a sanitary and epidemiological examination of the hearth. It is equipped with a set for sampling and has a car. The GER tasks include the definition in the laboratories by the express method of the pathogen, the examination of food, control over the quality of water.

When planning bacteriological (sanitary-epidemiological) intelligence, its specific tasks, districts and objects, composition and equipment of the interlocks, movement routes, the time of intelligence, the order and form of the presentation of the exploration results are determined.

Events on the organization of sanitary and epidemiological intelligence include:

clarification of the situation in the emergency area, the possible time of intelligence, the definition of routes of movement, the nature of the alert and means of communication;
survey of the emergency area (settlements, livelihood systems).
collection and clarification of the data that local authorities and health care, institutions of veterinary and other services (the total number of residents in the village, the possible number of people remaining in the focus and the emergency area; area of \u200b\u200bextrusion of victims and ways of their evacuation);
sampling of soil and water surface reservoirs for microbiological control;
submission of reports on the results of exploration and relevant recommendations.

Various methods are used to collect information: directly

survey (bypass and inspection) areas, individual facilities, receiving data from medical workers and local authorities, survey of local residents, sampling and conducting laboratory research. The most fully and accurate information can be obtained in medical institutions, and the data on the epizootic setting is from the veterinary service specialists. The second on reliability is the source of information are authorities. In some cases, the only source of information may be the population.

The exploration results of the Senior Group report personally to the head who has organized intelligence, which uses the information received in the interests of anti-epidemic support of the population. The most important information should be reported to the head of work on the elimination of the consequences of emergencies.

To determine the type of biological agents in microbiological laboratories, a specific indication of the BS is based on the laboratory methods of express analysis. A preliminary response can be obtained after 1-3 hours, final - after 18-48 (72) hours.

The sanitary and epidemic state of the area can be appreciated as a prosperous, unstable, unfavorable and emergency.

Promotional condition: no quarantine infections and group outbreaks of other infectious diseases; the presence of single infectious diseases that are not related to each other and have emerged over time exceeding this disease; The epizootic situation is not dangerous for people; Satisfactory sanitary condition of the territory, water supply facilities; communal landscading; Effective organization of sanitary and hygienic and anti-epidemic support; Lack of mass infectious diseases in adjacent territories.

Unstable state: an increase in the level of infectious morbidity or the emergence of group diseases without a tendency to further distribution; The emergence of single infectious diseases related to each other or having a common source of illness beyond this territory in a satisfactory sanitary condition of the territory and the qualitative implementation of a complex of measures for anti-epidemic support; The presence of epizootic foci of zoonotic infections representing a threat to people; The emergency area is located in close proximity to the focus of hazardous infectious diseases.

Difficult state: the emergence of group cases of hazardous infectious diseases in the emergency area or epidemic foci of particularly dangerous infections in neighboring areas in the presence of conditions for their further distribution; numerous diseases of unknown etiology; The emergence of single diseases especially dangerous infections; Significant violations in organizing sanitary and hygienic and anti-epidemic support.

Emergency condition: sharp increase in the short term of the number of dangerous infectious diseases among the affected population; the presence of repeated or group diseases especially dangerous infections; Activation in the emergency area of \u200b\u200bnatural foci of hazardous infections with the emergence of diseases among people.

Disinfection of epidemic foci of infection (, disinsection,). Disinfection of apartment foci is carried out by the state sanitary and epidemiological service through the current and final disinfection.

- Destruction in the environment of pathogens of infectious diseases. It can be carried out by physical, chemical and combined disinfection groups.

Disinfection is divided into prophylactic, current and final.

Preventive is carried out constantly, regardless of the availability of infectious diseases (in the absence of an emergency) and aims to prevent their occurrence and distribution, the accumulation of pathogens of these diseases at environmental facilities. To do this, it is systematically carried out disinfection of drinking water, wastewater, common seats, etc.

Preventive disinfection is carried out utility services under the methodological control of the sanitary and epidemiological service.

Current disinfection is disinfection in the direct environment of a patient or carrier, carried out in order to prevent the dissemination of pathogens of infectious diseases in the environment.

Current disinfection is conducting medical personnel of medical and preventive institutions. Current disinfection is carried out repeatedly to hospitalization of the patient; In addition, the bacteria carriers of one or another infection among its surroundings are revealed.

Final disinfection - This is the prevention of the distribution of pathogens of infectious diseases through the objects with which the patient contacted. The final disinfection is carried out once after isolation (hospitalization) of the infectious patient, as well as in the case of its death at home or in a medical institution. The deadlines for final disinfection should be as short as possible. It is desirable that it is immediately after the evacuation of the infectious patient. Final disinfection is carried out disinfection brigades, usually consisting of 2-3 people. The brigade includes a disinfectionist doctor or an epidemiologist's assistant, or a disinfector instructor and 1-2 disinfect.

Disinsection - Destruction of insects (carriers of infectious diseases) is carried out by physical and chemical methods. The main one is considered the chemical method, which is to process objects insecticides.

- the destruction of rodents (sources of pathogens of infectious diseases). It is carried out by mechanical (caught) and chemical (use of poisoning bait) in ways.

Food disinfection is carried out by the sale and nutrition service, and the water is the water supply service. Control over the quality of disinfecting food and water, as well as their sanitary expenses, the service of state sanitary and epidemiological supervision is carried out.

Restrictive events: quarantine, observation.

In order to prevent the drift of infectious diseases and their distribution in the occurrence 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 holding of these events assigned to the responsible managers of administrative territories and the Sanitary Redeepidemic Commission.

Emergency epidemic situation - progressive increasing

the number of infectious patients in epidemic foci, leading to a violation of the prevailing rhythm of the life of the population of this territory, the possible endowment of the pathogen beyond its limits, weighting of the course of the disease and an increase in the number of adverse outcomes.

Quarantine is a system of temporary organizational, regulatory, administrative and economic, legal, medical and preventive, sanitary and anti-epidemic measures aimed at preventing the removal of the causative agent of a hazardous infectious disease outside the epidemic focus, ensuring the localization of the epidemic, epizootic or epiphyototic focus and subsequent their elimination.

Quarantine is introduced when patients with particularly dangerous infections among the population, group diseases with contagious infections with their increase in a short time. In the establishment of even single cases of diseases, lash febrors,, marburg, and some other contagious diseases, as well as mass diseases of the Siberian ulcers, yellow fever, tularemia, sap, meloidosis, suction typhoid, brucellosis, ppitactosis must be introduced quarantine mode.

The introduction of quarantine is accompanied by simultaneous administration of the observation regime in all administrative territories with a quarantine zone.

When the quarantine is applied to large administrative and industrial centers in the quarantine boundary, both the territory of the city itself and the settlements directly adjacent to it,

The administrative territory on which the focus of infection and settlements, quarantined due to the resettlement of them victims of epidemic foci, is declared a quarantine zone.

Observation-regulatory measures providing for the enhancement of medical and veterinary observation and conducting anti-epidemic, medical and prophylactic and veterinary and sanitary measures to restrict the movement and movement of people or farm animals in all adjacent to the quarantine zone of administrative-territorial entities that create a observation zone .

The observation is introduced in areas with a disadvantaged or emergency sanitary-epidasmic state, that is, the emergence of group non-contagome diseases or individual cases of contagious infections.

Observation and quarantine are canceled after the expiration of the maximum infectious disease since the insulation of the last patient, the final disinfection and sanitary processing of the service personnel and the population.

When the quarantine is introduced:

complete isolation of epidemic focus, quarantined settlements and the entire quarantine zone with the establishment of armed guards (cordon);
strict control over the entry and departure of the population and the export of property from the quarantine zone;
prohibition of travel through the center of infection of road transport and stops outside of the allotted places in the transit passage of railway and water transport;
creation of observator and conducting an event to observation of persons who were in the focus and out of the quarantine zone;
early detection of infectious patients, their isolation and hospitalization in a specially allocated medical institution;
restriction of communication between individual groups of the population;
establishing an anti-epidemic regime for the population, the work of urban transport, trading network and catering enterprises, economy facilities, depending on the emerging epidemiological situation, ensuring their smooth operation;
ensuring the population with food and water in compliance with the requirements of anti-epidemic regime;
establishment of anti-epidemic mode of work of medical institutions in the focus;
conducting measures to disinfect the objects of the external environment manufactured by industrial products and sanitary processing of the population;
translation of all food industry facilities on a special technological mode of operation, which guarantees the harmless of the products;
conducting emergency and specific prophylaxis;
control over the strict implementation by the population, enterprises, ministries and departments of established quarantine rules;
sanitary and explanatory work.

Quarantine can be replaced by observation. When the observation is introduced:

restriction of exit, entry and transit travel of all types of transport through the territory observated;
restriction of movement and movement of the population;
conducting the disinfecting of infected objects of the external environment;
active early detection of infectious patients, their isolation and hospitalization;
conducting sanitary processing of the affected population;
conducting emergency prevention among contact persons;
strengthening of veterinary and bacteriological control over the infestation of agricultural animals and animal husbandry products;
establishing anti-epidemic mode of work of medical institutions.

Armed Guard (cordon) of quarantined territory It aims to ensure its isolation and eliminate the removal of infection beyond its limits. It is carried out by the forces and means of the Ministry of Internal Affairs of Russia together with the Military units of the Ministry of Defense of Russia.

To control the implementation of the anti-epidemic regime during the departure and entry of the population, the export of cargo is deployed by special divisions of the control points (CAT), including sanitary control points (SCP- to control the correctness of the input or withdrawal of the formation and population from the quarantine zone) and - Experience items (PPP, for the purpose of material and technical supply; The operation of the PPP should be organized in such a way as to eliminate the possibility of contacting people outside the quarantine zone with people within its limits).

The SCB is deployed in the CAT forces and health care facilities with the mandatory presence of an insulator.

The CAT task is to control the performance of the throughput set in accordance with anti-epidemic requirements. From the quarantine zone is allowed to export any cargo (equipment, equipment, raw materials, goods and food) if there are documents about their disinfection and harmlessness. Departure, the yield of people from the quarantine zone is allowed if they have a document on the passage of observation.

The importation of goods to the quarantine zone (to unloading places) is carried out freely with the strict execution of the established rules by persons accompanying cargo.

The quarantine zone is unhindered, the formation of the Medicine service of rescuers and individual specialists sent to conduct emergence of emergence of epidemic foci, as well as persons permanently residing in the territory of the Quarantine Zone, but who left it before establishing quarantine.

Departure of individuals who are temporarily found in the quarantine zone (vacationers, commoded, etc.) are permitted after observation. For these purposes, special observatives are created, where medical observation is carried out for the overall surveillance during the period equal to the incubation period of the infectious disease. When cholera, observable is examined for vibrine.

Observators are deployed by the local administration and health authorities on a predetermined plan on the basis of hotels, hostel, rest houses, etc. As observants it is possible to use marine and river vessels, train stations, port facilities.

Information about temporarily residing in the quarantine zone to be taken, are submitted by the leaders of enterprises, institutions, communal services, homeowners to local authorities.

The observation of passengers and attendants, who left the focus before the introduction of quarantine, is organized by the heads of the relevant transport departments together with the territorial administration and health authorities.

The observator filling is simultaneously. Observable are placed in small groups, communication between groups is not allowed.

At the end of the observation, observable are delivered organized at the airport or to the railway station to send at the place of residence

With the appearance of cases of infectious diseases, among the observable, their observation, respectively, is extended. In the observator after hospitalization of the patient, the final disinfection is made.

The person entering the quarantine zone should have confirming the documents on vaccination (if necessary), the means of emergency prevention, individual means of protection.

The active early detection of infectious patients or suspicious PA disease is ensured by surveying the affected population in the epidemic focus, the organization of measuring body temperature and medical examination. These events are carried out by medical and nursing and nursing brigades.

Isolation and hospitalization of identified patients are organized by medical formations working in an epidemic focus. After hospitalizing infectious patients with disinfectural brigades, concluding disinfection is carried out.

The removal of quarantine or observation depending on the folding specific situation can be carried out gradually in individual settlements or immediately in the entire zone. Quarantine and observation are removed by the Chairman of the SPK on the recommendations of the health authorities, but not earlier than before the expiration of the maximum disease calculated since the insulation of the last ill and concluding disinfection in the hearth disease.

In an epidemic focus, one of the events of the anti-epidemic regime is the maximum disagreement of the population. It should be noted that in the focus it is unacceptable to the accumulation of people, including in polyclinical institutions. Given this, all medical care is approaching the population and finds himself at home or enterprises and institutions.

In the districts, the district principle is maintained, however, due to a sharp increase in the amount of work, the plots are divided into micro-phase.

The work of Pa Microfitch is carried out by a medical team as part of a doctor, two nurses and two disinfectors, as well as several activist activists (authorized) from the local population. The total number of population living on a microcum serviced by one brigade should not exceed 2 thousand people. Motor transport can be attributed to the brigade. In addition to directly therapeutic measures and active identification of patients, members of the brigade are conducting sanitary and explanatory work on the rules of the behavior of the population in the epidemic focus. It should be especially emphasized that the work of the brigade is constantly carried out and conditions for a strict anti-epidemic regime. Depending on the features of microorganisms that were the cause of emergencies, the appropriate type of protective clothing is used. Kits of protective clothing, selected in size and growth, are stored in medical and preventive institutions.

Each brigade makes up the consumer lists of the population living in this area, including visitors. The quarter traverses are held at least two times a day with a mandatory measurement of body temperature in all residents (thermometry is carried out by the lives themselves). The results of thermometry are recorded in a special magazine. In the event of a patient detection, the head of the brigade is immediately informed. The apartment organizes measures for the insulation of the patient and carrying out the current disinfection. Patients with elevated temperatures are hospitalized into the provisional compartment, and patients with symptoms characteristic of this disease are in an infectious hospital.

At the end of the day, each brigade fills in a special reporting form.

The head of the brigade summarizes the information received and on the same day will give them to the clinic, from where they enter the Health Department of the district. Here the obtained data is analyzed across the area and then in the form of reports are sent to the headquarters of the hearth and in SEC.

The personnel of the formations, institutions and divisions at the end of the working day undergoes complete sanitary processing with shift clothes. Depending on the specific conditions, these persons are placed in places of permanent residence or go to the "barracks" position.

It should be noted that at all stages of medical care for infectious patients, the necessary anti-epidemic regime should be provided.

General and special emergency prevention

Unlike, emergency prevention ensures fast protection of infected.

Emergency prophylaxis is divided into common and special. Prior to establishing a type of microorganism, which caused an infectious disease is carried out general, and after establishing the type of pathogen's microba - special emergency prevention

As a means of general emergency prevention, a wide range of actions are also used, active in respect of all or most causative agents of infectious diseases. The duration of the course of general emergency prevention is determined by the time necessary for identifying, identifying and determining the sensitivity of the pathogen to antibiotics and averages 2-5 days.

The main means of general emergency prevention is doxycycline

As a means of special emergency prevention, antibacterial drugs that have a high etiotropic effect on the causative agent allocated from infectious large in the epidemic focus, taking into account the results of determining its sensitivity to antibiotics are used.

Specific prophylaxis is carried out by vaccination brigades using serums, vaccines, anatoxins, gamma-I lobulins, bacteriophages.

The duration of the course of special emergency prevention is determined by the nosological form of the disease (the term of the incubation period calculated from the date of infection), the properties of the appointed antimicrobial drug.

The disposal of emergency medical prevention is issued by sanitary counter-epidemic commissions.

Responsibility for its holding is assigned to managers of institutions, enterprises, medical and nursing brigades.

Methodological guidance and control over the implementation of emergency prevention measures is conducted by health authorities.

The order of emergency prevention is determined by local executive authorities. First of all, it is carried out in institutions and formations involved in the prevention or to eliminate outbreaks of infectious diseases; In institutions, institutions and enterprises located in the focus and continuing their work as well as in children's teams. Its organization and holding are assigned to: in the first case, the leaders of the formations and institutions, in the second - on the heads of health care parts, departmental clinics and ambulatory, in the third - on managers and medical workers of institutions.

Emergency prevention among the other categories of the population is carried out by district polyclinics.

The effectiveness of emergency prevention measures largely depends on the clarity of their implementation and the population coverage of their population.

Similarly, with the start of emergency prevention in the foci of infection, it is recommended to conduct active immunization (vaccination or revaccination) of the population.

Among the methods of immunization, the most fully meets the requirements of anti-epidemic protection of the population, aerosol and oral administration.

For immunization, vaccination brigades are created as part of one doctor and two nurses.

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