ORDER OF THE MINISTRY OF HEALTH AND SOCIAL DEVELOPMENT OF THE RUSSIAN FEDERATION

of April 24, 2008 No. 194n

About approval of Medical criteria of determination of severity of the harm done to health of the person

According to Item 3 of Rules of determination of severity of the harm done to health of the person, N522 approved by the order of the Government of the Russian Federation of August 17, 2007 (The Russian Federation Code, 2007, N 35, to the Art. 4308), I order:

Approve Medical criteria of determination of severity of the harm done to health of the person according to appendix.

 

Appendix

to the order of the Ministry of Health and Social Development of the Russian Federation of April 24, 2008 No. 194n

Medical criteria of determination of severity of the harm done to health of the person

I. General provisions

1. These Medical criteria of determination of severity of the harm done to health of the person (further - Medical criteria), N522 "About Approval of Rules of Determination of Severity of the Harm Done to Health of the Person" are developed according to the order of the Government of the Russian Federation of August 17, 2007 (further - Rules).

2. Medical criteria are the medical characteristic of the qualifying signs which are used for determination of severity of the harm done to health of the person in case of production of forensic medical examination in civil, administrative and criminal trial based on determination of court, the judge's ruling, person making inquiry, the investigator.

3. Medical criteria are used for assessment of the damages found in case of medicolegal inspection of living person, research of corpse and its parts, and also in case of production of forensic medical examinations according to case papers and medical documents.

4. Severity of the harm done to health of the person is determined according to Rules and Medical criteria the doctor - the forensic scientist of medical institution or the individual entrepreneur having special knowledge and having the license for implementation of medical activities, including works (services) in forensic medical examination (further - the expert), attracted to examination production according to the procedure, established by the legislation of the Russian Federation.

5. The harm done to health of the person is understood as violation of anatomic integrity and physiological function of bodies and tissues of the person as a result of impact of physical, chemical, biological and psychogenic factors external среды*.

II. Medical criteria of the qualifying signs of weight of harm to health

6. Medical criteria of the qualifying signs concerning severe harm to health are:

6.1. Harm to health life-threatening the person who in character directly creates threat for life, and also the harm to health which caused development of life-threatening condition (further - harm to health, life-threatening the person).

Harm to health, life-threatening the person, creating directly threat for life:

6.1.1. the wound of the head (hairy part, century and okologlaznichny area, nose, ear, cheek and temporal and mandibular area, other areas of the head) getting into skull cavity including without injury of brain;

6.1.2. code change (frontal, parietal bones) and (or) skull bases: cranial pole (front, average or back) either occipital bone, or the upper wall of eye-socket, or trellised bone, or wedge-shaped bone, or temporal bone, the crack of outside bone plate of the code of skull and fractures of facial bones except for isolated: nose, lower wall of eye-socket, plaintive stone, malar bone, upper jaw, alveolar shoot, palatal bone, lower jaw;

6.1.3. intracranial injury: brain substance crush; diffusion axonal injury of brain; bruise of brain of heavy degree; traumatic intracerebral or intra ventricular hemorrhage; bruise of brain of average degree either traumatic epidural, or subdural, or subarachnoidal hemorrhage in the presence of all-brain, focal and trunk symptoms;

6.1.4. the wound of neck getting into gleam of throat or throat, either cervical department of trachea, or cervical department of gullet; wound of thyroid gland;

6.1.5. fracture of cartilages of throat: thyroid or cricoid, either arytenoid, or nadgortanny, or corniculatus, or trakhealny cartilages;

6.1.6. change of cervical department of backbone: fracture of body or bilateral change of arch of cervical vertebra, either fracture of tooth of the II cervical vertebra, or unilateral change of arch of I or II cervical vertebrae, or multiple fractures of cervical vertebrae, including without dysfunction of spinal cord;

6.1.7. dislocation of one or several cervical vertebrae; traumatic gap of intervertebral disk at the level of cervical department of backbone with sdavleniye of spinal cord;

6.1.8. bruise of cervical department of spinal cord with violation of its function;

6.1.9. the wound of thorax getting into pleural cavity or into pericardium cavity or in sredosteniye cellulose, including without internal injury;

6.1.10. the closed damage (crush, separation, gap) of bodies of chest cavity: heart or lung, either bronchial tubes, or chest department of trachea; traumatic haemo pericardium or pheumothorax, either haemo thorax, or haemo pheumothorax; diaphragm or lymphatic chest channel, or thymus;

6.1.11. multiple bilateral fractures of edges with violation of anatomic integrity of framework of thorax or multiple unilateral fractures of edges on two and more anatomic lines with formation of the mobile site of chest wall as "the costal valve";

6.1.12. change of chest department of backbone: fracture of body or arch of one chest vertebra with dysfunction of spinal cord, or several chest vertebrae;

6.1.13. dislocation of chest vertebra; traumatic gap of intervertebral disk in chest department with sdavleniye of spinal cord;

6.1.14. bruise of chest department of spinal cord with violation of its function;

6.1.15. the wound of stomach getting into abdominal cavity including without internal injury;

6.1.16. the closed damage (crush, separation, gap): abdominal organs - spleen or liver, or (and) gall bladder, either pancreas, or stomach, or small intestine, or colonic gut, or rectum, or big epiploon, or mesentery of thick and (or) small intestine; bodies zabryushinny prostranstvapochka, adrenal gland, mochetochnik;

6.1.17. the wound of lower back and (or) basin getting into zabryushinny space with damage of bodies of zabryushinny space: kidney or adrenal gland, either mochetochnik, or the pancreas or which is descending and horizontal part of duodenum, or the ascending and descending colonic gut;

6.1.18. change of lumbar and sacral department of backbone: bodies or arches of one or several lumbar and (or) sacral vertebrae with syndrome of "horse tail";

6.1.19. dislocation of lumbar vertebra; traumatic gap of intervertebral disk in lumbar, lumbar and sacral department with syndrome of "horse tail";

6.1.20. bruise of lumbar department of spinal cord with syndrome of "horse tail";

6.1.21. damage (crush, separation, gap) of pelvic bodies: the opened and (or) closed injury of bladder or webby part of urethra, either ovary, or uterine (fallopian) tube, or uterus, or other pelvic bodies (prostate gland, seed bubbles, seminiferous channel);

6.1.22. the wound of wall of vagina or rectum, or crotch getting into cavity and (or) cellulose of small pelvis;

6.1.23. bilateral changes of front pelvic half ring with violation of continuity: fractures of both pubic and both sciatic bones like "butterfly"; fractures of bones of basin with violation of continuity of pelvic ring in back department: vertical changes of sacrum, podvzdoshny bone, the isolated gaps sacral подвздошного joints; fractures of bones of basin with violation of continuity of pelvic ring in front and back departments: unilateral and bilateral vertical changes of front and back departments of basin on one party (change Malgenya); diagonal changes - vertical changes in front and back departments of basin on counter parties (Vollyumye's change); different combinations of fractures of bones and gaps of joints of basin in front and back departments;

6.1.24. the wound getting into the vertebral canal cervical or chest, either lumbar, or sacral department of backbone including without injury of spinal cord and "horse tail";

6.1.25. the opened or closed injury of spinal cord: complete or incomplete break of spinal cord; crush of spinal cord;

6.1.26. injury (gap, separation, section, traumatic aneurism) of large blood vessels: aorta or carotid (general, outside, internal), either subclavial, or axillary, or humeral, or podvzdoshny (general, outside, internal), either femoral, or subnodal arteries and (or) the main veins accompanying them;

6.1.27. stupid injury of reflexogenic zones: areas of throat, area of carotid sine, areas of solar plexus, area of genitalia in the presence of clinical and morphological data;

6.1.28. thermal or chemical, either the electric, or beam burns of the III-IV degree exceeding 10% of surface of body; the burns of III degree exceeding 15% of surface of body; the burns of the II degree exceeding 20% of surface of body; the burns of the smaller area which were followed by development of burn disease; burns of airways with the phenomena of hypostasis and narrowing of glottis;

6.1.29. freezing injuries of the III-IV degree with the area of defeat exceeding 10% of surface of body; freezing injuries of III degree with the area of defeat exceeding 15% of surface of body; freezing injuries of the II degree with the area of defeat exceeding 20% of surface of body;

6.1.30. the radiation injuries which are shown serious sharp radiation illness and extremely heavy degree.

6.2. Harm to health, life-threatening the person, caused disorder of the vital functions of human body which cannot be compensated by organism independently and usually comes to an end with death (further - life-threatening condition):

6.2.1. shock of heavy (III-IV) degree;

6.2.2. coma of II-III degree of different etiology;

6.2.3. sharp, plentiful or massive blood losses;

6.2.4. sharp heart and (or) vascular failure of heavy degree, or heavy extent of violation of brain blood circulation;

6.2.5. sharp kidney or sharp hepatic, either sharp nadpochechnikovy insufficiency of heavy degree, or sharp панкреонекроз;

6.2.6. sharp respiratory insufficiency of heavy degree;

6.2.7. it is purulent - septic condition: sepsis or peritonitis, either purulent pleurisy, or phlegmon;

6.2.8. the disorder of regional and (or) organ blood circulation leading to heart attack of internal body or gangrene of extremity; embolism (gas, fatty, fabric, or thrombembolia) vessels of brain or lungs;

6.2.9. sharp poisoning with chemical and biological substances of medical and not medical application, including drugs or psychotropic drugs, either sleeping medicines, or the medicines operating mainly on cardiovascular system or alcohol and its substitutes, either technical liquids, or toxic metals, or toxic gases, or the food poisoning which caused the life-threatening condition given in Items 6.2.1-6.2.8 of Medical criteria;

6.2.10. different types of mechanical asphyxia; effects of general impact of high or low temperature (heatstroke, sunstroke, general overheating, overcooling of organism); effects of impact of high or low atmospheric pressure (barotrauma, lacunar disease); effects of impact of technical or atmospheric electricity (electric trauma); effects of other forms of adverse effect (dehydration, depletion, organism overstrain) which caused the life-threatening condition given in Items 6.2.1-6.2.8 of Medical criteria.

6.3. Sight loss - total persistent blindness on both eyes or such irreversible condition when as a result of injury, poisoning or other external impact the person had deterioration in sight that corresponds to the visual acuity equal to 0,04 below.

Loss of sight on one eye is estimated on the basis of permanent loss of general working capacity.

Post-traumatic removal of one eyeball which had sight to injury is also estimated on the basis of permanent loss of general working capacity.

Determination of severity of the harm done to health of the person as a result of loss of blind eye is carried out on the basis of duration of disorder of health.

6.4. Loss of the speech - irreversible loss of capability to express thoughts the articulate sounds clear for people around.

6.5. Hearing loss - complete persistent deafness on both ears or such irreversible condition when the person does not hear informal conversation at distance of 3-5 cm from auricle.

Loss of hearing on one ear is estimated on the basis of permanent loss of general working capacity.

6.6. Loss of any body or loss of its functions by body:

6.6.1. loss of hand or leg, i.e. their department from trunk or permanent loss of functions by them (paralysis or other condition excluding their functions); loss of brush or foot is equated to loss of hand or leg;

6.6.2. the loss of productive capability which is expressed at men in capability to copulation or fertilization at women - in capability to copulation or conception, either incubation, or child-bearing;

6.6.3. loss of one small egg.

6.7. Termination of pregnancy - the termination of course of pregnancy irrespective of term caused by damage suffered to health, with development of abortion, pre-natal death of fruit, premature birth or caused need of medical intervention.

Termination of pregnancy as a result of diseases of mother and fruit shall be in direct cause and effect relationship with damage suffered to health and shall not be caused by specific features of organism of the woman and fruit (diseases, pathological conditions) which were available before damnification to health.

If the external reasons caused need of termination of pregnancy by medical intervention (uterus scraping, Cesarean section and other), then these damages and the come effects are equated to termination of pregnancy and estimated as severe harm to health.

6.8. Mental disturbance which emergence shall be in cause and effect relationship with damage suffered to health i.e. to be its effect.

6.9. Disease of drug addiction or toxicomania

6.10. Indelible disfiguration of person

Severity of the harm done to health of the person expressed in indelible disfiguration of his face is determined by court.

Production of forensic medical examination is limited only to establishment of indelibility of this damage, and also its medical effects according to Medical criteria.

It is necessary to understand such injuries of face which do not disappear independently eventually (without surgical elimination of hems, deformations, violations of mimicry and other, or under the influence of not surgical methods) as indelible changes and their elimination requires surgery (for example, cosmetic transaction).

6.11. Considerable permanent loss of general working capacity on one third at least (permanent loss of general working capacity over 30 percent).

To the severe harm of health causing considerable permanent loss of general working capacity on one third at least irrespective of outcome and rendering (non-rendering) medical care, refer the following damages:

6.11.1. the opened or closed fracture of humeral bone: intra joint (shoulder heads) or circumarticular (anatomic neck, under - and chrezbugorkovy), or surgical neck or diaphysis of humeral bone;

6.11.2. the opened or closed fracture of the bones constituting elbow joint;

6.11.3. the opened or closed fracture dislocation of bones of forearm: change elbow in the upper or average third with dislocation of head of beam bone (fracture dislocation Montedzha) or fracture of beam bone in the lower third with dislocation of head of elbow bone (fracture dislocation Galeazzi);

6.11.4. the opened or closed change of acetabular hollow with shift;

6.11.5. the opened or closed change of proximal department of femur: intra joint (change of head and neck of hip) or extraarticular (intertrochanteric, chrezvertelny changes), the change of big and small spits except for isolated;

6.11.6. the opened or closed femur diaphysis change;

6.11.7. the opened or closed fracture of the bones constituting knee joint, except for patella;

6.11.8. the opened or closed change of diaphysis of tibial bone;

6.11.9. the opened or closed fracture of anklebones of both tibial bones in combination with change of joint surface of tibial bone and gap of distal intertibial sindesmoz with incomplete dislocation and dislocation of foot;

6.11.10. compression fracture of two and more adjacent vertebras of chest or lumbar department of backbone without dysfunction of spinal cord and pelvic bodies;

6.11.11. open dislocation of shoulder or forearm, either brushes, or hip, or shin, or foot with gap of the copular device and capsule of joint.

Permanent loss of general working capacity in other cases is determined as a percentage, multiple to five, according to the Table of percent of permanent loss of the general working capacity as a result of different injuries, poisonings and other effects of impact of the external reasons attached to these Medical criteria.

6.12. Complete loss of professional working capacity

Professional working capacity is connected with possibility of accomplishment of certain amount and quality of work on specific profession (specialty) by which the main labor activity is performed.

Extent of loss of professional working capacity is determined according to Rules of establishment of extent of loss of professional working capacity as a result of labor accidents and occupational diseases approved by the order of the Government of the Russian Federation of October 16, 2000 N 789 (The Russian Federation Code, 2000, N 43, the Art. 4247).

7. Medical criteria of the qualifying signs concerning average weight of harm to health, are:

7.1. Temporary violation of functions of bodies and (or) systems (temporary disability) lasting over three weeks (more than 21 day) (further - long disorder of health).

7.2 Considerable permanent loss of general working capacity less than on one third - permanent loss of general working capacity from 10 to 30 percent inclusive.

8. Medical criteria of the qualifying signs concerning little harm to health are:

8.1 Temporary violation of functions of bodies and (or) systems (temporary disability) duration up to three weeks from the moment of causing injury (up to 21 days inclusive) (further - short-term disorder of health).

8.2 Insignificant permanent loss of general trudosposobnostistoyky loss of general working capacity less than 10 percent.

9. Superficial damages, including: the graze, bruise, the bruise of soft fabrics including bruise and hematoma, the superficial wound and other damages which are not involving short-term disorder of health or insignificant permanent loss of general working capacity are regarded as the damages which did not do harm to health of the person.

III. Final provisions

10. For determination of severity of the harm done to health of the person availability of one Medical criterion suffices.

11. With several Medical criteria weight of the harm done to health of the person is determined by that criterion which corresponds to bigger severity of harm.

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