“An ambulance may not come right away”: a military doctor spoke about ways to save a person in extreme situations

- Tell me, what is tactical medicine, and how does it relate to medicine in general?

- She relates to medicine very indirectly. Tactical medicine is a set of first aid measures that can and should be used during fire contact, in war or in an emergency. That is, we teach people without medical education all the skills of first aid, the so-called extended care.

- What do the knowledge of tactical medicine give to military personnel and civil society? How important are they?

- This is the vital knowledge needed by everyone, and not just those who serve in law enforcement agencies. This is what you need to absorb with your mother’s milk, and in the army you must include in the "course of the young soldier."

Tactical medicine is constantly evolving, new methods and first aid devices appear. And, of course, this should be available not only to military personnel. To instill the skills of first aid is absolutely necessary for everyone. In my opinion, the defense capability of our country depends in some sense on this.

- But in the Russian army there is a certain medical preparation, or is saving the life a lot exclusively for doctors?

- Doctors, of course, save lives, and Russian military hospitals are equipped with everything necessary. Another thing is that doctors are not always at the forefront and they can not always be sent to the war zone. In such extreme conditions, military personnel should be able to help themselves and their injured comrade. This, in fact, is tactical medicine.

It allows the wounded to wait for qualified medical care, that is, to hold out from the moment of fire contact to the so-called evacuation cell.

We are making efforts to instill such important skills into the fighters. The current level of training in law enforcement agencies is clearly insufficient. For example, in the Ministry of Internal Affairs only two hours a year are allocated for medical training of police officers. For the traffic police, this, in my opinion, is six hours, for the military - eight hours.

Of course, this is catastrophically small. We believe that if the military personnel are properly trained, including conscripts, if they have a stable skill and understanding of how to provide medical assistance in an emergency, then they will be able to do this in civilian life. Moreover, if in the army we train instructors for the provision of first aid, we give these people an additional profession after leaving the armed forces.

- What medical manipulations can really be done in the conditions of military operations, when you are literally under bullets? How complicated can they be?

- Naturally, on the battlefield, the possibilities of providing medical assistance are limited. Although much depends on the knowledge, tools and preparations available at hand. For example, I know a person who, at the time of fire contact, made a vascular suture (used to restore blood flow) and thus saved a friend’s life. I personally only had to suture the wounds. In any case, it is important not to be afraid to do all the necessary manipulations as part of an extended first aid.

- How well are our military equipped with first aid equipment?

- We have good hemostatics (means to stop bleeding), various dressings that are in no way inferior to foreign analogues. But a little we lag behind in the fight against the consequences of occlusion (impaired patency of hollow anatomical formations), in immobilization (ensuring the stationary state of the victim), there is also the problem of heat loss. However, in all these areas we are working hard, trying to convey to the top what needs to be done. In fact, we are experiencing major difficulties with the certification of new medical devices.

- You interact with different power structures. How is interdepartmental interaction arranged in Russia? And why do you think there is still no single center that would train tactical medicine specialists at the state level?

- There really is no interagency center for tactical medicine, and ideally, of course, it should appear. It will allow to train employees of all law enforcement agencies and will become a platform for the exchange of experience. This can all be realized under the auspices of the Kalashnikov concern. Why is there no interdepartmental center in Russia? Firstly, such a task arose on the agenda not so long ago, and secondly, it is necessary to settle all organizational and financial issues.

Last December, a decision was made to create a training center on the basis of the Ministry of Defense. But then again, this is a departmental institution. Where to send your employees to other law enforcement agencies? In such conditions, each department is twisted as it can.

• Providing field medical assistance during a field training competition among EW specialists in the Stavropol Territory
• © Ministry of Defense of the Russian Federation

Therefore, at the proper level, interagency cooperation in Russia is absent. It, if I may say so, is carried out by a fairly narrow circle of specialists in tactical medicine. We know each other, we go to each other, share experiences, help as much as we can.

Nevertheless, this is a solvable problem, and the situation is gradually improving. On March 5-6, the first conference on tactical medicine will be held at the branch of the Military Medical Academy in Moscow, where I teach. This is a ray of light that will help in solving the problem. In addition, there are relevant specialists in Russia, and if you have the administrative resources, you can create an interdepartmental center by combining specialized departmental institutions.

- What causes the deaths of fighters in armed conflicts and civilians?

- In the war and in civilian life, from 60 to 70% of all victims die from blood loss, not receiving timely quality first aid, which helps to survive until the evacuation or arrival of doctors. Therefore, it is so important to teach the maximum number of people to stop bleeding.

- And what, ideally, should be in the first-aid kit or in the backpack of our military, and what is at the moment?

- The situation with the first-aid kit at the FSB and FSO is best. Gradually, new dressings and hemostatic agents are introduced. Unfortunately, our industry does not produce all that is needed so far. For example, there are not enough domestic self-fixing tapes. At the same time, there are Israeli ones, which are distinguished by special clamps to increase pressure.

There is a need for domestic multifunctional scissors that can cut not only bandages, but also metal. There is not enough hepatogloss (hemostatic agent) in first-aid kits, occlusive dressings are not certified (they provide hermetic isolation of the affected part of the body). Their appearance in the medicine cabinet would help in the fight against pneumothorax (accumulation of air or gases in the pleural cavity, which leads to lung collapse). So far, IPP (individual dressing package) is used for these purposes in Russia.

At the same time, high-quality anti-burn products and tows are produced in our country. For example, these are Esmarch and Alpha rubber hemostatic plaits. Some domestic products, in my opinion, are better than many foreign analogues.

Also, the fighter’s first-aid kit should have a decompression needle in order to remove tense pneumothorax. And some option for maintaining airway patency. For example, a Gwedel tube or adapter.

The extended first-aid kit, which is used in our center for tactical medicine, has an Ambu bag (a device for performing temporary artificial ventilation of the lungs), antiseptics, anti-shock sets, various tourniquets, dressings and a modern device for ensuring airway patency. It can be installed by anyone in 3-5 seconds. All the funds that I'm talking about are of domestic production. And they should be able to use every citizen of our country.

- Well, what can you say about the first-aid kit of an extreme sportsman or climber?

- In general, it will not differ in anything special, although it is important to take into account the type of human activity. If, for example, a person goes to the mountains, then he will need more funds for immobilization and life support in case of injuries or illnesses. If a person takes too many things with him, then the first-aid kit should be formed depending on the goals and objectives.

- And if we are talking about driver’s first-aid kits, which are and should be in every car?

- Everything is simple here. According to Russian law, a driver who does not have a medical education and relevant licenses cannot use medicines to help the victim. Therefore, the car should only have a tourniquet and an individual dressing bag. But from my point of view, such a kit is not enough for a quality first aid.

• Mobile first aid kit
• © Alexey Sukhorukov / RIA News

Arterial bleeding with a tourniquet, which should be in the driver’s first aid kit, you will not stop. In “Hour X” it is unrealistic to help the victim with such a set of medicines. Therefore, I recommend getting an extended version of the first-aid kit, where you need to include hemostatics, a mask for resuscitation, iodine, zielonka, a variety of tourniquets and dressings, atraumatic wipes, a warmth-keeping blanket, anti-shock set, occlusive dressings necessary for injuring the chest.

Everyone has the right to make a decision for himself about the composition of the first-aid kit. But it’s worthwhile to understand that in our country there are places where an ambulance may not arrive on time or ambulance aircraft will not land.

“And how much does such an extended first-aid kit cost?”

- There are such first-aid kits on sale, they cost around 20-25 thousand rubles. I believe that this is an affordable price, if you put human life on the other side of the scale.

- How do you generally assess the level of literacy of the Russian population in providing first aid? And is it possible to ensure that most citizens are at least able to stop blood flow, perform indirect heart massage and do artificial respiration?

- Naturally, we need to strive for this, so that each of us from a young age has the skills to provide first aid. As you rightly said, you need to be able to stop bleeding and have resuscitation skills. You also need to train instructors who would teach first aid in everyday life, during extreme sports and at work. Now in Russia it is the lot of enthusiasts.

I will give an eloquent example: in our accident on the roads of the eight injured, one dies. In all European countries, this figure starts at 50. That is, for 50 injured - one dead. And one of the reasons is not quite correct, illiterate medical assistance, or its absence.

- Is this actually pre-medical help?

- Of course. It is necessary because an ambulance may not arrive immediately, despite tough time standards. And, given the size of our country, it can be half an hour. While she is on her way, it is required to stop the bleeding or to do other manipulations so that the victim can safely wait for the arrival of specialists.

- But there are risks that the layman will not be able to assess a person’s condition and by his attempt to help, it will only hurt ...

- This is precisely the meaning of the training that is carried out in our center. Self-training is not bad, but practical skills and special classes are indispensable. People must reflexively understand what manipulations are required. This is how to brush your teeth. So in an extreme situation you need to act on the machine.

See the full version of the interview on the RTD website