**4.2 Organization of MPIP**

#### *4.2.1 Surgical and trauma care*

The relevant clinics from the Multidisciplinary Hospital for Active Treatment (MPHAT) and Hospital for Emergency Medicine, as well as the clinical departments of surgery, orthopedics and traumatology, resuscitation and anesthesiology in the district, regional and municipal hospitals are used as a base. If necessary, the bed capacity of the same hospitals is used. In some cases, staff and facilities from other surgical units (ophthalmology, maxillofacial surgery, etc.) of hospitals can be used. This allows in EDS for a short time and without significant difficulties to be included in the organizational scheme of medical care. About 60% of the inpatients can be discharged and a specialized bed stock can be released for the needs of the victims. For work in a trauma center, if necessary, medical teams (trauma, surgical, etc.) are formed on a functional principle, without seriously violating the readiness of these wards for admission and treatment of victims. These teams must arrive at the scene no later than one hour after the emergency medical teams. At this time, the medical situation, the scope of work and the

possible number of required specialized surgical teams should be clarified. If necessary, they can be strengthened with teams from medical institutions in neighboring regions [7, 8].

### *4.2.2 Radiological care*

In case of accidents at the NPP, in case of incidents with sources of ionizing radiation, in case of cross-border transfer of radioactive substances in the therapeutic wards of the MPHAT, an opportunity must be created to provide radiological assistance to the victims. All therapeutic wards of the medical establishments, in the vicinity of the NPP, must be ready for possible admission of radiation patients and those with combined radiation injuries. For this purpose, it is necessary for physicians-therapists to have radiobiological training and in case of radiation conditions to organize the work of the ward in radiological terms and to conduct radio protective measures in the medical institution. The existing departments of radiotherapy and isotope diagnostics, based most often in oncology dispensaries, oncology hospitals, etc., have a corresponding place in this functional radiological system. The medical staff from these radiology departments are involved in providing radiological assistance to the victims [7, 20–26].

The duty and responsibilities according to the International Atomic Energy Agency (IAEA) require doctors to have the relevant knowledge of radiation protection, which enables them to initiate preliminary treatment and provide assistance to specialized units in the event of a radiation accident. Another task of health care in the section of radiological care is the control of the radiation parameters of the working and living environment, which directly affect the person [22]. The radiation control department must organize and conduct the necessary radiationhygienic measures on the given territory.

The organization of the radiological assistance is related to the plan for radiation protection of the country in case of an accident at the NPP, which ensures the implementation of the plan in its medical section [7, 20–26].

#### *4.2.3 Toxicological care*

The organization of toxicological care uses a mixed approach, including the establishment of staff and functional units. The expanding chemical pathology necessitated the establishment of full-time clinics and toxicology departments in the settlements with large sites of the chemical industry. These units, in addition to providing toxicological assistance to the population, also serve to train medical personnel in this field. In the other hospitals, the therapeutic wards are re-profiled into toxico-therapeutic ones for admission of toxicologically ill patients for emergency toxicological care. Good interaction should be ensured with the intensive care unit of the hospital [7, 10].

On the basis of the staff clinics and toxicology departments, specialized medical teams are established, provided with medical and sanitary equipment and transport. These teams must be constantly prepared to work in a chemical outbreak or to strengthen the therapeutic wards of neighboring hospitals where toxicologically ill patients are hospitalized [7–10].

#### *4.2.4 In outbreak of biological contamination (OBC)*

When creating an outbreak of biological infection all types of medical care (first medical, first medical, qualified and specialized) are within the area of the outbreak. For this purpose, the medical and prophylactic establishments on the territory in the OBC mainly are used [7–10].

**63**

**Figure 3.**

*Medical Provision of the Population within an Outbreak of a Traumatic Defeat an Earthquake…*

The first medical and qualified medical care for vital indications is provided at the medical center according to various schemes. Most often, two groups of medical forces are created for rescue operations in the center of a combined defeat: in the

Medical sorting is performed in the OTD. According to the severity of the OTD, the distribution of the victims by sorting groups allows for homogeneous treatment

Depending on the severity of the injuries the victims are sorted into two main

a.Slightly injured (40%). This group includes victims of soft tissue injuries who

b.Moderately and severely injured (60%). These are victims who need urgent medical attention and inpatient treatment. This group can be divided into four

• Group T3. Injured with some slightly graded cranio-cerebral injuries or some insignificant spinal cord injuries and others slightly injured (20–40%). These are persons with injuries of the small bones of the frontal part of the skull

• Group T 2. Persons to whom medical care can be postponed for 6–8 hours (20%). These victims have an advantage of transportation, but do not need extreme treatment. These include victims with some surface thoracic or

(mandible, nose), medium and small soft tissue injuries, etc.;

*DOI: http://dx.doi.org/10.5772/intechopen.94259*

biologically infected area and outside it **[**2, 7–10].

and prevention measures [7–10, 16–18, 27]**.**

do not need hospital treatment;

• Group T4. Dying and agonizing;

*Triage groups in an OTD. (the worst prognostic option).*

*4.2.5 In the outbreak of combined defeat*

**5. Medical triage in an OTD**

groups in Bulgaria [7, 10]**:**

subgroups (**Figure 3**):

*Medical Provision of the Population within an Outbreak of a Traumatic Defeat an Earthquake… DOI: http://dx.doi.org/10.5772/intechopen.94259*
