On approval of the Rules for provision of first aid by persons without medical education, including those appropriately trained and the First aid standard

New Unofficial translation

Order of the Minister of Healthcare of the Republic of Kazakhstan dated December 15, 2020 No. ҚР ДСМ-269/2020. Registered with the Ministry of Justice of the Republic of Kazakhstan on December 20, 2020 No. 21814

      Unofficial translation

      In accordance with clauses 1 and 6 of article 90 of the Code of the Republic of Kazakhstan dated July 7, 2020 "On Public Health and Healthcare System" I HEREBY ORDER:

      1. To approve:

      1) The Rules for provision of first aid by persons without medical education, including those appropriately trained according to Appendix 1 to this order;

      2) The First aid standard according to Appendix 2 to this order.

      2. To recognize as invalid the order of the Minister of Healthcare of the Republic of Kazakhstan dated August 26, 2019 No. ҚР ДСМ-114 "On approval of the Standard of organization of first aid in the Republic of Kazakhstan" (registered in the Register of State Registration of Regulatory Legal Acts as No. 19290, published on August 29, 2019 in the Reference Control Bank of Regulatory Legal Acts of the Republic of Kazakhstan).

      3. Department for organization of medical aid of the Ministry of Healthcare of the Republic of Kazakhstan, in accordance with the procedure, established by law, shall ensure:

      1) state registration of this order with the Ministry of Justice of the Republic of Kazakhstan;

      2) placing this order on the Internet resource of the Ministry of Healthcare of the Republic of Kazakhstan;

      3) within ten working days after the state registration of this order, submission to the Legal Department of the Ministry of Healthcare of the Republic of Kazakhstan of information about implementation of measures, stipulated by subclauses 1) and 2) of this clause.

      4. Control over execution of this order shall be entrusted to the supervising Vice Minister of Healthcare of the Republic of Kazakhstan.

      5. This order shall come into force upon expiry of ten calendar days after the date of its first official publication.

      Minister of Healthcare
of the Republic of Kazakhstan
A. Tsoy

  Appendix 1
to the order of the
Minister of Healthcare
of the Republic of Kazakhstan
dated December 15, 2020
No. ҚР ДСМ-269/2020

Rules for provision of first aid by persons without medical education, including those appropriately trained

Chapter 1. General Provisions

      1. These Rules for provision of first aid by persons without medical education, including those appropriately trained (hereinafter referred to as the Rules) have been developed in accordance with clause 1 of article 90 of the Code of the Republic of Kazakhstan dated July 7, 2020 "On Public Health and Healthcare System" and shall determine the procedure for the provision of first aid by persons without medical education, including those appropriately trained.

      2. The following concepts are used in these Rules:

      1) first aid is a set of basic urgent measures to save a person’s life, prevent complications in emergency conditions, and also to reduce the threat to the health and life of an injured person in an emergency, which are taken at the scene by the injured person himself/herself (self-help) or another nearby person (mutual assistance) before healthcare professionals arrive;

      2) certified first aid trainer is a person passed additional training in first aid and basic cardiopulmonary resuscitation;

      3) certificate is a document of a standard form on first aid training;

      4) persons without medical education are the contingent of persons that is subject to compulsory passage of first aid courses;

      5) appropriately trained persons are the contingent of persons that is subject to compulsory passage of first aid courses and has a certificate on training in the first aid skills.

Chapter 2. Procedure for provision of first aid by persons without medical education, including those appropriately trained

      3. First aid shall be provided by persons without medical education, including those appropriately trained, who have been taught the first aid skills.

      4. Training persons without medical education in the first aid skills shall be carried out by the certified trainer in accordance with clause 2 of article 90 of the Code of the Republic of Kazakhstan dated July 7, 2020 "On Public Health and Healthcare System".

      5. Persons without medical education, including those appropriately trained, shall provide first aid to the injured person, in conditions according to Appendix 1 to these Rules.

      6. Persons without medical education, including those appropriately trained when providing first aid to the injured person shall ensure knowledge of bases, features and methods of first aid provision.

      7. Training persons without medical education in the first aid skills shall be carried out in the form of theoretical training and practical classes using the list of simulation equipment for training in the first aid skills according to Appendix 2 to these Rules.

      8. the contingent of persons without medical education that is subject to compulsory passage of the first aid courses:

      1) employees of internal affairs bodies, carrying out operational and other activities, connected with interaction with the population;

      2) military servants of the Armed Forces of the Republic of Kazakhstan, bodies of the national or state security service, troops of the National Guard;

      3) employees of firefighting service

      4) rescuers of emergency rescue service;

      5) members of air, water and railway transport crews;

      6) drivers of all types of public vehicles;

      7) employees of departmental and private security providers;

      8) employees of educational organizations (teachers of all types of educational institutions, employees of preschool and educational institutions);

      9) employees of hazardous productional facilities;

      10) employees of healthcare organizations, without medical education.

      9. Training the employees of an organization (enterprise) in providing first aid to the injured person shall be ensured by the employer in accordance with these Rules.

      10. newly employed persons shall pass the first aid training within the time limits, established by the employer (or his/her authorized person), but no later than one month after the admission to work.

      11. The training shall be carried out in a specialized training center that have appropriate license or the employer shall organize the onsite training cycle.

      12. Training the persons without medical education in first aid skills shall be carried out with periodicity of once every 3 years.

      13. Training in the first aid skills shall be carried out at the expense of the budget, funds of the employer or own funds of the citizens of the Republic of Kazakhstan.

      14. A person providing first aid shall carry out the following activities to assess the situation and ensure a safe environment for first aid:

      1) identification of threatening factors for one's own life and health;

      2) identification of threatening factors for the life and health of the injured person;

      3) elimination of threatening factors to life and health;

      4) termination of the action of damaging factors on the injured person;

      5) assessment of the number of the injured person;

      6) transportation of the injured person.

      15. A person providing first aid shall assess the condition of the injured person according to the following criteria:

      1) checking up the presence of life-threatening bleeding;

      2) checking up consciousness;

      3) checking up breathing.

      16. A person providing first aid shall call the ambulance by number 103 and if necessary, other emergency response services by number 112 and transmits the following data from the words of the injured person:

      1) surname, name, patronymic (if any), age and sex of the injured person;

      2) data on the condition of the injured person and circumstances of the accident, injury or disease;

      3) address and telephone, as well as the orientation data on travel directions to the location of the injured person.

  Appendix 1
to the Rules for provision of
first aid by persons without
medical education, including
those appropriately trained

List of conditions for providing first aid

      Unconsciousness;

      2. cessation of breathing and blood circulation;

      3. external bleeding;

      4. foreign bodies of the upper respiratory tract;

      5. injury to various areas of the body;

      6. burns, effects of exposure to high temperatures, heat radiation;

      7. frostbite and other effects of exposure to low temperatures;

      8. poisoning;

      9.convulsions;

      10. bites.

  Appendix 2
to the Rules for provision of
first aid by persons without
medical education, including
those appropriately trained

List of simulation equipment for training in the first aid skills

      1. Stretcher (soft, hard);

      2. cervical corset;

      3. hemostatic tourniquets (several types to compare actions when applied);

      4. foreign bodies of the upper respiratory tract;

      5. Protective mask with a non-return valve for artificial ventilation of the lungs;

      6. foldable tires;

      7. hypothermic packages;

      8. first aid kits for studying the contents and practicing actions for its use.

  Appendix 2
to the order

First Aid Standard

Chapter 1. General Provisions

      1. This First Aid Standard (hereinafter referred to as the Standard) have been developed in accordance with clause 6 of article 90 of the Code of the Republic of Kazakhstan dated July 7, 2020 "On Public Health and Healthcare System".

      2. This Standard establishes the requirements for measures on provision of first aid in the Republic of Kazakhstan.

Chapter 2. Measures on provision of first aid

      3. Positioning the injured person in a recovery (lateral) position:

      1) in the presence of breathing, put him/her to the recovery (lateral) position:

      take off glasses (if he/she wears them);

      kneel next to the injured person, while the injured person's legs should be straight;

      put his/her hand, which is closer to you, at a right angle to the body, bend at the elbow, palm up;

      put the far hand across the chest, and put the back of the hand on the injured person's cheek as close to the floor (ground);

      with the other hand, take the far leg above the knee and lift it up, while the foot should remain on the floor (on the ground);

      holding the brush near the cheek, press on the far leg to turn the injured person onto its side towards you;

      adjust the upper leg so that the thigh and knee are bent at right angles;

      tilt the head back so that the airways are open;

      regularly check breathing, until the arrival of the ambulance team (hereinafter referred to as the ambulance);

      2) do not leave the injured person unattended and monitor his/her condition until the arrival of the emergency service 103 (112).

      4. Cardiopulmonary resuscitation:

      1) if the injured person is found unconscious and without breathing, take measures to eliminate the hazard, call the emergency service 103 (112) and start performing chest compressions continuously until it arrives;

      2) if the injured person adult is over 12 years old, make 30 pressure on the center of the chest with your hands (with the base of one palm, covering it with the other palm on top) to a depth of 5-6 cm and 2 blows into the mouth (if no blows are carried out, then press without interruption), continuously continue pressing and blowing until the arrival of the ambulance. Continue pressing and blowing until the first signs of life appear;

      3) if the injured child (from 1 to 12 years old), make 5 blows, clasping the injured child's mouth with the lips, the duration of one blowing into the mouth for one second, 30 pressing on the center of the chest to a depth of 4-5 cm (pressing with one hand) and 2 blowing. Continue pressing and blowing until the first signs of life appear;

      4) if the injured person is an infant (from 0 to 12 months), make 5 blows, clasping the injured infant's mouth and nose at the same time, 30 pressures on the center of the chest to a depth of one third of the chest with two fingers and 2 blows, clasping the injured infant's mouth and nose at the same time. Continue pressing and blowing until the first signs of life appear;

      5. If there is a foreign body in the airway:

      1) the injured person choked, if he/she can speak (coughing, crying), then the cough should be encouraged, not disturbed, not hit on the back, monitor the injured person's condition until the arrival of the ambulance;

      2) if the injured person cannot speak, there is a cough, crying, then it is necessary to inflict up to five sliding blows with the hand in the interscapular region;

      3) if the injured person is a pregnant woman or a person with a large belly:

      hold five pressure on the center of the chest with your hands;

      if it does not help, repeat the blows to the interscapular region;

      monitor the condition of the injured person until the arrival of the ambulance;

      stand behind the injured person, wrap your arms around him/her;

      clench one of the hands into a fist and press from the side of the thumb to the stomach, between the navel and the chest;

      put the second palm on the fist;

      make sharp strong pushes in the stomach;

      five thrusts to the abdomen, then five blows to the back until coughing appears;

      4) if the injured person has lost consciousness, carry out basic resuscitation measures.

      6. Basic resuscitation:

      1) if the injured person is found unconscious, but with the presence of breathing, take measures to eliminate the hazard, transfer the injured person to a recovery position and call the emergency service 103 (112), monitoring the condition of the injured person;

      2) if the injured person is found unconscious and breathless, take measures to eliminate the hazard, call the emergency service 103 (112) and until its arrival start performing the chest compressions continuously;

      3) to increase the injured person's survival and restore cardiac activity, if possible, use an automatic defibrillator with a quality control sensor for chest compressions built into the electrodes, intended for persons without medical education;

      4) when restoring breathing and cardiac activity, transfer the injured person to a recovery (lateral) position;

      5) do not leave the injured person unaccompanied and monitor his/her condition until the arrival of the emergency service 103 (112).

      7. In case of external bleeding:

      1) call 103 (112);

      2) In case of head bleeding:

      apply a pressure bandage from available means (bandage) in several layers;

      seat the injured person in a comfortable position;

      3) in case of nasal bleeding:

      squeeze the wings of the nose with your fingers for 10-15 minutes;

      apply a cold compress to the bridge of the nose through a towel;

      don't throw the head back;

      don't blow the nose and lie down;

      4) in case of neck bleeding:

      quickly press the bleeding place with your fingers;

      apply a bandage from available means (bandage) in several layers, press it with your hands;

      press it until the arrival of the ambulance;

      5) in case of abdomen, chest bleeding:

      apply a bandage from available means (bandage) in several layers;

      if there are foreign objects in the chest or abdominal wall - do not touch or try to remove them;

      6) in case of a bleeding limb:

      use a trouser belt, a belt from a bag, a tie, fabric as a tourniquet;

      apply a tourniquet above the bleeding site;

      insert a short stick under the fabric, screw it in 2-3 turns until the bleeding stops;

      apply a pressure bandage from available tools in several layers.

      8. In case of an injury:

      1) in case if the injured person is in a safe location, if he/she is conscious and breathes, call 103 (112);

      2) determine the type of the injury: open or closed:

      In case of a closed injury:

      1) apply a cold compress to the damaged area through the fabric for 10-15 minutes;

      2) fix the limb using available means;

      3) put the injured person to a comfortable position;

      4) monitor the condition of the injured person until the ambulance arrives;

      In case of an open injury:

      1) when bleeding, rinse the wound with clear water;

      2) apply a bandage from available means (bandage), in several layers;

      3) fix the limb using available means;

      4) put the injured person to a comfortable position;

      5) monitor the condition of the injured person until the ambulance arrives.

      In case of spinal injury, it is necessary to fix the head in line with the body, all the time holding it with your hands.

      If there are foreign objects in the chest or abdominal part of the victim's body, if there is an injury to the chest / abdomen, do not touch or try to remove them.

      In case if the internal organs are visible during injuries, cover with a damp cloth, then with polyethylene, apply a tight bandage from available tools.

      In case of prolonged bleeding, apply a tourniquet above the bleeding site using available means (trouser belt, bag belt, tie, cloth).

      If there is a fracture, fix the injured person in the initial position until the arrival of the ambulance.

      9. Transportation of the injured person:

      1) if the victim is unconscious, transported in a recovery (lateral) position;

      2) for head and neck injuries - on the back with rollers around the head and with a soft roller under the neck;

      3) with a spinal injury - on a hard stretcher on the back with rollers under the neck, lower back and under the knees or on a soft stretcher - on the stomach;

      4) in case of chest injury - half-sitting with a bolster under the knees or in a recovery (lateral) position on the injured side;

      5) in case of abdominal injury - in a recovery (lateral) position;

      6) with a pelvic injury - on the back with a roller under the knees and slightly spread legs.

      If the injured person is found unconscious and breathless, perform basic resuscitation activities and call 103 (112).

      10. in case of a thermal burn:

      1) take measures to eliminate the hazard, if impossible – call 103 (112);

      2) the injured is conscious, with breathing and unconscious, without breathing – basic resuscitation until the arrival of the ambulance, call 103 (112);

      3) identify damage to the skin of the injured person:

      In case of formation of a grey or black scab of the skin, perform:

      cutting off clothing around the edge of the burn wound;

      applying a wide, clean and moist bandage to the wound;

      use a plastic bag to preserve the moisture of the bandage;

      if there is redness, swelling and blistering:

      cooling with cold water for at least 15 minutes;

      cutting off clothing around the edge of the burn wound;

      applying a wide, clean and moist bandage to the wound;

      ensure that the injured person is in a comfortable position;

      monitor the condition of the injured person until the ambulance arrives.

      11. In case of frostbite:

      if the injured person is conscious and with breathing, call 103 (112), if the injured person is unconscious and without breathing – perform basic resuscitation and call 103 (112);

      move the injured person to a warm premise;

      gently remove clothing and shoes from the affected area;

      give a warm drink;

      warm the affected part of the body gradually;

      apply a bandage from available tools to the affected areas of the body;

      monitor the condition of the injured person until the arrival of the ambulance;

      it is prohibited to massage the affected areas of the body, to rub in ointments, oils, alcohol;

      it is prohibited to apply to the affected areas of the body hot items (a hot water bottle, heater and others);

      it is prohibited to drink alcohol beverages.

      12. In case of poisoning, depending on the route of ingestion of the poison:

      1) if the injured person is conscious and with breathing, call 103 (112), if the injured person is unconscious and without breathing – perform basic resuscitation and call 103 (112), monitor the condition of the injured person until the ambulance arrives;

      2) in case of ingestion of poison into the injured person's body through the mouth:

      give a lot of water to drink;

      to a recovery lateral position (so as not to be choked by vomiting matters);

      monitor the condition of the injured person until the arrival of the ambulance;

      3) in case if the poison enters the injury person's body through the respiratory tract:

      Get the injured person to a clean air in a safe place;

      Ensure comfortable position;

      Release from hampering clothing;

      monitor the condition of the injured person until the arrival of the ambulance;

      4) in case of poisoning the injured person's body through the skin and mucous surfaces:

      clean the surface of the skin of the mucous surface from the toxic substance with improvised means (bandage);

      rinse the skin, mucous surface with water;

      monitor the condition of the injured person until the arrival of the ambulance.

      In all cases, do not induce vomiting and do not give laxatives in case of poisoning with oil products, acids, alkali.

      If necessary, take adsorbent drugs (activated carbon and other).

      13. In case of fainting:

      If the injured person breathes, call 103 (112), if he/she doesn’t breath, perform basic resuscitation, call 103 (112);

      lay on the back and raise legs;

      unfasten the tight parts of the clothing;

      provide an influx of fresh air;

      wipe the injured person's face with cool water or put a wet towel on the forehead;

      in the presence of vomiting, turn his/her head to one side or transfer to a restorative lateral position (so as not to be choked by vomiting matters);

      do not lift the injured person to an upright position;

      monitor the condition of the injured person until the arrival of the ambulance.

      14. In case of a pain in the chest:

      if there is a strong, burning, chest pain that radiates to the arm or neck:

      call 103 (112);

      if necessary, stop physical activities;

      make the injured person to seat in a comfortable position;

      unbutton tight clothes;

      monitor the condition of the injured person until the arrival of the ambulance (if necessary, perform basic resuscitation);

      15. In case of a convulsion:

      In case if an injured person with convulsions is found, call 103 (112);

      do not try to stop the attack or forcibly restrain the injured person;

      remove nearby objects that may cause injury;

      put a soft pillow under your head (any means at hand).

      If the convulsions have stopped, the injured person is conscious:

      avoid sudden movements from the injured person;

      monitor the condition of the injured person until the arrival of the ambulance.

      If the convulsions have not stopped, the victim is unconscious, but breathes:

      Put him/her to the recovery (lateral) position;

      monitor the condition of the injured person until the arrival of the ambulance.

      If the convulsions have not stopped, the injured person is unconscious and there is no breathing, basic resuscitation is performed until the arrival of the ambulance.

      16. In case of biting:

      1) take measures to eliminate hazard, if impossible – call 103 (112);

      2) if, upon finding an injured person, the place is safe for provision of first aid:

      injured person is conscious and with breathing – call 103 (112);

      3) identify the bite on the body of the injured person;

      4) if bleeding is detected: rinse the wound with water, apply a pressure bandage from available tools (bandage), monitor the condition of the injured person until the arrival of the ambulance;

      5) in the absence of bleeding: rinse the wound with water, apply cold to the bite site, monitor the condition of the injured person until the arrival of the ambulance;

      6) for poisonous snake bites, do not suck out the poison, make an incision or use tourniquets;

      7) in places where wasps / bees bite, remove the sting carefully;

      8) in case of edema at the site of the bite, apply a cold compress.

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