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OCCUPATIONAL SAFETY AND HEALTH
Instruction on labor protection for the operator of the boiler room. Full document
Occupational Safety and Health / Standard instructions for labor protection Safe Operation 1. General requirements for labor protection 1.1. The occupational safety requirements set out in these Standard Instructions* apply to persons performing the work of a boiler room operator. *The administration of the enterprise, taking into account the requirements of this Standard Instruction on labor protection and the characteristics of the boiler installation, must develop and approve in the prescribed manner production instructions for servicing boilers for boiler room personnel. The production instructions must be posted in a visible place in the boiler room and issued to operating personnel. 1.2. Persons at least 18 years of age who have been trained in the appropriate program, have a certificate from the qualification commission for the right to service the boiler, and have undergone a medical examination and safety training may be allowed to service the boiler. 1.3. Instruction on labor safety and training in safe methods and methods of work are mandatory for all employees and newcomers to work, including those undergoing industrial practice. 1.4. When performing work, the boiler room operator may come into contact with dangerous and harmful production factors.
1.5. The boiler room operator must be aware of possible contact with harmful and dangerous production factors: when working in a boiler room - harmful chemicals, dust, noise, indoor microclimate, exposure to electric current, thermal radiation. 1.6. There are 3 classes of conditions and nature of work: Grade 1 - optimal conditions. The adverse impact on human health of dangerous and harmful production factors is excluded. Grade 2 - acceptable conditions. The level of hazardous and harmful production factors does not exceed the established hygienic standards. A slight change in health is possible, which is restored during regulated rest during the working day or by the beginning of the next shift. Grade 3 - dangerous and harmful working conditions. The level of hazardous and harmful production factors exceeds hygienic standards, which can lead to a persistent decrease in efficiency or health problems. Contact with dangerous and harmful production factors can lead to injuries or to the development of various occupational diseases with damage to the cardiovascular, respiratory, nervous systems, liver, kidneys, etc. 1.7. When performing work in accordance with the type of dangerous and harmful production factors, the boiler room operator is obliged to use personal protective equipment (working clothing, safety shoes and safety devices: goggles, respirator, headphones, etc.), as well as electrical protective equipment with mandatory adherence to personal hygiene rules. 1.8. A boiler room operator on duty must not be assigned to perform any other duties not provided for in the production instructions while the boiler is operating. The operator should not leave his workplace without permission from the boiler room administration or take part in work that was not assigned to him. 1.9. In addition to these requirements, the boiler room operator must comply with: (01) the requirements set out in the tariff and qualification characteristics for the level of theoretical and practical knowledge of an employee of the relevant qualification; (02) requirements of the Production Instructions for Boiler Maintenance; (03) rules for the technical operation of equipment, fixtures, tools with which he works or which he serves; (04) internal labor regulations. 1.10. The boiler room operator must immediately inform the administration about all noticed malfunctions of equipment and devices and make an entry in the shift log. 1.11. When performing manual auxiliary operations, it is allowed to carry a load weighing up to 20 kg, for women - 10 kg at a distance of up to 20 meters. In other cases, the cargo must be moved using mechanisms and devices. 1.12. Persons are allowed to carry out work using lifting machines controlled from the floor and hanging loads on the hook of these machines after instruction and testing of skills in operating the machines and securing loads. 1.13. Unauthorized persons may be allowed into the boiler room only with the permission of the administration and accompanied by its representative. 1.14. When staying on the territory of the enterprise (ship repair plant), it is prohibited: (01) walk on the carriageway and railroad tracks; (02) to cross railway tracks near a moving train; (03) crawl under the wagons and through the automatic coupler of a standing train; (04) to pass through the area of work of cranes during the production of cargo work. 1.15. The boiler room operator must know the Rules for providing first aid in case of accidents (Appendix) and be able to provide it. 1.16. In case of accidents, it is necessary to provide first aid to the victim, call a doctor and report the incident to the boiler room administration, if possible maintaining the situation at the scene of the incident for investigation. 1.17. Labor protection requirements are mandatory for the employee. Failure to comply with these requirements is considered a violation of labor discipline. 2. Labor protection requirements before starting work 2.1. When performing dangerous, unfamiliar or rarely performed work, the boiler room operator must receive targeted safety training from the work manager. 2.2. Before starting work, it is necessary to put your work clothes in order, prepare proper personal protective equipment, and inspect equipment, lifting equipment and tools. Boilers, all equipment, tools and accessories necessary for servicing boilers must be in good condition. 2.3. Hand tools and accessories must meet the following requirements: (01) files, rasps, hammers and sledgehammers must be firmly mounted on wooden handles, the strikers of hammers and sledgehammers must not be hardened, the surface of the striker must be slightly convex; (02) chisels, cross-cutters, punches must not have hardening or cracks, their length must be at least 150 mm; (03) spanners must have undeveloped jaws and match the size of the nuts without the use of spacers; (04) the vice must be well secured to the workbench, the jaws of the clamps’ vice must have a good (unworked) notch; (05) on the hoist and hoists there should be inscriptions about the permissible load capacity and the date of the next test; (06) pneumatic tool air hoses must be undamaged, securely fastened to the fitting, connected to each other using barbed nipples and secured with clamps; (07) electric and pneumatic grinders should have protective covers; (08) portable lamps must be factory-made with a voltage of no more than 12 V. 2.4. A special box or bag must be used to carry the tool to the place of work. Carrying tools in pockets is not permitted. 2.5. The power tool must have a complete hose wire with a plug, the wire insulation must not be damaged, and the wire connection terminals must be securely closed. When working with power tools with voltages over 36 V, you must use dielectric gloves and rugs (galoshes). The power tool must be checked for short circuits to the frame. 2.6. A sharpening machine can be used if the machine has serviceable wheels placed in protective covers, tool rests, transparent screens and dust collection devices. The gap between the circle and the tool rest should not exceed 3 mm. 2.7. The boiler room must be clean and lit in accordance with sanitary standards. It is prohibited to clutter the boiler room or store any materials or objects in it. Passages in and exits from the boiler room must always be free. Spilled oil and debris must be cleaned up. Persons working in the boiler room are required to maintain cleanliness. 2.8. The boiler room operator taking over is required to check the operation of the mechanisms, boilers, and fittings. Find out from the person handing over the shift about any malfunctions in the work. Noticed faults must be recorded in the shift log. 3. Labor protection requirements during work 3.1. Before lighting the boiler, you should check: the serviceability of the furnace, flues, shut-off and control devices, fuel combustion equipment, instrumentation, fittings, filling the boiler with water. 3.2. Immediately before lighting the boiler, the firebox and flues must be ventilated for 10 to 15 minutes. 3.3. When preparing to light a boiler operating on gaseous fuel, it is necessary to check the gas pressure with a pressure gauge, the serviceability of the gas pipeline, taps, valves, and blow the gas pipeline through a purge plug. Ignition of the furnaces of boilers equipped with automatic equipment should be carried out in accordance with the production instructions. 3.4. When lighting the burners, you must not stand against the lighting hatches; the worker must be provided with personal protective equipment (glasses, etc.). 3.5. The ignition torch should be removed from the firebox only when the combustion becomes stable. If the fuel oil does not ignite, you must immediately stop supplying it to the nozzle, remove the pilot torch from the firebox and ventilate the firebox, gas ducts and air ducts for 10 - 15 minutes, determine the cause of the fuel not igniting and eliminate it. Only after this can you start igniting the injector again. 3.6. If the flame goes out before igniting the burner of a boiler operating on gaseous fuel, you must immediately stop the gas supply to the burner, ventilate the firebox and flues for 10 - 15 minutes. Only after this can you begin to re-ignite the burner. 3.7. Tightening the bolts of manholes and hatches during heating of the boiler at a pressure in the boiler of no more than 3 atm. should be done with caution, only with a working key, without the use of extension levers, in the presence of the person responsible for the boiler room. 3.8. When lighting, it is necessary to monitor the movement of boiler elements during thermal expansion using movement indicators (benchmarks). 3.9. Before putting the boiler into operation, the following must be done: (01) checking the proper operation of safety valves, water indicating devices, pressure gauges and feeding devices; (02) checking water level readings using direct action indicators; (03) checking and turning on automatic safety systems, alarms and automatic boiler control equipment; (04) boiler blowdown. 3.10. While on duty, the boiler room operator must monitor the serviceability of the boiler and all boiler room equipment, strictly observe the established operating mode of the boiler, check the serviceability of the pressure gauge, water indicating devices, safety valves, and feed pumps (injectors). 3.11. Safety valves must be adjusted to the pressure allowed in the boilers, sealed and checked at least 2 times a shift by detonating the manual drive. 3.12. Pressure gauges must be checked annually and have a red line on the dial indicating the maximum pressure; the operation of pressure gauges and test taps must be checked daily. 3.13. Cleaning clogged taps of water indicator glasses, test and three-way taps, and pressure gauges should be done with a bent wire, standing away from the tap. 3.14. When blowing water indicator glasses, especially when warming up cold glasses, you should follow the established sequence of opening the taps to avoid glass rupture. 3.15. The boiler room operator is obliged to monitor the water gauge glasses and prevent the water level in them from falling below the established limit. 3.16. To avoid water hammer and rupture of the pipeline, the isolation valves should be opened slowly, with time, and only after the pipeline has been sufficiently heated can the valves be opened completely. If there are drain valves on the steam lines, they should be opened first. 3.17. If all or part of the burners go out while the boiler is operating on gas, you must immediately stop the gas supply to the burners by shutting off the shutoff valves in front of the burners, ventilate the furnace, flues and air ducts, find out and eliminate the cause of the violation of the normal combustion mode. 3.18. If all the nozzles go out while the boiler is operating on liquid fuel, it is necessary to immediately stop the supply of fuel (as well as steam during steam spraying), remove the blast and draft, and eliminate the cause of the cessation of combustion. 3.19. All devices and devices for automatic control and safety of the boiler must be maintained in good condition and checked regularly. 3.20. Periodic purging of the boiler is carried out in the presence of the person responsible for the change. Blowing the boiler can only be started if the blow-down fittings are in working order, and boilers undergoing repair or cleaning must be disconnected from the blow-off lines. The water level in the boiler before purging should be slightly higher than normal. Opening the vent valves should be done carefully and gradually. While purging the boiler, it is necessary to monitor the water level in the boiler. If water hammer, pipeline vibration, or other abnormalities occur in the purge lines, purge must be stopped immediately. At the end of the purge, check that the shut-off devices on the purge line are securely closed and do not allow water to pass through. 3.21. The operating personnel must be notified that the boiler is being purged. To avoid burns, the worker blowing the boiler must stand away from the doors. Blowing must be stopped immediately if gases escape through the hatches during it, as well as if malfunctions of the boiler or blowing device are detected. 3.22. Before starting any work inside a boiler connected to other operating boilers by common pipelines (steam line, feed, drain, drain lines, etc.), as well as before inspecting or repairing elements operating under pressure, the boiler must be separated from all pipelines plugs. 3.23. Opening hatches and hatches, as well as repairing boiler elements, is permitted only in the complete absence of pressure. Before opening hatches and hatches located within the water space, water should be removed from the elements of boilers and economizers. 3.24. Before starting work, the firebox and flues must be well ventilated, illuminated and reliably protected from possible penetration of gases and dust from the flues of operating boilers. The cleanliness of the air in the firebox or flues must be confirmed by analysis. 3.25. When sections of pipelines and gas ducts are disconnected, as well as on the starting devices of smoke exhausters, blower fans and fuel feeders, signs must be posted on valves, gate valves and dampers: “DO NOT TURN ON! PEOPLE ARE WORKING.” In this case, fuse-links must be removed from the starting devices of smoke exhausters, blower fans and fuel feeders. Installation and removal of plugs is carried out according to the approval order. 3.26. All work inside the boiler and flues must be carried out by at least two workers, one of whom must be near the manhole and maintain contact with the workers in the boiler. Work inside the furnaces and flue ducts of the boiler may only be carried out at a temperature not exceeding 50°C with written permission (permit) from the head of the boiler room. The worker’s stay inside the boiler or flue at this temperature should not exceed 20 minutes. 3.27. When working in the boiler, on its platforms and in gas ducts, a voltage of no higher than 12 V should be used for electric lighting. 3.28. Before closing hatches and manholes, it is necessary to check whether there are people or foreign objects inside the boiler, as well as the serviceability of the devices installed inside the boiler. 3.29. Stopping the boiler in all cases, with the exception of an emergency stop, should be carried out only by written order of the administration. 3.30. The boiler operator is prohibited from: (01) leave boilers unattended until combustion in the furnace has completely stopped, residual fuel has been removed from it and the pressure has been reduced to zero; (02) commissioning of boilers with faulty fittings, feeding devices, automatic safety systems, emergency protection and alarm systems; (03) ignite extinguished gas in the firebox without preliminary ventilation of the firebox and flues; (04) light a gas flare from an adjacent burner; (05) raise the steam pressure in the boiler above that allowed by the Gosgortekhnadzor inspection; (06) jam safety valves or put additional stress on them; (07) carry out purging when the purge valves are faulty, open and close the valves by hitting them with a hammer or other objects; (08) while the boiler is operating, tap rivet seams, weld boiler elements, etc.; (09) lubricate the bearings and tighten the seals while the pumps are operating; (10) use boxes and other temporary fixtures and devices in place of ladders and platforms; (11) lengthen the wrenches (put pipes on them, etc.), and also hit the wrench to avoid breaking the bolts and damaging the threads. 4. Labor protection requirements in emergency situations 4.1. The boiler room operator is not allowed to take or leave duty during the liquidation of accidents in the boiler room. 4.2. If signs of gas contamination in the boiler room are detected, turning on and off electric lighting, electrical equipment, lighting boilers, and using open fire is prohibited. 4.3. The boiler room operator must take immediate measures to eliminate malfunctions that threaten the safe and trouble-free operation of the equipment. If it is impossible to eliminate the malfunctions on your own, then you must inform the boiler room administration about this. 4.4. The boiler room operator is obliged to immediately stop the boiler in emergency cases and report the incident to the head of the boiler room or the person replacing him, if: (01) more than 50% of the safety valves or their replacement safety devices have ceased to function; (02) the pressure has risen above the permitted value by more than 10% and continues to rise, despite the cessation of fuel supply, a decrease in draft and blast, and increased water supply to the boiler; (03) water has leaked from the boiler (below the lower edge of the water indicator glass), refilling the boiler with water is prohibited; (04) the water level is rapidly decreasing, despite the increased supply of water to the boiler; (05) the water level has risen above the upper edge of the water indicator glass and it is not possible to reduce it by blowing the boiler; (06) all feeding devices are discontinued; (07) all water-indicating instruments stopped working; (08) cracks, bulges, gaps in welds, breaks in two or more located nearby connections; (09) gas contamination of the boiler room with boilers operating on gaseous fuel was detected, the gas supply was stopped, an explosion of the gas-air mixture occurred in the boiler furnace or gas ducts; (10) the power supply was stopped due to artificial draft, and the elements of the boiler and its lining were damaged; (11) a fire broke out in the boiler room, soot or fuel particles caught fire in the flue ducts. 4.5. If a leak appears in rivet seams or in places where pipes are rolled, fistulas on the heating pipes of the boiler, as well as other damage and malfunctions of the boiler, fittings, pressure gauges, safety devices and auxiliary equipment that do not require immediate shutdown of the boiler, the boiler room operator is obliged to immediately report this administration. 4.6. When the boiler stops due to soot fire or fuel carryover in the economizer, steam superheater or flue ducts, you should immediately stop the supply of fuel and air to the furnace, shut off the draft by stopping the smoke exhausters and fans, and completely close the air and gas dampers. If possible, fill the flue with steam and after combustion stops, ventilate the firebox. 4.7. If a fire occurs in the boiler room, it is necessary to call the fire department and take measures to extinguish it. In the event of a fire in a boiler room with boilers operating on gaseous fuel, you must immediately turn off the gas pipeline of the boiler room using a valve installed outside the boiler room. 4.8. In case of ignition of combustible substances, it is necessary to use a fire extinguisher, sand, earth or cover the fire with a tarpaulin or felt. It is forbidden to pour water on burning fuel and non-disconnected electrical equipment. 4.9. If you detect the slightest signs of poisoning or irritation of the skin, mucous membranes of the eyes, or upper respiratory tract, you must inform your supervisor and consult a doctor (first aid station). 4.10. The boiler room must have a clock, telephone or sound alarm to call administration representatives in case of emergency. 5. Labor protection requirements at the end of work 5.1. At the end of the work (shift), the boiler room operator must: (01) put the workplace in order, remove tools, equipment, other materials and personal protective equipment to the places designated for them; (02) put overalls and safety shoes in a personal closet for overalls, in case of contamination, hand over to the laundry (replace); (03) wash hands and face with soap and water or take a shower. Application (required). Rules for the provision of first aid to victims 1. General provisions 1.1. First aid is the simplest measures necessary to preserve the health and save the life of a person who has suffered a sudden illness or injury. The rescue of the victim in most cases depends on how quickly and correctly the first aid will be provided. 1.2. The essence of first aid is to stop the impact of traumatic factors, to carry out the simplest medical measures and to ensure the speedy transportation of the victim to a medical institution. 1.3. For the correct setting of first aid work, the following conditions must be met: (01) in each work shift, special persons should be assigned responsible for the condition and systematic replenishment of first aid supplies and devices stored in first aid kits; (02) in each work shift, people capable of providing first aid should be identified and trained; (03) care provided by a non-specialist should only be care provided before a doctor, and not instead of a doctor, and should include the following: temporary control of bleeding, dressing of a wound (burn), immobilization (immovable fixation) for severe injuries, resuscitation measures ( artificial respiration, closed heart massage), the issuance of painkillers and other drugs for well-known diseases, the transfer and transportation of victims; (04) the first aid kit must contain all the necessary medical equipment (according to the packaging manual) for first aid. 1.4. Signs of life and death of a person. 1.4.1. Signs of life: (01) heartbeat; the assisting person determines with his hand or by putting his ear (by ear) below the left nipple of the victim's chest; (02) the pulse is determined on the inside of the forearm, on the neck; (03) the presence of breathing is established by the movements of the chest, by moistening the mirror attached to the nose of the victim, or by the movement of cotton brought to the nasal openings; (04) pupil reaction to light. When a beam of light is directed, a sharp narrowing of the pupil occurs. Signs of life are unmistakable proof that immediate assistance can still save a person. 1.4.2. Signs of death. (01) Human death consists of two phases: clinical and biological. Clinical death lasts 5 - 7 minutes. A person does not breathe, there is no heartbeat, but there are still no irreversible changes in the tissues of the body. During this period, the body can still be revived. After 8 - 10 minutes, biological death occurs. In this phase, it is no longer possible to save the victim's life (due to irreversible changes in vital organs: the brain, heart, lungs). (02) Distinguish between doubtful signs of death and obvious cadaveric signs. Doubtful signs of death: the victim is not breathing; heartbeat is not determined; there is no reaction to a needle prick of a skin area; the reaction of the pupils to strong light is negative (the pupil does not narrow). Explicit cadaveric signs: clouding of the cornea and its drying; when squeezing the eye from the sides with fingers, the pupil narrows and resembles a cat's eye; rigor mortis (starts from the head 1 to 4 hours after death); body cooling; cadaveric spots (resulting from the flow of blood into the lower parts of the body). 2. Methods of resuscitation (revival) of victims of clinical death 2.1. Carrying out artificial respiration by the mouth-to-mouth or mouth-to-nose method. 2.1.1. Artificial respiration should be performed if the victim does not breathe or breathes with difficulty (rarely, convulsively) or if breathing gradually worsens regardless of the causes (electric shock, poisoning, drowning, etc.). 2.1.2. You should not continue to do artificial respiration after the appearance of independent. 2.1.3. When starting artificial respiration, the caregiver must: (01) if possible, lay the casualty on their back; (02) release the victim from clothing restricting breathing (remove the scarf, unfasten the collar, trouser belt, etc.); (03) free the victim's mouth from foreign objects; (04) with the mouth tightly closed, open it, push the lower jaw forward, doing this so that the lower teeth are in front of the upper ones (as shown in the figure - not shown). If it is not possible to open the mouth in this way, then carefully insert a board, a metal plate or a spoon handle, etc. between the back molars (at the corner of the mouth). and unclench your teeth; (05) stand to the side of the victim's head, put one hand under the neck, and with the palm of the other hand press on the forehead, tilting the head back as much as possible; (06) lean towards the victim's face, take a deep breath with an open mouth, completely tightly cover the victim's open mouth with his lips and exhale vigorously (at the same time covering the victim's nose with his cheek or fingers). Air can be blown through gauze, a scarf, a special device "air duct", etc. With tightly clenched jaws of the victim, it is necessary to take measures in accordance with paragraph 2.1.3, subparagraph (04), because artificial respiration by the mouth-to-nose method is carried out with the victim's mouth open; (07) in the absence of spontaneous breathing and the presence of a pulse, artificial respiration can be performed in the "sitting" or "vertical" position (on a support, on a mast, etc.); (08) observe the second interval between artificial breaths (the time of each breath of air is 1,5 - 2 s); (09) after restoration of spontaneous breathing in the victim (visually determined by the expansion of the chest), stop artificial respiration and put the victim in a stable lateral position (turning of the head, torso and shoulders is carried out simultaneously). 2.2. External cardiac massage. 2.2.1. External cardiac massage is performed during cardiac arrest, characterized by: (01) pallor or cyanosis of the skin; (02) absence of a pulse in the carotid arteries; (03) loss of consciousness; (04) cessation or disturbance of breathing (convulsive breaths). 2.2.2. Conductive external heart massage is required to: (01) lay the victim on a flat, hard base (floor, bench, etc.); (02) position yourself at the side of the victim and (if one person is assisting) make two quick, vigorous blows in the mouth-to-mouth or mouth-to-nose manner; (03) put the palm of one hand (usually the left) on the lower half of the sternum (stepping back 3 transverse fingers above its lower edge). Put the palm of the second hand on top of the first. The fingers of the hands do not touch the surface of the body of the victim; (04) press with quick jerks (arms are straightened at the elbow joints) on the sternum, shifting it strictly vertically down by 4-5 cm, with a pressure duration of no more than 0,5 seconds. and with an interval of pressing no more than 0,5 s; (05) for every 2 deep breaths, perform 15 chest compressions (with one person assisting); (06) with the participation of two people in resuscitation, carry out the "breathing-massage" ratio as 1:5 (ie, after deep inhalation, carry out five pressures on the chest); (07) when performing resuscitation by one person every 2 minutes, interrupt the heart massage for 2 - 3 seconds and check the pulse on the victim's carotid artery; (08) when a pulse appears, stop external cardiac massage and continue artificial respiration until spontaneous breathing appears. 3. First aid for injury 3.1. A wound is a damage to the integrity of the skin, mucous membrane or organ. 3.2. The first aid provider must remember that: (01) help should be provided with cleanly washed hands with soap or, if this cannot be done, lubricate the fingers with iodine tincture. Touching the wound itself, even with washed hands, is prohibited; (02) Do not wash the wound with water or medicines, fill it with iodine or alcohol, cover with powder, cover with ointments, put cotton wool directly on the wound. All of the above can interfere with wound healing, bringing dirt from the surface of the skin, thereby causing its subsequent suppuration; (03) do not remove blood clots, foreign bodies from the wound (because this can cause bleeding); (04) in no case should any tissues or organs protruding outwards be pressed into the inside of the wound - they must be covered from above with clean gauze; (05) do not wrap the wound with insulating tape; (06) with extensive wounds of the limbs, they must be immobilized (fixed motionless). 3.3. To provide first aid for injuries, you must: (01) open the individual package in the first aid kit (bag) (according to the instruction printed on its wrapper); (02) apply a sterile dressing to the wound (without touching the part of the dressing that is applied directly to the wound) and secure it with a bandage; (03) in the absence of an individual dressing bag, use a clean handkerchief, a clean cloth, etc.; (04) in the presence of disinfectants (iodine tincture, alcohol, hydrogen peroxide, gasoline), it is necessary to treat the edges of the wound with them; (05) give the victim painkillers. 3.4. If the wound is contaminated with earth, it is necessary to urgently consult a doctor (for the introduction of tetanus toxoid). 3.5. In case of moderate and severe injuries, it is necessary to deliver the victim to a first-aid post or medical institution. 3.6. In case of penetrating wounds of the chest cavity, it is necessary to transport the victims on a stretcher in the "lying" position with the head part raised or in the "semi-sitting" position. 3.7. With penetrating wounds of the abdomen, it is necessary to transport the victim on a stretcher in the "lying" position. 4. First aid for bleeding 4.1. Bleeding is the outflow of blood from a vessel as a result of an injury or complication of certain diseases. 4.2. There are the following types of bleeding: (01) capillary - occurs with superficial wounds, blood oozes in tiny droplets. To stop bleeding, it is enough to press a gauze swab to the wounded area or apply a slightly pressure sterile bandage; (02) venous - blood is dark red, flows out in an even stream; (03) arterial - blood of a scarlet color, is thrown upwards by a pulsating jet (fountain); (04) mixed - occurs when both veins and arteries bleed in the wound. This is observed with deep wounds. 4.3. When a vein is injured on a limb, the latter must be lifted up and then a pressure sterile bandage applied. If it is impossible to stop the bleeding with the above method, you should squeeze the blood vessels below the wound site with your finger, apply a tourniquet, bend the limb in the joint or use a twist. 4.4. Arterial bleeding can be stopped, just like venous bleeding. In case of bleeding from a large artery (with insufficient application of a pressure bandage), it is necessary to apply a tourniquet above the site of bleeding. 4.5. After applying a tourniquet or twist, you must write a note indicating the time of their application and put it in a bandage (under a bandage or tourniquet). 4.6. Keep the applied tourniquet for more than 1,5 - 2,0 hours. is not allowed, because this can lead to necrosis of the bloodless limb. 4.7. If pain occurs from the imposition of a tourniquet, it is necessary for 10-15 minutes. take off. To do this, before removing the tourniquet, they press the artery through which blood flows to the wound with a finger; dissolve the tourniquet should be slow; after 10 - 15 minutes, the tourniquet is applied again. 4.8. After 1 hour, even if the victim can endure the pain from the tourniquet, it should still be removed for 10-15 minutes. 4.9. In case of moderate and severe venous and arterial bleeding, the victims must be taken to a first-aid post or any medical institution. 4.10. In case of nosebleeds, the victim should be seated, put a cold lotion on the bridge of the nose, squeeze the nostrils with your fingers for 4-5 minutes. If the bleeding does not stop, it is necessary to carefully insert a dense gauze or cotton swab moistened with a 3% hydrogen peroxide solution into the bleeding nostril, leaving the end of the gauze strip (cotton) outside, for which after 2,0 - 2,5 hours you can remove the swab. If it is impossible to stop the bleeding of the victim, it is necessary to deliver to the first-aid post (in the "sitting" position) or call the medical staff to him. 4.11. First aid for mixed bleeding includes all of the above activities: rest, cold, pressure bandage (tourniquet). 5. First aid for burns 5.1. Burns are: (01) thermal - caused by fire, steam, hot objects, sunlight, quartz, etc.; (02) chemical - caused by the action of acids and alkalis; (03) electrical - caused by the action of an electric current. 5.2. According to the severity of burns are divided into: (01) 1st degree burns - characterized by redness and swelling of the skin; (02) 2nd degree burns - blisters form on the skin; (03) 3rd degree burns - characterized by the formation of scabs on the skin as a result of necrosis of the superficial and deep layers of the skin; (04) 4th degree burns - charring of skin tissues occurs, damage to muscles, tendons and bones. 5.3. Providing first aid to victims of thermal and electrical burns must: (01) remove the victim from the zone of the heat source; (02) extinguish burning parts of clothing (throw any cloth, blanket, etc., or smother the flame with water); (03) give the victim painkillers; (04) put a sterile dressing on the burned areas, in case of extensive burns, cover the burn surface with clean gauze or an ironed sheet; (05) for eye burns, apply cold soaks from a solution of boric acid (1/2 teaspoon of acid to a glass of water); (06) deliver the victim to the first-aid post. 5.4. The person providing first aid for chemical burns must: (01) if solid particles of chemicals come into contact with the affected areas of the body, remove them with a swab or cotton; (02) immediately flush the affected area with plenty of clean cold water (for 10 to 15 minutes); (03) in case of skin burns with acid, make lotions (bandage) with a solution of baking soda (1 teaspoon of soda per glass of water); (04) in case of skin burns with alkali, make a lotion (bandage) with a solution of boric acid (1 teaspoon per glass of water) or with a weak solution of acetic acid (1 teaspoon of table vinegar per glass of water); (05) if liquid or acid vapor gets into the eyes or mouth, rinse them with plenty of water and then with a solution of baking soda (1/2 teaspoon per glass of water); (06) if splashes or vapors of alkali get into the eyes or mouth, rinse the affected areas with plenty of water and then with a solution of boric acid (1/2 teaspoon per glass of water); (07) if acid or alkali enters the esophagus, give no more than 3 glasses of water to drink, lay down and cover the victim warmly; (08) in severe cases, take the victim to a medical center or any medical institution. 5.5. It is forbidden: (01) touching burned areas of the body with hands; (02) lubricate with ointments or sprinkle powders on burned areas of the skin and mucous surfaces; (03) burst bubbles; (04) remove various substances adhering to the burnt place (mastic, rosin, resins, etc.); (05) to tear off clothes and shoes from the burned area. 6. First aid for general hypothermia and frostbite 6.1. Frostbite is tissue damage caused by exposure to low temperatures. 6.2. With mild frostbite (blanching and redness of the skin, up to loss of sensitivity), the first aid provider must: (01) move the casualty to a warm room as soon as possible; (02) give the victim hot tea, coffee, hot food; (03) put the frostbitten limb in a warm bath (basin, bucket) at a temperature of 20°C, bringing it to the temperature for 20 - 30 minutes. up to 40°C (in case of contamination, wash the limb with soap). 6.3. With a slight frostbite of limited areas of the body, the latter can be warmed with the help of the warmth of the hands of the first aid provider. 6.4. In case of severe frostbite (appearance of blisters on the skin, necrosis of soft tissues), the caregiver must: (01) urgently transfer the victim to a warm room; (02) treat the skin around the blisters with alcohol (without piercing them); (03) put a sterile dressing on the frostbitten part; (04) give the victim hot tea, coffee; (05) apply general body warming (warm wraps, heating pads, etc.); (06) transport the victim to a first-aid post or medical facility. 6.5. It is forbidden to rub frostbitten parts of the body with snow, alcohol, apply a hot heating pad. 7. First aid to the victim from the action of electric current 7.1. The first aid provider must: (01) release the victim from the action of electric current, observing the necessary precautions (when separating the victim from live parts and wires, it is imperative to use dry clothes or dry objects that do not conduct electric current); (02) within 1 min. assess the general condition of the victim (determination of consciousness, color of skin and mucous membranes, breathing, pulse, pupil reaction); (03) in the absence of consciousness, lay the victim down, unbutton the clothes, create an influx of fresh air, bring a cotton swab moistened with a solution of ammonia to the nose, carry out general warming; (04) if necessary (very slow and spasmodic breathing, weak pulse) start artificial respiration; (05) carry out resuscitation (revitalization) measures until the function of vital organs is restored or until obvious signs of death appear; (06) if the victim vomits, turn his head and shoulders to the side to remove the vomit; (07) after resuscitation, provide the victim with complete rest and call the medical staff; (08) if necessary, transport the victim on a stretcher in the prone position. 8. First aid for injuries: fractures, dislocations, bruises, sprains 8.1. Violent damage to the body, caused by external influences, resulting in impaired health, is called trauma. 8.2. Seriously injured persons must not be carried until a doctor or other qualified person has arrived, unless they must be removed from a hazardous area. 8.3. A fracture is a break in the integrity of a bone. 8.4. Fractures are characterized by: (01) sharp pain (worse when trying to change position); (02) bone deformity (due to displacement of bone fragments); (03) swelling of the fracture site. 8.5. There are open (violation of the skin) and closed (the skin is not broken) fractures. 8.6. The caregiver for fractures (dislocations) should: (01) give the victim painkillers; (02) with an open fracture - stop bleeding, treat the wound, apply a bandage; (03) provide immobilization (creation of rest) of the broken bone with standard splints or available materials (plywood, boards, sticks, etc.); (04) in case of a fracture of a limb, apply splints, fixing at least two joints - one above, the other below the fracture site (the center of the splint should be at the fracture site); (05) in case of fractures (dislocations) of the shoulder or forearm, fix the injured arm in the physiological position (bent at the elbow joint at an angle of 90°) by placing a dense ball of cotton wool or a bandage in the palm, hanging the arm to the neck on a kerchief (bandage); (06) in case of fracture (dislocation) of the bones of the hand and fingers to a wide splint (the width of the palm and a length from the middle of the forearm to the fingertips), bandage the hand by putting a ball of cotton wool or bandage into the palm, hang the hand to the neck with a scarf (bandage ); (07) in case of a fracture (dislocation) of the femur, apply an external splint from the armpit to the heel, and an internal splint from the perineum to the heel (if possible, without lifting the limb). Transport the victim on a stretcher; (08) in case of fracture (dislocation) of the bones of the lower leg, fix the knee and ankle joints of the affected limb. Transport the victim on a stretcher; (09) in case of a fracture (dislocation) of the collarbone, put a small piece of cotton wool into the armpit (on the side of the injury) and bandage the arm bent at a right angle to the body; (10) in case of damage to the spine, carefully, without lifting the victim, slip a wide board, thick plywood, etc. under his back. or turn the victim face down without bending the torso. Transportation only on a stretcher; (11) for broken ribs, bandage the chest tightly or pull it off with a towel while exhaling; (12) in case of a fracture of the pelvic bones, slip a wide board under the back, put the victim in the “frog” position (bend the legs at the knees and spread them apart, and move the feet together, put a roller of clothes under the knees). Transport the victim only on a stretcher; (13) apply "cold" to the fracture site (rubber ice pack, cold water bottle, cold packs, etc.) to reduce pain. 8.7. Any attempts to independently compare bone fragments or reduce dislocations are prohibited. 8.8. In case of a head injury (may be observed: headache, loss of consciousness, nausea, vomiting, bleeding from the ears), it is necessary: (01) lay the casualty on his back; (02) fix the head on both sides with soft rollers and apply a tight bandage; (03) if there is a wound, apply a sterile dressing; (04) put "cold"; (05) provide peace; (06) when vomiting (unconscious), turn the victim's head to the side. 8.9. With bruises (characterized by pain and swelling at the site of the bruise), it is necessary: (01) apply cold to the injury site; (02) apply a tight bandage; (03) create peace. 8.10. When stretching ligaments, you must: (01) fix the injured limb with bandages, splints, improvised materials, etc.; (02) provide rest to the injured limb; (03) apply "cold" to the injury site. 8.11. When squeezing the victim with a weight, it is necessary: (01) free him from gravity; (02) provide assistance depending on the damage. 9. First aid for shock 9.1. Shock (insensibility) - the state of the body as a result of impaired circulation, respiration and metabolism. This is a serious reaction of the body to injury, representing a great danger to human life. 9.2. The signs of shock are: (01) pallor of the skin; (02) clouding (up to loss) of consciousness; (03) cold sweat; (04) dilated pupils; (05) acceleration of breathing and pulse; (06) drop in blood pressure; (07) in severe cases, there may be vomiting, ashy complexion, cyanosis of the skin, involuntary feces and urination. 9.3. The first aid provider must: (01) provide the necessary assistance, corresponding to the type of injury (stop bleeding, immobilize the fracture site, etc.); (02) wrap the victim in a blanket, laying him horizontally with his head slightly lowered; (03) when thirsty (excluding abdominal injuries), give the victim some water to drink; (04) call for qualified medical assistance immediately; (05) transport the casualty on a stretcher to the hospital with extreme care. 10. First aid in case of foreign bodies entering human organs and tissues 10.1. If a foreign body enters the respiratory throat, it is necessary: (01) ask the victim to make several sharp coughing shocks; (02) inflict 3-5 short blows with a brush on the interscapular region with the head tilted down or in the prone position; (03) grasp the victim from behind, clasping the hands between the xiphoid process of the sternum and the navel and apply 3 to 5 quick pressures on the victim's abdomen. 10.2. If a foreign body (mote) gets into the eye, it is necessary to rinse the eye with a stream of water (from a glass using cotton wool or gauze), directing the latter from the corner of the eye (temple) to the inner corner of the eye (toward the nose). 10.2.1. Do not rub your eyes. 10.2.2. In case of severe injuries, it is necessary to put a sterile bandage on the eye and urgently deliver the victim to a first-aid post or medical institution. 10.3. If foreign bodies get into soft tissues (under the skin, nails, etc.), it is necessary: (01) remove the foreign body (if there is confidence that this can be done); (02) treat the injection site of the foreign body with iodine solution; (03) apply a sterile dressing. 11. First aid for poisoning 11.1. In case of gas poisoning (acetylene, carbon monoxide, gasoline vapors, etc.), the victims feel: headache, "knocking in the temples", "ringing in the ears", general weakness, dizziness, drowsiness; in severe cases, there may be an excited state, respiratory failure, dilated pupils. 11.1.1. The caregiver must: (01) withdraw or remove the victim from the gassed area; (02) unfasten clothing and let in fresh air; (03) lay the victim down with legs raised (in case of carbon monoxide poisoning, strictly horizontally); (04) cover the victim with a blanket, clothing, etc.; (05) bring a cotton swab moistened with a solution of ammonia to the nose of the victim; (06) give plenty of liquid to drink; (07) when breathing stops, begin artificial respiration; (08) urgently call for qualified medical assistance. 11.2. In case of chlorine poisoning, it is necessary: (01) rinse eyes, nose and mouth with a solution of baking soda (1/2 teaspoon per glass of water); (02) give the victim sips of warm water; (03) send the victim to the first-aid post. 11.3. In case of poisoning with spoiled foods (headaches, nausea, vomiting, abdominal pain, general weakness may occur), it is necessary: (01) give the victim 3 to 4 glasses of water or a pink solution of potassium permanganate to drink, followed by induction of vomiting; (02) repeat washing 2-3 times; (03) give the victim activated charcoal (tablets); (04) give the victim warm tea to drink; (05) lay down and cover the casualty warmly; (06) in case of respiratory failure and cardiac arrest, start artificial respiration and external heart massage; (07) deliver the victim to the first-aid post. 11.4. First aid for poisoning with caustic substances. 11.4.1. In case of poisoning with strong acids (sulfuric, hydrochloric, acetic) and strong alkalis (caustic soda, caustic potassium, ammonia), burns of the mucous membrane of the oral cavity, pharynx, esophagus, and sometimes the stomach occur. 11.4.2. Signs of poisoning are: severe pain in the mouth, pharynx, stomach and intestines, nausea, vomiting, dizziness, general weakness (up to fainting). 11.4.3. In case of acid poisoning, you must: (01) give the victim inside every 5 minutes a tablespoon of soda solution (2 teaspoons per glass of water) or 10 drops of ammonia diluted in water; (02) give the victim milk or egg whites shaken in water to drink; (03) if breathing is disturbed, give artificial respiration; (04) deliver the victim to the first-aid post. 11.4.4. In case of poisoning with strong caustic alkali, the victim must: (01) to drink little by little cold water acidified with acetic or citric acid (2 tablespoons of 3% vinegar solution per glass of water); (02) give inside vegetable oil or egg white shaken with water; (03) apply mustard plaster to the epigastric region; (04) deliver the victim to the first-aid post. 12. First aid for fainting, heat and sunstroke 12.1. Fainting is a sudden, short-term loss of consciousness (from a few seconds to a few minutes). 12.1.1. Fainting can occur as a result of: fright, severe pain, bleeding, a sharp change in body position (from horizontal to vertical, etc.). 12.1.2. With fainting, the victim is observed: profuse sweat, cold extremities, weak and frequent pulse, weakened breathing, pallor of the skin. 12.1.3. When providing first aid for fainting, you must: (01) lay the victim on his back, lower his head, raise his legs; (02) unfasten clothing and let in fresh air; (03) wet face with cold water; (04) bring a cotton swab moistened with a solution of ammonia to the nose; (05) lightly pat on the cheeks; (06) after removing the victim from fainting, give the victim strong tea, coffee; (07) in case of repeated fainting, call for qualified medical assistance; (08) transport the casualty on a stretcher. 12.2. Heat stroke and sunstroke occur as a result of a significant overheating of the body and, as a result, a significant rush of blood to the brain. 12.2.1. Overheating is facilitated by: elevated ambient temperature, high humidity, waterproof (rubber, tarpaulin) clothing, hard physical work, violation of the drinking regime, etc. 12.2.2. Heat and sunstroke are characterized by: general weakness, feeling hot, redness of the skin, profuse sweating, palpitations (pulse rate 100-120 beats per minute), dizziness, headache, nausea (sometimes vomiting), fever up to 38-40 °C. In severe cases, confusion or complete loss of consciousness, delirium, muscle cramps, respiratory and circulatory disorders are possible. 12.2.3. For heat and sunstroke, you need to: (01) immediately move the casualty to a cool room; (02) lay the victim on his back with a pillow under his head (clothing, etc.); (03) remove or unfasten clothing; (04) moisten the head and chest with cold water; (05) put cold packs or ice on the head (forehead, parietal region, occiput), inguinal, subclavian, popliteal, axillary regions (places of concentration of many vessels); (06) while remaining conscious, give strong cold tea or cold salted water to drink; (07) in case of respiratory and circulatory disorders, carry out the full range of resuscitation measures (artificial respiration and external heart massage). 13. First aid for pain and convulsive conditions 13.1. For pain in the heart area, helping the victim, you must: (01) create complete peace; (02) lay the patient down and raise his head; (03) give (under the tongue) a tablet of validol, nitroglycerin, sedatives; (04) urgently call for qualified medical assistance; (05) if pain persists, carry out transportation on a stretcher. 13.2. For abdominal pain not related to eating or drinking, the first aid provider should: (01) lay the victim horizontally; (02) put "cold" on the abdomen; (03) exclude: physical activity, taking fluids, food by the victim; (04) urgently call for qualified medical assistance; (05) in case of severe pain, transport the victim to the first-aid post or medical institution on a stretcher. 13.3. In a seizure (may be accompanied by loss of consciousness, foam on the lips, wheezing, involuntary urination), the first aid provider should: (01) support the patient's head; (02) insert a bandage, spoon, etc. into the oral cavity (between the teeth); (03) free from clothing the area of the neck and chest; (04) apply a cold compress to the forehead; (05) after the seizure is over, put the patient in the "on the side" position; (06) urgently call for qualified medical assistance; (07) carry out transportation on a stretcher. 14. First aid for drowning 14.1. After removing the victim from the water, the first aid provider must: (01) put the victim belly down on a bent knee so that the lower part of the chest rests on it, and the upper body and head hang down; (02) with one hand press on the chin or raise the head (so that the mouth is open) and with vigorous pressure (several times) on the back with the other hand to help remove water; (03) after stopping the flow of water, lay the victim on his back and clean the mouth; (04) start artificial respiration; (05) in the absence of a pulse, dilated pupils, perform an external heart massage; (06) when breathing occurs, bring a piece of cotton wool soaked in a solution of ammonia to the nose; (07) when conscious, give the victim a tincture of valerian (20 drops in 1/2 cup water) to drink; (08) change the victim into dry clothes, give him strong tea; (09) keep the casualty warm; (10) provide the victim with complete rest; (11) call for qualified medical assistance. 15. First aid for bites 15.1. With the bites of poisonous insects and snakes appear: dizziness, nausea, vomiting, dryness and bitter taste in the mouth, rapid pulse, shortness of breath, drowsiness (in especially severe cases, there may be convulsions, loss of consciousness and respiratory arrest). 15.2. Burning pain, redness and swelling of the skin occur at the site of the bite. 15.3. The first aid provider must: (01) lay the casualty in a horizontal position; (02) put a sterile dressing on the wound (preferably with ice); (03) fix the affected limb by bandaging it to a service splint (improvised means) or to the body; (04) give the victim a large amount of liquid (partially), 15 - 20 drops of valerian tincture in 1/2 cup of water; (05) for bites from poisonous snakes (especially cobras), in the first minutes, apply a tourniquet to the limb above the bite; (06) to monitor the condition of the victim; (07) in severe cases, urgently call for qualified medical assistance; (08) transport the casualty in the prone position. 15.4. It is forbidden: (01) cauterize the bite site; (02) give the victim alcohol; (03) suck the poison out of the wound. 15.5. The first aid provider for animal bites should: (01) treat the skin around the wound (scratch) with a solution of iodine tincture; (02) apply a sterile dressing to the wound; (03) send (accompany) the victim to a medical facility. 16. Transportation of casualties 16.1. Transportation of the victim should be as quick, safe and gentle as possible. 16.2. Depending on the type of injury and the available means (personnel, improvised), the transportation of the victims can be carried out in different ways, maintenance, carrying out, transportation by transport. 16.3. Transport the wounded up or down should always be head up. 16.4. It is necessary to lay the victim on a stretcher from the side opposite to the injured part of the body. 16.5. When transporting on a stretcher, you must: (01) ensure that the casualty is in a correct and comfortable position; (02) so that when carried on the hands, the helpers go "out of step"; (03) lift and place the injured person on the stretcher in concert (on command); (04) in case of fractures and severe injuries, do not carry the victim to the stretcher on your hands, but place the stretcher under the victim (the fracture site must be supported). 16.6. The correct position of the victims during transportation: (01) the position "lying on the back" (the victim is conscious). Recommended for wounds of the head, spine, limbs; (02) position "lying on the back with legs bent at the knees" (put a roller under the knees). Recommended for open wounds of the abdominal cavity, for fractures of the pelvic bones; (03) the position "lying on the back with the lower limbs raised and the head down". Recommended for significant blood loss and shock; (04) prone position. Recommended for spinal injuries (unconscious); (05) "semi-sitting position with outstretched legs". With neck injuries and significant injuries of the upper limbs; (06) "semi-sitting position with bent legs" (put a roller under the knees). With injuries of the genitourinary organs, intestinal obstruction and other sudden illnesses, injuries of the abdominal cavity and injuries of the chest; (07) position "on the side". Recommended for severe wounds, when the victims are unconscious; (08) "sitting position". Recommended for minor injuries of the face and upper limbs.
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