MINISTRY OF PUBLIC OF UKRAINE

ODESSA STATE MEDICAL UNIVERSITY

DEPARTMENT OF MEDICINE OF CATASTROPHES AND MILITARY MEDICINE

METODICAL INSTRUCTIONS FOR

THE THIRD YEAR STUDENTS

FOR PRACTICAL CLASSES

Odessa 2009

Given instructions are approved on the methodical meting of the department.

Minutes № of ____________

Head of the department

___________________________

Reapproved

Minutes № of ____________

Head of the department

___________________________

Theme 1: 'organisation of medical-evacuation provision in the system of mes in extremal situations. (seminar, 2 hours)

Actuality of the theme: it envisage deep training for the work in extremal conditions -at liquidation of consequences of accidents and catastrophes in the industry, radiationaly and chemically dangerous objects and in the regions of natural calamities (earthquakes, floods, big fires, etc.)

Educational goals of the lesson:

In the result of this lesson the student must:

Know:

- Basic principles of organisation of medical provision of population in ES (Emergency Situations)

- Goals and organisation of state service of Catastrophe medicine of Ukraine

- Bases of medical-evacuation provision in the system of MES, forces and means, which are used for this purpose.

Know how to:

- organise medical-evacuation provision in emergency situations

• carry out medical sorting

Contents of the theme of the lesson:

1. Basic principles of organisation of medical provision of the population in emergency situations:

- state and priority character;

- double-level structure of CMS (Catastrophe Medicine Service); 4

- this provide control and organisation of CMS;

- double-stage system of organisation of UMA (Urgent Medical Aid) to the victims of ES;

- medical sorting as one of the main principle of timely rendering of UMA to population inES;

- echelonment and manoeuvre by forces and means of CMS;

- principles of interaction;

- this provide timeliness, continuity and effectiveness of rendering of UMA;

- principle of one-moment at liquidation of medical consequences;

- universality of CMS;

- sufficiency of forces and means of CMS, economy and expediency;

- material interests and juridical responsibilities, juridical and social protecting of medical and other professionals of the service, which take part in organisation and rendering of EMA to victims of ES;

- preparation of the population and persons with professions of increased risk for actions and rendering of medical aid in ES.

2. Tasks and organisation of state CMS of Ukraine.

3. Structure of CMS on the state level.

4. Structure of CMS of territorial level.

5. Medical sub-units that are created on the basis of working medical institutions in Armed Forces in accordance to order of Minister of Defence on.

6. Co-ordination commissions of the state CMS.

1. The essence of the MEP (Medical-Evacuation Provision).

8. Stages of medical evacuation.

9. Types and capacity of medical aid (basic concepts).

10. Medical sorting. Basic principles of carrying out of medical sorting.

Theme 2 :

'ORGANISATION AND RENDERING OF THE FIRST MEDICAL AND THE FIRST DOCTOR'S AID TO POPULATION THAT SUFFERED IN EMERGENCY SITUATIONS. FORCES AND MEANS WHICH ARE USED FOR THIS PURPOSE'.

(Seminar, 2 hours)

Actuality of the thane: it envisage deep training for the work in extremal conditions -at liquidation of consequences of accidents and catastrophes in the industry, radiationaly and chemically dangerous objects and in the regions of natural calamities (earthquakes, floods, big fires, etc.).

Educational goals of the lesson:

In the result of this lesson the student must:

Know:

- basic measures of the first aid, capacity of the first medical and doctor's aid

- organisation bases of rendering of medical aid in ES and using of necessary volume of medical aid at different ES.

Knows how to:

Evaluate condition of affected persons and using of necessary volume of medical aid at different ES.

The matter of the theme of the lesson:

1. The first medical aid.

2. Basic means of reanimation.

3. The signs of the clinical death are:

4. Stages of the cardiac-pulmonary reanimation:

- restoration of permeability of respiratory ways;

- APV (Artificial Pulmonary Ventilation) with the using of active insufflation of the air (oxygen) into the lungs of the victim;

- artificial maintenance of the blood circulation by the way of closed (indirect) massage of the heart;

- infusion of medicines, recording of an ECG, defibrillation;

- intensive therapy in the post-reanimation period mat is aimed on the maintenance and stabilisation of vital functions of the organism;

5. Means of cardiac-pulmonary ventilation.

6. The volume of the first aid includes:

7. Organisation of the first aid at traumas, burns, fractures of bones, haemorrhages.

8. Pre-doctor's (assistance's) aid, its goal and volume.

9. The first doctor's aid. Organisation of the first doctor's aid in conditions of ES.

lO.Immediate measures of the first doctor's aid.

11 .Measures that can be postponed.

12.Qualified medical aid.

13.Specialised medical aid

14. Solving of typical problems that concern the rendering of the first medial and the first doctor's aid.

Problem 1.

Initial data:

On the second floor of the 5-floor house explosion of the natural gas (propane-butane) occurred. Dwellers who were evacuated from the ruins and other apartments gathered in the yard near the house.

In the clinic of this settlement there is sanitary automobile UAZ-452 in good repair.

After having come to the place of the accident you, as a physician of the ambulance, found out the victims (other persons went by their-selves to the nearest poryclinics):

1. The victim A Some about 20-25 years old, with the lost of consciousness; pupils react on the light, anyzocoria, haemorrhage from the ears, without any visible damages of the head, deformation of the left forearm.

2. The victim B. Some about 65-7- years old, in conscious; the skin is pale, the wound of the right shin, movements in the right extremity is extremely painful, fracture of the middle third of the shin.

3. The victim C. 45 years old, evacuated from the ruins, the consciousness is not clear, spread damages of soft tissues of upper extremities, squeezing of the thorax.

4. The victim D. Some about 55-60 years old. Acutely increased psychic and motor excitement, spread damage of the right forearm, the right arm is being fixed by another hand.

5. The victim E. The child, 9-10 years old. Evacuated from the ruins, unconscious; pupils react on the light closed lesion of the thorax and abdomen is checked.

6. The victim F. Some about 47-50 years old. By the words of witnesses he fall down from the fifth floor. Without consciousness, pupils slightly react on the light, 'eye-glasses' symptom, haemorrhage from the mouth an nose.

7. The victim G. 30 years old. In consciousness, fracture of the shin, forearm,, a lot of scratches.

The task is to cany ant medical sotting, determine the volume of the firs aid organise the evacuation.

Theme 3 ' organisation and rendering of qualified and specialised medical aid to population that suffered in es. Forces and measures which are used for this purpose

Actuality of the theme: it envisage deep training for the work in extremal conditions -at liquidation of consequences of accidents and catastrophes in the industry, radiationaly and chemically dangerous objects and in the regions of natural calamities (earthquakes, floods, big fires, etc.

Educational goals of the lesson:

In the result of this lesson the student must:

Know:

- the organisation and measure of qualified and specialised medical aid in ES.

- basic measures and volume of qualified and specialised medical aid in ES.

- organisation bases of rendering of qualified and specialised medical aid in ES.

Know how to:

evaluate the condition of victims and use the necessary volume of medical aid at different ES.

The matter of the theme of the lesson:

1. Organisation and bases of rendering of qualified and specialised medical aid in ES.

2. The order of using offerees and measures of CMS.

3. Studying of the structure and possibilities of specialised medical brigades.

4. Organisation of medical distribution of victims.

5. Determination of necessity in specialised brigades.

6. Evacuation to me medical institutions.

7» Solving of typical problems. (Problem 2).

Problem 2.

Initial data: The leakage of EATS (Extra Active Toxic Substances) occurred at the chemical factory. The season- summer, wind - 2 m/sec in the direction of dwelling area, time-14:00.

Determine:

- the whole number of sanitary losses and their structure;

- necessary number of medical brigades for the rendering of the first medial aid;

• necessary number of medical brigades for rendering of urgent specialised medical aid.

• REFERENCE INFORMATION: Dispatcher of the "Ambulance" follows the exemplary norms:

- at 3 victims - 2 brigades (1 of them of intensive therapy);

• 3-5 victims - 3 brigades (1 of them of intensive therapy)

- 6-10 victims - on every 5 persons - 3 brigades;

- more man 10 victims - on every 10 persons - 5 brigades.

Brigade of urgent medical aid of toxic-therapeutic profile during 12 hours can render medical aid to 25 persons.

It is known that correlation between persons with different degrees of damages in conditions of industrial accidents is relatively constant:

1-4% - heavy 5-10%- average 85-90%- light Lethality is-1-2%.

Variants of situation problems

Variants	1	2	3	4	5	6	7	8	9	10
Number of workers at the factory	400	900	700	800	1500	600	1200	1400	3000	4000
Provision with means of protection	20	30	40	50	60	50	70	70	30	20

Theme 4 'natural calamities, their medical and tactical characteristic. Ecological situation on the territory of ukraine and probable character of accidents, catastrophes and natural calamities.'

Actuality of the theme: it envisages deep training for the work in extremal conditions -in the regions of natural calamities (earthquakes, floods, fires, etc.).

Educational goals of the lesson:

In the result of this lesson the student must:

Know:

- types of natural calamities and their medical-tactical characteristic

- method of forecasting of sanitary-medical consequences of natural calamities.

Know how to:

- carry out calculation of forces and means of rendering of medical aid at natural calamities.

- theoretically and practically investigate and forecast medical-sanitary consequences of natural calamities.

The matter of the theme of the lesson:

1. Medical-tactical characteristic of the most frequent natural calamities.

2. Floods, catastrophic flooded zones.

3. Characteristic of losses at floods.

4. Liquidation of medical consequences of catastrophic floods.

5. Hurricanes and storms, medical-tactical characteristic.

6. Snow-slip, snowdrifts and icing, lightings.

7. Medical-tactical characteristic of earthquakes.

8. Characteristics of degree and structure of the losses at catastrophes.

9. Organisation of medical provision of population at earthquakes.

10.Medical-tactical characteristic of fires (forest fires, upper and lower fires, underground

fires, fires in cities and populated areas).

11 .Peculiarities of rendering of medical aid at fires.

12.Ecological situation in Ukraine.

13.Possible character of natural calamities on the territory of Ukraine.

14. Solving of typical problems at evaluation of situation at natural calamities.

Educational algorithm of self work of students:

1. Carry out the evaluation of consequences of natural calamities.

2. Acquaint with cards of programme control and situational problems.

Problems forecasting and evaluation of es.

At night in the region N break of the dam occurred. Along the river there are two settlements A and B on the distance 11 and 24 km from the dam.

It is necessary to determine number of sanitary losses in the settlements and the number of medical brigades for the rendering of the first doctor's and specialised medical aid.

Variants	1	2	3	4	5	6	7	8	9	10
Settlement 'A' (x1000 people)	3	4	5	6	7	8	9	10	15	25
Settlement 'B' (x1000 people)	15	20	30	8	10	8	10	15	20	5

Algorithm of the solving of the problem:

1. Determine in what zone the settlement is located.

2. Determine the amount of sanitary losses in each settlement

3. Calculate the necessary number of brigades for the rendering of the first doctor's aid,

4. Determine the amount of victims, which demand qualified and specialised medical aid.

5. Calculate the necessary number of specialised brigades in dependence on the structure victims at floods.

Problem 4 forecasting and evaluation of the situation at earthquakes.

Settlement is located in the zone with force of 8 balls.

Determine of the necessary number of brigades for rendering of the first doctor's and specialised medical aid, if it is known that

Variants	1	2	3	4	5	6	7	8	9	10
Complete demolition of buildings, %	20	30	40	50	60	70	80	55	35	25
Population (x 1000 people)	40	50	60	15	10	8	10	15	20	50

Algorithm of the solving of the problem:

1. Determine the number of victims at earthquakes.

2. Determine me amount of sanitary losses.

3. Calculate the necessary number of brigades for the rendering of the first doctor's aid.

4. Determine the amount of victims. Needs in qualified and specialised medical aid.

5. Calculate the necessary amount of specialised brigades in dependence on the structure of victims at earthquakes.

THEME 5 :

'Medical-tactical characteristic of transport catastrophes.'

Actuality of the theme: it envisages deep training for the work in extremal conditions -at liquidation of consequences of transport accidents and catastrophes.

Educational goals of the lesson:

In the result of this lesson the student must:

Know:

- types of transport catastrophes and measures of EM A.

• Method of evaluation of medical situation and carry out medical sorting

Know how to:

- carry out calculation of amount of forces and measures for rendering EMA at transport catastrophes.

- theoretically and practically forecast consequences of transport catastrophes.

The matter of the theme of the lesson:

1. Types of transport catastrophes.

2. Aviation catastrophes.

3. Automobile catastrophes.

4. Railway catastrophes.

5. Water catastrophes.

6. Damages of people at catastrophes.

7. Organisation of work of brigades of CMS in the places of catastrophes.

8. Measures of UMA to the victims.

9. Solving of typical problems at the evaluation of situation at transport catastrophes.

Educational algorithm for the self work of students:

1. Carry out the evaluation of consequences of transport catastrophes.

2. Acquaint with cards of programme control and situational problems.

Materials for methodical provision of the lesson:

1. Tables.

2. Situational problems.

3. Cards of programme control.

PROBLEMS EVALUATION OF SITUATION AT TRANSPORT CATASTROPHES.

On the distance 20 km from the city the bus with 50 passengers got into the Road-Transport Accident (RTA). In the result of it the fire occurs which was liquidated by the driver and passengers. Road police informed the medical service about mis accident The first ambulance (1 doctor, 1 doctor's assistant) arrived to the place of accident in 40 minutes.

During the examination there were revealed the following victims:

1. The victim A, some about 30 years old, pale skin, pulse rate - 120/sec, left hip and left shin is deformed and shorten.

2. Hie victim B, some about 40 years old, in consciousness. Pulse rate - 100/sec, spread, crushed wound of the foot and the ankle. There are fragments of the bone in the wound.

3. Hie victim C, 50 years old, consciousness is not clear, the thorax is deformed, palpatory there is the fracture of the 3-4 ribs on the right side, vesicular breathing is not heard, wet crepitations, pulse rate 120/sec.

4. The child, 10 years old, is crying, suffers from the pain in the abdomen. There is the scratch on the anterior abdominal wall 5x3 cm, abdomen is tensed and painful.

5. The woman, 20 years old, suffers from pain in the right forearm. Hie right forearm is deformed in the lower third. Pathological movements and pamfulness of the lower third of the right forearm. There are rings on the fingers of the right hand.

6. The victim F, some about 40 years old, damaged, aggressive. He has multiple bruises and scratches of hands.

7. Hie woman, pale, some about 30 years old; she answers on the questions with lateness, simply. Abdomen is increased by size (pregnancy 24-26 weeks). There is a cut wound 5x0.5 cm in the left malar region.

8. The victim H, a man, 60 years old, in consciousness, pale. He complains on the pains in the back. There is spread haemotoma in the region of 4-5 lumbar vertebras. Movements in lower extremities and sensitivity is absent

9. The victim I, some about 30 years old, out of consciousness; he has a contusioned wound of the parietal zone. Pupils are evenly dilated. Pulse rate is 60/sec.

10.The victim J, 50 years old, dimmed consciousness. There are no any visible damages. Anyzocoria. Pulse rate is 64/sec.

11.The victim K, 40 years of age, in consciousness. Hyperaemia of the neck, upper extremities and body is marked. There is a deformation of the left shin.

12.The victim L, 50 years old, in consciousness. There is the hyperaemia of the body, upper extremities (somewhere there are vesicles with the fluid). Spread wound of the foot

13.The victim M, 30 years, in consciousness. Spread, scalped wound in the parietal region. Pupils D=S. Pulse rate is 88/sec.

14. Five victims, from 30 up to 40 years of age, talkative. There is a hyperaemia of the body, upper extremities. They walk by themselves.

15.The child, 5 years old, is crying. There are no any visible damages.

Prepare the answer:

Your first actions as a doctor of the ambulance.

Carry out the medical sorting, render the medical aid, calculate the necessary number of

ambulances, quantity of transport for evacuation of people.

REFERENCE DATA:

Dispatcher of the "Ambulance" follows the exemplary norms:

- at 3 victims - 2 brigades (1 of them of intensive therapy);

- 3-5 victims - 3 brigades (1 of them of intensive therapy)

- 6-10 victims - on every 5 persons - 3 brigades;

- more than 10 victims - on every 10 persons - 5 brigades.

It is needed 20 minutes per one victim of the surgical profile. It is needed 20 minutes per one victim of the therapeutic profile.

Answer: my first actions, diagnosis, urgent medical aid and its volume, medical institution where the victim must be transported.

Teme 6 'medical-tactic characteristic of accidents at the fire-and explosion- unsafe objects.

Actuality of the theme: it envisages deep training for the work in extremal conditions -at liquidation of consequences of accidents and catastrophes in industry.

Educational goals of the lesson:

In the result of this lesson the student must:

Know:

- characteristic of damages at accidents on me fire-and explosion- unsafe objects;

- mechanism of explosion trauma;

- mechanism of gunshot wound;

- organisation of the work of the brigade of UMA in the places of catastrophe.

Know how to:

- Forecast consequences of accidents on the fire-and explosive- unsafe objects;

The matter of the theme of the lesson:

1. Characteristic of damages in case of accident on the fire-and explosion- unsafe objects;

2. Mechanism of explosion trauma.

3. Mechanism of me gunshot wound.

4. Organisation of the work of the brigade of UMA in the places of catastrophes.

5. Measures of UMA to the victims.

6. Solving of typical problems, which concern the consequences of accidents on the fire-and explosion unsafe objects.

Educational algorithm of the self work of students:

1. Carry out the evaluation of consequences of accidents on the fire- and explosion- unsafe objects.

2. Acquaint with cards of programme control and situational problems.

Materials for the lesson:

1. Tables.

2. Situational problems.

3. Cards of programme control.

Problem 6

FORECASTING AND EVALUATION OF EMERGENCY SITUATIONS ON THE

Explosively unsafe object.

Explosion of cisterns with liquid propane occurred at the railway station. Determine the degree of damages of buildings and probable character of traumas at people in the dependence on the distance from the place of explosion and its force.

Algorithm of the solving of the problem:

1. It is necessary to determine in what zone people and buildings are located. For that purpose determine radiuses of zones of explosion.

2. Determine the extra-pressure in the zone of location of buildings and people.

3. According to extra-pressure determine the probable character of traumas and degree of destruction of buildings.

The zone of detonation -wave - is located in the outlines of cloud of explosion. Radius of this zone is calculated according the formula: Ri=17.5 x ³VQ, where Q - quantity of liquid gas in tones. In me borders of the detonation wave (zone 1) the extra-pressure is constant - Ap=1700 kPa

Zone of action of products of explosion (zone 2) - the zone of flying away of products of gas-air mixture in the result of detonation. The radius is R₂=1.7 x iy The extra-pressure is calculated according to the formula: A p₂=1300 x (Ri/R) ³+50, where R - radius from the centre of explosion in metres.

EXAMPLE. Explosion of cisterns with 100 tones of liquid propane occurred on the territory of the port Determine the degree of destruction of buildings (mechanical work-shop) - industrial building with metal carcass which is located on the distance of 300 metres from the centre of explosion and probable character of traumas.

Solvine of ike problem.

1. Determine the radius of action of detonation wave (Ri), zone 1 -

R,=17.5x³VlOO=80m.

2. Determine the radius of action of products of explosion (r2), zone 2 -

R₂=1.7x80=136m.

3. So, people and building is in the zone 2.

4. Determine extra-pressure in the zone 2 on the distance 100 m from the centre of explosion according the formula or with the help of graphic:

Ap₂=l. 300x(80/100)³+50.

5. The building is located in the zone 3 - zone of action of air wave; according to the graphic p*

AP₃=60 kPa

6. Determine the degree of destruction of the building - in the dependence on the function of the object, material and extra-pressure of the wave in the place of localisation; according the table find the degree of destruction:

7. For the mechanic work-shop (industrial building with metal carcass) - degree of destruction at the extra-pressure 60 kPa is complete.

Reference data.

1. The graphic of "Dependence of borders of the action of extra-pressure on the amount of gas-air mixture*.

2. The table "Degree of destruction of objects at different extra-pressure of the wave', kPa:

Theme 7 'accidents at atomic electro-stations and radioactively unsafe objects, their medical-tactical characteristic'.

Actuality of the theme: it envisages deep training for the work in extremal conditions -at liquidation of consequences of accidents and catastrophes in industry and radioactively unsafe objects.

Educational goals of the lesson:

In the result of this lesson the student must:

Know:

- types of accidents at AES;

- characteristic of damages of personal of stations and population;

- zones which border on the place of living of people according to the degree of radio-nuclide pollution;

- norms of radioactive safely;

- principles of protection of population;

- method of evaluation of medical situation.

Know how to:

- carry out calculation of forces and means for the rendering of EMA in case of accidents at AES and radioactively unsafe objects;

- theoretically and practically forecast the consequences of accidents at AES and radioactively unsafe objects.

The matter of the theme of the lesson:

1. Types of accidents at AES.

2. Characteristic of damages of personal of the station and population.

3. Penetrating radiation.

4. Radioactive pollution of territory and objects.

5. Zones that border on the place of living of people according to the degree of radionuclide pollution.

6. Norms of radioactive safely.

7. Principles of protection of population.

8. Solving of typical problems.

Educational algorithm of the self work of students:

1. Carry out the evaluation of consequences of accidents at AES and radioactively unsafe objects.

2. Acquaint with cards of programme control and situational problems.

Materials for the lesson:

1. Tables.

2. Situational problems.

3. Cards of programme control.

Theme 8: 'medical-tactical characteristic of accidents at chemically unsafe objects'.

Actuality of the theme: it envisages deep training for the work in extremal conditions -at liquidation of consequences of accidents and catastrophes in industry and chemically unsafe objects.

Educational goals of the lesson: In the result of this lesson the student must:

Know:

- types of accidents on the chemically unsafe objects;

- characteristic of damages of personal and population;

- chemical pollution of the territory and objects;

- norms of chemical safety;

- principles of protection of population;

- method of evaluation of chemical situation;

- organisation and rendering of medical aid to population in case of accident at chemically unsafe objects.

Know how to:

- carry out the calculation of forces and means for rendering of EMA in case of accidents at chemically unsafe objects;

- forecast the consequences of accidents at chemically unsafe objects.

The matter of the theme of the lesson:

1. Types of accidents at the chemically unsafe objects.

2. Character of damages of the personal and population.

3. Chemical pollution of the territory and objects.

4. Norms of chemical safety.

5. Principles of protection of the population.

6. Solving of typical problems concerning the evaluation of situation in cases of accidents at the chemically unsafe objects.

Educational algorithm of the self work of students:

1. Carry out the evaluation of consequences of accidents at chemically unsafe objects.

2. Acquaint with cards of programme control and situational problems.

Materials for the lesson:

1. Tables.

2. Situational problems.

3. Cards of programme control.

"Medicine of catastrophcs" Tests of the initial level of knowledge

1. The situations of emergency belongs to the regional level, if:

a) it develops in the territory of more than two districts

b) it develops in the territory of potentially

dangerous unit e) if develops in the territory of two or more regions

d) it threatens to spread to territories adjacent to Ukraine

e) ii develops in (he territory of borne dangerous unit

2. According to the causes of their development situations of emergency in tne territory of Ukraine are the following, except one:

a) situations of emergency on transport

b) situations of emergency of technogenic character

c) situations of emergency of natural character

d) situations of emergency of social and political character

e) situations of emergency ot military character

3. Name the main conditions dia twill influence on the organization and carrying out measures for rendering medical assistance to victims of a disaster:

a) probably of appearing of a large number of victims within a short period of time.

b) complexity of the sanitary and epidemic situation in the period of cam-ing out rescue operations and liquidation of medical and sanitary consequences of catastrophes and accidents

c) capacity of medicaJ institution for work is diminished

d) climatic and geographical conditions (season, relief, weather conditions)

e) all above-mentioned

4. I he WHO classification of catastrophes includes the following principal groups, except one:

a) meteoToaical

b) topological -,

c) natural

d) tectonic

e) accidents

5. Situation caused by the elements or peoples ctivity and accompanied by mass casualties, putting out of action some of medical institutions, which demands assistance of outside forces and means for liquidation of its consequences with the use of special forms and methods is called:

a) mass sanitary losses

b) catastrophe

c) situation of emeigency

d) natural calamity

e) cataclysm

6. A situation caused by the elements or people's activity, when a pronounced disproportion between medical aid needs and the ability of available medical forces and means to give medical aid with the use of everyday forms and methods of work, is called:

a) mass sanitary losses

b) catastrophe

c) situation of emergency

d) natural calamity

e) cataclysm

7. Specialized teams constantly ready for action:

a) refer to the state level

b) refer neither to the state nor to the territorial fevel

c) refer to the territorial level

d) refer to both state and territorial levels c) do not exist.

8. Specialized territorial medical teams constantly ready for action:

a) refer to the state level

b) refer neither to the state nor to the territorial level

c) refer to the territorial level

d) refer to both state and territorial levels

e) do not exist

9. The scientific and practical center of emergency medkine aad medicine of catastrophes:

a) refer to the s»ta.te level

b) refer neither to the stale nor to the territorial level

e) refer to the territorial level

d) refer to both state and territorial levels

e) do not exist

10. Specialized medical teams constantly ready for action:

a) refer to the state level

b) refer neither to the state nor to the territorial level

c) refer to the territorial level

d) refer to both state and territorial levels

e) do not exist

11. First medical aid teams:

a) refer to the state level

b) refer neither to the srare nor to the territorial level

c) refer to the territorial level

d) refer to both state and territorial levels

e) do not exist

12. Which of the following tasks are not the tasks of the service of Medicine of catastrophes:

a) Cooperation of medical forces means and medical institutions in the sphere of medical protection of population

b) Prognostification of consequences of extremal situations

c) Liquidation of medical and sanitary consequences of extremal situations by medical forces and means

d) Woiking out recommendations foi carrying out measures aimed at weakening negative effects of the consequences of extremal situations

e) Organization of medical aid to victims and material providing.

13. At the reception ward of hospital of Medicine situation of emergency (MES) entered from xone of catastrophe 20 peoples. On examination of victim of 30 year extracted from under fragment of building defined the pallor of the skin, the victim in a consciousness, he has a deformation of a right leg numerous injuries of soft tissues of lower extremities. Your decision as a doctor of reception ward which spend medical sorting victims:

a) A victim doesn't require a medical aid in this moment

b) Aid can be delayed

c) A victim require emergency

d) A victim require symptomatic treatment c) A victim require in evacuation to another medical institution

14, At the reception ward of hospital of Medicine situation of emergency (MES) entered a victim of 47-50 year which after explosion fall out from demolishing flat from fourth floor. On examination of a victim define loss a consciousness, pupils poorly react to light, the symptom of "glasses"., victim has a blood from mouth and nose. Your decision as a doctor of reception ward which spend medical sorting victims:

a) A victim doesn't require a medical aid in this moment

b) Aid can be delayed

c) A victim require emergency

d) A victim require symptomatic treatment

e) A victim require in evacuation to another medical institution

15. Medical aid which is given to a victim for eliminating or weakening consequences of life-threatening injuries, for prophylaxis of probable complications and preparation of victims for further evacuation is called:

a) first aid

b) first aid given by a doctor's assistant

c) first medical assistance

d) qualified medical assistance

e) specialized medical assistance

16. A victim of the shipwreck was pulled out of is 28 °C. What measures of first medical aid not be carried out?

a) rewanning of the chest, abdomen and neck

b} rewatmmg of the back, of ike neck and the head

c) rewarming in a hot bath

d) stomach lavage with 5% solution of sodium becsrboaate (t=45-50 °C)

e) wamiiug of the cardiac region and river with the help of a hot- water bottle

17. in explosions at mines after taking the necessary medical measures the following categories of victims ave lifted up from the mine ia the first place:

a) victims with severe injuries - thermal bums covering up to 40% of the body surface, fractures of ribs, carbon monoxide poisoning of severe and average severe degree, shock of tJhe first and second degree.,

b) with extremely severe injuries - thermal burns covering, more than 40% of the body surfase, intracavital hemorrhages, terminal conditions.

c) with average severe injuries: thermal burns covering up to 20% of the body surfase. solitary closes fractures of the forearm, bones, the bones of the hand, carbon monoxide poisoning of moderate degree shock of the first degree

d) with small injuries: thermal bums covering up to 10% of the body surfase. contusions, a mild carbon monoxide poisoning.

18. What type of medical aid is given to a victim for elimination or weakening the consequences of injuries threatening to the victim's life prophylaxis of possible complications and preparation of the victim for evacuation?

a) first medical aid

b) medical aid given by a doctor's assistant

c) first medical assistance

d) qualified medical assistance

e) specialized medical assistance

19. What medical aid is given for eliminating the consequences of injuries, first of all life-threatening injuries , for prevention from die development of complications, treating for developed cam plications?

a) first medical aid

b) medical aid given by a doctor's assistant

c) first medical assistance

d) qualified medical assistance

e) specialized medical assistance

20. What measures of first medical assistance do not refer to emergency measures?

a) elimination of acute respiratory insufficiency

b) provisional arrest of external bleeding by all available means

c) correction of immobilization with use of special

d) administration off antidotes, to victims of poisoning

e) partial sanitary treatment in poisoning caused by strongly acting poisonous substances

21. What main items do not refer to medical sorting sings?

a) those who require emergency first aid

b) sequence and place of rendering medical assistance

c) aid can he delayed

d) those who are subject to provisional isolation

e) those who lequiie symptomatic treatment

22. Which of the following factors

survival of the cerebral cortex after cardiac arrest?

a) the use of calcium antagonists (Nimodipin)

b) moderate hypctventilatkm

c) hypothermia

d) the use of nootropic agents (Nootropiil Cerebrolysin)

e) hyperthenma

23. What symptoms arc not the leading ones in diagnosing apnoe?

a) the absence of respiratory' excursions of the chest

b) the absence of airstream during exhalation

c) the absence of excursion of the epigastric region

d) the pallor of the skin

c) pale and cyanotio visible mucous membranes

24. The most effecthe urgent method of mechanical pulmonary ventilation is:

a) me rhythmic compression of the chest

b) Silvester's method

c) Hulgen-Nilsou" s meiliod

d) "mouth-to - mouth" method

e) the chest massage

25. Indicate the possible causes of the inflation of the ventricle in carrying out the artificial pulmonary ventilation using the "mouth-to -mouth" method?

a) the wrong positron of the head and the partial or complete obturation of me opening to the larynx

b) excessive volume and frequency of ventilation and the wioag position of die head

c) partial or complete obturation of the opening to the larynx and excessive volume and frequency of ventilation

d) cardiac sphincter insufficiency and excessive volume and frequency of ventilation

e) the wrong position of the head and the cardiac sphincter insufficiency.

26. In what position are victims with craniocerebral trauma transported?

a) on a broad shield in the supine position

b) on a stretcher in the half-sitting position

c) While transporting the victim on the stretchers the victim's head should be slightly lowered

d) While transporting the victim on the stretchers the victim's head should be turned sideways and raised

e) While transporting the victim on the stretchers the victim's head shoufd be tamed sideways and slightly lowered

27. Which depositions in carrying out the artificial pulmonary ventilation ?

a) ii\ case of absence of respiratory excursions

b) in case of absence of respiratory excursions and

weak pulse e) in ease of absence of respiratory excursions and

faffing of bfood pressure

d) the condition of victim from frequent and superficial respiration

e) in case of absence of respiratory excursions and cardiac arrest

28. What is the frequency of inhalations of carrying out artificial pulmonary ventilation by the "mouth-to - mouth" method?

a) S-10 per minute

b) 12-14 per minute

c) more than 10 per minute

d) 16-18 per minute

e) 18-20 per minute

29. What is the most wide-spread error in tarrying out artificial pulmonary ventilation?

a) insufficient closing of the nose

b) insufficient force of inhalation

c) insufficient adduction of the head

d) insufficient abduction of the head

e) insufficient abduction of ilie tongue

30. What must be done ventricular correct if the gastric contents get into the oral cavity while carrying out artificial pulmonary ventilation?

a) stop carrying out artificial pulmonary ventilation

b) turn a victim's head sideways and cleanse me oral

cavity e) goon carrying out pulmonary \entiiation

d) turn the victim over into prone position (lay the victim down on his abdomen)

e) bend the victim's head forward ami cleanse his oral cavity

31. What are the mains sign of cardiac arrest?

a) die absence of pulse on the peripheral arteries

b) loss of consciousness, weak pulse cramps

c) respiratory arrest, weak pulse

d) loss ot consciousness, respiratory arrest

e) loss of consciousness, the absence of pulse, respiratory arrest, cramps

32. At what per minute should be rhythmically compressed against the spine in carrying out closed chest cardiac massage by two persons ?

1. 30-40 per minute

c) 50 per minute

d) 60-70 per minute

e) about 70 per minute

33. What are signs of efficiency of the closed chest massage?

a) the presentee of pulse on a carotis and a pulmonalis dilatation of the pupils ^^ ^^ ^^^^^^^

b) th6 presence of pulse on a carotis or a femoralis, mvosis, the skin turns pink

c) dilatation of the pupils, the compression of the chest with the amplitude of 4-5 cm

d) the correctness of carrying out the close chest massage within 15-20 minutes

e) rendering assistance to a victim within 5 minutes after cardiac arrest . ,„ ,,

34. The following kinds of medical aid are given to victims on the first stage of a situation of emergency:

a) first doctor's assistant's aid and first aid

b) first doctor's assistant's aid

O doctor's assistant's aid and qualified assistance

d) flist medical assistance and qualified assistance

e) first aid and specialized assistance ft

35. What measures don't concern to first aid given by a di>i.tor in case of facial wounds?

a) eimiination of asphyxia

b) stopping a bleeding

c) transportirnmobinzari

d) surgical treatment of wounds of the face and the jaw

e) all above-mentioned

36. What percentage of pregnant women will require medical aid?

a) 2-5 %

b) to 10%

c) about 25%

d) 50%

e) all pregnant women actually

37. What main streams of victims are distinguished

In medical sorting?

a) those who require emergency First aid

b) those who require symptomatic treatment

c) firj,t aid can be delayed

d) those who are subject to provisional isolation

e) all above-mentioned

38. A patient aspirated a solid foreign body 4phonia, cough and asphyxia are observed. Which of the following measures shouldn't betaken?

a) turn the patient on his side and deliver a few heavy blows in the intescapular region

b) lay down the patient on Ms back and do a few compression the epigastric region in the direction to the chest

c) try carefully to remove the foreign hody blindly or in direct laryngoscopy

d) in case of inefficiency of other methods try to push the foreign body farther

e) in case of inefficiency of other methods and impossibility to perform laryngotracheoscopy, carry out cooicotomy.

39. Name the most complete definition of the Medical Evaettatieaal Organization (meo)

a) The MEO is organization of timely and consecutive measures for rendering medical assistance and treating victims at the stages of medical evacuation with obligatory transportation of the victims from the contamination zone to medical institutions in accordance with the character of injuries, i.e. according to medical indications.

b) The essence of the MEO is a forced division uf the process of victim's of a treatment into stages during catastrophes

c) The essence of the MEO is: a uniform classification and medical documentation ensure continuity and sequence in carrying out medical measures at the stages of medical evacuation

d) The essence of die MEO is throwing into the disaster zone medical forces and means of the public health services., proper organization of ihcir work and rational evacuation of victims from the zone of disasters While carrying out these measures victims are given consecutively all necessary types of medical aid: first aid, first aid given by a doctor's assistance, first medical assistance, qualified medical asistance, specialized medical assistance

e) MEO- is forces and means of public health services deployed on louteb of medical evacuation foi reception, medical sorting and giving certain types of medical aid to victims and (if necessary) their pieparalion for furthei evacuation.

40. What does the term "the stage of evacuation " mean?

a) Timely and consecutive measures for rendering medical assistance aud treating victims in the stages of medical evacuation with compulsory transportation of the victims from the disaster zone to medical indications

b) A forced division of the process of victims treatment into stages during catastrophes

c) A uniform classification and medical documentation ensure eligibility and sequence in carrying out medical measures, at the stages of medical evacuation

4. forces and means of the public health services deployed on routes of medical evacuation for reception, medial sorting and giving certain types of medical aid to victims and (if necessary) their preparation for further evacuation

42. Medial sorting is method of:

a) Streaming victims to the principle of their need of homogenous medical, prophylactical and evacuational measures according to medical indications and a concrete situation

b) Medical aid given in time and rational evacuation

c) Concrete, continuous, recurring and successive process of giving victims all kinds of medical aid

d) Sorting which is carried out on the basis of

diagnosis and prognosis

e) There is no definition

43. The first team of emergency medical aid arrived in the disaster zone must do their utmost to obtain the following information:a) Information about piobable contamination of the environment which may be dangerous to victims and the team members; information on measures taken for liquidation of the contamination.

b) Information about probable contamination of the environment

c) The team must determine the number of victims and the main types of injuries ('burns, chemical trauma, mechanical tiauma, etc.)

d) The team must establish contact with the supervision over rescue operations and with representatives of the Ministry of Internal Affairs in the disaster zone and with their help transmit information about the situation in the zone to the control point arid to managers of public health services.

e) All above- mentioned

44. Which of the following factors do not enhance survival of die cerebral cortex after cardiac arrest?

a) use of calcium channel blockers

b) use of noofcropic agents

d) moderate hyperventiJation

e) all above- mentioned

45. After primary cardiac arrest spontaneous respiration usually disappears in:

a) 10 sec

b) 20 sec

c) 30 see

d) 60 sec

e) 5 min

46.After primary cardiac arrest consciousness is lost in:

a) 10-15 sec

b) 20-25 sec e) 30 see

d) 60 sec

e) 5 min

47. The most frequent ECG- symptom of acute cardiac death is:

a) electromechanical dissociation with rough broad ventricular complexes

b) complete atrioventricular block '

c) slow ventricular rhythm

d) sinus bradicardia (less than 10 beats per minute)

e) ventricular fibrillation

48. What is the primary symptom of cardiac arrest?

the absence of cardiac tones on auscultation

52. What specialised medical teams are busiest during the first da\s of floods:

a) theiapeulic

b) surgical

c) eptdemiological

d) infection

e) neurosurgical

53. What are the most frequent injuries in earthquakes:

a) ttauma to internal organs

2. fractures of extremities

3. c) burns

d) ciubh byiidtome

e) cianiocetebral oauma

54. What trauma arc the most frequent injuries in hurricane?

a) fractures of extremities

b) bums

c)ttauma to internal organs

d) crush- syndrome

c) umioteiebxal tiauina

55. What percentage of a total of victims of catastrophes do pregnant women constitute?

a) 2-5%

b) up to 10 %

c) about 25%

d) 50 °o

e) more than 50 %

56. The following natural calamities occur the most frequently;

a) earthquakes

b) floods

c) typhoons

d) humcancs

e) droughts

57. ib body hjpoiherfitia in water with fbe temperature below 25 "C the following symptoms develop:

a) hvpoglvtemm

b) hyperglyceima

c"i the content of sugar in blood is not altered

d) glucosuna

e) hyaline cylinders in ui me

58. In a victim with severe hypothermia in water the following parts of the body is rewarmed in the first place:

4) The head, the back of the head and the neck b) The chest (the cardiac region), the abdomen (the liver), the back of the head and the neck

d) The chest (the cardiac region^ the head and the neck

e) the head and feet

59. Which medical measures should not be carried out in victims which are in a severe shock caused by hypothermia?

a) lewamuug vitally mipoitaut oigaus (the Iivei, Ihe heart), the back of the head, the neck

b) gastric la% age with the use of warm water (45-50 "C) 01 a waim 5 % solution of sodium bicaibonate

c) subclavian vein cathetenzarion with continuous mfesioa of (40 °C) 10 per cest solution of glucose, a warm 5 % solution of sodium bicarbonate, Rheopolyglukin and othei agents

d) imnicmon \n a bath with tbc watci tcnipciatuic of 36 "C

e) Artificial pulmonary ventilation (AVP)

60. In catastrophes at water, if the temperature of a water is about +10 °C, the approximate duration of permissible period of staying in water people with ordinary clothes on is:

a) up to 1 hour b; up to 3 hows

c) up to 5 houis

d) up to 7 hours c) up lo 9 liours.

61. In catastrophes at water, if the temperature of a water is about +15 "C, the approximate duration of critical period of staying in water people with ordinary clothing on is:

a) up to 1 hour

b) up to 5 hours

c) up to 7 hours d; up to 9 hours e) up to 16 hours

62. In catastrophes at water, if the temperature of a water about +20 T, the approximate duration of permissible period of people's staying in sateris:

a) up to 1 hour

b) up to 3 hours e) up to 5 hours d) up to 7 hours e\ up to 9 hours

63. In water mild degree hypothermia ("adynamic firm") develops of the body temperature doesn'c fail beiow:

a) 35 C

b) 30°C

c) 25 T

d) 20'C

e) 15^o'C

64. In water accidental hypothermia of average severity develops of the bodj temperature doesn't

65. The plane-crash is:

a) an accident which doesn't result in casualties but

causes a considerable destruction of the plane The repair of the plane is impossible of inexpedient, b) Partial or complete destruction of an aueiaft on

complete disappearance of an aircraft e) an accident which result in the death of even one

air crew's member one passenger

d) an accident which result in the death of even one member of the aircrew or one passenger

e) any accident with an aircraft involved

66. The most frequent causes of the plane- crash are:

a) the weather (thunderstorm, ice- formation, fog, wind, gradient)

b) sabotage and military operations

c) human error (a pilot's error, an air traffic control officer's error, an error of a crew's member)

d) maintenance

e) fauJriness in elements of the design of an aircraft

67. Name the correct classification of accident, and catastrophes on water transport ;

a) A shipwreck, disaster, an accident

b) A shipwreck resulted in people's deaths; disaster.

an accident l) blupwieck, disaster which led lo deaths of people,

an accident

d) A shipwreck resulted in people's deaths, disaster which led to people's deaths, an accident with out casualties

e) A shipwreck resulted in people's deaths, disaster which led lo people's deaths, an accident vvnli oui casualties without sacrifices.

68. In what zone of explosion is the maximum damage be registered?

a) w die zone of aii shock wave

b) in the zone of action of the detonation wave

c) in the zone of action of explosion products

d) in the zone of action of the head shock wave

e) in the zone of action of direct and lateral shock wave

69. Present- day nations about the mechanism of forming of a bullet wound is determined by the theory of:

a) molecular concussion .

b) the head shock wave

c) the direct and lateral shock wave

d) the speed of a missile

e) the initial speed of a missile

70. Name the principle damage factors at a dangerousfy explosive objects?

a) an air shock wave, secondary missiles

b) secondary missiles, ruined buildings

c) circumstances causing mental disorders, air shocfe wave

d) ruined buildings, air shock wave 6) all above- mentioned

71. What zones don't refer to the bullet wound zones?

a) the zone of contusion

b) the zone of wound canal

c) the zone of primary necrosis

d) the zone of definite necrosis

e) the zone of molecular concussion

72. What doesn't have substantial influence otf the character of tissue damage in a bullet wound?

a) the type of a wounding missile

b) the speed of a of a wounding missile

c) the weight of a wounding missile

d) the shape of a wounding missile

e) the number of a wounding missile

73. What surplus pressure in the front of shock wave in disaster at dangerously explosive object is considered to be unsafe?

a) 3 kPa

b) 5kPa

c)10 kPa

d)20kPa

e) 25 kPa

74. In inhalation of products of burning the most frequent injurious factors are:

a) the direct effect of heat

b) carbon monoxide poisoning

c) lack of oxygen

d) cyanide intoxication

e) methemoglobin formation

75. Severe-degree injuries are caused by an explosion with the excessive pressure of:

a) 10-20kPa

b) 20-40 kPa

c) 40-60 kPa

d) 60-80 kPa

e) 60-100 kPa

76. Name a zone in which the basis of pathomorphologkal alterations is multiple focal mieroriiptures of muscles of "ladder" type ruptures of the muscle bundles fibers as well as the ruptures of wails of large and small blood vessels that results in the appearance of miero-and macrofocai haeniorhages.

1. the zone of explosive dispersion of tissues (complete anatomical defect)

2. b) the zone of tearing off, smashing and of tissues (in complete anatomical defect)

c) the zone of contusion of tissues in the preserved part of the injured segment.

d) the zone of concussion of organs and tissues in adjacent segments

e) all mentioned- above

77. Name the topographicoanatomieal levels of tissue damage in the amputation of as extremity in contact mine explosion.

a) the level of explosive dispersion of tissues (complete anatomical defect)

b) the level of amputation, tissue smashing (in complete anatomical defect)

c) the level of contusion of tissues in the preserved part of the injured segment.

d) the level of concussion of organs and tissues in adjacent segments

e) ail mentioned-above

78. In explosions in mines the following injuries occur the most frequently:

a) only carbon monoxide poisoning

b) mechanical injuries in combination with carbon monoxide poisoning

c) thermal hums in combination with mechanical injuries

d) isolated severe mechanical injuries

e) thermal bums in combination with carbon monoxide poisoning

79. On arriving in the area of explosion at & mine the rescuers, having found a victim, must connect the victim up to:

a) a gas- mask

b) an isolating oxygen respiratory appaiatus

c) a pulmonary inhalator

d)"mine - rescuer"

4. any oxygen- respiratoiy apparatus

80. Victims of explosion in mines are sorted according to:

a) the degree of severity of their condition

b) the sxpecf of bums

c) the degree of carbon oxide poisoning

d) according the degree of shock

e) according to air above- mentioned

81. The ahsorhed dose unit of raeliation in SI is:

a) Sivert (Sv)

b) Gray(Gi)

c) Ber (biological equivalent of Roengen)

d) Curie (Cu)

e) Roentgen (R)

f) Recquerel (BQ)

82. Nuclear disasters are subdivided into:

a) Localized, local and general

c} general, local and integrate

d) integrate and general

e) all above- mentioned

83. The following measures of protection don't refer to measures of protection from radiation effect:

a) a shelter

b) evacuation

c) the control of admittance to the area of contamination

d) taking stable iodine

s) teansporting victims from the area of contamination

84 The permissible dose of irradiation of personnel •working with radial ioatii is;

a) 5 ber

b) 30ber

c) 40 ber

d) 100ber

e) 500 ber

85. The principle objective criteria for determining die degree of severity of acute radiation disease are:

a) die term of appearance of nausea and vomiting h) appearance of the primary erythema

c) lymphopcnia wiihin the frrst twenty- four hours

d) lymphopenia on day 3 after irradiation

e) all above- mentioned

86. Victims with the primary reaction to acute radiation disease must be referred to the category of victims requiring emergency first aid if they have acute radiation disease of:

a) 1,11 degrees

b) l,111 degiees,

c) 1,11411 degrees

d) 111,1V degrees

e) 1,11,111,1V degrees,

87. What occurs if a single irradiation dose is 100-200 rad?

a) ability to work is altered

b) ability to work is not altered but the development of acute radiation disease of the first degree is possible

c) ability to work is altered and the de\ eJopment of first degree radiation disease is possible.

d) ability to work k altered and the development of second degree radiation disease is possible

e) ability to work is not altered but the development of second degree radiation disease is possible

88. What is the purpose of medical sorting of victims of nuclear disasters?

a) carrying out special treatment

b) urgency and volume of medical care

c) ways of evacuation

e) all above- mentioned

89. Clinical symptoms of acute chemical poisoning develop the most rapidly if the toxicant penetrates:

a) through the skin

b) through the wound surface

c) orally

d) per rectum

e) by inhalation

90. Name an average lethal concentration of extremely dangerous poisons in the air (g/m³ ):

a) less than 0,5

b) o,5-5,0

c) 5,0-50,0

d) 50,0-100,0

e) 100.0 less than 0.5

91. in SAPS poisoning the following syndromes may occur:

a) acute intoxication psychosis

b) the aspirative and obturative syndrome

c) disturbances in consciousness and cramps

d) the restrictive syndrome

e) all above- mentioned syndromes

92. If all people in the zone of chemical disaster will have individual means of protection

a) there will be no victims:

b) there will be 1% of victims

c) there will be 10% of victims

d) there will be 20% of victims

e) tiieie will be 40% of victims

93.In the zone of chemical contamination there are children aged 2 to 5. What wag of evacuation must be used?

a) on the stretchers or in the arms

b) on loot or accompanied by adults

c) without assistance, not accompanied by adults

d) accompanied by their patents

e) any way

94. The -zone of chemical contaminaton is divided into:

a) the zone of extremely dangerous contamination

b) the toxic zone

c) the zone of dangerous contamination

d) the concentration zone

e) ail above- mentioned

95. The bask initial signs of POS poisoning are as follows, except:

a) blurred vision

b) tremor of the tongue and eyelids

c) mydriaais

d) myosis

e) gasrro- intestinal hyperactiviry

96. The clinical picture of scute poisoning wilh phosphororganic substances (POS) is caused by:

a) their central chohnergic action

b) inhibition of choliaesteraze and eadogeaic cholmergic intoxication

c) a decrease in secretion of acetylcholin on postgaaglionaiy prcsinaptic membranes

d) the primary suppression of the respiratory center

e) negative inotropic effect

97.The sanitary and epidemiological reconnaissance in the region of the emergency situation has revealed the following: group infections disease with the tendency to further spread are arising; single cases of extremely dangerous infections disease (plague, cholera) have been registered. Such condition is determined as:

a) sate condition

b) unfavourable condition

c) unstable condition

d) unsafe condition c) emergency condition

98. What are the principal task of the Antiepidemk Emergency committee?

a) approval of die plan of liquidation of the nidus

b) determination of the terms of introduction and lifting of restrictive and regime measures,

c) rendering administrative, consultative and methodological assistance to various services

d) hearing the account of persons in charge about works of liquidation of the nidus

e) all above- mentioned

99. What contingent of persons is forbidden to enter the zone of quarantine?

a) staff of formations diiected to the zone foi rendering aid of liquidation of the infection nidus

b) specialized teams diiected to the zone for rendering assistance in liquidation of the infection nidus

e) permanent residents of inhabited areas in the zone of quarantine

d) relatives of permanent residents of inhabited areas in the quarantine zone

e) all above- mentioned

100. What measures must those who wish to leave the zone of quarantine undergo?

a) fluorography

b) decontamination

c) observation

d) hospitalizaiion

e) medical examination

1. AIRPLANE ACCIDENTS AND AIRPORT TERRORISM: MEDICAL EMERGENCY PLAN Villa G.F. - Lugani D. – Seletti G.I.R.C.C.S. San Raffaele Hospital - Milan, Italy

2. Baskett P.J., Weller R.: "Medicine for Disasters", Wright, London and Boston, 1988.

3. Clarke R., Ehrlich A., Gunn S.W.A. et al.: "London Under Attack. Report of the GLAWARS Commission", Blackwell, Oxford and New York, 1986.

4. Gunn S.W.A.: International Cooperation in Disaster Medical Relief. The Role of UNDRO, In "New Aspects of Disaster Medicine", Ohta M., Ukai T., Yamamoto Y. (eds.), Herusu, Tokyo, 1989.

5. Gunn S.W.A.: The scientific basis of disaster medicine: a new discipline. Japan. J. Acute Med., 15: 1721, 1991.

6. Gunn S.W.A.: "Multilingual Dictionary of Disaster Medicine and International Relief', Kluwer Academic Publishers, Dordrecht, London, Boston, 1990.

7. Gunn S.W.A., Manni C.: Training for Health Disasters. Disaster Management, 2: 102, 1989.

8. Marshall V.C.: "Major Chemical Hazards". Wiley, New York and Chichester, 1987.

9. Pan American Health Organization: "Epidemiologic Surveillance After Natural Disaster", Washington, 1982.

10. Simmonds S., Vaughan P., Gunn S.W.A.: "Refugee Community Health Care", Oxford University Press, Oxford and New York, 1985.

11. United Nations: "Mitigating Natural Disasters. A Manual for Policy Makers and Planners", UNDRO, Genova, 1991.

12. World Health Organization: Basic Documents, WHO, Geneva, 1988.

13. Yamamoto Y., Morikawa M.., Makino T., Otsuka T.: The International Medical Cooperation by Japanese Government on Disaster Relief and the Future of this Program, In "New Aspects of Disaster Medicine", Ohta M., Ukai T., Yamamoto Y. (eds.), Herusu, Tokyo, 1989.

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