How does a protocol differ from a tactical medicine algorithm?

51
Providing mutual assistance
Providing mutual assistance. Photo: website of the Ministry of Defense of the Russian Federation


Basic concepts


Tactical medicine is a field that combines knowledge and skills in providing first aid in combat conditions, disasters or other emergency situations. It is an integral part of the training of military personnel, rescuers and other specialists whose work involves risk to life.



In this article we will look at the basic algorithms and protocols of tactical medicine that can save lives in extreme conditions. I hope that the article will be useful to everyone who is interested in safety and survival in extreme situations, and will also help you better understand the principles of tactical medicine and apply them in practice.

The first thing that is absolutely necessary to understand is that the creation of algorithms and protocols for tactical medicine is an important step in ensuring safety and survival in extreme situations. This makes it possible to increase the efficiency of first aid, train specialists and standardize the process of providing assistance. Let's look at each of the goals.

Improving the effectiveness of first aid. Algorithms help to quickly and correctly respond to various situations, which can save the life of the victim.

Training of specialists. Algorithms are the basis for training military personnel, rescuers and other tactical medicine specialists. They allow us to systematize knowledge and skills, as well as ensure their transfer to new generations.

Standardization of care. Algorithms set standards for first aid, which ensures its high quality and safety. This is especially important in conditions where time is of the essence.

Evacuation of the wounded from the battlefield
Evacuation of the wounded from the battlefield. Photo: website of the Ministry of Defense of the Russian Federation

Based on this, tactical medicine protocols are a set of instructions and recommendations that are used to provide first aid in combat or other situations in order to ensure maximum effectiveness and safety.

The protocols and algorithms themselves may differ depending on the countries where they appeared, or on the organizations that develop these protocols. The most striking example is the MARCH–PAWS protocol and our Russian “KULAK-BARIN” protocol. I would like to note that, by and large, regardless of the name of the algorithm or protocol for providing care, the basic principles of tactical medicine are preserved in all cases. These include: rapid response, use of minimally invasive methods, control of bleeding and stabilization of the condition.

The most famous of all tactical medicine protocols is Tactical Combat Casualty Care. Why the TCCC protocol is the most famous in the world, I think it’s not worth going into too much depth, but I want to say that this protocol is one of the very first in the world, the most studied and the most expanded, and therefore the most effective (here you can throw as much as you like into me stones).

If necessary, I will definitely analyze each of the protocols with you in my subsequent articles and carry out an analysis and comparison so that you have an idea about each of them, but for now I will list a couple more protocols that exist.

The second assistance protocol is the NATO Tactical Medical Handbook, which represents the same TCCC, but adapted for NATO member countries.

The third most popular protocol is the “Protocol of the International Committee of the Red Cross.” The protocol itself is designed to provide medical care in conflict zones and other emergency situations, and is based on the principles of humanity, neutrality and independence.

Well, the last protocol, which I will try to mention in this article, will be the “Protocol of the Ministry of Emergency Situations of Russia” (especially so that they do not think that we are not developing anything), in which the Ministry of Emergency Situations examines the actions of its employees working in emergency situations.

In reality, there are a huge number of such protocols, and I can give examples of at least a dozen more of them. However, all these protocols must comply with the recommendations and international standards for tactical medicine developed by organizations such as the International Committee of Military Medicine (ICMM) and the International Association of Tactical Medicine (IATT).

Tactical medicine protocols are a sequence of actions that must be performed when providing first aid in combat or other emergency situations. They are aimed at ensuring maximum efficiency and safety of medical care in extreme conditions. Below are examples of a number of tactical medicine protocols:

MARCH:
◦ M (Massive Hemorrhage) – massive bleeding;
◦ A (Airway) – airway patency;
◦ R (Respiration) – breathing;
◦ C (Circulation) – blood circulation;
◦ H (Head Injury/Hypothermia) – head injury or hypothermia.

cab:
◦ C (Compression) – chest compression;
◦ A (Airway) – ensuring airway patency;
◦ B (Breathing) – artificial respiration.

ABC:
◦ A (Airways) – airway patency;
◦ B (Breathing) – breathing;
◦ C (Circulation) – blood circulation.

SALT:
◦ S (Sort) – sorting of victims;
◦ A (Assess) – condition assessment;
◦ L (Lifesaving interventions) – carrying out life-saving measures;
◦ T (Treatment and Transport) – treatment and transportation.

These are just a few of the many acronyms used in tactical medicine protocols. They help standardize first aid and provide more effective treatment for the wounded.

Providing self-help on the battlefield
Providing self-help on the battlefield. Photo: website of the Ministry of Defense of the Russian Federation

What is the difference between a protocol and an algorithm?


Tactical medicine algorithms represent a sequence of actions that must be performed to provide assistance to the victim. They may vary depending on the nature of the injury, the condition of the victim and environmental conditions. Algorithms help medical workers quickly make decisions and act effectively in extreme situations.

In turn, tactical medicine protocols are more detailed instructions that determine the procedure for dealing with various types of wounds and injuries. The protocols contain information about what treatment methods should be used, what medications and equipment are needed, and how to organize the evacuation of the victim.

Thus, tactical medicine algorithms are more general and universal, while tactical medicine protocols are more specific and detailed.

Here are some differences between tactical medicine algorithms and protocols:

Purpose: algorithms are designed to quickly make decisions in emergency situations, and protocols are designed to ensure quality treatment and care for victims.

Level of detail: Algorithms typically provide general guidelines, while protocols describe each step of the care process in detail.

Application areas: Algorithms can be used in any emergency situation, whereas protocols are most often developed for specific types of injuries or injuries.

It is important to note that tactical medicine algorithms and protocols are not mutually exclusive. They complement each other and help ensure effective care for victims in extreme conditions.
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  1. -2
    29 May 2024 14: 53
    How is this protocol?.. my nephew, the second one is 200...
    .THE DETAILS OF THE HEROIC DEATH OF A URAL MAN WHO KILLED IN THE SVO ZONE HAVE BEEN KNOWN
    Sverdlovsk Ombudsman Tatyana Merzlyakova told how paramedic Vladimir Noskov died. After his death, two days of mourning were declared in Rezh.

    In the city of Rezh, a two-day mourning was declared due to the death of three fellow countrymen. In the Northern Military District zone, city residents Alexander Bryukhanov, Vladimir Noskov and Fyodor Danilov died heroically. One of them was vilely shot by the Ukrainians when he was carrying the wounded from the battlefield. The Commissioner for Human Rights in the Sverdlovsk Region, Tatyana Merzlyakova, wrote about this on her VKontakte page.

    1. +6
      29 May 2024 17: 19
      With all due respect to you, but what does this have to do with it?
      1. 0
        5 July 2024 16: 17
        As the fire in an industrial building in Fryazino on June 24 showed, people generally do not think about how to save themselves. From the window from which they called for help and near which they suffocated, it was:
        5 m to the doorway
        6m to the door opening to elevators and stairs
        5m past the elevators to the stairs
        A total of six dead. For an ordinary person, running or walking these meters while holding your breath would not be difficult, they just didn’t think about getting out themselves, but waited for help. But the 7th floor with 6m ceilings is like the 13th floor in a residential building.
        What kind of tactical medicine is there... there are fans, but the bulk of the population doesn’t care
  2. +5
    29 May 2024 16: 31
    Algorithms are very useful in principle and especially when teaching people without any medical knowledge, but with harmful stereotypes from feature films and books.
    It is necessary to hammer it into automaticity, because one of the main obstacles to saving the wounded/victim is that those around him simply do not know what needs to be done, in what sequence. We'd be happy to help, but how?
    Hence the cases when the wounded were given “horse” doses of promedol, tourniquets were applied incorrectly, and so on..
    March or kulak-master, according to my own feelings, are very well adapted to the level of an ordinary person.
    1. +5
      29 May 2024 17: 20
      Yes, I completely agree, these are the two most understandable and adapted protocols for a civilian
    2. +2
      29 May 2024 18: 51
      Algorithms are very useful in principle and especially when teaching people without any medical knowledge, but with harmful stereotypes from feature films and books.
      It is necessary to hammer it into automaticity, because one of the main obstacles to saving the wounded/victim is that those around him simply do not know what needs to be done, in what sequence. We'd be happy to help, but how?
      Hence the cases when the wounded were given “horse” doses of promedol, tourniquets were applied incorrectly, and so on..
      March or kulak-master, according to my own feelings, are very well adapted to the level of an ordinary person.

      I don't agree. The main drawback of all these algorithms and protocols is that a person does not understand what he is doing and does before, which he does not understand. Hence the difficulty in remembering all these algorithms, especially Western ones.

      Why the hell is A, B, C? Пairway patency, Дgasping (tautology!) and Кcirculation? Then P, D, K. laughing
      That is, you also need to remember that A - (Airways), B (Breathing), C (Circulation). And translate it correctly. wink

      For almost 30 years now, I have been hearing how in qualified medicine they are also trying to introduce algorithms and protocols. Only there they are called standards and clinical recommendations. So what? Things are still there today.
      1. +2
        29 May 2024 22: 21
        Quote: Arzt
        I don't agree. The main drawback of all these algorithms and protocols is that a person does not understand what he is doing and does before, which he does not understand. Hence the difficulty in remembering all these algorithms, especially Western ones.

        I also don’t agree with you. Sometimes it is not understanding that is important, but action “here and now”, at the level of a person without special training. In the future, let there be “hands” of specialists.
        Quote: Arzt
        For almost 30 years now, I have been hearing how in qualified medicine they are also trying to introduce algorithms and protocols.

        It's a multi-faceted problem. request
        1. 0
          29 May 2024 23: 00
          I also don’t agree with you. Sometimes it is not understanding that is important, but action “here and now”, at the level of a person without special training. In the future, let there be “hands” of specialists.

          Why do you think specialists are specialists? They KNOW what they are doing. And this understanding can be given in the same time as algorithms, even faster. Unlike algorithms, understanding does not need to be taught. It comes once and for all, like the ability to swim, for example.
          1. +1
            29 May 2024 23: 06
            Quote: Arzt
            Why do you think specialists are specialists? They KNOW what they are doing.

            Why are you so... there are those who understand.
            Quote: Arzt
            And this understanding can be achieved in the same time as algorithms, even faster. Unlike algorithms, understanding does not need to be taught. It comes once and for all, like the ability to swim, for example.

            No you can not. Or we will come to your same phrase:
            Quote: Arzt
            For almost 30 years now, I have been hearing how in qualified medicine they are also trying to introduce algorithms and protocols. Only there they are called standards and clinical recommendations. So what? Things are still there today.

            There will be action without understanding.
        2. 0
          29 May 2024 23: 02
          There's a multi-faceted request problem

          Same problem. Standards don't work in real life, and neither do protocols.
  3. 0
    29 May 2024 16: 39
    Well, some historical materials)
  4. +2
    29 May 2024 16: 46
    In this article we will look at the basic algorithms and protocols of tactical medicine that can save lives in extreme conditions.

    Dear author! You yourself understand that it is impossible to explain medicine with your fingers.
    After numerous training sessions on the dummy, not everyone was able to “revive” it.
    Sorry, without practice your algorithms and protocols are empty words.
    hi
    1. +2
      29 May 2024 17: 18
      Perhaps these articles will one day become a call for someone to switch to practice, the main thing is that people find it interesting
      1. +1
        29 May 2024 17: 21
        Quote: Latvian_Tactical_Medicine
        the main thing is that people are interested

        Practical medicine is of interest. This is what internship and residency are for. You can talk as much as you like about the structure of a tooth (for example), but no one will allow patients to be treated after completing an internship and passing exams.
        1. +1
          29 May 2024 18: 51
          Ideally, yes, but in order to master the skills of tactical medicine, you do not need to have a medical education) there are training grounds and skills training for this. I won’t go into specifics about practicing skills in the ZBD.
          But again, I agree here too, practical medicine arouses the most interest
        2. 0
          29 May 2024 18: 55
          Practical medicine is of interest. This is what internship and residency are for. You can talk as much as you like about the structure of a tooth (for example), but no one will allow patients to be treated after completing an internship and passing exams.

          Internship and residency are not practical medicine. This is a continuation of the perversion called “studying to become a doctor at a medical university.” laughing

          We need a residency, like in the nasty West. bully
          1. 0
            29 May 2024 22: 24
            Quote: Arzt
            Internship and residency are not practical medicine.

            You are completely wrong. This is “entry” into practical medicine. But a lot depends on the “mentor”, but with this we have complete... request
            1. 0
              29 May 2024 23: 07
              You are completely wrong. This is “entry” into practical medicine. But a lot depends on the “mentor”, but with this we have a complete .... request

              Yes, a mentor is important, but the principle is more important.
              And the fundamental difference between our residency and Western residency is carefully hidden by our medical community, mainly by universities.

              At the same time, the Government is told that in America it takes 3-5 years to train for a residency, while here we have 2. That’s why they are so smart. Yeah. laughing
              1. 0
                29 May 2024 23: 17
                Quote: Arzt
                And the fundamental difference between our residency and Western residency is carefully hidden by our medical community, mainly by universities.

                Yes, nothing is hidden. It's just that no one is interested. Besides universities, of course, there is an excellent “feeding ground” for them; the longer the training, the more money.
                I myself found myself in a “golden moment” (although I was already 150% self-prepared laughing) when, for the sake of experimentation, the institution of “subordination” was introduced for a couple of years. We were distributed in the 5th year, the 6th year was 80% focused only on the specialty. They approached the internship almost ready, they were just “polishing” there.
                Well, who needs this now?
                Quote: Arzt
                Yes, a mentor is important, but the principle is more important.

                The principle is the principle, but when you work with young people, in order for them to turn out something better, you have to spend 2-3 years (from their student days).
                1. +1
                  29 May 2024 23: 28
                  Yes, nothing is hidden. It's just that no one is interested. Besides universities, of course, there is an excellent “feeding ground” for them; the longer the training, the more money.
                  I myself found myself in a “golden moment” (although I was already 150% self-prepared laughing) when, for the sake of experimentation, the institution of “subordination” was introduced for a couple of years. We were distributed in the 5th year, the 6th year was 80% focused only on the specialty. They approached the internship almost ready, they were just “polishing” there.
                  Well, who needs this now?

                  The government is interested. And patients are also interested in having an intelligent doctor teach them, and not an 8th year student at the institute. laughing

                  Everything about subordination is absolutely accurate. That's how it should be done. Throw out all the rubbish that has accumulated there over the years from the program, condense the theory into the first 3 years and free up a full year for subordination. Or, more precisely, sub-residency. As it was in the USSR.

                  After all, the fundamental difference between our residency and Western residency is that In our country, residency is still a study, but in the States, residency is already a job.

                  Dr. House is not a teacher at the department, he is simply one of the most experienced doctors at the clinic. And its residents are not dull “blades”, but young doctors whom the hospital trains for itself, and for the staff, of course. Therefore, they are vitally interested in training them faster. And in our residencies you can easily drink beer for 2 years.

                  And these residents are on the staff of the hospital and are already earning money, and not feeding the university bosses.

                  ACC in Germany is 3 Euros, FAH is already 500 - 5. wink

                  No one teaches in the States for 10 years, this is a myth. 6 years, diploma in teeth and forward, plow. negative
                  1. +1
                    29 May 2024 23: 46
                    I’ll try to answer you briefly, because it’s already night for me).
                    Quote: Arzt
                    For almost 30 years now, I have been hearing how in qualified medicine they are also trying to introduce algorithms and protocols. Only there they are called standards and clinical recommendations. So what? Things are still there today.

                    The problem is twofold. On the one hand, there is a good wish to reduce the number of errors by standardizing the process of obtaining information (diagnosis) and, accordingly, further actions (treatment). On the other hand, “beating off” the ability and desire to “think” (why? act according to the standards and come what may). Stepping aside in the event of an unfavorable outcome is seriously punishable (including criminal liability); in the event of a favorable outcome, no one will notice.
                    Quote: Arzt
                    Yes, a mentor is important, but the principle is more important.

                    This institute has always been “on a voluntary basis.” There will soon be no “dinosaurs” (and even those that can think) left at all. There is no material or other incentive. A completely different approach begins to prevail (and not yesterday, by the way) - “why would I teach someone what I myself can do and have mastered “for nothing”? To create competitors for myself in the “clearing””?
                    What to do about it? Well, I don’t know, not the Minister of Health and Higher Education request
                    therefore
                    Quote: Arzt
                    And patients are also interested in having an intelligent doctor teach them, and not an 8th year student at the institute.
          2. 0
            1 June 2024 19: 43
            Once upon a time, internship and residency were the primary specialization or improvement of the experience of a specialist doctor...
      2. +2
        29 May 2024 19: 14
        Perhaps these articles will one day become a call for someone to switch to practice, the main thing is that people find it interesting
        Perhaps they will. Personally, I'm very interested! And, yes, it would be nice to brush up on what I was (briefly) taught many years ago.
        Thanks, Author!
        1. +4
          29 May 2024 19: 15
          Thank you for the kind words!) I try!)
          1. +1
            29 May 2024 22: 56
            Tell me, Author, do you know of tactical medicine courses in St. Petersburg? I would go to study...
            1. +3
              29 May 2024 23: 51
              I would recommend at any cost to attend classes on tactical medicine taught by Artyom Nikolaevich Katulin. I am his student, but now I can’t say for sure whether UCTM travels to other regions or not to conduct classes. This is the most powerful instructor in our country.
              I say it as it is, not as an advertisement. And so I conduct classes myself, but so far Peter has not been standing, but in a month we will definitely contact our colleagues, maybe we will come.
              1. +1
                30 May 2024 07: 12
                I would recommend at any cost to attend classes on tactical medicine taught by Artyom Nikolaevich Katulin.
                Thanks! I'll look.
                1. +2
                  30 May 2024 13: 46
                  For the benefit of! Let the knowledge be as useful as possible for you!)
              2. 0
                1 June 2024 19: 40
                And Artyom Nikolaevich Katulin probably needs to make a series of educational films (through public funds). At the moment, they should be made mandatory for viewing in high schools, technical schools - universities and military educational institutions....
                1. +1
                  2 June 2024 17: 19
                  I agree, this kind of films should be included in the curriculum of educational institutions
    2. +4
      29 May 2024 17: 20
      But I have no offense, in essence and in fairness everything has been said to the point
  5. +2
    29 May 2024 20: 38
    in modern warfare, medicine is probably the most problematic and pressing issue...
    1. +3
      29 May 2024 20: 48
      This is where it hits the bull’s eye, it is in modern medicine, with the use of a different arsenal of weapons, that medicine has become a truly problematic and pressing issue, or rather, ignorance of it
      1. +2
        29 May 2024 20: 53
        Dear Latvian_Tactical_Medicine! And what do we all want from military medicine, if for the last 30 years we have been engaged in the massive construction of a “happy” capitalist future with all its “bells and whistles”... Was there any time before medicine, and military medicine in particular... We lost it, took it away and They sold, for next to nothing, everything they could, including medicine with its achievements, successes, plans and objectives...
        1. +3
          29 May 2024 22: 08
          Well, now is the time for progress, when all the mistakes, shortcomings, etc. opened up like an abscess with the beginning of the SVO
          1. +2
            1 June 2024 19: 30
            Dear Latvian_Tactical_Medicine! To rehabilitate the place of the “abscess”, Russia will need decades.. You see for yourself that, even during the war, so many “rats” were entrenched in the Russian military department - traitors - traitors who will be “excused” by the entire “fifth column” ... And in 5-10 years, these “ratties” will quietly get out, on parole, and go to the “Canary Islands to write memoirs” and spend the people’s millions... To fight against “ulcers,” especially during times of war and enemy encirclement, firm determination is needed , political will, iron balls and very strict legislation regarding embezzlers, traitors, idiots and “waiters”, local members of the “fifth column”, no matter in what chairs and on what “floors” of power they sat...
      2. +1
        1 June 2024 19: 35
        Dear Latvian_Tactical_Medicine! A necessary, timely article! Thank you!!!!!!!!! Write, I will be very glad to read you again....
        1. 0
          2 June 2024 17: 21
          Thank you very much, analysis of the MARCH protocol is already in progress. If you want, you can voice a topic that worries you at the moment. I read the comments and will be ready to consider the possibility of writing an article exactly on the topic that interests you
          1. 0
            5 July 2024 16: 26
            Quote: Latvian_Tactical_Medicine
            I will be ready to consider the possibility of writing an article exactly on the topic that interests you

            Purely theoretically, and just in case, I am interested in the differences in the triage of the wounded between the Reich/NATO and USSR/RF standards.
            I read that “with them” the doctor must first help those who will recover with help, so there are more deaths there, but under the Soviet system there are fewer deaths and more disabled people.
            And in general, the procedure for providing assistance if there are many wounded, but there is only one healthy and able to help. This is possible both in case of accidents and in wars, that is, it can be useful.
            I also want a doctor’s healthy criticism of a car first aid kit and advice on how to equip a “normal” one to help if you witness an accident in a remote area, where the doctor is tens of kilometers away on bad roads. Actually, this is a sad experience; on an expedition, in case of injuries, the only medical supplies at hand are what was in the first aid kit of the car.
  6. +1
    29 May 2024 22: 18
    Continue author. It will be interesting to read and comprehend. It will be possible to discuss.
    1. +1
      29 May 2024 23: 37
      Thank you very much, let’s continue) I’ll be glad to communicate)
  7. +1
    30 May 2024 00: 59
    Anton Pavlovich Chekhov wrote about protocols and algorithms, indirectly of course, in his story Ambulance. Re-read, you will understand the author of the article.
    It’s just that the list of abbreviations makes me want to write the “Zion” protocols, sorry, it’s not very clear (for me). It is probably very important to understand the difference between protocols and algorithms, but why? We need at least some practical example from tactical medicine. Which could at least briefly show how a protocol is selected following an algorithm (did I understand correctly?) and as a result, a tactician who does not have a serious medical education helps (saves) the victim.
    1. +1
      30 May 2024 05: 01
      You have very good knowledge in the field of literature and this is gratifying, I won’t hide it!)
      I will analyze the algorithms and protocols separately in even more detail, just for now we are gradually immersing ourselves in the terminology and answering questions along the way!) I read the comments and see what people are asking me to write
    2. +2
      30 May 2024 18: 07
      Anton Pavlovich Chekhov wrote about protocols and algorithms, indirectly of course, in his story Ambulance. Re-read, you will understand the author of the article.
      It’s just that the list of abbreviations makes me want to write the “Zion” protocols, sorry, it’s not very clear (for me). It is probably very important to understand the difference between protocols and algorithms, but why? We need at least some practical example from tactical medicine. Which could at least briefly show how a protocol is selected following an algorithm (did I understand correctly?) and as a result, a tactician who does not have a serious medical education helps (saves) the victim.

      Aha laughing
      But what about him? - asks the clerk. - After all, he’s drowned!
      - So what, what is it, drowned? Those who are dead from drowning should not be pumped out, but rubbed. This is what it says in every calendar.
  8. +1
    30 May 2024 04: 37
    Thanks for the article, knowledge of even the simplest algorithms (a strict sequence of simple actions) can save someone’s life in everyday life, let alone in combat.
    1. +2
      30 May 2024 13: 49
      “Theory without practice is dead, practice without theory is blind.” The words belong to Alexander Vasilievich Suvorov
  9. +1
    30 May 2024 13: 06
    I hope for a continuation of the article or even a series. For a long time there were no articles that directly corresponded to the theme of the site.
    1. +2
      30 May 2024 13: 48
      There will be articles, now we are gradually preparing materials for the next articles, I will try to first tell the basic concepts, history, etc., and gradually move on to the most interesting articles with an analysis of actions in certain situations
      1. +1
        30 May 2024 16: 07
        One more point: I would be very interested in your opinion on bleeding control products from different manufacturers and different types. What works, what works, but poorly or completely unusable.
        For example, have you worked with a turnstile from Medplant, how justified is the proposed design in extreme conditions? If anything, I didn’t like it at all, but this is a purely personal impression.
        Interesting opinion about the "Alpha" harness and Rudnev's contactor. I managed this thing in training, but in reality I’m not sure...
        1. +1
          30 May 2024 17: 02
          Okay, we’ll do the analysis of the harnesses separately too :)
        2. +1
          30 May 2024 17: 02
          But looking ahead, I’ll say that I didn’t like Medplant either)