Differences between tactical medicine and field and civilian medicine

38
Russian female soldier

History, which I will tell you during this article, happened to me in the recent year 2021, shortly before the start of a special military operation. At that time I was an employee of the special forces department and full-time tactical medicine instructor in a number of similar units that were part of various departments.

As part of one of the courses, an officer who did not take part in the lesson approached me and allowed himself to ask a rather strange, but at the same time very interesting question: “Why are you teaching tactical medicine? We have field and civilian medicine. Tactical medicine was invented by NATO member countries, that is, our opponents. Do we really need tactical medicine and what is its fundamental difference?”



Over time, I began to be asked this question much more often. Undoubtedly, all this is connected with the events that occurred in our country in February 2022. After several months, the number of questions of this kind sharply decreased from military personnel, while it increased manifold from people who are far from combat operations and are trying in every possible way to increase their level of knowledge on mutual assistance to people (for example, terrorist attacks in the Belgorod and Kursk regions, terrorist act in Crocus City Hall).

Terrorist attack at Crocus City Hall
Terrorist attack in Crocus City Hall. Photo: Wikimedia Commons

Let's start with an analysis of the concept of “civil medicine”.

Civil medicine


If we turn to any of the popular search engines, we will understand that as such this term does not exist in the modern world, but one way or another we understand by this phrase the provision of assistance by a civilian in the event of an emergency to another person (victim). This action also has a generally accepted name - “providing first aid”.

First aid is a series of actions that are performed directly at the scene of an incident by people who are at the time of the incident next to the person who has been injured (wounded), and aimed at saving the life and health of the injured person. Such actions include stopping bleeding with a tourniquet, chest compressions, artificial ventilation, immobilization of limbs, applying a pressure bandage, that is, everything that was taught and continues to be taught in schools during life safety lessons.

If we go a little deeper, then, of course, in the methodological materials of the Ministry of Emergency Situations we can also find actions in case of sunstroke and heatstroke, carbon monoxide poisoning, frostbite and drowning, but in the vast majority of cases, unfortunately, people do not know about the existence of such recommendations they don't know. Based on this, “civil medicine”, at best, gives us the opportunity to perform a number of simple actions to save a person - call emergency medical personnel and hand over the victim to them.

It is important to remember that from the point of view of the legislation of the Russian Federation, we do not have the right to exceed the established level of assistance to the victim - give injections, give pills. That is why they recently began to remove drugs from first aid kits en masse and limit its contents to ordinary bandages, tourniquets, napkins, and so on. Exceeding these measures may result in a criminal offense for the person providing assistance, for example, “causing death by negligence.”

Application of a tourniquet. Photo: Ministry of Defense of the Russian Federation
Applying a tourniquet to the thigh. Photo: website of the Ministry of Defense of the Russian Federation

Field medicine


Let’s move smoothly to the concept of “field medicine”.

A more correct term would actually be "combat medicine" - a branch of military medicine that aims to minimize casualties among paramilitary units by providing medical care to military personnel in the field. Field medicine involves treating wounds, illnesses and injuries in the absence of professional equipment.

For people who are not familiar with the situation, I will try to describe an approximate situation that is currently occurring during a special military operation.

A group of military personnel moves to a designated area to carry out a combat mission. During the mission, the group encounters an enemy unit. During fire contact, one of the servicemen is wounded (our attention will also be focused on this further), after which the wounded person is sent to a field hospital, where he is provided with all the necessary assistance to prevent the possibility of complications after injury or death.

People providing assistance in the field are certified doctors who, in accordance with the current legislation of the Russian Federation, have the right to perform surgical intervention if the situation requires it.

It is important to understand that in reality, a doctor who is involved in a field hospital never performs combat missions, and all his work is fully aimed at saving human life. To put it simply, this is the same specialist who can be found in a regular hospital near your home, but has a rank and is located in or near a combat zone.

Such doctors know and understand what medications the wounded person needs and what manipulations need to be carried out in order to stabilize the condition and transfer the victim to the next stage - to a professional medical institution, where in the event of an emergency or emergency situation, all necessary assistance will be provided using full range of medical drugs and equipment.

Tactical medicine


Well, now I’ll tell you what tactical medicine is.

The very concept of tactical medicine in our country began to be introduced en masse a little more than ten years ago. Before this, it was called “combat medicine” and was aimed at providing medical care to military personnel on the battlefield in combat conditions.

If we open old textbooks on combat medicine, we will understand that they describe the algorithm for a soldier’s actions in the event of injury and what actions are required to eliminate the fatal outcome.

Let's take as an example getting a gunshot wound in the forearm, and based on old Soviet training manuals, we learn that in this case it is worth applying a tourniquet to stop the bleeding, a pressure bandage on the wound site and injecting painkillers such as "Promedol".

At the same time, in books on combat medicine there is catastrophically little information about what drugs should be administered to a soldier when he is injured, how the infusion is carried out, which diligently hints to us that a wounded soldier is immediately sent to the next stage of hospitalization. In reality, this is not always the case, and a wounded soldier may remain in the so-called “red” or “yellow” zone for quite a long time (I’ll talk about this in the next article).

Beginning in 2012–2013, the approach to providing medical care in combat zones was radically revised. The basis was taken from Western-style materials that appeared and were introduced into the armed forces of the NATO bloc in 1994.

Tactical medicine itself was and continues to represent a set of medical and tactical measures (tactical-special training), which are carried out directly on the battlefield, as in the case of combat medicine, as well as throughout the pre-hospital period (during evacuation), while tactical medicine reveals the principle of action of certain drugs that a soldier can use immediately after being wounded, which will multiply the percentage of his survival, and also introduces new terminology caused by the emergence of new medical components of first aid kits (for example, hemostatic agents).

First aid kit individual
Individual first aid kit. Photo: website of the Ministry of Defense of the Russian Federation

In conclusion, we return to the most important question: which type of medicine needs to be known and studied?

If we consider this issue as a civilian, then the most suitable option for us would be to study tactical medicine. This discipline will significantly increase the initial level of knowledge that was obtained during classes at an educational institution during our youth, and for some, even today.

Of course, at the same time, the legislative framework must develop, and a person with tactical medicine skills (having a standard certificate) must be able to use painkillers and anti-inflammatory drugs on an equal basis with qualified medical personnel.

Tactical medicine itself reveals such concepts as “finger pressure” (one of the options for temporarily stopping bleeding in the absence of a tourniquet), tells how and how to properly carry out wound tamponade or infusion therapy in case of severe blood loss.

If you are a military personnel, then the choice is quite obvious - it is also worth studying tactical medicine.

But if we talk about military field medicine, then this area is quite highly specialized, and in the course of ordinary civilian life it will not be useful, except if you want to become a field surgeon or doctor.

For the purpose of self-development, I would recommend reading it, so that in your head you actually have an accurate picture of all actions in relation to the wounded (injured): from the moment of receiving this same wound (injury) to the complete rehabilitation of the victim.
38 comments
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  1. +6
    22 May 2024 05: 34
    “From a medical point of view, war can be viewed as a catastrophic epidemic of severe injuries with a shortage of everything - from personnel to iodine” - some very good book...
  2. +3
    22 May 2024 06: 11
    The buzzword is "tactical". They call it everything around - from pants to medicine))).
    1. +6
      22 May 2024 11: 28
      The name "tactical medicine" has as much meaning as the name "hybrid warfare". If there is a tactical war, then there must be an operational and a strategic one, but there were no non-hybrid wars at all.
    2. +1
      22 May 2024 15: 59
      Quote: Maxim Shalak
      The buzzword is "tactical".
      You underestimate the power of this word! On April 1, one company announced that a tactical kilt had appeared in its product line. We were joking. So she was inundated with orders! (Yes, a kilt... But a tactical one! And I still don’t have one!!!)
      PS If, as I understand, tactical medicine is field medicine for fighters, then it is a very useful thing (you never know where a medical instructor is), but not every fighter will be able to remember and learn it.
    3. 0
      8 June 2024 22: 29
      Quote: Maxim Shalak
      The buzzword is "tactical"

      As a trauma surgeon with almost 30 years of experience explained to me: “If in peacetime one out of ten patients dies, they will be forced to write explanatory notes and will be generally removed from work. If in war, out of ten patients admitted to the operating room, seven survive - for such high quality they can help and reward"
  3. +5
    22 May 2024 06: 54
    I remembered:
    “We pour soup into spoons and eat it in bowls.
    How do you do this? The spoons are small and the plates are large?
    On the contrary, we made the spoons large and the plates small, and for convenience we attached a handle to the plates.” laughing
  4. +4
    22 May 2024 07: 39
    Important topic. And the point, of course, is not in terms - tactical medic or medical instructor...
    1. +6
      22 May 2024 08: 47
      . Important topic. And the point, of course, is not in terms - tactical medic or medical instructor...

      Another Anglicism. tactical medicine.

      In our language, the word “tactics” is still a broader concept. We can talk about different tactics of action among a military doctor on the battlefield, a mountain camp doctor, a ship’s doctor, an emergency doctor, a clinic doctor and a multidisciplinary hospital doctor.
      Moreover, the tactics will be different for a patient with the same pathology, for example, with a gunshot wound to a limb.
      Although the principles of assistance will be the same.

      A more correct term is “military medicine.” It’s immediately clear what we’re talking about, plus it covers the whole spectrum, from self-assistance and mutual aid on the battlefield, to the organization of hospital bases in buried protected structures in the event of World War III. soldier
  5. +1
    22 May 2024 07: 50
    ...tactical medicine reveals the principle of action of certain drugs that a soldier can use immediately after being wounded, which will multiply the percentage of his survival, and also introduces new terminology caused by the emergence of new medical components of first-aid kits (for example, hemostatic agents)
    It is important to remember that from the point of view of the legislation of the Russian Federation We do not have the right to exceed the established level of assistance to the victim - give injections, give pills. That is why they recently began to remove drugs from first aid kits en masse and limit its contents to ordinary bandages, tourniquets, napkins, and so on. Exceeding these measures may result in a criminal offense for the person providing assistance, for example, “causing death by negligence.”.

    No less than Solovyov’s Karnaukhov tries “not to exaggerate the importance of life.”


    https://youtu.be/Bf9tNOi6lLE
  6. +2
    22 May 2024 07: 53
    Thank you. Very helpful to understand. Most likely, it will be useful for many to take courses and have a “cheat sheet” in the “expanded” first aid kit - table Name, analogues - briefly what for - briefly doses places repetitions - briefly contraindications, special conditions.
    1. +3
      22 May 2024 08: 01
      Thank you, if necessary, I will also write a separate article about this, what is required in the first aid kit and what drug is for what
      1. +4
        22 May 2024 08: 54
        That would be great!

        And it would also be great if you provided links to sources"I would recommend reading it too, so that you actually get an accurate picture of all actions in relation to the wounded in your head", and, if possible, video tutorials/courses.
        And if there is data on recommended courses in different cities.

        “It’s better to have it and not need it than to have it and not have it.”
        1. -1
          22 May 2024 12: 34
          Evich Yuri talks very well on YouTube
      2. +2
        22 May 2024 09: 08
        In the Soviet army, all these procedures, practically on the battlefield, were performed, or should have been performed, by a medical instructor. We had it in our battery. In civilian life they were called paramedics. They graduated from medical school and received some additional knowledge when they joined the army. During training, our medical instructor always had a bag with which he never parted. But I don’t know what kind of drugs were there.
        1. +2
          22 May 2024 10: 12
          And in the training centers (divisions) there were training medical companies, where for 6 months they trained medical instructors.
        2. +1
          22 May 2024 11: 19
          In the Soviet army, all these procedures, practically on the battlefield, were performed, or should have been performed, by a medical instructor. We had it in our battery. In civilian life they were called paramedics. They graduated from medical school and received some additional knowledge when they joined the army. During training, our medical instructor always had a bag with which he never parted. But I don’t know what kind of drugs were there.

          That's right. Doctor from the battalion. But this is ideal. laughing
          1. +6
            22 May 2024 12: 32
            Ideally, this is when each fighter knows how to provide self-help and mutual assistance :)
            1. 0
              22 May 2024 17: 19
              Ideally, this is when each fighter knows how to provide self-help and mutual assistance :)

              It's true. I mean that a doctor in a battalion is a rarity. It’s good if it’s in the regiment.
        3. +2
          22 May 2024 12: 37
          Every fighter must be able to provide assistance; they will kill a paramedic and then what to do next?
        4. The comment was deleted.
        5. +1
          23 May 2024 17: 44
          You won’t believe it, not only a medical school, but also a veterinary technical school, in our battalion there was a medical instructor with a civilian specialty of veterinary paramedic, so that in the troops they equated military personnel to animals, it’s a joke, of course.
      3. +1
        22 May 2024 20: 06
        Please write about MARCH-PAWS, otherwise 90% of those reading here have wild ideas... In my opinion, action algorithms are more important than a list of drugs. And then there are “experts” who like to “inject more promedol for painful shock.”
        1. +1
          22 May 2024 20: 13
          We agreed, one of these days we will make an article on the protocols)
  7. -1
    22 May 2024 12: 32
    Evich Yuri talks intelligently
    1. +1
      22 May 2024 12: 34
      Artem Nikolaevich Katulin also tells a very cool story. I recommend reading his book)
      1. +2
        22 May 2024 12: 36
        ozone costs 500 rubles, everyone who is going to SVO should read
      2. +1
        22 May 2024 20: 12
        Cool guy, I saw him when I was studying. And the book is good, but there is some problem with it - it was overloaded in my opinion.
        I would pay attention to the Directory of Tactical Medicine, posted on the website of the Russian Ministry of Defense
        https://medicine.mil.ru/first-aid/Metodicheskie-materialy/Ukazaniya-spravochniki-pamyatki
        or
        https://www.vmeda.org/wp-content/uploads/2022/10/handbook-tactical-medicine-2022.pdf
        Everything is fine there.
        By the way, the term “tactical medicine” is now fixed by order of the Russian Ministry of Defense.
        As for the “akhfitser” who asked you the question “why”... it was because of such mentally disabled figures that our army was simply choking on blood.
        1. +2
          22 May 2024 20: 29
          Well, everyone is just used to working according to the old manuals. So tactical medicine turned out to be a wonder for people :)
          1. +1
            22 May 2024 20: 43
            Unfortunately, the APPI began the SVO, which was also completed according to training manuals. It was such a shame... People didn’t know how to use tourniquets, about “time to pee” - a whole discovery, hemostatics - “what’s that?” Moreover, career military personnel...
  8. +1
    22 May 2024 17: 06
    An article from the category of “how we fucked up the entire legacy of a great civilization and are reinventing the VILOSEPED, but through which they poop” “Tactical clownery” cannot be called anything other than forced bashing, when all the principles of a systematic approach to organizing the process of providing MP in the Armed Forces have been forgotten.
    Tactical medicine itself reveals such concepts as “finger pressure” (one of the options for temporarily stopping bleeding in the absence of a tourniquet)

    Where to find a tree... to gnaw it or beat it... Haven't you patented it yet?))) The method of stopping bleeding that we taught to schoolchildren))) the basic skill of PMP which is taught in all courses, in addition to all kinds handy ways to stop CT if there is no tourniquet.
    They just pulled together scattered data from various textbooks and manuals on PMP and SMP and called it TM, it sounds cool, it’s actually funny.
    All your tactics (the first stage, which turns out to be self-help and mutual assistance + SI) are described in the EMS protocols for the relief of shock conditions (hypovolemic, traumatic, cardiogenic, etc.) + Desmurgy + minimal PSO skills + Asepsis and prevention of infectious diseases. This is what is needed on the battlefield, and then there is evacuation in stages. The speed of passage of which and the volume already depend on others.

    PS: People who provide MP in the field and teach it to show sincere respect. And it’s bombing because that harmonious system that was safely buried 20 years ago, especially the office geeks went through the drugs in the first aid kits... (AI, essentially an ideal set for everything) and now something is being invented... which is where push it in systematically? The database contains a VPM with its stages. Get it and apply it, adjusted to modern means.
  9. +2
    22 May 2024 19: 30
    Yu. Evich was one of the first to talk about takmed in Russia. The “Angel” project began working together with him, but they have already fled; now the “coolest” takmed course is in RUS (Gudermes). Of the ones known to me bully There are also courses in Partizan (St. Petersburg), at Bati Terminator (Novorossiysk), and the cherry on the cake - “Red Zone” (Moscow region) - I recommend it!
  10. +1
    22 May 2024 20: 17
    Military medicine is a separate world, MARCH and TSSS are trifles compared to the more serious literature and approaches that were in the USSR in the late period of Afghanistan... Itself and mutual assistance on the battlefield.... PS By the way, I’m looking for the 3rd edition of this manual, there is some added there according to ZOMP......
    1. +2
      22 May 2024 20: 37
      MARCH is part of the implemented and used Takmed system, an algorithm that is simple enough for mass development. And this system works, allowing us to significantly reduce mortality on the battlefield.
      "...During the military conflicts in Iraq and Afghanistan, the lowest mortality rate among the wounded in the history of the US armed forces was achieved. In an analysis of 56 cases of injuries to US Army personnel, it was revealed that the mortality rate among the wounded decreased from 763% at the initial stage of hostilities to 20% in Afghanistan and 8,6% in Iraq. At the same time, the survival rate of wounded with critical indicators of the injury severity index (10,1-25) increased from 75% to 2,2% (Afghanistan) and from 39,9%. up to 8,9% (Iraq)... To a large extent, the results achieved are explained by the improvement in the quality of the components of the complex of care for the wounded at the prehospital stage" (c)
      https://cyberleninka.ru/article/n/organizatsiya-i-taktika-dogospitalnoy-pomoschi-ranenym-v-boyu-v-usloviyah-sovremennoy-voyny-opyt-voysk-stran-nato-v-irake-i-afganistane
      As for the manual book you cited, it’s a simple experiment. There are many people on this site who served in the Soviet army. Let's ask how many of them knew about this book, read it, or studied from it.
  11. +1
    22 May 2024 21: 01
    The term tactical medicine appeared in 2009–2013 in the units of the Special Forces of the Armed Forces of the Russian Federation, simultaneously with the receipt of modern foreign samples of medical equipment to provide assistance at the pre-hospital stage.
    To use these samples, original training materials were required - the TCCS manual (Tactical Сombat Сasualty Сare) - tactics of providing assistance on the battlefield.
    Directly the term "tactical medicine" in combat units came as an abbreviated name for the leadership of the TCCS. During the period 2009-2013, it was obvious that the local application of the TCCS would lead to the further development of military medical training through the application and adaptation of this guide.
    There was military medical training in Soviet times, so it was necessary to develop it, and not use other people’s terms.
  12. +1
    23 May 2024 15: 31
    The article was written by an author who has a superficial understanding of both the work of the civil and military healthcare systems and the content of first aid measures (the so-called “tactical medicine”). Some moments are generally astonishing in their stupidity: the author’s description of his vision of the work of military medical units, the interpretation of the newly discovered concept of “combat medicine,” mixing together scraps of terms heard somewhere and other information.
    In general, the materials presented do not correspond to reality at all.
    The author’s recommendation to military personnel to “study tactical medicine” indicates not only a lack of systematic knowledge in the field of medicine, but also that the author either has nothing to do with military service or does not care about the combat training system.
  13. +1
    24 May 2024 11: 03
    Regarding the correct use of the term “tactical medicine” in relation to domestic conditions, it is necessary to refer to
    Order of the Minister of Defense of the Russian Federation of June 13, 2023 N 340

    "On approval of the Procedure for organizing the training of military personnel and medical specialists of medical (military medical) organizations and medical units (military medical) units of the Armed Forces of the Russian Federation to carry out first aid measures."
    https://medicine.mil.ru/first-aid/Normativno-pravovye-akty
    I quote:
    "....3. Military personnel are trained to carry out first aid measures during classes in the combat training system in the subject of training "Military medical training" (one of the tactical medicine courses: basic course, advanced course, special course) under the guidance of attracted medical specialists and trained non-staff specialists in tactical medicine to carry out first aid measures from among military personnel and medical specialists..."
    1. ada
      0
      28 May 2024 04: 06
      Quote: Ryazanets87
      ... need to contact
      Order of the Minister of Defense of the Russian Federation dated June 13, 2023 N 340 ...

      I looked. Even I wanted to drink... without having a bite sad
      Maybe there will be some specialist here - a military medic who has completed the position of NMS - a HF or S doctor and will break down into its components the structure of one of the types of comprehensive support for the life activity of military organisms in various states (from daily activities in MV and in the form of what kind of battle, there, well, let's say, at the level related to the term “tactical”, that is, it is “the main tactical unit - a military unit (regiment, brigade from among combat and combat support, of course) - medical support, and for one and the order military medical training military personnel in our modern army? Well, without revealing secrets and information that became known to him during his service, relying on what is publicly available, so to speak? A? recourse
  14. +1
    25 May 2024 21: 01
    Quote: bk0010
    but not every fighter will be able to remember and assimilate

    From what...
    It all depends on the training system...
    Even before his own, one former “our” who served in the army before the camp ran a channel on YouTube where he talked about “how it is to serve there”...
    So, they keep all their equipment at home, including a “first aid kit” (not like ours) - demonstrating it, he said that they all undergo training (such as courses) in military medicine, are able to remove bullets from muscle tissue, wounds sew up, etc. - everyone passes the “exam” and if they don’t pass, then they are not allowed to serve, and that’s money...
    And yes, he is a simple “fighter”...
    1. 0
      8 June 2024 22: 26
      The approach is correct IMHO. Anything can happen, a unit may find itself partially surrounded with no way to remove the wounded, or in peacetime there is bad weather and you simply cannot get through. East of the Urals this is not uncommon in winter.