APPROVED

USSR Ministry of Health

SCHEME FOR DETERMINING THE SEVERITY OF OCCUPATIONAL INJURIES

The conclusion on the severity of an industrial injury is given by doctors of medical and preventive institutions in which the treatment of victims is carried out. It is issued at the request of the administration of the enterprise, institution, organization, state farm, collective farm in which the accident occurred, as soon as possible (no more than 3 days from the moment the request was received).

When determining the severity of an industrial injury, the nature and localization of the existing injuries, their danger to the life and health of the victim are taken into account.

Severe industrial injuries of various localization include:

1. Mechanical damage

1.1. Head, face, neck

1.1.1. Open and closed fractures of the bones of the vault and base of the skull.

1.1.2. Fractures of the upper and lower jaw.

1.1.3. Intracranial hemorrhages of a traumatic nature, injuries, bruises and concussions of the brain.

1.1.4. Penetrating wounds and bruises of the eyeball, accompanied by visual impairment.

1.1.5. Wounds of large main vessels of the neck, penetrating wounds of the pharynx, esophagus, trachea.

1.1.6. Extensive wounds to the head, face, neck with possible subsequent disfigurement of these areas.

1.2. torso

1.2.1. Closed and open injuries of the organs of the chest and abdominal cavities, retroperitoneal space, pelvis.

1.2.2. Rib fractures with damage to the pleura and lung, fracture of the sternum, compression of the chest.

1.2.3. Fractures of the bodies, arches and articular processes of the vertebrae, two or more spinous or transverse processes of the vertebrae.

1.2.4. Dislocations and fracture-dislocations of the vertebrae with or without damage to the spinal cord.

1.2.5. Fractures of the pelvic bones with violation of the integrity of the pelvic, ruptures of the sacroiliac and pubic joints of the pelvis.

1.3.1. Dislocations and fracture-dislocations in large joints of the extremities.

1.3.2. Closed and open fractures of the long bones of the extremities, patella, neck of the scapula.

1.3.3. Multiple fractures of the bones of the metacarpus and metatarsus, isolated and multiple fractures of the bones of the carpus and tarsus.

1.3.4. Crushing of the hand, foot and their parts.

1.3.5. Injuries to the tendons of the deep and superficial flexors of the hand, the biceps of the shoulder, the Achilles tendon, the ligaments of the knee and ankle joints.

1.3.6. Traumatic amputation of the upper or lower limb.

1.3.7. Damage to large main vessels and nerve trunks of the extremities.

1.3.8. Compression of the soft tissues of the extremities with crush syndrome.

2.1. Thermal and chemical burns of I-II degree with an area of ​​more than 20% of the body surface, III degree with an area of ​​more than 1% of the body surface, IV degree burns, radiation burns.

2.2. Frostbite III-IV degree, general cooling of the body.

2.3. The impact of electric current, accompanied by impaired consciousness, respiratory and cardiovascular disorders.

2.4. Foreign bodies of the pharynx, esophagus and respiratory tract, requiring emergency resuscitation.

Other injuries are not included in the number of severe industrial injuries.

METHODOLOGICAL INSTRUCTIONS FOR THE APPLICATION OF THE "SCHEME FOR DETERMINING THE SEVERITY OF OCCUPATIONAL INJURIES"

Basic principles for determining severity

industrial injuries

In all cases of industrial injuries, the victim is provided with the necessary assistance at the scene of the incident, after which he, if necessary, is sent for qualified treatment to a medical and preventive institution.

If an injury occurs at work, the administration and the trade union organization of each enterprise, institution, organization, state farm or collective farm are obliged to investigate its causes within 24 hours.

The results of the investigation are formalized by the "Act on an accident at work". If the injury is severe, then the investigation of the causes of its occurrence is carried out in a special manner and is drawn up by an act of a special investigation, which is drawn up by the technical inspector of the trade union within 7 days from the moment of its occurrence.

The issue of the severity of an industrial injury is decided by the doctors of the medical and preventive institution in which the victim is treated, in accordance with the "Scheme for determining the severity of industrial injuries".

The basis for determining the severity of occupational injuries is the principle of taking into account the nature of anatomical damage to organs and systems, the danger of existing damage to the life and health of the victim, the real possibility of restoring functions lost as a result of injury.

Solving the issue of the severity of an industrial injury requires the doctors of a medical and preventive institution to have the appropriate knowledge and experience not only in treatment, but also in determining a possible prognosis for various types of injuries. Upon admission of the victim to a medical and preventive institution, the doctor needs to identify all the injuries he has, evaluate the function of the vital systems of the body, determine the danger of the injuries to the life and health of the victim (prognosis of the outcome), as well as the possibility of restoring the function of damaged organs.

When deciding on the severity of an industrial injury, one should be guided by the "Scheme for determining the severity of industrial injuries", approved by the USSR Ministry of Health on September 22, 1980.

Use in practice "Schemes for determining the severity

industrial injuries"

1. Mechanical damage

1.1. Head, face, neck

1.1.1. All, without exception, open and closed fractures of the bones of the vault and base of the skull are included - regardless of the general condition of the victim. The diagnosis of skull fractures must be confirmed by the results of a clinical and radiological examination of the victim in a medical and preventive institution. In the absence of convincing radiological data indicating the presence of fractures (especially the bones of the base of the skull), clinical data and the mechanism of injury are of leading importance. This group of injuries also includes fractures of the bones of the nose, accompanied by massive bleeding and damage to the sinuses of the main bone. Fracture of the outer plate of the cranial vault in the presence of cerebral and focal neurological symptoms should also be classified as a severe occupational injury.

1.1.2. All fractures of the upper and lower jaws are included, excluding fractures of the coronoid process of the lower jaw, tears of the cortical layer of it, as well as damage to the crowns of individual teeth.

1.1.3. Includes extradural, subdural, subarachnoid and other intracranial hemorrhages of traumatic etiology, as well as any nature and localization of damage to the substance of the brain, including bruises. These injuries, as a rule, are accompanied by a severe general condition of the victim, severe cerebral and focal neurological symptoms, often respiratory and cardiovascular disorders. In the presence of clinically determined cerebral and focal neurological symptoms, this group of severe occupational injuries also includes concussions of the brain.

1.1.4. This group of severe occupational injuries includes injuries and foreign bodies of the eyeball, in which there is a real danger of impairment or loss of vision. Signs of these injuries are pain and acute visual impairment in the damaged eye, hemorrhages in the membranes and chambers of the eye. With penetrating wounds, there is an outflow of chamber fluid and prolapse of the tissues of the eyeball into the wound.

1.1.5. The most typical signs of this group of injuries are: massive bleeding from wounds in the neck, outflow of blood from the pharynx, its presence in the sputum during expectoration, impaired external respiration and the act of swallowing. Wounds of large main vessels of the neck are accompanied by acute anemia of the brain and pose a serious danger to the life of the victim. Penetrating wounds of the pharynx, esophagus and larynx are fraught with the risk of subsequent development of inflammatory complications in the mediastinum.

1.1.6. As a rule, their extensive wounds lead to severe disfigurements of the head, face, neck. Extensive should be considered wounds in which it is not possible to count on primary healing without plastic replacement of defects. Wounds of the face with damage to the facial nerve and its large branches, loss of part of the nose, one or two auricles should also be classified as severe occupational injuries.

1.2. torso

1.2.1. In case of damage to the organs of the chest and abdominal cavities, pelvis and retroperitoneal space, the following are characteristic: the clinical picture of shock, internal bleeding, acute peritonitis, pneumo- or hemothorax, hematuria. The severe general condition of the victim, the presence of the above symptom complexes, taking into account the mechanism of injury, are the basis for classifying the existing work injury as severe.

1.2.2. Multiple, bilateral and double fractures of the ribs without clinical signs of damage to the pleura, but accompanied by a pronounced disorder of external respiration, should also be attributed to this group of severe occupational injuries. Signs of dysfunction of the heart and lungs - difficulty in external breathing, unstable blood pressure, congestion in the pulmonary circulation after the release of the chest from compression - indicate that this occupational injury is one of the severe ones.

1.2.3., 1.2.4. Of all spinal injuries, only uncomplicated fractures of the sacrum and coccyx without displacement of fragments, as well as an isolated fracture of the transverse or spinous processes of the vertebrae, can be classified as light.

1.2.5. Fractures of the wings of the ilium should also be included in this group of injuries if they are accompanied by a state of shock and massive interstitial bleeding.

1.3. Upper and lower limbs

1.3.1. The large joints of the limbs include: shoulder, elbow and wrist joints of the upper limb; hip, knee, ankle and tarsal joints of the lower limb. Habitual dislocation of the shoulder, which occurred in the victim in the performance of work duties, is not among the severe work-related injuries.

1.3.2. Long tubular bones include: clavicle, humerus, radius and ulna of the upper limb, femur and tibia of the lower limb. Intra-articular fractures of the epiphyses of the shoulder, femur, lower leg, ulna (excluding fractures of the styloid process) and radius, fractures of the patella and neck of the scapula should be attributed to this group of severe occupational injuries. Avulsion extra-articular fractures of long tubular bones, fractures of the body of the scapula, which do not threaten limb function impairment after treatment, are not classified as severe occupational injuries.

1.3.3. Multiple fractures of the bones of the metatarsus and metacarpus should be considered open and closed fractures of two or more bones or one bone with two or more fracture planes. Avulsion fractures of individual bones of the metatarsus and tarsus, metacarpus and wrist, isolated fractures of individual phalanges of the fingers, fractures of the sesamoid bones do not belong to the group of severe occupational injuries.

1.3.4. Crushing of the hand, foot and their parts is considered damage to several different tissues that form them (bone, muscle, tendon, blood vessels and nerves). When deciding on the severity of this group of injuries, the possibility of restoring the anatomical integrity and functional ability of injuries to the hand or foot is taken into account. Crushing of the hand, threatening with the loss of the terminal phalanx of the I finger, two phalanges of each of the other fingers or three phalanges (in total) of the II-V fingers, one hand, as well as two or more fingers of one foot, should be classified as a serious industrial injury. Extensive scalped wounds of the soft tissues of the foot and hand, which require plastic replacement of defects during the treatment, also belong to the group of severe occupational injuries.

1.3.5. Open and closed injuries of more than half of the anatomical volume of the patellar ligament, quadriceps femoris tendon, lateral ligaments of the knee and ankle joints, as well as a complete rupture of the cruciate ligaments of the knee and deltoid ligaments of the ankle joint should be considered as severe. Isolated and partial injuries of the tendons of the superficial flexors of the hand, tendons of the extensor fingers of the foot and hand, which do not threaten subsequent dysfunction of the fingers, are not classified as serious occupational injuries.

1.3.6. Traumatic amputation is the complete separation of a part of a limb as a result of an injury. Amputation of the upper limb above the level II-V of the metacarpophalangeal joints, lower limb - above the level of the distal third of the metatarsal physes is considered a severe occupational injury. The group of severe occupational injuries should also include amputation of one or more phalanges of the I finger, two or more phalanges of each of the other fingers, three or more phalanges (in total) of the II-V fingers of one hand, two or more toes above the level of the metatarsophalangeal joints .

1.3.7. The main signs of injuries in this group are massive bleeding from the wound, if any, severe circulatory disorders in the distal limb, loss of function of the damaged nerve trunks of the limbs. The large main vessels and nerves of the upper limb include: subclavian, axillary and brachial (up to the level of its division into radial and ulnar) arteries; axillary and main (up to the level of the lower third of the shoulder) veins; brachial plexus, radial, ulnar and median nerves throughout. The large main vessels and nerves of the lower limb include: femoral, popliteal and posterior tibial (up to the level of the upper third of the leg) arteries; deep vein of the thigh and popliteal vein; sciatic and tibial nerves throughout, peroneal nerve to the level of the upper third of the leg.

1.3.8. The basis for referring to this group of severe industrial injuries is mainly the mechanism of damage; during a clinical examination of the victim, the possibility of developing a general autointoxication of the body with subsequent dysfunction of the cardiovascular, nervous and urinary systems is taken into account.

2. Other damage (thermal, chemical, electrical, radiation, foreign bodies)

2.1. This group of severe occupational injuries includes thermal and chemical burns of the IV degree, regardless of the area of ​​damage, thermal and chemical burns of the eyeball in the presence of clinically pronounced signs of visual impairment. Thermal and chemical burns of the pharynx, esophagus, respiratory tract with clinically pronounced symptoms of swallowing and breathing disorders should also be classified as severe occupational injuries. Severe occupational injuries also include radiation burns, regardless of the degree and area of ​​damage.

2.2. Extensive frostbite III degree, frostbite IV degree, regardless of size, are among the severe industrial injuries. Often occurring limited frostbite of I-II degree of the face, fingers, feet and hands, as a rule, ending in a complete recovery of the victim, do not belong to the group of severe occupational injuries. A clinically pronounced violation of the general condition of the victim - lethargy, lethargy, adynamia, a decrease in body temperature by more than 1 degree. C - with general cooling of the body is the basis for classifying this condition as a group of severe occupational injuries.

2.3. Any deviations in the function of the cardiovascular system, disturbance of external respiration or consciousness at the time of exposure to electric current, as well as during the examination of the victim in a medical institution, regardless of their severity, are the basis for classifying electrical injury as a group of severe industrial injuries. In all cases, it is necessary to take into account the paths of passage of electric current in order to assess the possibility of further development of the adverse effects of its impact.

2.4. This group of severe occupational injuries also includes the consequences of asphyxia as a result of immersion in water or other liquid media.

The combination of these severe occupational injuries with other injuries, as well as with each other, is the basis for classifying this injury as a group of severe occupational injuries according to the leading injury.

Severe occupational injuries also include extensive wounds of the skin and underlying tissues of various localization, often accompanied by profuse bleeding, blood loss, and shock. Extensive should be considered injuries in which it is not possible to count on healing without plastic replacement of the defect. These injuries include extensive scalped wounds of the extremities, perineum, torso, lower leg and face.

Issuance procedure

medical and prophylactic institution

about the severity of the work injury

A conclusion on the severity of an industrial injury is issued by a medical and preventive institution in which outpatient or inpatient treatment of the victim is carried out, at the request of the enterprise, institution, organization, state farm or collective farm where the accident occurred.

It indicates the surname, name, patronymic of the victim, age, position, date and time of admission (appeal) to this medical and preventive institution, a complete diagnosis is given indicating the nature and localization of the damage and a conclusion on whether or not the existing damage belongs to group of severe work injuries.

The issued conclusion on the severity of the injury must have the stamp and seal of the medical institution, the signature of the attending physician and the head of the department (or head physician), and the date of issue.

An approximate diagram of the conclusion on the severity of an industrial injury is attached.

A conclusion on the severity of an industrial injury can be drawn up by a medical institution on the form "Extract from the medical history of an outpatient, inpatient (underline) patient" (registration form N 27, approved by the USSR Ministry of Health 10/111 1956). In this case, it is necessary to comply with the above requirements for the execution of the conclusion.

The attending physician makes an appropriate entry about the issued conclusion in the medical history (individual card of the outpatient patient), indicating the severity of the injuries and the date of issuance of the conclusion.

The term for issuing a conclusion should be as short as possible and not exceed 3 days from the moment the request of the enterprise, institution, organization, state farm or collective farm in which the accident occurred was received by the medical and preventive institution.

Doctors of emergency and urgent care, medical workers who provide only first aid or transport the victim to a medical institution, do not give an opinion on the severity of an industrial injury.

Application

to the Guidelines

by application

"Schemes for determining the severity

industrial injuries"

CONCLUSION ON THE SEVERITY OF OCCUPATIONAL INJURY

Name of the medical institution

(stamp)

Issued by ___________________________________________________________

(name of the enterprise, institution, organization, state farm,

Collective farm, at the request of which the conclusion is issued)

that the victim __________________________________________

(last name, first name, patronymic, age)

__________________________________________________________________

(position held)

enrolled in _____________________________________________________________

(name of the hospital department, polyclinic)

__________________________________________________________________

(date and hour)

Diagnosis ________________________________________________________________

(indicating the nature and location of damage)

According to the Scheme for determining the severity of industrial injuries,

approved by the Ministry of Health of the USSR on September 22, 1980, the indicated damage _____

__________________________________________________________________

(applies, does not apply - write out)

among severe work-related injuries.

Head department

(or chief physician) ___________ ______________________________

(signature) (surname, name, patronymic)

Attending doctor ___________ ______________________________

An industrial injury on the way to work (from work) or directly at work is a fairly common case. In order to dispel all doubts, illusions and contradictions regarding this event, the Labor Code of the Russian Federation in its articles gave clear explanations on this issue. Let's figure it out, translating the dry legal language into a simple one that everyone can understand.

Not every scratch, bruise, or bump is an injury.

Legislation defines an injury as damage to health, as a result of which an employee has lost the ability to perform his work, is forced to undergo medical treatment, is transferred to lighter work, has become disabled or died.

If the incident happened at the workplace, during working hours and led to a deterioration in the state of health, the case is not considered to be at work. And it doesn't matter whose fault it happened.

Classification of injuries

What should I do if a work injury occurs?

There is a certain algorithm of actions in the event of accident causing harm to health. It is defined by law (Article 228 of the Labor Code of the Russian Federation), and any head of an enterprise must know it:

1. It is necessary to immediately provide all possible medical assistance on the spot and call doctors or ensure the delivery of the victim to the hospital.
2. According to the situation, eliminate the causes of the accident - turn off the electricity, turn off the water, stop the production line, etc.
3. If there is no further threat, leave the scene undisturbed.
4. If such a threat is not excluded, document the situation at the scene: video filming, photography, scheme.
5. To convey information about the incident to the relatives of the victim, the state labor inspectorate, insurers, the trade union, etc.
6. Enter the relevant information in the emergency incident register available at the enterprise.

You can download a sample work injury report ->

Determining the severity of a work injury

Further, the Labor Code regulates: after all the above actions, a commission is created to investigate the incident. She carries out the procedure for registration of an industrial injury. The number and composition of the commission depends on the complexity of the investigation. It consists of three or more people, it includes: the employer or his authorized representative, labor inspector, representatives of the trade union, law enforcement agencies, medical workers, representatives of the prosecutor's office.

Investigating the incident by collecting information, testimonies, this commission determines whose fault this incident occurred. The amount of payments to the victim depends on this, and who will make these payments. Also, the commission is obliged to carry out a classification of harm. So, for example, if the incident was recorded at the workplace, during working hours, but the injured employee was in a state of intoxication, then the injury will be defined as an accident.

The determination of an industrial injury according to the severity falls on the shoulders of the medical and social commission. It determines the nature of the injury: mild or severe. It also affects the size and source of payments.

Investigating the fact that happened, this commission draws up a documented work injury and draws up an act. An example of an act is shown below.

The terms of the commission's work range from three to fifteen days, depending on the complexity of the situation.

Injury at work - payments

In the event of an accident, a one-time and monthly monetary compensation is paid, sick leave and rehabilitation measures are paid. The amount of payment and the source of these payments depends on the classification and severity of the injury.

If the commission establishes that the employee himself is to blame for what happened, then the amount of compensation will be much lower.

Also, the amount of money paid depends on the severity of the injury. The degree of severity is determined by the medical and social commission. According to the severity of injuries are divided into severe and light. Payment for severe injuries is much higher than for minor ones.

If the work injury is classified as mild, then the payment of monetary compensation is made by the employer himself. If the severity of the injury is severe, then the payment comes from the FSS.

Payment for sick leave in case of an industrial injury occurs in accordance with the Labor Code of the Russian Federation.

In addition to the basic payments provided for by Russian law, an injured worker may request payment of moral damages. As a rule, the employer and the employee agree on the amount of damage independently. If the parties cannot come to a common denominator, the dispute will be resolved by the court.

There is no statute of limitations for this requirement.

Work injury is a situation that is unpleasant for both the employer and the employee. Sometimes, trying to avoid publicity and bureaucratic delays, the parties resolve the issue through an oral agreement. In this case, in case of violation of the contract, it will be very difficult to prove something and protect your rights.

Accident this is an event as a result of which employees and other persons involved in production activities in the course of carrying out lawful actions caused by labor relations with the employer or performed in his interests received bodily injuries, injuries, injuries.
Accidents have different classifications in Art. 227 of the Labor Code of the Russian Federation, they are described as follows:
Employment-related
1. Accidents at work.
Cases that occurred with employees, pupils, students working on the territory of the enterprise and outside it, if the work was carried out on the instructions of the management; on the way to the place of work on the transport provided by the organization, as well as when performing work after hours, on weekends and holidays by order of the head or persons authorized. Also as a result of acute poisoning, heat stroke and frostbite that occurred at work.
2. Work-related accidents. These are cases that occurred while performing state and public duties, going to and from work by personal and public transport, participating in sports competitions and training, disability due to the performance of donor functions, on business trips.
3. Household accidents. These are accidents that occur outside the premises of the enterprise, outside working hours and not while driving to and from work.

Classification by the number of victims

1. Single (one person injured).
2. Group (simultaneously injured two or more people).

Classification by cause of injury

1. mechanical
2.thermal, electrical, chemical.

Severity classification

1. Light (shots, scratches, abrasions, etc.).
2. Severe (bone fractures, concussion, etc.).
3. Lethal (associated with the death of the victim).

Determining the severity of health damage in industrial accidents is regulated by Order of the Ministry of Health and Social Development of the Russian Federation of February 24, 2005 N 160 "On determining the severity of health damage in industrial accidents" and is displayed in the Appendix:

Determining the severity of health damage in industrial accidents

1. Accidents at work according to the severity of health damage are divided into 2 categories: severe and light.
2. Qualifying signs of the severity of damage to health in an accident at work are:
- the nature of the health injuries received and the complications associated with these injuries, as well as the development and aggravation of existing chronic diseases in connection with the injury;
- the consequences of the resulting health damage (permanent disability).
The presence of one of the qualifying features is sufficient to establish the category of severity of an accident at work.
Signs of a severe accident at work are also damage to health that threatens the life of the victim. Prevention of death as a result of medical care does not affect the assessment of the severity of the injury.
3. K heavy accidents at work include:
1) damage to health, the acute period of which is accompanied by:
- shock;
- coma;
- blood loss (volume more than 20%);
- embolism;
- acute insufficiency of the functions of vital organs and systems (CNS, cardiac, vascular, respiratory, renal, hepatic and (or) a combination of them);
2) damage to health, qualified during the initial examination of the victim by doctors of a hospital, trauma center or other healthcare organizations as:
- penetrating wounds of the skull;
- fracture of the skull and facial bones;
- contusion of the brain;
- intracranial injury;
- wounds penetrating into the lumen of the pharynx, trachea, esophagus, as well as damage to the thyroid and thymus;
- penetrating wounds of the spine;
- dislocation fractures and fractures of the bodies or bilateral fractures of the arches of the I and II cervical vertebrae, including those without impaired spinal cord function;
- dislocations (including subluxations) of the cervical vertebrae;
- closed injuries of the cervical spinal cord;
- fracture or fracture-dislocation of one or more thoracic or lumbar vertebrae, including without impaired function of the spinal cord;
- wounds of the chest, penetrating into the pleural cavity, pericardial cavity or mediastinal tissue, including without damage to internal organs;
- abdominal wounds penetrating into the peritoneal cavity;
- wounds penetrating into the cavity of the bladder or intestines;
- open wounds of the retroperitoneal organs (kidneys, adrenal glands, pancreas);
- rupture of the internal organ of the chest or abdominal cavity or pelvic cavity, retroperitoneal space, rupture of the diaphragm, rupture of the prostate gland, rupture of the ureter, rupture of the membranous part of the urethra;
- bilateral fractures of the posterior half-ring of the pelvis with a rupture of the iliac-sacral joint and a violation of the continuity of the pelvic ring or double fractures of the pelvic ring in the anterior and posterior parts with a violation of its continuity;
- open fractures of long tubular bones - humerus, femur and tibia, open injuries of the hip and knee joints;
- damage to the main blood vessel: aorta, carotid (general, internal, external), subclavian, brachial, femoral, popliteal arteries or accompanying veins, nerves;
- thermal (chemical) burns:
III - IV degree with a lesion area exceeding 15% of the body surface;
III degree with a lesion area of ​​more than 20% of the body surface;
II degree with a lesion area of ​​more than 30% of the body surface;
respiratory tract, face and scalp;
— radiation injury of medium (from 12 Gy) severity and above;
- abortion;
3) injuries that do not directly threaten the life of the victim, but are serious in consequences:
- loss of vision, hearing, speech;
- loss of any organ or complete loss of its function by the organ (in this case, the loss of the most functionally important part of the limb (hand or foot) is equated to the loss of an arm or leg);
- mental disorders;
- loss of reproductive function and ability to bear children;
- Indelible disfigurement of the face.

Samo conclusion on the severity of the work injury has the right to give only clinical expert commissions (CEC) of a medical institution where the treatment of the victim is carried out. This conclusion is provided at the request of the employer or the chairman of the commission for the investigation of an accident at work. KEK is obliged to provide a conclusion within 3 days from the date of receipt of the request. In addition, the conclusion must necessarily be drawn up in the discharge summary, regardless of the nature of the treatment performed.

If the victim was hospitalized, then the Medical Report is issued by the head of the department of the medical organization where the treatment is carried out. At the same time, the attending physician makes an entry about the issued Medical Report in the Medical Card of the outpatient patient or in the Medical Card of the inpatient, indicating the date of issue. At the end of the treatment of the victim in the hospital, an extract from the medical record of the outpatient, inpatient patient makes a note about the nature of the injuries received and their severity at the time of admission and at the time of discharge from the hospital.

Not every major injury is accompanied by unbearable pain, just as not every minor injury is painless. Received bodily injuries are evaluated not by the degree of pain, but by the consequences and reactions of the body. That is why a classification of industrial accidents has been developed for a competent investigation.

Terminology

In order to conduct an investigation in the proper manner, one should refer to the order of the Ministry of Health of the Russian Federation No. 160 of 2005. According to its provisions, absolutely all injuries, regardless of the cause of an accident at work, are classified into light and severe. And they are distinguished by the complexity of damage, as well as by the duration of disability over time.

In most cases, the forensic examination establishes that the injury is 100% severe if the victim develops its consequences, the appearance of chronic diseases against this background, permanent disability or death. Severe injuries have 3 degrees of severity.

Also in this order, the concept of “classification of industrial accidents” is clearly defined and a three-stage scheme is provided, which indicates possible bodily injuries and their relationship with degrees of severity.

First degree of severity

The first stage of the scheme is characterized by health damage, which was initially accompanied in a patient with profuse blood loss, shock, problems with the functioning of the cardiovascular system, central nervous system, kidneys, liver, and lungs. Even if these health problems exist for a short time when an injury occurs, the latter will always be considered severe.

Second degree of severity

The second stage, unlike the first, may not appear immediately, but upon admission to the initial examination upon arrival at a healthcare organization (more often an emergency room or intensive care unit). Only a doctor can determine the presence of the following injuries during a qualified examination using medical equipment.

The classification of industrial accidents provides for classifying the injury to the second degree of severity if the following injuries were revealed during the examination:

• penetrating wound of the skull;
• fractures of the bones of the face and skull;
• brain injury;
• penetrating wounds in the pharynx, trachea, esophagus, thyroid gland;
• injury to the spinal column (dislocations and fractures of the vertebrae);
• chest injury with damage to the pleural cavity, cardiac muscles, or without them;
• penetrating wound of the abdomen with damage to the organs of the gastrointestinal tract, genitourinary system;
• rupture of organs;
• fractures of the pelvic bones, shoulder, femur, tibia;
• open joint injuries;
• injury to large blood vessels;
• burns of a thermal and chemical nature with a lesion area of ​​​​more than 15% of the body, as well as burns of the face, respiratory tract, inguinal region;
• spontaneous abortion (miscarriage).

Third degree of severity

The classification of accidents related to production distinguishes a separate group of severity of injuries that cannot threaten the life of the victim, but are recognized as serious consequences:

• loss of vision (in one or both eyes);
• loss of the ability to speak and hear;
• loss of an organ, or termination of its functioning;
• mental disorders;
• facial disfigurement.

Special cases

Some types of industrial accidents are classified by the Ministry of Health as severe not because the injury is on one of the lists, but because it can aggravate the course of chronic diseases, and sometimes become a catalyst for irreversible processes leading to death.

One of these special cases was the injury of Anna German, a Soviet singer. In 1967, she was in a car accident, having received multiple bone fractures. For fifteen years, the singer took strong painkillers and struggled with thrombophlebitis and sarcoma, a bone cancer. All these fatal injuries appeared after the accident. Forensic medical examination proved that pain, manifestations of new diseases and complication of chronic ones are sure signs of a serious injury.

More often there are situations when the conclusion indicates that the injury is mild, but subsequent medical examinations and monitoring of the victim's condition require retraining it into severe. Here, the investigation is carried out directly by representatives of the Labor Inspectorate.

For example, a welder during work is injured from an electric arc. After a few days in the hospital, he feels better and informs the doctor about his recovery. After some time, it turns out that when injured, the welder's reproductive system was so damaged that it would no longer function. Such an accident should be immediately transferred to the category of severe.

Sometimes minor injuries can cause death, as Ministry of Health Order No. 160 warns. In such cases, not only the general classification comes to the rescue. The investigation of accidents at work in this situation is carried out jointly by the Labor Inspectorate and the Prosecutor's Office.

For example, an employee has a broken leg, and the attending physician first issues a certificate of minor injury. In the process of fracture, adipose tissue from the bone marrow enters the bloodstream, developing a fat embolism. Death occurs within two days. It would seem a minor injury, but its consequences are fatal.

General classification of all NS

Before proceeding with the investigation, it is necessary to make sure that the injury is directly related to the production process, and when contacting a medical institution, the patient reported this, and the doctor put down the code “04” on the sick leave - an injury at work.

All NS can be divided into production and household (those that do not fall under the definition of production).

Production NS

The Labor Code of the Russian Federation provides a classification of industrial accidents. So, these include injuries received by an employee during working hours on the territory of the employer or outside it, in the performance of official duties, as well as when traveling to and from the place of work on company vehicles. Also included in this category are injuries that an employee receives when performing overtime work, during the elimination of emergency situations.

There is also a classification of the causes of accidents at work. It was determined by the Order of Rostrud No. 21 of 2005:

1. By source of injury: This includes 19 causes, some attributable to the employer and some to the employee. Each reason is assigned a unique code.
2. According to the type of incident, all causes are divided into several groups and subgroups:

2.1. On transport (8 subgroups).

2.2. Fall from a height (4 subgroups).

2.3. Collapse (4 subgroups).

2.4. Injury by moving, rotating or flying parts, elements, materials (5 subgroups).

2.5. Foreign bodies (3 subgroups).

2.6. Physical overload (3 subgroups).

2.7. Electric shock (1 subgroup).

2.8. Radiation (5 subgroups).

2.9. Extreme temperatures and natural factors (5 subgroups).

2.10. Fire and smoke (4 subgroups).

2.11. Harmful substances (2 subgroups).

2.12. Nervous overload.

2.13. Contact with dangerous animals and plants (3 subgroups).

2.14. Contact with water (2 subgroups).

2.15. Illegal actions of third parties.

2.16. Intentional self-harm.

2.17. Emergency (4 subgroups).

2.18. Other reasons.

Household NS

If an accident occurred to an employee outside the employer's territory during off-hours, on the employer's territory, but not in the performance of official duties (for example, a turner is injured in the process of turning parts for personal needs), if the employee was in a state of alcohol, drugs and other toxic intoxication, then the injury is recognized as not related to production - household.

Thus, the official classification of industrial accidents makes it possible to determine not only the cause of the injury, but also its source.

3.7. DETERMINATION OF THE SEVERITY OF ACCIDENTS AT WORK

According to the severity of accidents at work are divided into two categories - severe and light.
Signs of the severity of an accident at work are:
. the nature of the injuries received and the complications associated with these injuries, as well as the aggravation of existing and the development of chronic diseases;
. duration of health disorder (temporary disability);
. the consequences of the injuries received (permanent disability, the degree of loss of professional ability to work).
The presence of one of the above signs is sufficient to establish the category of severity of an accident at work.
Signs of a severe accident at work are also injuries that threaten the life of the victim.
Prevention of fatal outcome as a result of medical care does not affect the assessment of the severity of the injury.
Severe accidents include industrial accidents, which in the acute period are accompanied by:
. shock of any severity and any genesis;
. coma of various etiologies;
. significant (up to 20%) blood loss;
. acute heart or vascular insufficiency, collapse, severe cerebrovascular accident;
. acute renal or hepatic insufficiency;
. acute respiratory failure;
. a disorder of regional and organ circulation, leading to a heart attack of internal organs, gangrene of the extremities, embolism (gas and fat) of cerebral vessels, thromboembolism;
. acute mental disorders.

. penetrating wounds of the skull;
. fracture of the skull and facial bones;
. brain contusion of severe or moderate severity;
. intracranial trauma of severe or moderate severity;
. wounds penetrating into the lumen of the pharynx, larynx, trachea, esophagus, as well as damage to the thyroid and thymus;
. penetrating wounds of the spine;
. fractures or dislocations of the bodies and bilateral fractures of the arches of the I and II cervical vertebrae, including those without impaired spinal cord function;
. dislocations (including subluxations) of the cervical vertebrae;
. closed injuries of the cervical spinal cord;
. fractures or dislocations of one or more thoracic and lumbar vertebrae with dysfunction of the spinal cord;
. chest wounds penetrating into the pleural cavity, pericardial cavity or mediastinal tissue, including without damage to internal organs;
. abdominal wounds penetrating into the peritoneal cavity;
. wounds penetrating into the cavity of the bladder or intestines;
. open wounds of the retroperitoneal organs (kidneys, adrenal glands, pancreas);
. rupture of the internal organ of the chest or abdominal cavity or pelvic cavity, retroperitoneal space, diaphragm, prostate gland, ureter, membranous part of the urethra;
. bilateral fractures of the posterior half-ring of the pelvis with a rupture of the iliac-sacral joint and a violation of the continuity of the pelvic ring or double fractures of the pelvic ring in the anterior and posterior parts with a violation of its continuity;
. open fractures of long tubular bones: humerus, femur and tibia, open injuries of the hip and knee joints;
. damage to a large blood vessel: aorta, carotid, subclavian, brachial, femoral, popliteal arteries or accompanying veins;
. thermal (chemical) burns of III-IV degree with a lesion area exceeding 15% of the body surface;
. third degree burns with an area of ​​damage of more than 20% of the body surface;
. II degree burns with a lesion area of ​​more than 30% of the body surface;
. burns of the respiratory tract, face and scalp;
. radiation injuries of medium (12...20Gy) and severe (20Gy and more) severity;
. abortion.
Serious accidents at work include such injuries that do not directly threaten the life of the victim, but are serious in consequences:
. loss of vision, hearing, or speech;
. loss of any organ or loss of its function by an organ (in this case, the loss of the most functionally important part of the limb (hand or foot) is equated to the loss of an arm or leg);
. mental disorders;
. loss of ability to reproductive function and childbearing;
. permanent disfigurement of the face.
Serious accidents at work also include:
. long-term health disorders with temporary disability (lasting 60 days or more);
. permanent disability (disability);
. loss of professional ability to work by 20% or more.
Minor accidents at work include:
. health disorders with temporary disability lasting up to 60 days;
. loss of professional ability to work by less than 20%.
Doctors of emergency and urgent care, as well as any other medical workers providing first aid to the victim, do not give a conclusion on the severity of the injury.
Their competence includes determining the nature of further treatment of the victim (outpatient or inpatient), as well as a statement of death.
The conclusion on the severity of the work injury is given at the request of the employer or the chairman of the commission for the investigation of an accident at work by the clinical expert commission (CEC) of the medical institution where the victim is treated, within three days from the date of receipt of the request. This conclusion must also be drawn up in the discharge summary, regardless of the nature of the treatment performed.
The degree of loss of professional ability to work is determined in accordance with the Regulations "On the procedure for establishing by medical and labor expert commissions the degree of loss of professional ability to work as a percentage of employees who have been injured, an occupational disease or other damage to health associated with the performance of their labor duties", approved by the Decree of the Government of the Russian Federation dated April 23, 1994 No. 392.