PAWS – analysis of the tactical medicine protocol

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Application of a cohesive bandage
Application of a cohesive bandage. Photo: Youtube.com


PAWS - is tactical medicine protocol, which is a comprehensive approach to providing medical care in the field. It is based on the principles of military surgery and tactical medicine and includes the following main elements:



Otsenka sostoyaniya postradavshego: Before starting treatment, it is necessary to conduct a quick and accurate assessment of the wounded person's condition, including an assessment of vital functions, the nature and severity of injuries. This allows you to prioritize care and select the most effective treatment methods.

Pain Control: To reduce pain in the victim, various methods of pain relief are used, such as the administration of analgesics and sedatives. The choice of pain relief method depends on the nature of the injury, the condition of the victim and the availability of necessary medications.

Antibiotics: If there are signs of infection or the risk of its development, broad-spectrum antibiotics should be prescribed. The choice of antibiotic depends on the suspected causative agent of the infection and its sensitivity to the drugs.

Wounds: wound treatment includes stopping bleeding, cleaning the wound from contamination, treating with antiseptics and applying a bandage. If necessary, surgical treatment of the wound is performed to remove non-viable tissue and restore the integrity of the skin.

Tires (Splinting): immobilization of fractures and dislocations using special splints or other means helps prevent additional damage and facilitate transportation of the victim. Splints are applied to the damaged limb in such a way as to ensure its immobility in the area of ​​the fracture or dislocation.

Protocol PAWS has a number of advantages over other tactical medicine protocols:

- simplicity: protocol PAWS easy to remember and perform even under stress and fatigue;

- efficiency: the protocol allows you to quickly and effectively provide assistance to victims in the field, which can save their lives;

- versatility: The protocol can be used to help victims with various types of injuries and illnesses.

However, the PAWS protocol is not without the following disadvantages:

- need for training: for efficient use of the protocol PAWS you need to undergo special training;

- limited resources: in some cases it may not be possible to use all protocol elements PAWS, for example, in the absence of necessary medications or equipment.

Overall protocol PAWS is an effective tool for providing first aid to the wounded in combat conditions. However, its application requires careful planning and preparation, as well as the availability of the necessary resources.

Thigh wound
Thigh injury. Photo: Youtube.com

P – Pain Control


In the tactical medicine protocol PAWS pain control is a system of measures aimed at reducing pain in victims. It involves the use of various methods and drugs for pain relief.

Basic principles:

- quick onset of action. Pain relief should begin as early as possible to prevent the development of pain shock and other complications;

- individual approach. The choice of method and drug for pain relief depends on the nature of the injury, the condition of the victim and the presence of contraindications;

- gradual increase in dose. To achieve optimal effect, pain relief should be carried out gradually, with increasing doses of the drug until the pain is completely eliminated.

In the protocol PAWS The following drugs are used for pain relief:

- opioid analgesics. These are the most effective drugs for eliminating severe pain. They act on opioid receptors in the brain, blocking the transmission of pain impulses. In the protocol PAWS opioids such as morphine, fentanyl, tramadol and others are used;

- non-steroidal anti-inflammatory drugs (NSAIDs). These drugs have analgesic, anti-inflammatory and antipyretic effects. In the protocol PAWS NSAIDs such as ketorolac, diclofenac, ibuprofen and others are used;

- local anesthetics. These drugs are used for local anesthesia during surgery. The PAWS protocol may use local anesthetics such as lidocaine, novocaine and others;

- ketamine. This drug has an analgesic and sedative effect. It can be used for short-term pain relief and stabilization in victims with severe injuries;

- promedol. The drug belongs to the group of opioid analgesics. Has a pronounced analgesic effect. Used for injuries, burns, cancer, etc.;

- fentanyl. The drug also belongs to the group of opioid analgesics, but is characterized by a faster onset of action and greater effectiveness. Used for severe pain of various origins;

- tramadol. Another representative of the group of opioid analgesics. It is moderately effective and has fewer side effects compared to other drugs in this group;

- ketorolac. A non-steroidal anti-inflammatory drug with a pronounced analgesic effect. Can be used for pain of varying severity.

Pain relief for the wounded
Pain relief for the wounded. Photo: Youtube.com

A – Antibiotics


In the tactical medicine protocol PAWS Antibiotics are a system of measures aimed at preventing or treating infectious complications in victims. It involves the use of various antibiotics to fight bacterial infections.

In the protocol PAWS The following antibiotics are used to treat infections:

- cephalosporins. This is a group of broad-spectrum antibiotics that are effective against many gram-positive and gram-negative bacteria. In the protocol PAWS cephalosporins such as ceftriaxone, cefotaxime, ceftazidime and others are used;

- fluoroquinolones. This is another group of broad-spectrum antibiotics that is effective against many bacteria, including some strains that are resistant to other antibiotics. In the protocol PAWS fluoroquinolones such as levofloxacin, ciprofloxacin and others can be used;

- aminoglycosides. This group of antibiotics is effective against gram-negative bacteria but can cause side effects such as nephrotoxicity and ototoxicity. In the protocol PAWS aminoglycosides are rarely used, only for severe infections when other antibiotics are ineffective;

- macrolides. These antibiotics are effective against some gram-positive bacteria and atypical microorganisms such as mycoplasma and chlamydia. In the protocol PAWS macrolides can be used for infections of the respiratory tract, skin and soft tissues;

- carbapenems. These are powerful antibiotics that are effective against most bacteria, including resistant strains. In the protocol PAWS carbapenems are used for severe and life-threatening infections;

- tetracyclines. This group of antibiotics is rarely used due to their side effects and limited effectiveness. However, they may be useful for some infections, such as anthrax and plague.

W – Wounds


In the tactical medicine protocol PAWS wounds is a system of measures aimed at treating wounds and preventing their infection. It involves the use of various medications to treat wounds, stop bleeding, and prevent infection.

Basic principles:

- quick assessment of the wound condition. It is necessary to assess the nature of the wound, the degree of tissue damage, the presence of bleeding and other complications;

- stop bleeding. If bleeding occurs, measures must be taken to stop it. This can be done using a pressure bandage, tourniquet, or other methods;

- wound treatment. The wound must be cleaned of dirt, foreign bodies and necrotic tissue. For this, various antiseptic solutions and preparations are used;

- applying a bandage. A sterile dressing is applied to the wound, which protects it from further contamination and promotes healing;

- prevention of infection. To prevent the development of infection, antibiotics are used, as well as other drugs that promote wound healing.

In the protocol PAWS The following drugs are used to treat wounds:

Antiseptic solutions. These solutions are used to cleanse the wound of dirt and microorganisms. In the protocol PAWS Antiseptics such as hydrogen peroxide, chlorhexidine, iodine and others are used.

Painkillers. They are used to relieve pain when treating a wound. In the protocol PAWS Painkillers such as lidocaine, novocaine and other local anesthetics can be used.

Hemostatic agents. They are used for bleeding from a wound. In the protocol PAWS hemostatic agents such as hemostatic sponge, thrombin and others can be used.

Anti-inflammatory drugs. They help reduce inflammation and swelling around the wound. In the protocol PAWS Anti-inflammatory drugs such as diclofenac, ibuprofen and other NSAIDs can be used.

Medicines to stimulate healing. They promote the formation of new tissue and restoration of damaged skin areas. The PAWS protocol can use drugs such as methyluracil, solcoseryl and others.

Antibiotics. They are prescribed if an infection is suspected or if there are signs of inflammation. In the protocol PAWS Broad-spectrum antibiotics are used, such as cephalosporins, fluoroquinolones and others.

Secondary examination of the wounded
Secondary examination of the wounded. Photo: Youtube.com

S – Splinting


In the tactical medicine protocol PAWS splints are a system of measures aimed at immobilizing (immobilizing) injured limbs in order to prevent additional injuries and facilitate transportation of the victim.

The following types of splints are used to immobilize limbs:

Soft tires. These are elastic bandages or tapes that are placed over the damaged limb and provide its fixation. Soft splints can be used for fractures, dislocations and other injuries that do not require rigid fixation.

Hard tires. These are solid structures, such as wooden or plastic splints, that provide more reliable immobilization of the injured limb. Hard splints are used for bone fractures, joint damage and other severe injuries.

Vacuum tires. These are modern devices that create a vacuum environment around the damaged limb, ensuring its fixation and reducing swelling. Vacuum tires are the most convenient and effective, but require special equipment for their use.

Splinting
Splinting. Photo: Youtube.com
53 comments
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  1. +1
    7 June 2024 04: 51
    Antibiotics are mandatory with an open wound, but not if an infection is suspected. With a closed one, in most cases, too. Although not right away.
    1. 0
      8 June 2024 15: 22
      Quote: Prokop_Svinin
      With an open wound, antibiotics are mandatory

      An open wound is the first sign of suspicion of infection)
  2. +1
    7 June 2024 06: 04
    Interesting article...but the Latin names of drugs are extremely difficult to remember. smile
    1. +3
      7 June 2024 07: 00
      I think maybe it’s worth dividing the articles into 2 parts? To make it easier to remember? Or is it better to immediately issue information in one stream?)
      1. +1
        7 June 2024 08: 07
        As it is, it’s normal. Those who are really interested will highlight the material in “bookmarks” and re-read it again.
        Thanks, Author!
        1. +1
          7 June 2024 08: 12
          Thank you very much hi
          In any case, I’m always ready to give explanations on any incomprehensible terminologies and so on) then for now I’ll leave the article in this format)
      2. +1
        8 June 2024 15: 25
        Quote: Latvian_Tactical_Medicine
        To make it easier to remember?

        To make it easier to remember, the article is scanned, divided into convenient pieces, and then they proceed according to their usual memorization methods. People who seriously work with their memory choose from a huge arsenal of mnemonic techniques those that suit them. You can’t make an article for everyone)
      3. +1
        8 June 2024 21: 01
        No, it is not necessary in two parts, so that it does not turn out that someone read only the second and remembered half.
        By the way, is there a rule: “before providing assistance, make sure you don’t fall next to the same lesion” in tactical medicine?
        And then I remember the Egyptian chicken and six dead people.
        1. 0
          9 June 2024 06: 18
          Good afternoon. Yes, this is a rule before the MARCH protocol. And now he looks SMARCH-PAWS. S - Safety
    2. +2
      7 June 2024 09: 54
      Interesting article...but Latin names of drugs are extremely difficult to remember. smile

      I'll tell you a secret - it's not necessary. Even doctors don’t know them. laughing They are not here.
      By the way, isn’t it difficult to remember abbreviations in the enemy’s language?
      1. +1
        7 June 2024 10: 04
        I agree, the most important thing is to understand where to look if something happens)
        The judges also don’t know all the articles by heart, but they know where to look)))
        1. +3
          7 June 2024 10: 30
          I agree, the most important thing is to understand where to look if something happens)
          The judges also don’t know all the articles by heart, but they know where to look)))

          What I mean is that it seemed to Lyokha that the medicines here were written in Latin.
          In fact, everything is much worse. laughing

          Promedol is the Russian word for it.
          In Latin - Sol. Promedoli 2% pro inject 1 ml.
          International nonproprietary name (INN) - Trimeperidine.
          The chemical name according to the IUPAC Nomenclature is 1,2,5-Trimethyl-4-propionyloxy-4-phenylpiperidine hydrochloride.

          Who can remember all this? fool
          1. +2
            7 June 2024 10: 31
            Well, let's say I, approximately when never)))
  3. +3
    7 June 2024 08: 38
    If we ignore the fact that this is a person’s life, today’s “protocols” protocols in medicine are like the Unified State Exam in education...why? - the general education qualification in medicine is also falling, so everything is described in detail
    and if the case does not fall into those described, what should the doctor do?
    But what to do next if in this case he did not follow the protocol - will he be punished?
    This reminds me of technological maps for car repairs...
    and thanks to the author
    1. +3
      7 June 2024 08: 53
      Thanks a lot. No, the point here is that the protocol and algorithm are the basis, and then if you dive deeper, then knowledge begins to stick to this basis.

      Imagine that you got into the car, started it, took off the handbrake, engaged the gear, and then an exciting journey begins) it’s the same here, only we are in the process of manipulating the car before sending it off)

      Next, analysis of combined or multiple injuries (wounds) begins. And there the protocol begins to break down. In some cases, an anesthetic is given immediately after the bleeding stops, and in some cases it is not given at all and the protocol is broken)
      1. +2
        7 June 2024 09: 02
        Thanks a lot. No, the point here is that the protocol and algorithm are the basis, and then if you dive deeper, then knowledge begins to stick to this basis.

        these are our illusions...
        but in fact: just now I went to an appointment in the village of Pesochnoye, people from St. Petersburg know that there is a large oncology center there (named after Petrov), so what? - they tell me - where are the protocols of your operation...???? I answer - the organ is no longer there - why do you need protocols to prescribe treatment? - no, until we see the protocols - no conversations - and even the fact that you brought the results of the last examination (from some muho.ska) - keep it for yourself...
        and in 1 - Medical Institute - they talked differently (based on the same examinations)
        1. +2
          7 June 2024 09: 12
          Well, I don’t know, if “acquiring” knowledge and acquiring skills is an illusion, then I’m very sorry. First of all, you need to pay attention to your goal setting, it seems to me.
          Imagine the situation: you were born, and at the age of 6 (let’s say) you saw a bolt in the wall and first tried to unscrew it with your finger. It didn’t work out, and then the elders showed that this bolt could be unscrewed using a tool and applying the laws of physics. For you, in the end, is this knowledge, an algorithm for how to act when you unscrew a bolt, or an illusion?
          1. 0
            7 June 2024 10: 00
            Well I do not know, if “acquiring” knowledge and acquiring skills is an illusion, then I'm very sorry. First of all, you need to pay attention to your goal setting, it seems to me.

            the question is what we understand/want to understand by this phrase!
            Unified State Examination - outwardly, this is also a measure that allows you to better show “your” knowledge and enroll in several universities at the same time, but in reality, this is also an illusion...
            bachelor's degree - - externally - also a measure that allows a student to change the “trajectory/vector” of his learning at any moment - but this is an illusion...
            why I give these two examples - firstly, it was part of my life,
            secondly, it is “acquiring” knowledge and acquiring skills
        2. +1
          7 June 2024 10: 04
          these are our illusions...
          but in fact: just now I went to an appointment in the village of Pesochnoye, people from St. Petersburg know that there is a large oncology center there (named after Petrov), so what? - they tell me - where are the protocols of your operation...???? I answer - the organ is no longer there - why do you need protocols to prescribe treatment? - no, until we see the protocols - no conversations - and even the fact that you brought the results of the last examination (from some muho.ska) - keep it for yourself...
          and in 1 - Medical Institute - they talked differently (based on the same examinations)

          Sergei at the oncology center had something else in mind. They wanted exactly the “Operation Protocol” in order to understand what exactly the surgeons removed and what and how they sewed it back on. Description of anatomical changes in the body after surgery.
    2. 0
      7 June 2024 10: 00
      If we ignore the fact that this is a person’s life, today’s “protocols” protocols in medicine are like the Unified State Exam in education...why? - the general education qualification in medicine is also falling, so everything is described in detail
      and if the case does not fall into those described, what should the doctor do?
      But what to do next if in this case he did not follow the protocol - will he be punished?
      This reminds me of technological maps for car repairs...
      and thanks to the author

      ABOUT! Finally some sane thoughts. All these protocols are like "Guides to hand-to-hand combat against burglars for housewives." laughing
      1. +2
        7 June 2024 10: 06
        Reminds me) on YouTube I once came across a video in the recommendations: “what to do if you were attacked with a window frame” laughing
      2. 0
        7 June 2024 10: 09
        All these protocols


        my friend went to the states in the early 90s (he’s a great doctor) and returned quickly enough: everything is there! it was written down in the protocols, and if I’m not mistaken, a lot of time had passed, then a lot of things were still not included in what was described in the protocols and surgical actions were often interrupted - because everyone knew about the responsibility for “exiting” these protocols
        In our country, according to him, much cannot be done for other reasons - the lack of these therapeutic agents, and replacement with (as I say - analogues) does not give the expected effect
        incl. - my opinion - the protocols reflect a decrease in educational qualifications in medicine, i.e. an attempt to replace knowledge, skills, competencies with a certain course of events...
        1. +3
          7 June 2024 10: 15
          my friend went to the states in the early 90s (he’s a great doctor) and returned quickly enough: everything is there! it was written down in the protocols, and if I’m not mistaken, a lot of time had passed, then a lot of things were still not included in what was described in the protocols and surgical actions were often interrupted - because everyone knew about the responsibility for “exiting” these protocols
          In our country, according to him, much cannot be done for other reasons - the lack of these therapeutic agents, and replacement with (as I say - analogues) does not give the expected effect
          incl. - my opinion - the protocols reflect a decrease in educational qualifications in medicine, i.e. an attempt to replace knowledge, skills, competencies with a certain course of events...

          Protocols in medicine in the States (and here) grew out of legal disputes between doctors and patients. Lawyers needed more or less clear documents that they could rely on in court.
          They have an indirect relationship to real treatment. Yes
          1. 0
            7 June 2024 10: 17
            They have an indirect relationship to real treatment. yes

            +100500
            This is exactly what I tried to write about (this is not directly related to the article)
    3. +1
      8 June 2024 15: 30
      Quote: Dedok
      If we ignore the fact that this is a person’s life, today’s “protocols” protocols in medicine are like the Unified State Exam in education...why?

      In the country of Zabugoriya, doctors and medical technicians are separated. Doctors are doctors. Medical technicians are a bit like our paramedics. They know how to work using algorithms like this, especially when the doctor indicates which algorithm to use. Frees the doctor from mechanical work. They can replace a doctor on the battlefield, when there is no time for the subtleties of making a diagnosis, it is necessary to perform a simple algorithm to give the wounded a chance to reach the doctors.
      1. 0
        9 June 2024 06: 19
        Well, our people are used to the fact that if you are an instructor, you must be a doctor of science and cure any disease)
        1. +1
          9 June 2024 12: 18
          That's it, yes, then yes) You're a doctor!! ))
          1. 0
            9 June 2024 15: 02
            Medical sciences) Otherwise there is no trust)
            1. +2
              9 June 2024 16: 51
              Well, to be absolutely precise, it sounds (increasingly, to the point of hysteria): You are a DOCTOR!!
              “You’re a doctor” is a reference to “you’re a programmer,” when they try to encourage a person to repair an electric kettle.
  4. 0
    7 June 2024 10: 09
    Dear author, have you ever used nefopam? If yes, how do you rate it?
    1. +3
      7 June 2024 10: 29
      Yes, I have used nefopam several times, as an analgesic it is quite good and there is no fear of respiratory depression. Moreover, I will say that in the first aid kit there are always a dozen syringe tubes and for moderate injuries I used them; I wrote a rather interesting article about nefopam in my telegram channel
      1. +1
        7 June 2024 10: 34
        Thanks for the answer)
        Just recently our medical backpacks were being assembled, and the question arose about the contents.
        1. +2
          7 June 2024 10: 43
          Feel free to ask these kinds of questions in the telegram group, I will always tell you and advise you on filling the first-aid kit of 1-2-3 echelons)
        2. +1
          7 June 2024 10: 44
          The components are good! This is gratifying!
  5. 0
    7 June 2024 10: 35
    The material is presented haphazardly and chaotically. Firstly, the MARCH-PAWS protocol, if we consider the option of its application in our country, was developed not for providing medical care, but for performing first aid measures. In other words - for use by citizens who do not have a medical education. The conditions for which first aid is provided, the content and procedure for carrying out measures are regulated by Order of the Ministry of Health No. 220n 2024.
    A number of the author’s recommendations, given that the protocol is recommended for use in combat conditions, are surprising.
    Antibiotics: If there are signs of infection or risk of developing it, broad-spectrum antibiotics should be prescribed. The choice of antibiotic depends on the suspected causative agent of the infection and its sensitivity to the drugs.
    .
    The choice of an antibacterial drug in combat conditions depends on the duration of its action and actual availability. In addition, the sensitivity of the infectious agent to the drug can only be determined in laboratory conditions.
    To achieve optimal effect, pain relief should be carried out gradually, with increasing doses of the drug until the pain is completely eliminated.

    First of all, any drug has maximum single and daily doses, exceeding which is unacceptable. For example, if we are talking about a narcotic analgesic, an uncontrolled increase in the dose leads to respiratory depression, and in the case of nefopam, it leads to uncontrollable vomiting. Secondly, where can I get morphine, fentanyl and other analogues for pain relief? The pharmacy will not sell them, and emergency medical teams or employees of medical organizations will provide assistance to the victim based on clinical recommendations, and not the protocol in question. If we are talking about military personnel, then the standard painkillers are completely different drugs.
    Wounds: Wound treatment includes stopping bleeding, cleaning the wound of contamination, treating with antiseptics and applying a bandage. If necessary, surgical treatment of the wound is performed to remove non-viable tissue and restore the integrity of the skin.

    Again, in the context of combat trauma, especially gunshot wounds, removal of nonviable tissue is the sole purview of a trained physician. The thesis “restoring the integrity of the skin” does not stand up to any criticism at all: the application of surgical sutures for a gunshot wound is possible only in a specialized hospital, in other cases it is a gross mistake, leading to the development of severe complications.
    In general, the article is written very superficially, and blind application of the recommendations contained in it in practice can cause harm to health.
    1. +3
      7 June 2024 10: 42
      It’s immediately obvious that you are a theorist and have nothing to do with practice, I’m talking about combat operations if anything ;)
      1. 0
        7 June 2024 11: 08
        Dear Latvian! As a theorist, in the form of a discussion: the use of recommended drugs without understanding the mechanism of their action can lead to negative consequences. In particular, ketorolac (in addition to the analgesic effect) helps reduce thrombosis and, as a result, increased bleeding. Contraindications for its use include: ongoing bleeding, which in theory accompanies most combat injuries. Antiseptics (iodine, hydrogen peroxide) should not be used thoughtlessly, especially with extensive and deep injuries: iodine causes burns to the wound surface, and hydrogen peroxide not only has a bactericidal effect, but also damages the cellular structure of tissues, which generally impairs the healing process. There are many more, to put it mildly, controversial statements in the article, blind adherence to which leads to the fact that “theoreticians” at the hospital level eliminate the gross mistakes of “practitioners.”
        1. +1
          7 June 2024 11: 43
          Doesn’t it seem that in my article I do not recommend pouring iodine into shrapnel and bullet wounds, and using iodine to treat the surface around the wound?
          Doesn’t it seem that no one here recommends using ketorolac for traumatic amputation of a limb?
          There is an algorithm, and each injury is considered at the moment of receiving this injury and the drugs that will be used.

          It looks like you are convincing me that for severe TBI, I recommend using promedol.
          1. 0
            8 June 2024 03: 31
            In your article, without understanding and understanding the essence of the issue under consideration (perhaps a tribute to effective managers), you write about very serious things, without having the slightest idea about them. In fact, all the so-called your articles are an attempt to monetize some knowledge. The high-profile title of “TM instructor” has not been confirmed by anything and cannot be confirmed for the present, with the exception of special courses. But you didn't go through them. Sincerely...
            1. 0
              9 June 2024 06: 24
              Did you just come up with this yourself?)
            2. 0
              9 June 2024 06: 33
              This is why, 12 minutes after writing the comment, they offered to exchange knowledge?) Of course, you can later say that it was sarcasm, but it looks like a bad attempt at self-realization
  6. 0
    7 June 2024 12: 48
    Good afternoon author. Well, let's talk? I have questions for you.
    I'll start with the most important thing. These are temporary and, so to speak, positional frameworks of the protocol. It is very difficult to carry out some manipulations (primary treatment of wounds) under a “bush on a stump”, and even under enemy fire. This is already the level of a dressing and sorting station in the nearest rear, where the wounded must still be delivered.
    1. +1
      7 June 2024 13: 15
      Good afternoon, and if you don’t have such an opportunity, should you evacuate?)
      1. +2
        7 June 2024 13: 29
        Quote: Latvian_Tactical_Medicine
        and if you don’t have such an opportunity, evacuate?)

        I still strongly doubt the advisability of carrying out anti-survival operations under fire.
        Wouldn’t it be better to “split” the protocol into two parts (he suggests this himself) - the battlefield itself (very first aid and evacuation) and a “more or less “quiet place” (where at least garbage from mines does not fly from above and does not you have to look around so as not to catch a bullet.
        And just as an example:
        P – Pain Control
        – quick onset of action. Pain relief should begin as early as possible to prevent the development of pain shock and other complications;
        The PAWS protocol uses the following drugs for pain relief:
        – opioid analgesics. These are the most effective drugs for eliminating severe pain.

        Undoubtedly. On the battlefield we need the “here and now” effect, i.e. "on the needle". At this stage, promedol, morphine, fentanyl are “our everything.”
        – non-steroidal anti-inflammatory drugs (NSAIDs).

        But here is a slightly different approach. The drugs are good, “working”, but the effect does not come immediately (min 30). Therefore, they are more suitable for the “second” stage in order to enhance analgesia.
        – local anesthetics. These drugs are used for local anesthesia during surgical interventions.

        In general, I can hardly imagine case anesthesia for a gunshot wound of the thigh in the field request. But at the “second” stage during PHO, you are always welcome.
        1. +1
          7 June 2024 13: 45
          I don’t understand where everyone gets the idea that the PAWS protocol is carried out under fire and enemy shells) This apparently begs to be considered zones - red, yellow and green and what is carried out in each of the zones)
          1. +2
            7 June 2024 14: 07
            Quote: Latvian_Tactical_Medicine
            I don’t understand where everyone gets the idea that the PAWS protocol is carried out under fire and enemy shells) This apparently begs to be considered zones - red, yellow and green and what is carried out in each of the zones)

            That's it! hi
            Well, I’ll continue briefly with your permission)
            A – Antibiotics

            The thing is definitely necessary in the first stages too. It makes you want to take carbopenems right away, but later there will be problems with sensitivity. How do you like the option of protected penicillins? The drugs are “soft”, “working” and their spectrum is very wide, specifically for wound infections.
            W – Wounds

            The most burning question in my opinion!
            I got some information that a large number of amputations caused not by the severity of the injury to the limbs, but uncontrolled application of a tourniquet! It is necessary to clearly explain in which cases a pressure bandage is sufficient and when a tourniquet is necessary (you and I know, so no details).
            Regarding hemostatic agents, the sponge does not work. "Tachocomb", "Surgisel" are not available now, but analogues seem to be appearing and are not bad, including gels.
            There are no questions about immobilization laughing
            We won’t touch the PCS of wounds at all for now laughing
            hi
  7. +1
    7 June 2024 18: 13
    As I understand it, the MARCH protocol is more suitable for a fighter with an individual first aid kit, and PAWS is already for doctors?
    1. 0
      9 June 2024 06: 39
      These are two protocols sequential to each other) MARCH-PAWS)
  8. +2
    7 June 2024 19: 57
    It seems to me that such articles should not be written and posted on VO. It is empty in its essence, there are a lot of errors in the procedure. Unnecessary volume filled with drug names. Well, the terminology itself... PAWS.... Open some VPM textbook, everything is described there without any paint controls and other crap, much better.
    1. 0
      9 June 2024 06: 30
      Lots of errors in the procedure?) what?)
      That is, you would first apply a splint, then administer antibiotics, then look for wounds and at the end give pain relief?) When you say this kind of thing, you are probably a doctor of medical sciences and are developing the correct protocols for departments in your opinion?)
      1. The comment was deleted.
  9. +1
    8 June 2024 19: 53
    Here somewhere higher in the comments they wrote that doctors don’t sit here.
    There is one piece(s).
    He graduated from the PGMA Faculty of Medicine in 2008. Until now, he has been an X-ray endovascular surgeon in the Perm region. I obviously have some expertise in surgery. Experience as a surgeon and traumatologist in an emergency room, too. Military Faculty - my course just had its last graduation, then the Military Faculty was closed (
    It was interesting to read, of course, all these action protocols. Especially when you have a patient who is not according to protocol. Of course, I am interested in specific clinical cases of lesions and their analysis. Everything is beautiful during the briefing, but the reality is very different.
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      9 June 2024 06: 38
      Dear colleague, good day to you! I agree with you. Very often I tell people that, of course, knowing algorithms is useful. This is a skeleton. If we talk about theory, it is poorly adapted to combined injuries. Let me explain, I’m sure as a physician you will understand that there is a PAWS protocol and it works.
      And at the moment there is a fighter who is in trouble.
      Traumatic amputation of a limb + TBI occurs. And a huge number of such examples can be simulated. Maybe someday I’ll be able to sort out each of them, and I’ll be glad if you help me with this very analysis here!)
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        11 June 2024 07: 34
        Yes, this is a skeleton and a theory. We, too, were taught only the basics at the military college. Like the composition of all these old B-1...5 packages.
        Ideally, I would send all medical instructors and riflemen through the nearest emergency room for 2 months at a time to gain experience. I’m ashamed to say that during my studies, some girls in my group fainted at the sight of blood during operations. Regarding promedol, as a person who uses it, I can notice that it has a depressing effect on the heart and breathing. If such a patient is brought to us for coronary angiography, then even if everything is fine with his blood vessels, he goes to the cardiac intensive care unit for several hours for observation (of course, if there are beds there). On my own behalf, I’ll look in my contact for a link to a Yandex.disk video, my classmate posted it in the graduates’ chat at the beginning of the SVO (there is a clear picture of wounds and injuries)