5.1. Types of care
For any damage, comprehensive health care should be provided as early as possible. The most optimal is delivery of the victim to a specialized hospital immediately after injury. However, first aid to the victims must be provided directly at the scene of the incident, where most often, there are no medical workers, no conditions for medical and diagnostic manipulations.
If we do not consider the cases of mass injuries and disasters, when the organization and provision of assistance to victims have their own specifics, it can be divided into two periods - pre-hospital and hospital.
Pre-hospital period
This period includes almost all types of care that are provided outside the hospital: directly at the scene of the accident, at the victim's home, in an ambulance, in outpatient medical organization.
The main tasks of the pre-hospital period: saving the victim's life, maintaining the vital functions of the body, preventing complications that are dangerous to life and health, as well as transportation to a medical institution, where they can get specialized medical care.
First aid
First aid is provided directly at the scene of the accident in the order of self-help and mutual assistance, as a rule, using only available materials and in the absence of the possibility of drug treatment. Aid is provided symptomatically.
Primary pre-medical health care
The required qualification level is a nurse or paramedic. They have special medical devices and are trained to use them. No diagnosis is made, only life-threatening conditions are identified. Aid is provided according to the syndromes.
Primary medical health care
The required qualification level is a general practitioner (family doctors, district doctors of a district polyclinic). At this level it becomes possible to use medication.
Emergency medical care
This is a special type of care - the only one in the pre-hospital period that has the status of medical care (in accordance with the legislation of RF). It is provided by employees of linear ambulance crews, whose training, qualifications, and equipment have their own specifics.
The listed types of assistance exclude any operations, as well as medical manipulations for the reposition of bone fragments, do not provide for additional (including X-ray) investigation; however, during the examination, the doctor should make a preliminary diagnosis.
Primary specialized medical health care
In case of injuries to the musculoskeletal system, this type of assistance is provided in trauma centers. The traumatologist can, if necessary, perform additional investigation (radiography, CT, MRI), which allow to clarify the diagnosis and determine whether the victim needs to be referred to a specialized hospital or the necessary medical care can be provided on an outpatient basis.
Performing reconstructive operations is not included in the scope of tasks of the trauma center; however, the physician applies therapeutic fixation bandages, monitors the course of treatment, and conducts rehabilitation measures (Table 5.1)
Table 5.1. Tasks for the types of diagnostic care for injuries
| Period | Type of care | Diagnosis |
| Pre-hospital | First | Not in use |
| Primary health care (outpatient part) | Pre-medical | Not in use |
| Primary medical care | Preliminary |
| Specialized | Preliminary |
| Emergency medical care | Preliminary |
| Hospital | Medical specialized care | Clinical |
The type of assistance provided to the victim is determined by the feasibility and rationality of its provision in a given place and at a given time. The main factors that determine the volume of such assistance are medical equipment, the possibility and duration of transportation to a specialized hospital, health care provider qualifications, as well as the number of victims, which need to be treated simultaneously. It follows that, on the one hand, even an experienced traumatologist, being left without the necessary medical equipment (for example, at the place of a traffic accident), provides only first or primary pre-medical care. He is able to establish a preliminary, and in some cases, a clinical diagnosis right on the scene; however, in this case, it is not necessary, since it will not entail any changes in the tactics of providing assistance, but only takes additional time. On the other hand, the surgeon of the polyclinic, being not qualified as a trauma specialist, in the conditions of urban health care, will immediately send the victim to a specialized hospital (providing only primary medical care if necessary). In the conditions of a remote rural outpatient clinic, if a quick evacuation is impossible, he will take actions to establish a clinical diagnosis, to carry out accessible therapeutic manipulations at the level of some elements within the primary specialized healthcare.
In the context of urban healthcare, the outpatient link in the provision of medical care and treatment of victims with injuries of the musculoskeletal system is represented by a network of trauma centers, where specialized medical and sanitary care is provided.
In relation to victims with acute trauma, the function of the trauma center consists of:
- round-the-clock provision of emergency and urgent outpatient trauma care;
- determining the need for referral to a specialized hospital depending on the nature of the damage or the possibility of comprehensive outpatient treatment;
- performing the necessary manipulations (examination, blockade, immobilization) and outpatient operations as part of preparation for transportation to a hospital or during treatment in a trauma center.