Criteria for determining the severity of health. Forensic medical examination of living persons. Determination of the severity of harm to health. Concept, signs and types of harm to health

When imposing a punishment after committing a violation that led to harm to the victim, medical criteria for determining the severity of harm to health are taken into account. Usually, they apply to living citizens. However, they can be used in the implementation of other examinations.

general information

People often suffer in accidents. Causing damage leads to trouble not only for the victims, but also implies the responsibility of the driver. In order to determine it, the judge will take into account the material and moral damage caused. And also, the health of the injured person after the accident is taken into account. There are many criteria that lead to serious road accidents:

drunk driving;
driving a faulty car;
inattention of the person driving the machine;
and others like that.

Every trip, a motorist with the above criteria, runs the risk of harming the people around him. And only he is the culprit of the accident on the road, if it occurs. The answer, accordingly, will also be the guilty motorist. He will not only have to be punished, but also to compensate for the damage, including moral.

Damage inflicted on a person, leading to injuries, is equated with an attempt on the victim's health. Resulting in the damage caused is assessed by categories of severity, established based on the results of the expert examination... In total, there are three categories of the severity of the harm done.

In the presence of visible signs of a certain category of severity, it is still required to carry out a special examination. Only she can establish the final group of gravity of the harm inflicted on the injured person.

Forensic medical examination is carried out without fail in the presence of such factors:

determination of the cause of death;
the need to establish the category of harm caused;
if there are doubts about the sanity of the guilty person, an examination of his psychological state is carried out;
presence of addiction to drugs;
checking the state of the victim himself, whether he can adequately testify.

whether injuries led to death;
the possible duration of the victim's illness;
the degree of disability;
direct category of severity.

The categories of severity, as well as how to define them, described in the rules, are established exclusively at the legislative level. You can't just look at the injuries and establish the grade. For this, an expert examination is required.

After conducting an examination, the specialist determines the nosological unit. It is formed based on the condition of the injured person and the damage inflicted on him.

The main criteria that are taken to determine the severity of damage are:

the impact of trauma on general human activity;
time spent in a mutilated state;
whether there is organ loss;
if there is no way to continue to work.

Each of the listed factors influences the category of the severity of the harm caused as a result of the accident.

With this unit, manifestations of severity are determined and compared.

The expert conducting the examination is guided by the rules:

In order to determine the category of damage, one of the qualifying indicators will suffice. When a number of signs are present, the harm is considered more severe.
The moment of causing direct damage is taken into account. When harm occurs at different times, it is assessed individually and not summed up. If they gave a big trauma in the complex, they are considered in place.
The operation that prevented the fatal outcome is not taken into account for determining the severity group. The category of severity is determined by the fact of direct injury by the violator of the law prior to surgery.

Order of the Ministry of Health and Social Development 194N dated 04.24.2008 establishes individual criteria for determining the severity group. It is on this document that experts rely, I establish the category of damage to human health in accidents.

Classification

Let's analyze the types of injuries belonging to each degree of severity:

Harm	Description	Groups, signs
Serious harm to health	There is one or a number of manifestations:	life-threatening injuries; death is possible; disability.
	Life-threatening consequences:	complex injuries; open fractures of the limbs; rupture of organs; great blood loss; purulent wounds; other life-threatening injuries.
	Severe but not fatal injuries:	loss of ear and eye function; lost speech function; mental disorders due to trauma; loss of the fetus; skin damage that has left scars; loss of working capacity by at least thirty percent.
Moderate severity	No threat to human life	twenty-one day harm; body functions are temporarily knocked down; the ability to work is lost less than 30%.
Light harm to health	There are only two factors in determining this degree of severity of the damage caused:	subsequently, the victim is ill for less than twenty-one days; the ability to work is lost no more than ten percent.

Scratches and bruises, which did not cause much damage, cannot be attributed to harm to health.

The objects of forensic medical examination can be: a living person, a corpse, as well as case materials provided to a specialist. Exceptionally comprehensive medical documentation will be accepted, which provides comprehensive information about the nature of the damage.

A responsibility

After carrying out a forensic examination and establishing the degree of harm, the type and term of punishment is issued. Compensation for damage caused is also possible. If the guilty person independently expresses a desire to help the victim, his punishment can be mitigated.

Consider the punishments applied to the guilty person who harmed the victim in the form of a table:

The degree of harm	Description of violation	Punishment
Severe damage	The death of the victim through negligence of the guilty person.	forced labor up to 4 years; the inability to engage in a certain type of activity for up to 3 years; imprisonment - 5 years.
	The offender was under the influence of alcohol.	arrest up to 7 years; deprivation of the opportunity to hold certain positions - 3 years.
	Death by negligence of two or more people. The culprit was drunk.	imprisonment up to 9 years; forced labor up to 5 years.
Average harm	The degree of responsibility depends on the degree of disability.	sanction from 10 to 25 thousand rubles. cancellation of a driver's license from 1.5 to 2 years.
Light harm	The most loyal types of punishment.	sanction from 2.5 to 5 thousand rubles; revocation of driving license - from 1 to 1.5 years.

As can be seen from the spreadsheet document, the amount and type of punishment is directly related to the degree of damage caused to the victim.

In the event of harm, the perpetrator must pay compensation to the injured party. To do this, the injured party collects a certain package of documentation:

accident certificate;
papers from work, confirming the fact and amount of lost income;
papers confirming the actual costs;
expert opinions on disability.

When establishing the amount of compensation, the court takes into account the following factors:

complete loss of income;
reimbursement of expenses.

There is a possibility of getting moral harm. This includes the moral and physical suffering of the victim, which makes his condition even worse. Moral damages are paid in separate amounts. Its size depends on the category of the severity of the damage caused.

Video: In medical forensic expert on the severity of harm to health

Accidents often occur in which people suffer. The injured person can claim moral damage. In addition, he is entitled to compensation for the funds spent on treatment and the lost opportunity to work during recovery. The punishment for the guilty person will also be imposed on the basis of the degree of harm caused to the victim's health.

Registration number 12118

In accordance with paragraph 3 of the Rules for determining the severity of harm caused to human health, approved by the Government of the Russian Federation of August 17, 2007 No. 522 (Collected Legislation of the Russian Federation, 2007, No. 35, Art. 4308), I order:

Approve the Medical criteria for determining the severity of harm caused to human health, according to the appendix.

MEDICAL CRITERIA FOR DETERMINING THE DEGREE

THE SEVERITY OF HUMAN HEALTH INJURY

I. General Provisions

1. These Medical criteria for determining the severity of harm caused to human health (hereinafter referred to as the Medical criteria) were developed in accordance with the Decree of the Government of the Russian Federation dated August 17, 2007 No. 522 "On approval of the Rules for determining the severity of harm caused to human health" ( hereinafter referred to as the Rules).

2. Medical criteria are medical characteristics of qualifying signs that are used to determine the severity of harm caused to human health in the course of forensic medical examination in civil, administrative and criminal proceedings on the basis of a court ruling, a decision of a judge, a person conducting an inquiry,

investigator.

3. Medical criteria are used to assess injuries found during a forensic examination of a living person, examination of a corpse and its parts, as well as in the production of forensic medical examinations based on case materials and medical documents.

4. The severity of the harm , human health , is determined in medical institutions of the state health care system by a doctor - a forensic medical expert, and in his absence - by a doctor of another specialty (hereinafter - an expert) involved in the examination, in the manner prescribed by the legislation of the Russian Federation, and in accordance with the Rules and Medical Criteria.

5. Under the harm done to human health , is understood as a violation of the anatomical integrity and physiological function of human organs and tissues as a result of exposure to physical, chemical, biological and psychogenic factors of the external environment.

II. Medical criteria for qualifying signs of severity

harm to health

6. The medical criteria for qualifying signs in relation to serious harm to health are:

6.1.Harm to health, dangerous to human life, which by its nature directly poses a threat to life, as well as harm to health that caused the development of a life-threatening condition (hereinafter referred to as harm to health, dangerous to human life).

Harm to health, dangerous to human life, creating

directly life-threatening:

6.1.1 a head wound (scalp, eyelid and periorbital region, nose, ear, cheek and temporomandibular region, other areas of the head) penetrating into the cranial cavity, including without damage to the brain;

6.1.2 fracture of the fornix (frontal, parietal bones) and (or) the base of the skull: the cranial fossa (anterior, middle or posterior) or the occipital bone, or the upper wall of the orbit, or the ethmoid bone, or the sphenoid bone, or the temporal bone, except isolated cracks in the outer bone plate of the cranial vault and fractures of the facial bones: nose, lower wall of the orbit, lacrimal bone, zygomatic bone, upper jaw, alveolar ridge, palatine bone, lower jaw;

6.1.3 intracranial injury: crushing of the substance of the brain; diffuse axonal brain damage; severe brain contusion; traumatic intracerebral or intraventricular hemorrhage; cerebral contusion of moderate degree or traumatic epidural, or subdural, or subarachnoid hemorrhage in the presence of cerebral, focal and stem symptoms;

6.1.4 a neck wound that penetrates the lumen of the pharynx or larynx, or the cervical trachea, or the cervical esophagus; injury to the thyroid gland;

6.1.5 fracture of the cartilage of the larynx: thyroid or cricoid, or arytenoid, or epiglottis, or horn-shaped, or tracheal cartilage;

6.1.6 fracture of the cervical spine: a fracture of the body, or bilateral fracture of the cervical vertebral arch, or fracture of the tooth of the II cervical vertebra, or unilateral fracture of the arch of the I or II cervical vertebrae, or multiple fractures of the cervical vertebrae, including without dysfunction of the spinal cord;

6.1.7 dislocation of one or more cervical vertebrae; traumatic rupture of the intervertebral disc at the level of the cervical spine with compression of the spinal cord;

6.1.8 contusion of the cervical spinal cord with impaired function;

6.1.9 a chest wound penetrating into the pleural cavity or into the pericardial cavity, or into the mediastinal tissue, including without damage to internal organs;

6.1.10 closed damage (crush, separation, rupture) of the organs of the chest cavity: heart or lung, or bronchi, or thoracic trachea; traumatic hemopericardium or pneumothorax, or hemothorax, or hemopneumothorax; diaphragm or lymphatic thoracic duct, or thymus;

6.1.11 multiple bilateral rib fractures with a violation of the anatomical integrity of the chest frame or multiple unilateral rib fractures along two or more anatomical lines with the formation of a movable section of the chest wall of the "rib valve" type;

6.1.12 fracture of the thoracic spine: fracture of the body or arch of one thoracic vertebra with dysfunction of the spinal cord or several thoracic vertebrae;

6.1.13 dislocation of the thoracic vertebra; traumatic rupture of the intervertebral disc in the thoracic region with compression of the spinal cord;

6.1.14 contusion of the thoracic spinal cord with impaired function;

6.1.15 abdominal wound penetrating into the abdominal cavity, including without damaging internal organs;

6.1.16 closed injury (crush, tear, rupture): abdominal organs - spleen or liver, and / or gallbladder, or pancreas, or stomach, or small intestine, or colon, or rectum, or greater omentum , or the mesentery of the large and (or) small intestine; retroperitoneal organs - kidney, adrenal gland, ureter;

6.1.17 wound of the lower back and (or) pelvis, penetrating into the retroperitoneal space, with damage to the retroperitoneal organs: the kidney or adrenal gland, or the ureter, or the pancreas, or the descending and horizontal part of the duodenum, or the ascending and descending colon;

6.1.18 fracture of the lumbosacral spine: body or arch of one or more lumbar and (or) sacral vertebrae with cauda equina syndrome;

6.1.19 dislocation of the lumbar vertebra; traumatic rupture of the intervertebral disc in the lumbar, lumbosacral spine with cauda equina syndrome;

6.1.20 contusion of the lumbar spinal cord with equine syndrome

6.1.21 injury (crush, avulsion, rupture) of the pelvic organs: open and (or) closed damage to the bladder or membranous part of the urethra, or ovary, or uterine (fallopian) tube, or uterus, or other pelvic organs (prostate, seminal vesicles, vas deferens);

6.1.22 wound of the wall of the vagina or rectum, or perineum, penetrating into the cavity and (or) tissue of the small pelvis;

6.1.23 bilateral fractures of the anterior pelvic half-ring with discontinuity: fractures of both pubic and both ischial bones of the "butterfly" type; fractures of the pelvic bones with disruption of the continuity of the pelvic ring in the posterior part: vertical fractures of the sacrum, ilium, isolated ruptures of the sacroiliac joint; fractures of the pelvic bones with disruption of the continuity of the pelvic ring in the anterior and posterior parts: unilateral and bilateral vertical fractures of the anterior and posterior parts of the pelvis on one side (Malgen's fracture); diagonal fractures - vertical fractures in the anterior and posterior parts of the pelvis on opposite sides (Wollumier fracture); various combinations of bone fractures and ruptures of the pelvic joints in the anterior and posterior parts;

6.1.24 a wound penetrating into the vertebral canal of the cervical or thoracic, or lumbar, or sacral spine, including without damage to the spinal cord and cauda equina;

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

6.1.26 damage (rupture, rupture, dissection, traumatic aneurysm) of large blood vessels: the aorta or carotid artery (common, external, internal), or subclavian, or axillary, or brachial, or iliac (common, external, internal), or femoral, or popliteal arteries and (or) accompanying great veins;

6.1.27 blunt trauma of reflexogenic zones: larynx region, carotid sinus region, solar plexus region, external genital area in the presence of clinical and morphological data;

6.1.28 thermal or chemical, or electrical, or radiation burns of III-IV degree, in excess of 10% of the body surface; III degree burns, exceeding 15% of the body surface; 2nd degree burns, exceeding 20% of the body surface; burns of a smaller area, accompanied by the development of burn disease; burns of the respiratory tract with symptoms of edema and narrowing of the glottis;

6.1.29 frostbite of III - IV degree with an affected area exceeding 10% of the body surface; frostbite of the III degree with a lesion area exceeding 15% of the body surface; frostbite II degree with a lesion area exceeding 20% of the body surface;

6.1.30 radiation injuries manifested by severe and extremely severe acute radiation sickness.

6.2. Harm to health, dangerous to human life, causing a disorder of the vital functions of the human body, which cannot be compensated by the body on its own and usually ends in death (hereinafter referred to as a life-threatening condition):

1 shock of severe (III - IV) degree;

6.2.2 coma II - III degree of various etiology;

6.2.3 acute, profuse or massive blood loss;

6.2.4 severe acute heart and (or) vascular insufficiency, or severe cerebrovascular accident;

6.2.5 acute renal or acute hepatic, or severe acute adrenal insufficiency, or acute pancreatic necrosis;

6.2.6 severe acute respiratory failure;

6.2.7 purulent-septic condition: sepsis or peritonitis, or purulent pleurisy, or phlegmon;

6.2.8 Disorder of regional and (or) organ blood circulation leading to infarction of an internal organ or gangrene of a limb; embolism (gas, fat, tissue, or thromboembolism) of the vessels of the brain or lungs;

6.2.9 acute poisoning with chemical and biological substances of medical and non-medical use, including drugs or psychotropic drugs, or hypnotics, or drugs acting mainly on the cardiovascular system, or alcohol and its surrogates, or technical fluids, or toxic metals , or toxic gases, or food poisoning, causing a life-threatening condition described in paragraphs 6.2.1 - 6.2.8 of the Medical Criteria;

6.2.10 various types of mechanical asphyxia; the consequences of general exposure to high or low temperatures (heatstroke, sunstroke, general overheating, hypothermia of the body); consequences of exposure to high or low atmospheric pressure (barotrauma, decompression sickness); the consequences of exposure to technical or atmospheric electricity (electrical injury); consequences of other forms of adverse effects (dehydration, exhaustion, overstrain of the body) that caused a life-threatening condition listed in paragraphs 6.2.1 - 6.2.8 of the Medical Criteria.

6.3. Loss of sight- complete persistent blindness in both eyes or such an irreversible condition when, as a result of injury, poisoning or other external influence, a person has a deterioration in vision, which corresponds to visual acuity equal to 0.04 and below.

Loss of sight one eye assessed on the basis

Post-traumatic removal of one eyeball who had vision before the injury is also assessed by the sign persistent loss of total

work capacity.

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

6.4. Loss of speech- irreversible loss of the ability to express thoughts in articulate sounds, understandable to others.

6.5. Loss of hearing- complete persistent deafness in both ears or such an irreversible condition when a person does not hear spoken speech at a distance of 3-5 cm from the auricle.

Loss of hearing in one ear assessed on the basis persistent loss of general working capacity.

6.6. Loss of any organ or loss of functions by an organ:

6.6.1 loss of an arm or leg, i.e. their separation from the body or their persistent loss of functions (paralysis or other condition that excludes their functions); loss of a hand or foot equates to loss of an arm or leg;

6.6.2 loss of productive capacity, expressed in men in the ability to copulate or fertilize, in women - in the ability to copulate or conceive, or carry, or bear children;

6.6.3 loss of one testicle.

6.7. Abortion- termination of the course of pregnancy, regardless of the period, caused by harm to health, with the development of miscarriage, intrauterine fetal death, premature birth, or necessitating medical intervention.

The termination of pregnancy as a result of diseases of the mother and the fetus should be in a direct causal relationship with the harm caused to health and should not be due to the individual characteristics of the woman's body and the fetus (diseases, pathological conditions) that existed before the harm to health.

If external reasons necessitated termination of pregnancy by medical intervention (curettage of the uterus, cesarean section, etc.), then these injuries and the resulting consequences are equated to termination of pregnancy and are assessed as serious harm to health.

6.8. Mental disorder, the occurrence of which must be in a causal relationship with the harm caused to health, i.e. be it

consequence.

6.9. Disease of drug addiction or substance abuse.

6.10. Permanent facial disfigurement.

The severity of the harm caused to a person's health, expressed in the indelible disfigurement of his face, is determined by the court.

The production of a forensic medical examination is limited only to the establishment of the indelibility of the damage, as well as its medical consequences in accordance with the Medical Criteria.

Under indelible changes it is necessary to understand such injuries to the face that do not disappear on their own over time (without surgical removal of scars, deformities, impaired facial expressions, etc., or under the influence of non-surgical methods) and surgical intervention is required to eliminate them (for example, cosmetic surgery).

6.11. by at least one third ( permanent loss of general ability to workover 30

percent ).

The following injuries are classified as serious harm to health, causing a significant permanent loss of general working capacity by at least one third, regardless of the outcome and provision (non-provision) of medical care:

6.11.1 open or closed fracture of the humerus: intra-articular (shoulder head) or periarticular (anatomical neck, sub- and trans-tubercular), or surgical neck or diaphysis of the humerus;

6.11.2 open or closed fracture of the bones that make up the elbow joint;

6.11.3 open or closed fracture-dislocation of the forearm bones: fracture of the ulna in the upper or middle third with dislocation of the radial head (fracture-dislocation of Montage) or fracture of the radius in the lower third with dislocation of the head of the ulna (fracture-dislocation of Galeazzi);

6.11.4 open or closed fracture of the acetabulum with displacement;

6.11.5 open or closed fracture of the proximal femur: intra-articular (fracture of the head and neck of the femur) or extra-articular (intertrochanteric, pertrochanteric fractures), with the exception of an isolated fracture of the greater and lesser trochanters;

6.11.6 open or closed fracture of the femoral shaft;

6.11.7 open or closed fracture of the bones that make up the knee joint, excluding the patella;

6.11.8 open or closed fracture of the tibial shaft;

6.11.9 open or closed fracture of the ankles of both tibia in combination with a fracture of the articular surface of the tibia and rupture of the distal tibiofibular syndesmosis with subluxation and dislocation of the foot;

6.11.10 compression fracture of two or more adjacent vertebrae of the thoracic or lumbar spine without dysfunction of the spinal cord and pelvic organs;

6.11.11 open dislocation of the shoulder or forearm, or hand, or thigh, or lower leg, or foot with rupture of the ligamentous apparatus and the capsule of the joint.

Persistent loss of general working capacity in other cases is determined as a percentage of five, in accordance with the Table of percent of permanent loss of general working capacity as a result of various injuries, poisoning and other consequences of exposure to external causes attached to these Medical criteria.

6.12. Complete loss of professional ability to work.

Professional ability to work is associated with the ability to perform a certain volume and quality of work in a specific profession (specialty) in which the main labor activity is carried out.

The degree of loss of professional ability to work is determined in accordance with the Rules for establishing the degree of loss of professional ability to work as a result of industrial accidents and occupational diseases, approved by the Government of the Russian Federation dated October 16, 2000 No. 789 (Collected Legislation of the Russian Federation. 2000. No. 43. Art. 4247).

7. Medical criteria for qualifying signs in relation to

moderate harm to health are:

7.1. Temporary dysfunction of organs and (or) systems ( temporary disability ) duration over three weeks (over 21 days)(hereinafter referred to as a long-term health disorder).

7.2. Significant permanent loss of general working capacity less than one third - permanent loss of general working capacity from 10 to 30% inclusive.

8. Medical criteria for qualifying signs

in a relationship slight harm to health are:

8.1. Temporary dysfunction of organs and (or) systems (temporary incapacity for work) duration up to three weeks from the moment of injury (up to 21 days inclusive) (hereinafter - short-term health disorder ).

8.2. Insignificant persistent loss of general working capacity - persistent loss of general working capacityless than 10%.

9. Surface damage, including: abrasion, bruising, soft tissue contusion, including bruising and hematoma, superficial wound and other injuries that do not entail a short-term health disorder or insignificant permanent loss of general ability to work, are regarded as injuries that did not harm human health.

III. Final provisions

10. To determine the severity of harm caused to human health, it is sufficient to have one Medical criterion.

11. If there are several Medical Criteria, the severity of the harm caused to human health is determined by the criterion that corresponds to the greater degree of the severity of the harm.

12. The severity of harm caused to human health in the presence of several injuries resulting from repeated traumatic influences (including the provision of medical care) is determined separately for each such exposure.

13. In the event that multiple injuries are mutually aggravating each other, the severity of the harm caused to human health is determined by their totality.

14. In the presence of injuries of different age, the determination of the severity of the harm caused to human health by each of them is made separately.

15. The emergence of a life-threatening condition should be directly related to harm to health, dangerous to human life, and this relationship cannot be accidental.

16. The prevention of death due to the provision of medical care should not be taken into account when determining the severity of harm to human health.

17. A health disorder consists in a temporary dysfunction of organs and (or) organ systems, directly related to damage, disease, pathological condition, which caused temporary disability.

18. Duration of dysfunction of organs and (or) organ systems (temporary disability) is set in days based on objective medical data, since the duration of treatment may not coincide with the duration of the limitation of the functions of organs and (or) systems of human organs. The performed treatment does not exclude the presence of post-traumatic limitation of the functions of organs and (or) organ systems in a living person.

19. Loss of general working capacity with unfavorable labor and clinical prognosis or with a definite outcome, regardless of the timing of the disability, or with the duration of the health disorder over 120 days(hereinafter - permanent loss of general working capacity).

20. Persistent general disability consists in the irreversible loss of functions in the form of limitation of vital activity(loss of innate and acquired human self-care abilities) and the ability to work of a person, regardless of his qualifications and profession(specialty) (loss of innate and acquired human abilities for action aimed at obtaining a socially significant result in the form of a certain product, product or service).

21. In children, the labor prognosis in terms of the possibility of permanent loss of general (professional) working capacity in the future is determined in the same way as in adults, in accordance with these Medical Criteria.

22. In the event of a need for a special medical examination of a living person, a commission forensic medical examination is carried out with the participation of doctors - specialists of those medical institutions in which there are the conditions necessary for its conduct.

23. When performing a forensic medical examination of a living person who has any disease prior to injury or damage to a part of the body with a completely or partially previously lost function, only harm caused to human health, caused by and causally associated with it, is taken into account.

24. Deterioration of human health caused by the nature and severity of injury, poisoning, disease, late start of treatment, his age, concomitant pathology and other reasons, is not considered as causing harm to health.

25. The deterioration of a person's health condition caused by a defect in the provision of medical care is considered as causing harm to health.

26. Determination of the severity of harm caused to human health in the cases specified in clauses 24 and 25 of the Medical Criteria is also carried out in accordance with the Rules and Medical Criteria.

27. The severity of harm caused to human health is not determined if:

In the process of medical examination of a living person, study of case materials and medical documents, it is not possible to determine the essence of harm to health;

At the time of medical examination of a living person, the outcome of harm to health that is not dangerous to human life is unclear;

A living person, in respect of whom a forensic medical examination was assigned, did not appear and cannot be taken to a forensic medical examination, or a living person refuses a medical examination;

Medical documents are absent or they do not contain sufficient information, including the results of instrumental and laboratory research methods, without which it is impossible to judge the nature and severity of harm caused to human health.

Order of the Ministry of Health and Social Development of the Russian Federation of April 24, 2008 N 194n
"On approval of the Medical criteria for determining the severity of harm caused to human health"

With changes and additions from:

Registration N 12118

The severity of harm caused to human health during forensic medical examination in civil, administrative and criminal proceedings is determined on the basis of qualifying signs and medical criteria. Medical criteria are used to assess injuries found during a forensic examination of a living person, examination of a corpse and its parts, as well as in the production of forensic medical examinations based on case materials and medical documents.

Medical criteria for qualifying signs in relation to serious harm to health are, for example, harm to health that is dangerous to human life (significant damage to important organs, their loss), complete loss of professional ability to work; with regard to harm to health of moderate severity - temporary disability, long-term health disorder; with regard to minor harm to health - a short-term health disorder. Superficial injuries, including abrasion, bruising, soft tissue contusion and other injuries that do not entail a short-term health disorder or a slight persistent loss of general ability to work, are regarded as injuries that did not harm human health.

To determine the severity of harm caused to human health, it is sufficient to have one medical criterion, however, if, for example, multiple injuries mutually aggravate each other, the severity of harm to human health is determined by their totality. If the nature of the harm to health cannot be determined, the outcome of the harm caused is not clear, the necessary medical documents are not available, the person did not appear for a forensic medical examination, the severity of the harm inflicted on the person is not determined.

Provides a Table of percentages of permanent loss of general working capacity as a result of various injuries, poisoning and other consequences of external causes, which is also used in the forensic medical determination of the severity of harm caused to human health, according to the qualifying criterion and the medical criterion of permanent loss of general working capacity.

Order of the Ministry of Health and Social Development of the Russian Federation of April 24, 2008 N 194n "On Approval of Medical Criteria for Determining the Severity of Harm Caused to Human Health"

Registration N 12118

This order comes into force 10 days after the day of its official publication.

harm to health

6. The medical criteria for qualifying signs in relation to serious harm to health are:

6.1. Harm to health, dangerous to human life, which by its nature directly poses a threat to life, as well as harm to health that caused the development of a life-threatening condition (hereinafter referred to as harm to health, dangerous to human life).

Harm to health, dangerous to human life, posing a direct threat to life:

6.1.1. a head wound (scalp, eyelid and periobital region, nose, ear, cheek and temporomandibular region, other areas of the head), penetrating into the cranial cavity, including without damage to the brain;

6.1.2. fracture of the fornix (frontal, parietal bones) and (or) the base of the skull: the cranial fossa (anterior, middle or posterior) or the occipital bone, or the upper wall of the orbit, or the ethmoid bone, or the sphenoid bone, or the temporal bone, with the exception of an isolated external fissure bone plate of the cranial vault and fractures of the facial bones: nose, lower wall of the orbit, lacrimal bone, zygomatic bone, upper jaw, alveolar bone, palatine bone, lower jaw;

6.1.3. intracranial injury: crushing of the substance of the brain; diffuse axonal brain damage; severe brain contusion; traumatic intracerebral or intraventricular hemorrhage; cerebral contusion of moderate degree or traumatic epidural, or subdural, or subarachnoid hemorrhage in the presence of cerebral, focal and stem symptoms;

6.1.4. a neck wound that penetrates the lumen of the pharynx or larynx, or the cervical trachea, or the cervical esophagus; injury to the thyroid gland;

6.1.5. fracture of the cartilage of the larynx: thyroid or cricoid, or arytenoid, or epiglottis, or horn-shaped, or tracheal cartilage;

6.1.6. fracture of the cervical spine: body fracture or bilateral fracture of the cervical vertebral arch, or fracture of the second cervical vertebra tooth, or unilateral fracture of the cervical vertebrae I or II, or multiple fractures of the cervical vertebrae, including without dysfunction of the spinal cord;

6.1.7. dislocation of one or more cervical vertebrae; traumatic rupture of the intervertebral disc at the level of the cervical spine with compression of the spinal cord;

6.1.8. contusion of the cervical spinal cord with impaired function;

6.1.9. chest wound that penetrates into the pleural cavity or into the pericardial cavity, or into the tissue of the mediastinum, including without damage to internal organs;

6.1.10. closed damage (crush, separation, rupture) of the organs of the chest cavity: heart or lung, or bronchi, or thoracic trachea; traumatic hemopericardium or pneumothorax, or hemothorax, or hemopneumothorax; diaphragm or lymphatic thoracic duct, or thymus;

6.1.11. multiple bilateral rib fractures with violation of the anatomical integrity of the chest frame or multiple unilateral rib fractures along two or more anatomical lines with the formation of a movable section of the chest wall of the "costal valve" type;

6.1.12. fracture of the thoracic spine: fracture of the body or arch of one thoracic vertebra with dysfunction of the spinal cord, or several thoracic vertebrae;

6.1.13. dislocation of the thoracic vertebra; traumatic rupture of the intervertebral disc in the thoracic region with compression of the spinal cord;

6.1.14. contusion of the thoracic spinal cord with impaired function;

6.1.15. abdominal wound that penetrates the abdominal cavity, including without damage to internal organs;

6.1.16. closed damage (crush, tear, rupture): of the abdominal organs - spleen or liver, and / or gallbladder, or pancreas, or stomach, or small intestine, or colon, or rectum, or greater omentum, or mesentery large and (or) small intestine; retroperitoneal organs - kidney, adrenal gland, ureter;

6.1.17. a wound in the lower back and (or) pelvis that penetrates into the retroperitoneal space, with damage to the retroperitoneal organs: the kidney or adrenal gland, or the ureter, or the pancreas, or the descending and horizontal part of the duodenum, or the ascending and descending colon;

6.1.18. fracture of the lumbosacral spine: the body or arch of one or more lumbar and (or) sacral vertebrae with cauda equina syndrome;

6.1.19. dislocation of the lumbar vertebra; traumatic rupture of the intervertebral disc in the lumbar, lumbosacral spine with cauda equina syndrome;

6.1.20. contusion of the lumbar spinal cord with cauda equina syndrome;

6.1.21. damage (crush, separation, rupture) of the pelvic organs: open and (or) closed damage to the bladder or membranous part of the urethra, or ovary, or uterine (fallopian) tube, or uterus, or other pelvic organs (prostate, seminal vesicles, vas deferens);

6.1.22. wound of the wall of the vagina or rectum, or perineum, penetrating into the cavity and (or) tissue of the small pelvis;

6.1.23. bilateral fractures of the anterior pelvic semicircle with discontinuity: fractures of both pubic and both ischial bones of the "butterfly" type; fractures of the pelvic bones with disruption of the continuity of the pelvic ring in the posterior part: vertical fractures of the sacrum, ilium, isolated ruptures of the sacroiliac joint; fractures of the pelvic bones with disruption of the continuity of the pelvic ring in the anterior and posterior parts: unilateral and bilateral vertical fractures of the anterior and posterior parts of the pelvis on one side (Malgen's fracture); diagonal fractures - vertical fractures in the anterior and posterior parts of the pelvis on opposite sides (Wollumier fracture); various combinations of bone fractures and ruptures of the pelvic joints in the anterior and posterior parts;

6.1.24. a wound that penetrates into the vertebral canal of the cervical or thoracic, or lumbar, or sacral spine, including without damage to the spinal cord and cauda equina;

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

6.1.26. damage (rupture, separation, dissection, traumatic aneurysm) of large blood vessels: the aorta or carotid artery (common, external, internal), or subclavian, or axillary, or brachial, or iliac (common, external, internal), or femoral, or popliteal arteries and (or) accompanying great veins;

6.1.27. blunt trauma of reflexogenic zones: the larynx region, the carotid sinus region, the solar plexus region, the external genital area in the presence of clinical and morphological data;

6.1.28. thermal or chemical, or electrical, or radiation burns of III - IV degree, exceeding 10% of the body surface; III degree burns, exceeding 15% of the body surface; 2nd degree burns, exceeding 20% of the body surface; burns of a smaller area, accompanied by the development of burn disease; burns of the respiratory tract with symptoms of edema and narrowing of the glottis;

6.1.29. frostbite of III - IV degree with a lesion area exceeding 10% of the body surface; frostbite of the III degree with a lesion area exceeding 15% of the body surface; frostbite II degree with a lesion area exceeding 20% of the body surface;

6.1.30. radiation injuries, manifested by severe and extremely severe acute radiation sickness.

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

6.2.2. coma II - III degree of various etiology;

6.2.3. acute, profuse or massive blood loss;

6.2.4. severe acute heart and (or) vascular insufficiency, or severe cerebrovascular accident;

6.2.5. acute renal or acute hepatic, or acute adrenal insufficiency of severe degree, or acute pancreatic necrosis;

6.2.6. severe acute respiratory failure;

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

6.2.8. a disorder of the regional and (or) organ circulation, leading to an infarction of an internal organ or gangrene of a limb; embolism (gas, fat, tissue, or thromboembolism) of the vessels of the brain or lungs;

6.2.9. acute poisoning with chemical and biological substances of medical and non-medical use, including drugs or psychotropic drugs, or hypnotics, or drugs acting mainly on the cardiovascular system, or alcohol and its surrogates, or technical fluids, or toxic metals, or toxic gas or food poisoning causing a life-threatening condition described in paragraphs 6.2.1 to 6.2.8 of the Medical Criteria;

6.2.10. various types of mechanical asphyxia; the consequences of general exposure to high or low temperatures (heatstroke, sunstroke, general overheating, hypothermia of the body); consequences of exposure to high or low atmospheric pressure (barotrauma, decompression sickness); the consequences of exposure to technical or atmospheric electricity (electrical injury); consequences of other forms of adverse effects (dehydration, exhaustion, overstrain of the body) that caused a life-threatening condition listed in paragraphs 6.2.1 - 6.2.8 of the Medical Criteria.

6.3. Loss of vision is complete permanent blindness in both eyes or such an irreversible condition when, as a result of injury, poisoning or other external influence, a person has a deterioration in vision, which corresponds to a visual acuity of 0.04 and below.

Loss of vision in one eye is assessed on the basis of persistent loss of general ability to work.

Post-traumatic removal of one eyeball, which had vision before the injury, is also assessed on the basis of persistent loss of general ability to work.

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

6.4. Loss of speech is an irreversible loss of the ability to express thoughts in articulate sounds that are understandable to others.

6.5. Hearing loss is complete persistent deafness in both ears or such an irreversible condition when a person does not hear spoken speech at a distance of 3-5 cm from the auricle.

Hearing loss in one ear is assessed on the basis of permanent loss of general working capacity.

6.6. Loss of any organ or loss of functions by an organ:

6.6.1. loss of an arm or leg, i.e. their separation from the body or their persistent loss of functions (paralysis or other condition that excludes their functions); loss of a hand or foot equates to loss of an arm or leg;

6.6.2. loss of productive ability, expressed in men in the ability to copulate or fertilize, in women - in the ability to copulate or conceive, or carry, or bear children;

6.6.3. loss of one testicle.

6.7. Termination of pregnancy - termination of the course of pregnancy, regardless of the period, caused by harm to health, with the development of miscarriage, intrauterine fetal death, premature birth, or necessitating medical intervention.

Termination of pregnancy as a result of diseases of the mother and the fetus should be in a direct causal relationship with the harm caused to health and should not be due to the individual characteristics of the woman's body and the fetus (diseases, pathological conditions) that existed before the harm was caused to health.

If external reasons have necessitated termination of pregnancy by medical intervention (curettage of the uterus, cesarean section, etc.), then these injuries and the resulting consequences are equated to termination of pregnancy and are assessed as serious harm to health.

6.8. A mental disorder, the occurrence of which must be causally related to the harm caused to health, i.e. be a consequence of it.

6.9. Disease of drug addiction or substance abuse.

6.10. Permanent disfigurement of the face.

The severity of the harm caused to a person's health, expressed in the indelible disfigurement of his face, is determined by the court.

The production of a forensic medical examination is limited only to the establishment of the indelibility of the damage, as well as its medical consequences in accordance with the Medical Criteria.

Permanent changes should be understood as such injuries to the face that do not disappear on their own over time (without surgical removal of scars, deformities, impaired facial expressions, etc., or under the influence of non-surgical methods) and surgery is required to eliminate them (for example, cosmetic surgery).

6.11. Significant persistent loss of general working capacity by at least one third (persistent loss of general working capacity over 30 percent).

6.11.1. open or closed fracture of the humerus: intra-articular (shoulder head) or periarticular (anatomical neck, sub- and trans-tubercular), or surgical neck or diaphysis of the humerus;

The harm caused to human health is determined depending on the degree of its severity (serious harm, moderate harm and light harm) on the basis of qualifying signs and in accordance with medical criteria for determining the severity of harm to human health.

Decree of the Government of the Russian Federation of August 17, 2007 N 522 "On approval of the Rules for determining the severity of harm caused to human health" approved the relevant Rules. In accordance with these Rules, harm caused to human health means a violation of the anatomical integrity and physiological function of human organs and tissues as a result of exposure to physical, chemical, biological and mental factors of the external environment.

The qualifying signs of the severity of harm caused to human health are:

1) in respect of serious harm:

Harm, dangerous to human life;

Loss of sight, speech, hearing or any organ or loss of its functions by the organ;

Abortion;

Mental disorder;

Disease of drug addiction or substance abuse;

Permanent disfigurement of the face;

Significant persistent loss of general working capacity by at least one third;

Complete loss of professional ability to work;

2) in relation to the average gravity of harm:

Long-term health disorder;

Significant persistent loss of general working capacity by less than one third;

3) in respect of minor harm:

Short term health disorder;

Slight persistent loss of general working capacity.

Infliction of grievous bodily harm is qualified under article 111 of the Criminal Code of the Russian Federation ("Intentional infliction of grievous bodily harm"). This article of the Criminal Code of the Russian Federation contains the following criteria (signs) of grievous harm.

Harm, dangerous to human life.

Life-threatening injury is injury causing a life-threatening condition that can result in death. Preventing death from health care does not change the assessment of health harm as life-threatening.

Life-threatening harm to health can be both bodily injuries and diseases and pathological conditions.

Such injuries include those that, by their nature, pose a threat to the victim's life and can lead to death (first group), as well as those that cause the development of a life-threatening condition, the occurrence of which is not random (second group).

The first group of life-threatening injuries includes:

Penetrating wounds of the skull, including those without damage to the brain;

Open and closed fractures of the bones of the vault and base of the skull, with the exception of fractures of the bones of the facial skeleton and an isolated crack of only the outer plate of the cranial vault;

Severe brain contusion: moderate cerebral contusion with symptoms of stem section lesion;

Penetrating wounds of the spine, including those without damage to the spinal cord;

Fractures-dislocations and fractures of bodies or bilateral fractures of the arches of the cervical vertebrae, as well as unilateral fractures of the arches of the I and II cervical vertebrae, including those without dysfunction of the spinal cord;

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 with dysfunction of the spinal cord;

Wounds that penetrate the lumen of the pharynx, larynx, trachea, esophagus, as well as damage to the thyroid and thymus glands;

Chest wounds penetrating into the pleural cavity, pericardial cavity or mediastinal tissue, including without damage to internal organs;

Abdominal wounds that penetrate the peritoneal cavity;

Injuries that penetrate the bladder or intestinal cavity (with the exception of the lower third of the rectum);

Open wounds of the retroperitoneal organs (kidneys, adrenal glands,

pancreas);

Rupture of an internal organ of the chest or abdominal cavity, or pelvic cavity, or retroperitoneal space, or rupture of the diaphragm, or rupture of the prostate gland, or rupture of the ureter, or rupture of the membranous part of the urethra;

Bilateral fractures of the posterior semi-ring of the pelvis with rupture of the ilio-sacral articulation and discontinuity of the pelvic ring, or double fractures of the pelvic ring in the anterior and posterior parts with disruption of its continuity;

Open fractures of long bones - humerus, femur and tibia,

open injuries of the hip and knee joints;

Damage to a large blood vessel: aorta, carotid (common, internal, external),

subclavian, brachial, femoral, popliteal arteries or their accompanying veins;

Thermal burns of the III-IV degree with the affected area exceeding 15% of the body surface;

Burns of the III degree more than 20% of the body surface;

Second degree burns, in excess of 30% of the body surface.

The second group of life-threatening injuries includes injuries if they entailed a life-threatening condition. Diseases or pathological conditions arising as a result of the influence of various external factors and naturally complicated by a life-threatening condition or themselves posing a threat to human life are also life-threatening.

Life-threatening conditions include:

Severe shock (III-IV degree) of various etiology;

Coma of various etiologies;

Massive blood loss;

Acute heart or vascular failure, collapse, severe cerebrovascular accident;

Acute renal or acute liver failure;

Acute respiratory failure, severe;

Purulent-septic conditions;

Disorders of regional and organ circulation leading to infarction of internal organs, gangrene of the extremities, embolism (gas and fat) of the vessels of the brain,

thromboembolism;

A combination of life-threatening conditions.

1. Loss of sight, speech, hearing or any organ or loss of its functions by the organ.

Harm to health, leading to loss of vision, which is understood as complete persistent blindness in both eyes or a condition when there is a decrease in vision to a visual acuity of 0.04 and below (counting fingers at a distance of 2 m and up to light perception).

Loss of vision in one eye is the loss of its functions by an organ and is a serious health hazard.

The loss of one eyeball is the loss of an organ.

Loss of a blind eye qualifies for the duration of the health disorder.

Harm to health, leading to loss of speech, which is understood as the loss of the ability to express one's thoughts in articulate sounds, understandable to others, or as a result of loss of voice.

Harm to health, leading to hearing loss, which is understood as complete deafness or such an irreversible condition when the victim does not hear colloquial speech at a distance of 3-5 cm from the auricle.

Hearing loss in one ear as a loss of its functions by an organ is a serious health hazard.

When determining the severity of harm to health on the basis of loss of vision or hearing, the possibility of improving vision or hearing with the help of medical and technical means (corrective glasses, hearing aids, etc.) is not taken into account.

Loss of any organ or loss of its functions by an organ.

This group of damages also includes:

Loss of arms, legs, that is, their separation from the body or loss of their functions (paralysis or other condition that excludes their activity);

The loss of the most functionally important part of the limb (hand, foot) is equated with the loss of an arm or leg. In addition, the loss of a hand or foot entails permanent disability for more than one third and, on this basis, also refers to serious harm to health;

Damage to the genital organs, accompanied by a loss of productive ability, which is understood as the loss of the ability to copulate, or the loss of the ability to fertilize, conceive, carry and bear children;

Loss of one testicle, which is organ loss.

2. Termination of pregnancy.

Termination of pregnancy, regardless of its duration, is a serious harm to health if it is in a direct causal relationship with external influences, and is not due to the individual characteristics of the organism or the diseases being examined.

Forensic medical examination in these cases is carried out on a commission with the participation of an obstetrician-gynecologist.

3. Mental disorder, drug addiction or substance abuse.

The assessment of the severity of harm to health, which entailed a mental disorder, drug addiction, substance abuse, is carried out after a forensic psychiatric, forensic narcological and forensic toxicological examination.

4. Permanent disfigurement of the face.

In the event of injuries to the face, the expert assesses them in the usual manner, assessing their severity in accordance with the established criteria.

In addition, it is determined whether the damage is permanent. The smoothness of damage should be understood as the possibility of the disappearance of the visible consequences of damage or a significant decrease in their severity (i.e., the severity of scars, deformities, impaired facial expressions, etc.) over time or under the influence of non-surgical means. If cosmetic surgery is required to eliminate these consequences, then the damage is considered permanent.

The severity of the harm caused to a person's health, expressed in the indelible disfigurement of his face, is determined by the court. The production of a forensic medical examination is limited only to the establishment of the indelibility of the specified damage.

5. Significant persistent loss of general working capacity by at least one third.

Serious harm to health includes injuries, diseases, pathological conditions that entail a persistent loss of general working capacity by at least one third.

From a forensic medical point of view, permanent loss of ability to work should be considered with a definite outcome or with a duration of a health disorder for more than 120 days.

Distinguish between general, professional and special work ability. General - the ability of a person to unskilled labor, to perform a wide range of labor processes to meet his everyday needs, professional - the ability to work in a certain profession, special - the ability to professional activity in a particular specialty.

When determining the severity of harm to health, a persistent loss of general working capacity is meant.

The sizes of persistent disability are established according to a special table, in which the percentage of total disability is presented in multiples of five. Therefore, a loss of general working capacity of at least one third in practice means a loss of capacity for work in the amount of 35% or more.

6. Complete loss of professional ability to work.

Medium harm to health (Article 112 of the Criminal Code of the Russian Federation) - harm that is not dangerous to human life and did not entail the consequences specified in Article 111 of the Criminal Code of the Russian Federation, but caused a long-term health disorder or a significant permanent loss of general working capacity by less than one third.

A long-term health disorder is understood as the consequences directly related to the damage lasting more than three weeks (more than 21 days).

The duration of the health disorder is determined by the duration of temporary disability (temporary disability).

The duration of temporary disability is determined taking into account the data contained in medical documents.

A forensic expert, assessing the nature and duration of the disease or dysfunctions associated with harm to health, must proceed from objective medical data, including those established during the examination process.

The medical examiner should critically evaluate the data of medical records, as the duration of the victim's treatment may not correspond to the nature of the injury. On the other hand, there may be a refusal of the victim from a certificate of incapacity for work and premature exit to work at his own request. In all these cases, the forensic expert must assess the duration of the disease and its severity based on objective evidence.

A significant permanent loss of ability to work by less than one third includes loss of ability to work from 10 to 30% inclusive.

Light harm to health (Art. 115 of the Criminal Code of the Russian Federation) is harm that caused a short-term health disorder or a slight permanent loss of general working capacity.

A health disorder that lasts less than three weeks (less than 21 days) is considered a short-term disorder.

An insignificant permanent loss of general working capacity is a loss of working capacity in the amount of 5%.

To determine the severity of harm caused to human health, it is enough to have one of the qualifying signs. In the presence of several qualifying signs, the severity of harm caused to human health is determined by the sign that corresponds to the greater degree of the severity of harm.

The severity of harm caused to human health is determined in medical institutions of the state health care system by a doctor - a forensic medical expert.

The objects of a forensic medical examination are a living person or a corpse (its parts), as well as case materials and medical documents provided to the expert in accordance with the established procedure.

Medical documents must be authentic and contain comprehensive data on the nature of injuries and their clinical course, as well as other information necessary for a forensic medical examination.

If necessary, the expert draws up a request to provide him with additional materials, upon receipt of which the forensic medical examination is resumed.

If there is a need for a special medical examination of a living person, medical specialists from organizations that have the conditions necessary for such examinations are involved in the forensic medical examination.

When carrying out a forensic medical examination in relation to a living person who has any disease preceding the injury or damage to a part of the body with a completely or partially previously lost function, only harm caused to human health caused by and causally associated with it is taken into account.

The severity of harm caused to human health in the presence of injuries arising from repeated traumatic influences (including the provision of medical care) is determined separately for each such exposure.

In the event that multiple injuries mutually burden each other, the severity of the harm caused to human health is determined by their totality.

The deterioration of the health of the victim as a result of defects in the provision of medical care for the injuries caused to him is established by a commission with the participation of the relevant specialists, and this is not a basis for increasing the severity of the harm to health caused by the injury. In such cases, forensic experts are obliged to indicate in the conclusion the nature of the deterioration or complication that has occurred and the causal relationship between it and bodily injury, as well as with defects in the provision of medical care. Complications arising from the performance of operations or the use of complex modern diagnostic methods are qualified as harm to health if they were the result of defects during the specified medical interventions. In this case, the determination of defects in medical interventions is carried out on a commission.

Complications of operations or applied complex diagnostic methods in the absence of defects in their performance, which are the result of other reasons (the severity of the patient's condition, unforeseen features of the patient's reaction, etc.), are not subject to a forensic medical assessment of the severity of harm to health.

In the presence of injuries of different ages of occurrence, the severity of the harm caused to human health by each of them is determined separately.

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