Lviv national medical university

LVIV NATIONAL MEDICAL UNIVERSITY

BY DANYLO HALYTSKYY

Department of medicine of extraordinary situations

EXTRAORDINARY SITUATIONS OF NATURAL, TECHNOGENIC, SOCIO-POLITICAL AND MILITARY ORIGIN, THEIR MEDICALLY-SANITARY CONSEQUENCES.

Methodical recommendations for self-study of students of medical and stomatological faculties to practical and seminar lessons on educational discipline “Medicine of extraordinary situations”

Lviv – 2011

Methodical recommendations prepared: Chaplyk V.V., Pylypiv Ya.I., Humenyuk V.V., and Oliynyk P.V.

Translation: Humenyuk V.V.

Methodical recommendations are developed for self-study of students of medical and stomatological faculties to practical and seminar lessons on educational discipline “Medicine of extraordinary situations” on theme: Extraordinary situations of natural, technogenic, socio-political and military origin, their medically-sanitary consequences. As a result of study of theme students must know classification of extraordinary situations and description of their medically-sanitary consequences.

Methodical recommendations are recommended by a methodical commission of department of medicine of extraordinary situations of LNMU by Danylo Halytskyy for the printing.

Document № ___ from “ __” ___________ 2011.

A sequence of study of theme and methodical recommendations for independent preparation to practical lessons
I. Educational aim:

To learn a classification of extraordinary situations and order of liquidation of their medically-sanitary consequences.

II. Educational-having a special purpose task:

1. To know the order of classification of extraordinary situations of technogenic, natural, socio-political and military origin.

2. To know a medically-sanitary description of extraordinary situations of natural, technogenic, socio-political and military origin.

3. To know description of medically-sanitary consequences of extraordinary situations.

III. Time of lesson: 4 academic hours;
IV. Place of leadthrough of the lesson: educational class of department

V. Educational questions and timing:

Lesson №1.

1. An order of classification of extraordinary situations of technogenic, natural, socio-political and military origin.

2. Medically-sanitary description of extraordinary situations of natural origin.
Lesson №2.

1. Medically-sanitary description of extraordinary situations of technogenic origin

2. Medically-sanitary description of extraordinary situations of socio-political origin.

3. Medically-sanitary description of extraordinary situations of military origin.

VI.METHODICAL POINTING ON INDEPENDENT PREPARATION

During independent preparation to practical lessons students must use base material of methodical recommendations, the compendium of lectures on this topic, by educational material of the indicated literature.

As a result of independent preparation students must know the order of classification of extraordinary situations of technogenic, natural, socio-political and military origin, their medically-tactical description and to be ready to give an answer for the control questions of the lesson.

TASK FOR SELF-STUDY

1. 
   Check your base knowledge in accordance with an educational purpose and educational tasks and if necessary – correct them.
   
2. 
   A questions for self-control of base knowledge:
   

1. Order of classification of ES of technogenic, natural, socio-political and military origin

2. Classification of ES in accordance with territorial distribution and volumes of technical and financial resources, which are needed for liquidation of their consequences.

3. Classification of ES of natural origin on severity of consequences for a population and objects of national economy.

4. Medically-tactical description of extraordinary situations of natural origin

5. Medically-tactical description of extraordinary situations of technogenic origin

6. Medically-tactical description of extraordinary situations of socio-political origin

7. Medically-tactical description of extraordinary situations of military origin.

BASE EDUCATIONAL MATERIAL

Extraordinary situations of natural, technogenic, socio-political and military origin, their medically-sanitary consequences.

1.Order of classification of extraordinary situations of technogenic, natural, socio-political and military origin

From data of the Geneva center of researches of epidemiology of catastrophes, Ukraine enters in ten of the world countries, in which, in particular, in 2006 year there were observed most victims of natural calamities. Presence in Ukraine of the developed infrastructure of industry, its high concentration in separate regions, existence of large industrial complexes, in that number, those, which are attributed to potentially dangerous,  developed network of transport communications, and also oil- and gas pipelines, plenty of power objects, using in a production al lot of potentially hazardous substances – all of this increases a possibility of origin of technogenic ES, which carry in itself a threat for life and health of people, for economy of the state and natural environment. The total risks of technogenic ES  exceed the total risks of origin of ES of natural character considerably. Almost 1/3 of all industrial objects are presented by enterprises, which are related to the production, processing and storage of drastic poisonous, explosive and inflammable substances. At the terms of economic crisis, shortage of money facilities, very slowly and not in time an update or replacement of old capital production assets is carried out too late, the level of wear of equipment of which is almost critical. All of it increases a possibility of origin of technogenic dangers. There is possibility of origin of practically all spectrums of natural processes of geological, hydrological, meteorological origin on territory of Ukraine. Among ES of natural character in Ukraine happen more frequently such as: large floods, earthquakes, landslide processes, forest and field fires, hurricanes, tornados and squall winds.

Technogenic and natural processes can result in the origin of failures, catastrophes and, as a result of them, to the extraordinary situation on a separate object or territory.

Failure – is a break, destruction of buildings, equipment, transport vehicles and violation of production or transport process in investigation, as a result of which a threat for life and health of people is created on an object or certain territory.

Catastrophe – is a sudden, fleeting event, caused by forces of nature or activity of man, which entailed a numerous human losses, made harm or threat to the health of a lot of people, caused destruction or elimination of objects and other financial values in considerable sizes, and also entailed harm to the environment.

An extraordinary situation for health protection – is a circumstance, which arose up suddenly, at what a possibilities of organs and establishments of health protection from warning and liquidation of medically-sanitary consequences of ES does not answer to existent possibilities and require a mobilizing of additional medical forces and facilities from outside or substantial change of everyday forms and methods of work.

The purpose of classification of extraordinary situations (ES) is creation of effective mechanism of estimation of event, which became or can happen in the forecast term, and determination of degree of reacting at proper level of management. The general signs of ES are: presence or threat of death of people or considerable violation of terms of their life activity; infliction of economic losses; substantial worsening of the condition of environment. As a purpose of creation of the unique system of classification of extraordinary situations and determination of their levels, providing of the operative and adequate reacting on such situations, by Decision of Cabinet of Ministers of Ukraine from July, 15 in 1998 №1099 there was ratified a Statute about classification of extraordinary situations.

In accordance with reasons of origin of events, which can stipulate the origin of ES on territory of Ukraine, are differentiated:
Table 1. Classification of extraordinary situations

ES of technogenic origin are transport failures (catastrophes), fires, unprovoked explosions or their threat, failures with the extras (or the threat of extras) of dangerous chemical, biological, radioactive substances, sudden destruction of buildings, failures on engineering networks and buildings of life-support, hydrodynamic failures on dikes, dams and others like that.

Table 2. Classification of extraordinary situations of technogenic origin

NS of natural origin are dangerous geological, meteorological, hydrological marine and freshwater phenomena, degradation of soils of the earth, natural fires, change of the state of atmosphere, infectious morbidity of people, agricultural animals, mass defeat of agricultural plants by illnesses or wreckers, change of the state of water resources and biosphere and others like that.
Table 3.Classification of extraordinary situations of technogenic origin

NS of socio-political origin are related with the outlaw actions of terrorists and unconstitutional direction: realization or real threat of assassination (armed attack, capture and detention of important objects, of nuclear equipment and materials, of communication and telecommunications networks, attack or encroaching upon the crew of air or marine ship), theft (attempt of theft) or destruction of ships, theft or capture of people, setting an explosive devices in public places, theft or capture of weapon, finding of old weapons and ammunitions and others like that.
Table 4. Classification of extraordinary situations of socio-political origin.



NS of military origin are related to the consequences of applications of weapon of mass defeat or ordinary defeat, during which the second factors of defeat of population are as a result of destruction of the atomic and hydroelectric stations, compositions and depositories of radio-active and toxic matters and wastes, oil products, explosives, transport and engineering communications and others like that.
Table 5. Classification of extraordinary situations of military origin.

In accordance with territorial distribution, volumes of the caused or expected economic losses, amounts of people, which perished, after classification of signs there is determined four levels of extraordinary situations - national, regional, local and objective.

In the process of determination of level of ES three groups of factors are consistently examined: territorial distribution; size of the caused (expected) economic losses and human losses; classification signs of extraordinary situations.

In accordance with territorial distribution and volumes of technical and financial resources, which are needed for liquidation of consequences of ES:

to the national level belong :

• 
  ES, which spread or can spread on territory of other states;
  
• 
  ES, which spread on territory of two or the more regions of Ukraine (Autonomous Republic of Crimea, regions, Kyiv and Sevastopol), and for its liquidation a financial and technical resources are needed in volumes, which exceed a possibility of these regions, but not lesser as 1 percent from the volume of charges of the proper local budgets (ES of state level after territorial distribution);
  
• 
  ES, which brought to death more than 10 persons or over 300 suffered persons (suffered persons are persons, to life or to the health of which a harm was caused as a result of extraordinary situation), or the normal terms of life activity were broken for more than 50 thousands of persons on great while (more than on 3 days);
  
• 
  ES, as a result of which over 5 persons perished or over 100 persons suffered, whether the normal terms of life were broken for over 10 thousands of persons on long time (more than on 3 days), and losses, caused by an extraordinary situation, exceeded 25 thousands of low-limit of payment;
  
• 
  ES, losses from which exceeded 150 thousands of low-limits of payment;
  
• 
  ES, which in other cases, foreseen by the acts of legislation, after the signs is acknowledged as ES of state level.
  

to the regional level of ES belong such:

• 
  which spread on territory of two or more districts (cities of regional value) of Autonomous Republic of Crimea, regions, and for its liquidation a financial and technical resources are needed in volumes, which exceed to possibility of these districts, but not lesser as 1 % of volume of charges of the proper local budgets (ES of regional level after territorial distribution);
  
• 
  ES, which brought to death from 3 to 5 persons over or from 50 to 100 suffered persons, whether the normal terms of life were broken for 1-10 thousands of persons on great (more than on 3 days) while, and losses were exceeded by 5 thousands of low-limit of salary;
  
• 
  ES, losses from which exceeded 15 thousands of low-limit of fee, which happened on territory of two and more administrative districts (cities of regional value), Autonomous Republic of Crimea, regions, cities Kyiv and Sevastopol, or threatens by possibility of transference on territory of contiguous area of Ukraine, and also in the case, when for its liquidation a financial and technical resources are needed in volumes, which exceed own possibilities of separate district, but not lesser then 1% of volume of charges of the proper budget;
  

to the local level of ES belong such:

• 
  which goes out outside a potentially dangerous object, threatens by distribution of the situation or of its secondary consequences on an environment, nearby settlements, engineering buildings, and also in the case, when for its liquidation a financial and technical resources are needed in volumes, which exceed own possibilities of potentially dangerous object, but not lesser then 1% of volume of charges of the proper budget. To the local level all extraordinary situations belong also such ones, which arise up on the objects of communal sphere and others, that not included in the ratified lists of potentially dangerous objects;
  
• 
  ES, as a result of which 1-2 persons perished or from 20 to 50 persons are suffered, whether the normal terms of life activity were broken from 100 to 1000 persons on great (more than on 3 days) while, and losses were exceeded 0,5 thousands of low-limits of payment;
  
• 
  ES, losses from which exceeded 2 thousands of low-limit of payment.
  

to the object level belong all ES, which do not fall under the noted definitions.

Classification of extraordinary situations by their levels is carried out for providing of organization of co-operation of central and local government organs, enterprises, establishments and organizations in the process of decision of questions, related to ES and liquidation of their consequences. For determination of level of ES such criteria are set:

• 
  territorial distribution and volumes of technical and financial resources, which are needed for liquidation of consequences of extraordinary situation;
  
• 
  amount of people, which suffered, or the terms of life activity of which were broken as a result of extraordinary situation;
  
• 
  size of the caused (expected) losses.
  

Table 6. Classification of ES of natural origin on severity of consequences for a population and objects of national economy

Category of ES	Character of management		Maximal consequences of ES. Volume of direct losses
	Degree of recovery	Terms of recovery
Easiest	Fully	3 days	Broken work of communications, amount of losses to the 10 persons. Other damages are small.
Easy (weak)	Fully	1 year	Damage of communications, enterprises, buildings, settlements, loss of harvest and others like that. An amount of losses is up to 10^2 - 10^3 persons.
Middle	Fully	5-7 years	Damage and destruction of settlements, enterprises, loss of harvest, but without considerable losses for an environment. Amount of losses up to 10^4-10^6
Strong (heavy)	Not fully	Over 5-7 years	Various losses with the considerable losses of population. An amount of victims is up to 10^5-10^6.
Shattering	Non-recoverible	Non-recoverible	Various losses with the loss of natural basis, which results in the loss of territorial complex.

ES belongs to the certain level in case of accordance of it even one of values of criteria. In cases, when as a result of ES for the proper threshold values of levels of human losses or amounts of persons, which suffered or have violated the normal terms of life activity, the volume of losses does not arrive at certain criterion, then the level of ES is set on a degree lesser (for road-transport adventures – on two degree lesser). Setting an ES, which arose up on territory of several administrative-territorial units, as state and regional after territorial distribution or on the total indexes of its consequences, is not the same as setting of ES as state or regional separately for each of these administrative-territorial units. Setting an ES as state and regional level for the noted administrative-territorial units is carried out separately. Final decision in relation to the level of extraordinary situation with a subsequent reflection of it in statistics data, including the case of absence of sufficient information in relation to development of ES, accepts the specially authorized central organ of executive power, to the competence of which belongs the decision of questions of defense of population and territories from ES, on a concordance in the case of necessity with the interested ministries and other central organs of executive power, also taking into account the expert conclusion of regional commission on questions of technogenic and ecologic safety and extraordinary situations in relation to the level of ES.

In the cases, when the consequences of failure (catastrophes) can be attributed to different branches, or concrete types of ES, a final decision in relation to its classification is accepted by Commission on questions of techgenic-ecological safety and extraordinary situations at that level, which this situation behaves to. Thus all criteria of group 1 are consistently examined, that behave to these directions (branches), and with the parameters of criterion of group 2 the size of total economic losses is compared, the total set of threshold values of classification signs is whereupon examined.

For every type of extraordinary situations the ministries and other central organs of executive power, develop concrete classification signs (physical, chemical, technical, statistical et al) and special signs, which characterize a threat or origin of extraordinary situation, and also three values of every sign, which determine:

• 
  threshold value of sign, exceeding of which attributes a situation to the grade of extraordinary and requires from an operative duty personnel of a potentially dangerous object, or controller's service of settlement or administrative district to inform about it (without a stop of works from liquidation of consequences of extraordinary situation, which arose up) operative attendants and staff of civil defense (CD) of district and region for acceptance of the first decision in relation to taking of situation to the proper level;
  
• 
  threshold value of sign, in the case of achievement or exceeding of which a regional organs must immediately inform about the fact of extraordinary situation of a particular branch ministries, other central organs of executive power, on the object of which there was this situation, and also to inform an operative duty of Ministry of emergencies, that there was quickly mobilized a necessary forces and facilities to liquidation of extraordinary situation, including the failure-rescuing formings from other administrative districts (towns);
  
• 
  threshold value of sign, in the case of achievement or exceeding of which is required an urgent bringing in to reacting on the extraordinary situation the necessary forces and facilities, financial and technical resources or backlogs of ministries and other central organs of executive power, on the objects of which there was this situation, including the failure-rescuing formings from other regions and towns, and also Ministry of emergencies, which in the case of necessity bring over to liquidation of extraordinary situation necessary forces and facilities of troops and specialized formings of civil defense; co-ordinates effort of all attracted organizations, carries responsibility for the timely, complete and adequate reacting on an extraordinary situation.
  

2. Medically-tactical description of extraordinary situations of natural origin

The features of geographical position of Ukraine, big geological processes, presence of mountains, hills and low-laying areas, closeness of warm seas, predetermine a possibility of origin practically of all spectrum of the dangerous natural phenomena and processes of geological, geohydrologic and meteorological origin. On occasion they carry catastrophic character. There is the real danger of origin of catastrophic floods in Zakarpattya and Crimea.

The most dangerous natural phenomena are earthquakes, as a result of which can be broken work of treating and pharmacy establishments as a result of their complete or partial destruction, defeat of medical and pharmaceutical personnel, complete or partial loss of supplies of medications and medical equipment. As a result of destruction of engineering networks, absence of power-, water-, gas- and warm-supply on long time enough there can be the paralyzed work of pharmacies. Before restoration of the engineering providing the pharmacies will not be able to prepare extemporal medical forms, to get the cleared water, sterilize infusive solutions. Destruction of internal and external sewage networks, output outside of sewage waters and flows, close contact of people with muddy soil and objects of external environment, an accumulation and increased migration of population at intensive contamination of territory in the area of catastrophe can cause complication of sanitary-hygienic situation, origin of mass infectious diseases, especially in districts with natural infections. On territory of Ukraine, taking into account climatic and geographical features, most credible are natural calamities related to the geological, hydrological and meteorological natural phenomena. From seismological natural calamities most actual for Ukraine are earthquakes, landslides, settling of ground.

Earthquakes. Among ES of natural origin, earthquakes occupy the special place. More than 60% of all victims of natural calamities are the victims of earthquakes. In the last century more than 1,5 million people perished as a result of earthquakes, the inflicted harm is estimated in 10 trillion dollars. For Ukraine an actuality of prognostication of origin of earthquakes and early preparation to liquidation of their medically-sanitary consequences is determined by that, considerable part of its territory, which is placed in seismic-active areas of European continent, which is extraordinarily difficult in seismodynamic relation. The picture of seismic activity of the Western region of Ukraine changes, and especially in Peredkarpattya. At drafting of map of the seismic districting of the USSR in 1968 year, Peredkarpattya was examined as an aseismic region. One earthquake of 17.07.1875 was known only in the district of Kam’yanka-Buz’ka of the Lviv area with intensity in an epicentre 6 bals. There is known mention about the earthquake of 3.08.1670 in the district of Shklo-city by intensity 6 bals. However, the row of earthquakes for some past time, more detailed historical researches of the last years, compelled to change the point of view of scientists about seismic inactivity of Peredkarpattya. In 1963 years there was registered an earthquake of the unknown nature to the north Ternopil-town. In 1974-1979 years in the Ivano-Frankivsk region there were registered 8 earthquakes. The increase of seismic activity of the Western region of Ukraine is related to regional bursting tectonic changes in the so-called Pre-Carpathians bending of the earth's crust, which have a considerable length (hundreds of kilometers) and width to several kilometers. There is not eliminated a technogenic character of these earthquakes too, as a result of the long-term getting of oil and other minerals in this region and by violation of integrity of mountains in places, where are a tectonic breaks in upper part of the earth's crust.

The special influence on possibility of origin of earthquake in the Western region of Ukraine a powerful, in the energy relation, seismic area discovers, which is placed in Romania in the mountains of Vranch. Earthquakes, which arise up in this area, spread on territory of Hungary, Bulgaria, Yugoslavia, Moldova, Ukraine and even Russia. Pushed from earthquakes in the area of Vranch showed up with force 5-6 bals in Kyiv, 3-4 bals in Moscow and a little bit lesser – in Saint-Petersburg.The earthquake of 26.10.1802, which overcame an area over 2 million km² and came to Saint Petersburg, appeared especially destructive. The earthquake of 1940 attained territory of the Chernivtsi and even Khmel’nytsk region. Earthquake, which arose up on 4.03.1977, was perceptible in the north – in Petrozavodsk, on east – on the coast of Caucasus. On a south a fiveball isoseist went on the Kyiv region. Next earthquakes in 30.08.1986 and in 30.05.1990 showed up on territory of Ukraine with lesser force, but separate shoves by force up to 5 bals were registered more southly from Kyiv. In obedience to configuration of isoseists of earthquakes of area of Vranch, south-western part of Ukraine is in the area of possible shoves of considerable force.

Earthquakes by force 1 bal are registered only by the special devices, to 3 bals are classified as weak, to 4 - moderate, to 5 - powerful, to 6-7 – enough powerful, to 8 - destructive, to 11 – very destructive and to 12 bals - catastrophic.

The size of sanitary losses during earthquakes depends on the degree of destruction of buildings, daypart and time of year, closeness of population in the cell of earthquake and other factors. The analysis of consequences of the known earthquakes testifies that there can be such structure of sanitary losses:

• 
  traumas of lower and upper extremities – 26%;
  
• 
  contusion of soft tissues with hemorrhages – 21%;
  
• 
  plural damages – 14%;
  
• 
  syndrome of the protracted compression (crush-syndrome) – from 3,5% to 21%;
  
• 
  other traumatic damages – 18% to 35%.
  

The analysis of traumatic damages among a victim from an earthquake in Armenia (1988) showed, that 22,8% from them had traumas of skull, 4,3% - extremities, 19,9% - abdomen, thorax and pelvis, 12,2% - soft tissues. The syndrome of the protracted compression was diagnosed in 23,5% of victims. The study of reasons of origin of damages shows that 10% of cases are related to the falling down and destruction of buildings, 35% - with the secondary striking factors (by the wreckages of buildings and like that), and 55% arose up from the incorrect actions of victims, predefined by fear and panick state.

In addition, during earthquakes a lot of population and saving personnel, including medical formings, have neuro-psychical disorders, which considerably harden an organization of measures on liquidation of consequences of ES. From existent data, up to 10% of population in the area of earthquake will need the first psycho-neurologic aid and stationary treatment. A lot of population, personnel of saving, including in the medical formings will need calming and tranquilizing remedies.

To basic directions of organization of medicare during liquidation of consequences of earthquakes belong

• 
  timely grant of all types of medicare (first medical aid must be given not later than during first three hours);
  
• 
  control of the psychological state and giving a psycho-neurologic help to the personnel of the saving formings;
  
• 
  a leadthrough of measures, directed on prophylaxis of neuro-psychological disorders among a population in the area of earthquake;
  
• 
  measures, directed on non-admission of origin and liquidation of possible flashes of infectious diseases.
  

Floods. They are an extraordinary situations of natural origin, related to the increase of water level in the rivers and reservoirs. There is the real danger of origin of catastrophic floods in Pre-Carpatians, Post-Carpatians and Crimea. Reasons of origin of flood can be:

• 
  the seasonal melting of snow with the maximal flow of water, which induce the long-lasting getting up of water level in the rivers and reservoirs;
  
• 
  the intensive protracted rains or melting of snow during the increase of temperature of air in winter time, which results in the sharp increase of water level in the rivers and reservoirs;
  
• 
  overtaken wind of water on lakes, storage pools and sea mouths of the rivers. Often is observed on considerable territories and last from ten hours to a several days. Basic factors, which influence on the level of getting up of water, as overtaken wind character in large reservoirs and storage pools is speed and direction of wind, length of acceleration of wind above a reservoir and its configuration;
  
• 
  a failure (catastrophic) destruction of dambs and dikes.
  

Floods in Ukraine occupy the first place among ES of natural origin in relation to frequency, area of distribution and financial losses. More frequently all they happen in the western districts of Ukraine. Due to the amount of a victims the floods are on second place only after the earthquakes. In dependence on the scale of flood are distinguished:

• 
  low floods - observed on the flat rivers, characterized comparatively by the small area of submergence, does not result in human victims;
  
• 
  high floods - accompanied by the considerable getting up of water, submergence of large territories, inflict noticeable financial losses, are threaten to the life and health of people;
  
• 
  considerable floods - accompanied by the submergence of river pools and settlements, the real threat of origin of losses among a population, and necessity in their evacuation from the area of submergence appears;
  
• 
  catastrophic floods - accompanied by the submergence of very large territories, worsen the terms of life of population, make an economic activity on the flooded territories impossible, inflict considerable financial losses and sanitary losses among a population. The feature of catastrophic submergence of territories, related to the failures on hydrobuildings, is an origin of wave of breach in lower part of damb because of the rapid falling of water from of top part of hydroblock .
  

There are distinguished four areas of catastrophic submergence:

First area – arrives at a 6-12 km from hydrobuilding or place of overflow, the height of waves can achive a several meters, speed of flow is 30 km/hour and more, time-of-flow of area by the wave – to 30 minutes.

The second area is an area of rapid flow, arrives at a 15-20 km, speed of flow is 15-20 km/hour, time-of-flow of wave – to 1 hour.

The third area is an area of middle flow, km arrives at a 30-50, speed of flow 10-15 km/hour, time-of-flow of wave – 2-3 hours.

A fourth area is an area of weak flow, can be at 35-70 km, speed of flow is to 10 km/hour.

For prognostication of medically-tactical situation is determined by the quantity of population, which lives in each of areas of possible submergence, and sanitary losses in each of areas, forces and facilities of SSCM for the grant of medicare for suffering in the areas of submergence, place of development of the medical formings and establishments, districts of evacuation of population and medical establishments from the area of submergence.

The sanitary losses of population in the cases of catastrophic submergence (on the example of destruction of hydrostructures of the cascade on Dnipro river) can arrive at tens of thousands. To the basic kinds of defeats belong sinking and overcooling. The amount of diseases grows sharply: hypertensive crisises, heart attacks, strikes, psycho-emotional violations.

An amount and structure of sanitary losses depends on force, speeds of distribution of ES, closeness of population, degree of destruction of buildings and of communication networks, time of year and others like that. The process of forming of sanitary losses during catastrophic floods has certain features and depends mostly on timely notification, heights of wave, temperature of water and air, daypart and remoteness of settlement from hydrobuilding. So, the most considerable losses, mainly of surgical type, will be in the first area (to the area of extraordinarily dangerous submergence), through which the wave of breach will go during the first hour from the moment of formation. The height of wave can arrive a several meters, and exceed speed to 20 km/h. In an average the sizes of this area can make to 10 km from a dam.

Lesser, but still a considerable threat to the population remains in the second area (the area of rapid flow), at which the wave of breach goes during 3-4 hours after start with speed up to 10 - 15 km/h. On this territory there will be most victims of therapeutic type in the structure of sanitary losses. For the first area are characteristic plenty of irreparable losses, which can be increased in a night-time. At these terms general losses can arrive at 2 - 35% from the amount of population, which is in the area of catastrophic submergence. These losses can grow on 10 - 20% in cold time of year.

In the structure of sanitary losses during floods, especially in the second area, there are victims with the signs of asphyxia, sharp violations of respiratory and cardiac activity, cold, traumas of soft tissues, concussions of the head brain and psychical disorders. In a psychoneurologic help it is needed 10 -11% from the general amount of population, which appeared in the cell of natural calamity. Possible sharpening of chronic somatic illnesses.

In addition, during catastrophic submergences caqn be relatively observed the third area (the overflow zone), within the limits of which a speed of flow is not exceeded 10 km/h. The sizes of this area will depend on the volume of water, which gets in lower level of hydrostructure, and look of area, and can arrive at 30 - 70 km.

Storm. It is strong wind, speed of which is at 60-110 km/h with force 8-10 bals due to a scale of Bofort. At these terms the stream of wind breaks the large branches of trees, destroys the roofs of buildings, disroots the trees.

Hurricanes. It is the wind of large destructive force protracted at time (12 bals after a scale of Bofort). Speed of wind is exceeded 130 km/h. There are possible destructions of buildings on considerable territory and losses among a population. Combination of hurricane winds with snow or dust results in the origin of strong snow-storms or dust storms. During storms, hurricanes and tornados a a medically-sanitary situation will be determined foremost by character of building of settlements, sizes of front of passing of wind stream, timeliness of notification of population about approaching of natural calamity. In Ukraine such natural calamities are more characteristic for south and western areas, however is not eliminated a possibility of their origin in other regions of country too.

Tornados. The current of air, which has the twist wind, is capable to raise and carry on considerable distances the people, animals, blow off roofs from buildings, to disroot trees. Average speed of its moving is 40 - 60 km/h, has considerable sizes: a 350 - 400 m in a width, 1500 m and more in hight. Results from the action of hurricane winds and tornados are characterized by the amount of lost persons and victims, people which remained without a roof, by the amount of the blasted and damaged houses, production and cultural buildings, communications of the electric and connection systems and and others like that.

Muddy stream. Streams of water with the wreckages of mountain parts, which suddenly appear in the pools of the mountain rivers. They are distinguished after reason of origins: rain, snow, ice, vulcanic, seismic, anthropogenic; are characterized by the sharp increase of water level, wave forming motion, short action (1-3 hours) and considerable destructive effect. More frequently arise up in Carpathian mountains and separate districts of Crimean Mountain.

Natural fires (forest, peat, prairie). It the uncontrolled burning of vegetation and peat, which elementally spreads on enough considerable territories. Depending on character of burning, these fires are divided into basilar, upper and ground. On an area, which is overcome by a fire, they are divided into six classes.

A landslide is moving of the masses of mountain breeds down on a slope under the action of attractive power. To 90% of landslides are on territories, located on a height from 100 to 1700 m above a sea level. They arise up, as a rule, in spring and in summer on slopes, which have steepness over 19°, mostly on the banks of the rivers in Carpathians and Crimea. Landslides are classified after the rate of movement and after power of process. After the consequences (destruction of buildings, worsening of the epidemiology state) landslides are similar to the earthquakes; however areas of them are considerably lesser. Depending on the place of their origin, the amount of a victims can arrive from ones to tens and hundreds of people.

Settling of earthly surface. It is the phenomenon, predefined by formation of underground cavities, which can be related both to the natural phenomena (landslides of earthly surface, underground water-courses and others like that) and with the results of activity of people (mining, underground construction-works). As a consequence of that can be settling or falling down of earthly surface, which in same queue results in human and financial losses.
3. Medically-tactical description of extraordinary situations of technogenic origin
The modern industrial sources of technogenic danger are marked by dangerous physical, chemical and biological action. They create the risk of full or partial damaging of the living environment of human, of plant and animal world as a result of uncontrolled development of dangerous types of activity, using of dangerous technologies, action of technogenic and natural catastrophes. To the basic types of technogenic danger belong: radiation danger, chemical, hydrodynamic danger, explosive danger and biological danger.

Potentially dangerous productions in the process of the normal functioning don’t harm the health of population and environment. But on the industrial yards they retain the sources of technogenic danger (capacities, devices, communications, hydrodynamic buildings), which contain radioactive–, chemical–, biologic–, explosive- and fire-dangerous materials and substances, failures on  which can result in their extras (to outflowing) outside of enterprises and to make a striking influence on a population, what lives around such enterprises. After the factors of technogenic danger, which accompany economic activity, potentially dangerous productions apart on 5 kinds:

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  radioactively dangerous objects, which keep on the industrial areas or use in production activity materials or devices, which contain isotopes of radio-active elements, radio-active ores, fresh and exhaust nuclear fuel, radioactive wastes, nuclear reactors and others like that;
  
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  chemically-dangerous objects, which keep on the industrial areas or use in productive activity a severe poisonous substances (chlorine, ammonia, phosgene and others like that);
  
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  hydrodynamically-dangerous objects – hydrotechnical buildings of pressure front: dikes, dambs, sluices, storages of liquid wastes and others like that;
  
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  explosive- and fire-dangerous objects, which keep on the industrial areas or use in production activity a flammable and explosive matters (oil and oil products, natural gas, coal, woods and others like that);
  
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  biologically dangerous objects, what contain on the industrial areas or use in production activity a microscopic organisms or products of biological synthesis (viruses, bacterias, mushrooms, allergens, vaccines, enzymes, parts of DNA and others like that).
  

In Donetsk and Pridniprovskyy economic districts there is the most difficult ecologic situation, which is conditioned by high industrial development of these territories and by a highest in a country closeness of population. In these regions the specific indexes of extras of harmful matters in atmospheric air per 1 person of population in 2–3 times exceed a national index, and upcasts of waste waters into superficial reservoirs – in 3–4 times. The considerable technogenic loading on a population exists also in East and Central economic districts of Carpathians. And lowest – in Podil'skyy, Polis’kyy and NearBlacksea economic districts.

Research of risk of hydrodynamic failures witnessed that in Ukraine was 35 water accumulating reservoirs, located in 17 areas, which make a threat for a population. Destruction of their dikes will entail the catastrophic submergence of considerable territories and evacuation from numerous inhabited points of over 1,6 million persons. There was made the expert estimation of possible scales of evacuation of population from potentially flooding territories as a result of break of dikes, allowed to classify dangerous storage pools on 3 groups: extraordinarily dangerous (it will be necessary to evacuate from a dangerous area over 30 thousands persons), especially dangerous (from 10 to 30 thousands persons) and dangerous (up to 10 thousands persons).

A probability of hit, as a result of ES of technogenic origin, makes near a 100% of population in 8 regions of Ukraine (Volyn’, Dnipropetrovs’k, Zaporizhzhya, Kyiv, Mykolayiv, Odesa, Rivne, Tchernihiv), from 98,3 to 50% – in 11 regions (Vinnytsya, Donetsk, Zhytomyr, Ivano-Frankivsk, Ki­rovograd, Sumy, Ternopil, Kharkiv, Kherson, Khmel'nytsk, Tcherkasy), from 50 to 9,3% – in 5 regions (an Autonomous Republic of Crimea, Zakarpattya, Lugansk, L'viv, Poltava) and only in Tchernivtsi region – a 0,4% of population.

Districting of territory of Ukraine after the factor of potential hydrodynamic danger shows, that: the threatening level of danger have such regions as Zaporizhzhya, Poltava, Dnipropetrovsk and Kherson; considerable level of danger – Vinnytsya and Cher­kasy; a satisfactory level of danger is in Mykolayiv, Kirovohrad, Donetsk, Odesa, Zakarpattya, Kyiv, Autonomous Republic of Crimea, Rivne, and Tchernivtsi regions; insignificant danger is in Ivano–Frankivsk and absents – in Volhyn’, Zhytomyr, Lugansk, L’viv, Sumy, Ternopil, Kharkiv, Khmel'nytskyy and Cherni­hiv regions.