Health Care Point

HEALTH CARE POINT, or health point—the leading link in the health care system in the USSR—represents a medical-sanitary institution at a factory enterprise, on transportation, in a state farm, collective farm, machine-tractor station, etc., having as its task the rendering of initial medical aid in cases of accidents and sudden illnesses, and especially the carrying out of a series of sanitary-prophylactic measures aimed at combating morbidity and injuries among workers, and contributing to the fulfillment of the production-financial plan of the enterprise by participating in improving the production environment and production processes, rational organization of labor, and improvement of working conditions. Health care points in the USSR are the product of the revolution. In pre-revolutionary years, first aid points existed only as exceptions in the largest enterprises; they were quite primitively equipped and served almost exclusively by middle-level medical personnel. In most cases, the functions of first aid points were carried out by factory-plant polyclinics where they existed; first aid points dealt only with rendering first medical aid and did not carry out any preventive health work. In many cases, organized first aid points at enterprises also provided general outpatient medical aid of very poor quality. First aid points, which were completely dependent on the owners of enterprises, in case of accidents tried together with the technical inspection to exonerate the factory owners, freeing them from responsibility, attributing the causes of accidents to the carelessness of the worker, even when elementary technical safety measures were absent. In the villages, although injury rates in the estates of landowners where agricultural machines were used were very high, no first aid points existed, and rendering first aid was entrusted to a very sparse network of medical districts (see Medical District). Only the October Revolution began the rapid development of first aid points at factory-plant enterprises, setting before them the task of rendering first aid and carrying out preventive measures in production. But in the first years after the October Revolution, first aid points, not yet sufficiently consolidated and weakly linked with preventive institutions, concentrated their attention mainly on rendering first aid; sanitary-health measures were not at the center of their attention; the care for carrying out these measures fell almost entirely on the sanitary organization, which stood apart from the work of first aid points. Moreover, the vast majority of first aid points, mainly on small enterprises, were headed by paramedics. Over time, with the development of the country's industrialization and the strengthening of the medical-sanitary organization, the role of first aid points was increasingly elevated. Although the regulations on the work of these points, issued by the People's Commissariat of Health, included a number of paragraphs emphasizing the special importance of sanitary-health work at first aid points, it was still systematically not carried out at most first aid points, although it was supposed to be the most important organic part of the operational plan of first aid points. The rapid pace of the country's industrialization and the successful development of all socialist construction, requiring the strengthening of the country's labor resources and active assistance from the entire medical-sanitary network to socialist construction, posed before first aid points the task of a fundamental restructuring of their work in accordance with the increased requirements for them as health care points in production, covering a complex of diverse measures for protecting the health of workers in production. First aid points, in terms of their content of work, thus turned from first aid points into health care points—health points. The network of health care points has shown an unusually strong growth in all recent years, which has particularly increased in connection with the enormous successes of the country's industrialization, as can be seen from the following table: Years Number of health care points in the RSFSR Of which medical On 1/1 1930 g....... % growth to 1930 g. . . 1038 1453 2 679 First aid points abroad. In capitalist countries, first aid points exist only in large enterprises, and in the overwhelming majority of cases these points are served only by orderlies, at best by middle-level personnel, and only in very rare individual cases by a doctor, who mainly only supervises the work of the first aid points. First aid points provide only first aid in cases of accidents and sudden illnesses and do not carry out any preventive health work in enterprises. They are not granted any rights in carrying out sanitary supervision—First aid points mostly occupy random and poor premises. The premises of a first aid point usually in the largest enterprises include 2 rooms—a dressing room and a room for keeping the injured person until transfer to a hospital. First aid points have the necessary medicines, dressing materials, and equipment for rendering first aid. In factory-plant enterprises, first aid cabinets are usually located in the workshops, the contents of which (dressing materials, medicines) must correspond to a certain, approved by the proper authority, fixed list. In many enterprises, some workers, shop administration, and employees are trained in the matter of rendering first aid. Training is organized mainly by the Red Cross. In large enterprises, stretchers are available in the workshops. Transportation of victims of accidents to medical institutions is carried out in sanitary automobiles. The largest enterprises have their own sanitary automobiles; usually, in the absence of their own sanitary automobile, a car from the city's emergency aid organization is called to send the victim to the hospital. Organization of health care points in the USSR, their equipment and maintenance. Health care points are arranged in a specially built or adapted premises located near the workshops, especially the main and largest ones; the most rational placement is a health care point in the center of the location of workshops. The premises of a health care point must be on the first floor, be isolated from other premises of the enterprise, and meet the following sanitary-hygienic requirements: it must be light, dry, warm, well-ventilated, protected from the noise of adjacent workshops and shops. Free access to the health care point must be ensured. Access to its premises should not be hindered by narrow corridors, tight vestibules, narrow doorways, steep and frequent turns. In large enterprises, with a whole series of workshops scattered over a large area, especially when there are workshops that, due to production conditions, have a high attendance at the health point for medical aid, workshop health care points are organized in separate workshops, first of all, the most distant from the factory health care point and with relatively high injury rates, subordinate in their work to the central health care point. The premises of a health care point must have a waiting room, a doctor's office, a dressing room, one ward for temporarily keeping sick or injured persons from accidents until their transfer to the appropriate medical institution, and a toilet. The size of these premises of a health care point depends on the volume of work of the latter. According to the Regulations on First Aid Points at Enterprises, issued by the Supreme Economic Council, the People's Commissariat of Labor of the RSFSR and the People's Commissariat of Health (On the Health Front, 1931, No. 1), health care points in the RSFSR are organized on factory-plant enterprises with 200 or more workers and employees, depending on production conditions, and especially harmful and dangerous production conditions, health care points can be organized at enterprises with a smaller number of workers. Health care points are headed by doctors if there are at least 500 workers and employees at the enterprise; with a smaller number of workers and employees, a middle-level medical person is at the head of the health care point; depending on the nature of the enterprise, the level of morbidity and injury rates, the distance of the enterprise from medical institutions, the management of the health care point is entrusted to a doctor even with a number of workers and employees less than 500. If there are several small enterprises located close to each other, one common health care point is organized to serve them. Health care points, at the head of which is middle-level medical personnel, are under systematic medical supervision of a special, designated for this purpose doctor from the nearest medical institution. Health care points in large enterprises organize the immediate rendering of first aid in places where there are no workshop health care points, by arranging first aid kits and involving specially trained workers in the work of rendering first aid, working in these places. The location of health care points is chosen with the maximum approach of first aid to the place of the incident; thus, in the coal industry, in addition to surface health care points, underground health care points are arranged in mines when there are 300 workers in one shift and when work is carried out on horizons deeper than 100 m; in the absence of health care points in the mines themselves, first aid kits and stretchers must be available.

The same requirement applies to all other types of mineral development. Health Care Points have equipment, furnishings, special inventory, and are provided with medical supplies according to established norms. The Health Care Point is connected by telephone with all workshops of the enterprise and all work sites, as well as with the nearest medical institutions and with the city's district telephone network. Health Care Points are organized by health authorities; expenses for maintaining staff, providing medications, bandages, special inventory, and medical equipment are covered by the health department. Premises for the Health Care Point, household inventory and equipment, utilities, and transportation are provided to the Health Care Point at the enterprise's expense. Equipment of the Health Care Point and its medical supplies must meet certain standards. There are fixed minimum lists of equipment and supplies. In workshops without their own Health Care Points, first aid cabinets must be available. Health Care Points must have sanitary bags for cases requiring first aid at the scene of an accident. Staffing of Health Care Points is determined by the size of the enterprise, the nature of production, the territorial placement of individual workshops, the number of workers, the level of morbidity and injury rates. A medical Health Care Point must have at least one physician, a paramedic or nurse with surgical training, and a orderly. Staffing of Health Care Points must provide for the necessity of serving all shifts of workers and the presence of medical personnel at the Health Care Point during all working hours of that shift, and when there are several shifts at the enterprise, a physician must be available to provide assistance to workers of the second and third shifts if each shift has more than 500 workers. If the enterprise has 1,500-2,500 workers, the Health Care Point must have at least 2 physicians, and with 2,500-4,500 workers, at least 3 physicians. At large enterprises with significant injury rates, a surgeon with special training in traumatology is included in the Health Care Point staff. In the absence of a surgeon in the Health Care Point staff, a qualified surgeon from the nearest medical institution is attached to it for supervision and guidance in providing first aid. There should be at least 1 middle-level medical worker for every 1,500 workers per shift. At large enterprises with at least 1,500 workers, a registrar is included in the Health Care Point staff. Health Care Points are subordinate directly to the corresponding city health department or district health inspector - the district health department. Even where there is a unified dispensary, the Health Care Point, coordinating its work with all main links of the unified dispensary (unified plan of health work, exchange of data on morbidity and injury rates, referral to the unified dispensary for medical care and for dispensarization, etc.), operates under the direction of the appropriate health department. Medical care. Health Care Points provide initial medical care for sudden illnesses, poisonings, and accidents. As a rule, their function does not include providing systematic medical care. When seeking medical care at a Health Care Point for subacute and chronic diseases, as well as for acute diseases requiring further systematic treatment after first aid is provided, patients receive from the Health Care Point the necessary referral to the appropriate medical institution, which schedules these patients for appointments with specialists at specific times. At Health Care Points, as prescribed by physicians, necessary simple medical procedures are performed - dressings, subcutaneous injections, vaccinations, local cauterizations, etc., which frees workers who remain at work during illnesses not associated with loss of capacity to work from excessive time spent visiting an outpatient clinic to receive prescribed procedures. Health Care Points must be equipped with all necessary equipment, apparatus, and instruments for providing first aid - stretchers, surgical instruments, splints, syringes, a stomach tube, an oxygen pillow, a hot water bottle, and necessary medications. In cases of significant eye injuries, first aid by an ophthalmologist must be available at the Health Care Point. At large enterprises, especially in the chemical and food industries, where oral diseases arise due to production conditions, it is necessary to provide for first aid dental care at the Health Care Point in acute cases of mouth injury, as well as systematic observation of the oral cavity of workers in the corresponding 'harmful' workshops for timely selection of workers needing oral sanitation. At some Health Care Points of the largest enterprises, there are special traumatological offices. Health Care Points direct persons needing medical care to a polyclinic, a unified dispensary, or other specialized medical institutions, ensuring preliminary registration of workers in these medical institutions for appointments at specific days and hours to avoid waiting in queues. Sanitary-prophylactic work of Health Care Points. The Health Care Point takes under account and special systematic observation workers in workshops with high morbidity and injury rates, workers who are frequently and long-term ill, as well as those groups of workers who are subject to mandatory periodic medical examinations. The Health Care Point is also responsible for conducting medical examinations of newly hired workers when this is provided by law or is necessary due to local conditions. The Health Care Point also conducts periodic medical examinations of adolescent workers. These examinations are organized by the Health Care Point in its premises, involving specialists from the nearest polyclinic, or in the polyclinic itself. In the latter case, the medical staff of the Health Care Point actively participates in these examinations, preparing a sanitary characterization of the corresponding workshops and the material available at the Health Care Point characterizing the health status of the workers being examined. Proper accounting of the health status of these categories of workers enables the Health Care Point to plan and carry out a series of preventive measures to strengthen health, prevent loss of capacity to work, and restore it in case of its violation: assistance in changing professions, granting leave, placement in a rest home, referral to a dietary cafeteria, receipt of sanatorium-resort or other types of necessary specialized medical care. This accounting also makes it possible to identify disabled persons who place a heavy burden on production due to frequent absences due to illness, as well as malingerers and aggravators who disrupt normal work at the enterprise. The Health Care Point conducts systematic observation of the health of workers who cause significant defects and sharply reduced output. The Health Care Point takes the initiative in organizing the dispensarization (see) of workers in the most important, leading, and harmful workshops, shock workers, as well as workers of other of the above-mentioned categories; actively participates in conducting this dispensarization, examinations, in assigning different types of social-prophylactic assistance, including in the sanatorium-resort selection of workers for rest homes, sanatoriums, and resorts. The Health Care Point keeps records of professional poisonings and professional injuries at industrial enterprises, identifies and studies or participates in identifying and studying the causes of cases of injury and professional poisonings that have occurred, raises with labor protection authorities, plant management, and public organizations at the enterprise the question of preventive health measures in workshops to reduce morbidity and injury rates. Systematic observation and accounting of morbidity and injury rates and the implementation of appropriate sanitary-hygienic measures based on the data obtained constitute one of the main functions of health care points. Signal operational accounting aims to promptly identify all cases of morbidity and injury at the enterprise, their causes, and foci, and to inform plant management and workshop heads as quickly as possible about the illness of workers in the corresponding workshops in order to take necessary measures to replace workers who have not come to work due to illness with others and, if necessary, to carry out measures on technical safety, on weakening and eliminating harmfulness of production processes, etc. Signal accounting is based on data from the Health Care Point itself about the sick and those injured in accidents who have sought medical help at the Health Care Point, and on information received by the Health Care Point from other medical-prophylactic institutions of the district where workers from this enterprise have sought medical help. Timely transmission of this information to the Health Care Point about issued sick leave certificates, usually on the same day after completion of reception and summation of data by enterprises, is mandatory for polyclinics, outpatient clinics, dispensaries, consultations, etc. in almost all industrial centers and factory districts.

Usually in industrial centers with a small number of enterprises and medical-sanitary institutions, the medical institutions at the end of the workday compile by enterprise nominal lists of workers who have been issued sick leave certificates, indicating the shop, diagnosis, and period of exemption; this data is transmitted to the Health Care Point on the same day by telephone or through messengers, etc. Information about workers exempted by doctors from home care is included in the polyclinic's data. The Health Care Point informs the corresponding shops before the start of the next shift of the list of workers exempted from work due to illness. In many places, nominal lists are compiled at the end of work by each shift of the outpatient clinics, polyclinics, and immediately forwarded to the Health Care Point, which can thus signal to the shops about workers not reporting for work before the start of different shifts. On the basis of information received from medical institutions about the morbidity of workers, the Health Care Point outlines necessary practical measures, for example, in connection with detected infectious diseases, the carrying out of disinfection, isolation, vaccinations, etc. In addition, the Health Care Point transmits to the factory-plant payment point of the insurance fund information about the sick for the purpose of establishing in relation to some sick workers comradeship of home working control. In large industrial centers with a large number of enterprises and a significant network of scattered medical-sanitary institutions used by workers who often live far from the enterprises where they work, a central point for transmitting this information is usually organized, and in large districts, district points, to which medical institutions of different districts send lists of workers exempted from work due to illness, and from which these lists are then sent to the health care points of the corresponding enterprises. This system exists in Moscow, Leningrad, Kharkov, and other largest industrial centers. At most Health Care Points, the registration of cases is conducted as follows: I. In all cases of application to the Health Care Point due to illness, a corresponding record of the applicant is made on special cards (slips) - surname, name, patronymic of the worker, his number, shop, diagnosis. These cards (slips), arranged in boxes or packets by shops (by shop criterion), are reviewed (daily) by the Health Care Point's physicians (shop physicians, where they exist), who thus obtain necessary information about morbidity in the shops for reporting to the shop administration and for taking preventive health measures. The Health Care Point has the opportunity to get a complete picture of the morbidity of workers in all shops because all sick leave certificates are necessarily presented to the Health Care Point for registration and corresponding marking before payment of the due benefits at the payment point of the insurance fund. Information from sick leave certificates and the mentioned slips about morbidity is entered into individual cards. Summaries of morbidity, compiled for the entire enterprise and for individual shops, make it possible to determine the number of cases and days of disability per 100 workers for the entire enterprise and for individual shops per month, quarter, half-year, year, the average duration of one case of illness, the nature of morbidity (by type and severity of diseases), and thus to reveal the dynamics of morbidity, compare its level in individual shops, as well as with the level of morbidity in other similar enterprises. II. In all cases of application to the Health Care Point due to received injury, a corresponding record of the injury case is made on an industrial injury card. These cards are also arranged in small boxes or packets by shops (by shop criterion). Information from the cards is daily entered into a special register, with this information arranged by shops and by type of injury, and cases with loss of working capacity are specially marked in the register. The injury registration registers are daily reviewed by the medical personnel of the Health Care Point and shop physicians, where they exist, for the purpose of identifying the frequency and causes of industrial injuries and taking measures through the organs of the sanitary inspection of labor (Resolution of the Council of People's Commissars of the USSR of 4/VII 1932, Collection of Laws 1932, No. 52, Art. 317) to improve technical safety and eliminate the causes of injuries. Information about cases of injury with loss of working capacity is promptly reported to the shop administration. Data about the injury, its location, degree of severity, cause, etc., is entered, as in cases of illness, into the individual statistical card of the worker, and this is done even in cases when the injury did not lead to loss of working capacity. As in cases of illness, sick leave certificates issued for traumatic injuries are also presented to the Health Care Point before payment for them, for registration and for extracting from them the necessary information for the Health Care Point into the mentioned individual statistical card. Compiled from the indicated daily injury registration registers, decade and monthly summaries give a picture of the state of injuries, their nature and dynamics at the enterprise. Sanitary-hygienic work of the Health Care Point. The functions of the Health Care Point in this exceptionally important area of work are clearly defined by the resolution of the Council of People's Commissars of the USSR of 4/VII 1932 'on demarcation of the work of labor and health organs in enterprises' (item 'b'). 'The health organs,' says this resolution, 'exercise supervision over the general sanitary condition of the entire territory of the enterprise and all domestic institutions located on the territory of the enterprise (canteens, children's; nurseries, etc.), in particular over the fulfillment of all rules for sanitary maintenance of the enterprise insofar as it concerns the protection of the health of the surrounding population.' Health Care Points, on which the health organs have imposed the duty to carry out the indicated types of sanitary supervision at enterprises, use the corresponding rights granted to them by the said resolution (item 'v'): 'to carry out the tasks specified in item 'b', health organs have the right: to visit enterprises, to study and find measures to combat diseases, to directly demand from the administration of enterprises the elimination of detected shortcomings from the point of view of both protecting the health of the workers employed at the enterprise and the local population; to submit to labor organs proposals on issues related to the production process from the point of view of improving and healthifying the working conditions.' Within the competence of the Health Care Point in accordance with this resolution of the Council of People's Commissars of the USSR is the carrying out of sanitary supervision over the implementation of the sanitary minimum in shops, over the fulfillment by economic organizations of sanitary requirements concerning the maintenance of shops, workshops, yards, domestic institutions-dressing rooms, washrooms, toilets, smoking rooms, baths, buffets, canteens, club, as well as supervision over the condition on the enterprise of water supply, removal of filth, waste water, various waste and neutralization of production refuse harmful to health. The subject of special concern for the Health Care Point is the provision of workers with good drinking water, proper organization, maintenance and correct functioning of sanitary-hygienic installations-drinking fountains, showers, washbasins, baths, disinfection chambers, etc., establishment of systematic observation over the sanitary condition of workers' hostels, children's playgrounds, children's nurseries and over the routine established in them. The medical personnel of the Health Care Point also takes care of the proper organization of public catering, including diet meals for those in need of a diet, exercises sanitary supervision over the condition of canteens and buffets at the enterprise, striving to implement the sanitary minimum in them, observes the quality of the meals and food products served. The Health Care Point outlines the sanitary minimum for all shops and all the mentioned objects and takes measures to ensure its implementation. Usually, Health Care Points conclude special contracts on the sanitary minimum with the shop administrations. The Health Care Point carries out all current sanitary supervision at the enterprise. Physicians of the Health Care Point are granted the rights of state sanitary inspectors.

Health Care Points at new construction sites and major factory enterprises carry out a number of functions of preventive sanitary supervision: developing together with the district sanitary organization a plan of measures to ensure proper sanitary conditions of the construction site and to protect the health of workers of this enterprise and the surrounding population from the harmful influence of certain waste products and industrial wastes; participating in the consideration of issues related to the elimination or reduction of occupational hazards and the implementation of corresponding practical measures; drawing up together with interested organizations a plan for the arrangement of social and domestic institutions and living quarters for workers—dining rooms, buffets, nurseries, barracks, etc. A very important area of the sanitary-preventive work of Health Care Points are anti-epidemic measures: preventive vaccinations against typhoid fever, smallpox, isolation of bacillus carriers, disinfection and disinsection, sanitary processing of workers being hired. The main link in the preventive activities of Health Care Points is mass sanitary educational work, the content of which is determined mainly by the struggle to reduce morbidity and traumatic injuries—arranging lectures, talks, exhibitions, sanitary corners in red corners, using wall newspapers to illuminate various sanitary issues, conducting elementary classes on the basics of hygiene and sanitation and on providing first aid in the FZU school, in ROKK circles, with groups of public sanitary inspectors, etc. All sanitary-hygienic measures planned by Health Care Points for implementation at the enterprise are usually included as part of a unified plan of sanitary-technical measures in the enterprise's industrial financial plan. Individual sanitary-hygienic measures having the closest relation to the improvement of cultural and domestic service for workers are included in collective agreements. Health Care Points participate together with the labor inspection in developing a unified plan of health-improving measures at the enterprise (sanitary-hygienic measures, labor protection, safety engineering, etc.). Health Care Points thus also participate in the development of measures for the rationalization of the production process from the point of view of sanitation and hygiene, protection of health and improvement of working conditions. With regard to measures for improving production processes, which Health Care Points find it necessary to carry out on the basis of occupational hazards discovered by them, corresponding proposals are submitted by them to the trade union bodies dealing with labor issues. Health Care Points participate in the organization of work and rest regimes. Health Care Points take measures to organize rational healthy worker rest during the established short breaks in work and lunch breaks, to arrange physical culture sites on the factory territory and rest bases at clubs, to ensure proper use of the day off for rest—walks in the forest, along the river, healthy sports, etc. Organization of worker initiative. Health Care Points involve the working public in active participation in all its preventive and health-improving work by organizing at the enterprise, in workshops by shifts, health groups—groups for promoting health care, into which the factory activists are drawn. At a number of enterprises, the chairman of the health group is the chairman of the labor protection commission. Each member of the health group receives a specific area of work, which he carries out according to a pre-made concrete plan. Health groups receive systematic consultation from the medical personnel attached to them and included in their composition from the Health Care Point. Health groups usually undertake certain obligations for carrying out sanitary-hygienic work: sanitary minimum, in the field of water supply (supply of boiled water, drinking fountains), lighting, ventilation, public catering, in maintaining dormitories in cleanliness, in supervising the cleaning of all factory premises and the yard, in the successful implementation of anti-epidemic vaccinations, disinfection, in improving the sanitary condition of dining rooms, buffets, nurseries, in ensuring training of workers in first aid, in assisting in conducting medical examinations, dispensarization, implementing worker's comradeship control over workers released from work due to illness, in providing all possible assistance in carrying out all Health Care Point measures to reduce morbidity and traumatic injuries and improve cultural and domestic service for workers. Health Care Points involve workers in first aid circles and help ROKK cells organize their work, closely related to the work of the Health Care Point. The Health Care Point through health groups organizes the collection of worker proposals on issues of improving labor and living conditions. To assist the Health Care Point, the professional organizations of the enterprise allocate public sanitary inspectors from the sanitary active—members of health groups, ROKK cells. Public sanitary inspectors carry out public control over the fulfillment of Health Care Point requirements regarding the improvement of the sanitary condition of the enterprise and help organize the working public around the Health Care Point. The Health Care Point conducts all its work in close contact with the factory committee: the Health Care Point personnel makes reports on their activities, on the sanitary condition of the factory and on measures to reduce morbidity and traumatic injuries at meetings of the factory committee, its social and domestic sector, at meetings of insurance delegates, at factory meetings, participates in production conferences in workshops. Health Care Points involve the Komsomol cell, the pioneer organization, women delegates in sanitary-hygienic work, mobilizing their attention around the main issues of protecting and strengthening the health of workers and improving the sanitary condition of the entire enterprise. Health Care Points, through appropriate trade union organizations, take measures to ensure that contracts are concluded between individual workshops for socialist competition for the best implementation of the sanitary minimum. In rural areas—in state farms, machine-tractor stations, collective farms—Health Care Points operate on the same principles determined by the struggle to reduce morbidity and traumatic injuries as Health Care Points at enterprises, however taking into account the specific conditions of the territorial dispersion of agricultural work, their seasonality and nature. Health Care Points are organized in state farms and large collective farms in such a way as to ensure the provision of first aid during agricultural work in the field—sending a nurse, a sanitary worker with a first aid kit to the place of work, especially where agricultural machines are widely used, supplying sanitary bags to certain brigade leaders trained in first aid, who provide first aid to the corresponding area of work (field Health Care Points during the 1932 sowing campaign were created in the RSFSR 14,900, and during the harvest—18,000). In large state farms and collective farms, a medical Health Care Point is organized, which is usually entrusted with providing systematic medical care in the event of the outpatient clinic's remoteness. Health Care Points headed by middle-level personnel work under the supervision of a physician from the nearest medical institution. Health Care Points in state farms and collective farms, in addition to providing first aid, monitor the organization of nutrition in the field, supply of good quality drinking water, organization, in addition to permanent, summer nurseries for the duration of field work, conduct sanitary educational work, etc. The main task of Health Care Points includes carrying out necessary measures to combat agricultural traumatic injuries. Operational plan of Health Care Point. Each Health Care Point must have its own concrete work plan for the year, broken down by quarters and months with a detailed list of all sanitary and health-improving measures to be carried out throughout the enterprise territory and measures regarding the organization of proper medical-sanitary service for workers. The basis for drawing up the plan is data characterizing the sanitary condition of the enterprise, production processes in individual workshops, the composition and size of the working collective in them, the dynamics and level of morbidity with its breakdown into groups of diseases, the dynamics and level of traumatic injuries by workshops (corresponding indicators) and by detailed professions (individual types of work in workshops) with special attention to leading workshops and to those most unfavorable in terms of morbidity and traumatic injuries; moreover, when drawing up the plan, data on the condition and work of the health center and the degree, nature and quality of service of the workers of this enterprise by the relevant nearest medical-sanitary institutions, as well as data on the condition and activities of domestic institutions—dining room, buffets, bathhouse, laundry, nursery, etc. and the degree of involvement of the factory activists in preventive and health-improving work are taken into account. The establishment and presentation in the plan of the main factors affecting morbidity by its main types, preferably by workshops, is of particularly important significance for the operational plan. All the indicated data, included in the introductory part of the plan or the explanatory note to it, serve as the initial material for constructing a whole system—a complex of measures to reduce diseases and traumatic injuries and improve medical care for workers, covering all the above-mentioned aspects of the health center's activities and the ways and methods of implementing the planned measures.

The operational work plan of the Health Care Point is developed with the participation of health workers, is discussed in the factory committee; for the discussion of the plan in the part concerning individual shops, the shop worker, the shop active, and the shop health worker are involved; the plan is coordinated with the administration of the shops and of the entire enterprise and also with those medical-sanitary institutions which serve the workers of this enterprise. The plan is approved by the corresponding health department.