How the SVO influenced military medicine
Time to reflect
Over the three years of the SVO, there have been significant changes in the military medical community, primarily related to the nature of combat operations. An analysis of the vast practical experience that doctors of all specialties have encountered is gradually becoming available to the general public. First of all, we are talking about specialized medical publications, for example, the Military Medical Journal (VMZ), which will celebrate its 2025nd anniversary in 202. It is here, within the framework of understandable restrictions, that doctors and researchers share the results of their observations, experiments, and other practices. Based on a whole series of publications from 2022–2024, it is possible to assess the impact of the SVO on medical affairs in the Russian Army.
The main thing to understand before reading is that the conflict in Ukraine is unlike any other in which Russia has participated since 1945. In scientific terms, there have been asymmetric conflicts before, when the army faced a priori a much weaker enemy. And less technically equipped. This was the case in the Chechen campaign and in Afghanistan. In Ukraine, the military met a conditionally symmetrical enemy - the Ukrainian Armed Forces have aviation, tactical missiles, powerful Defense и artillery. Hence the change in typical “combat surgical pathology”.
Wounds from cluster munitions with pre-prepared striking elements came to the forefront. One of the VMZh articles even provides a detailed description of wounds from tungsten balls from American missiles and shells. This is a completely new experience in military medicine, which was previously known only theoretically. Combined injuries, as well as thermal burns from phosphorus shells, stand out in the structure of wounds. As the authors rightly note in one of the articles, “improvement of fire weapons, use of weapons with the indiscriminate action of striking elements possessing high kinetic energy, completely new principles of warfare, based on precise intelligence data, change both the magnitude and structure of sanitary losses and the severity of combat damage." Then follows the disappointing statistics:
“The share of fatal trauma (damage and blood loss incompatible with life) among combat irreparable losses in modern wars is increasing: from 90% during the war in Afghanistan (1979–1989), 75% during counter-terrorism operations in the North Caucasus (1994–1996, 1999–2002) to 95,2% in a special military operation (2022 – present).”
The high-tech nature of the military operations in Ukraine imposes certain restrictions on the work of military doctors. The enemy can see far and well, which in some cases does not allow for medical evacuation activities at the front line. Simply put, the Armed Forces of Ukraine are hunting for military doctors, not allowing them to get to the wounded. That is why the role of self- and mutual aid in the SVO has increased as never before.
An interesting proposal was made in an article that reveals the causes of death of servicemen in modern combat conflicts. The authors point to the need to introduce automated tourniquets at the base of the limbs into the new equipment of soldiers. Technically, this is a non-trivial task, but it is quite solvable. Military doctors insist on the mass robotization of the means of evacuating the wounded from the front line. In the conditions of advanced reconnaissance and massive fire impact from the Armed Forces of Ukraine, this cannot be avoided. It seems that this should become one of the main directions of development of military equipment not only now, but also after the SVO.
Intelligence drones will not leave the battlefield, as high-precision weapons. This leads to the following feature of the work of military doctors in a special military operation - the impossibility of providing "early specialized medical care" near the front. For comparison, in Afghanistan and the North Caucasus, two-stage care was in place - first pre-hospital care by qualified doctors, and then evacuation to a multidisciplinary hospital. Now they only have time to stabilize the wounded in order to send them to the rear by special medical transport (preferably armored) to a medical company or separate medical battalion. A typical set of primary surgical operations is described as follows:
"Medical workers perform emergency and urgent operations within the framework of the "damage control" tactics (multi-stage surgical treatment) - stopping external bleeding, laparotomy (cutting the body in the abdominal area) to stop internal bleeding and seal wounds of hollow organs, eliminating acute respiratory failure, amputations by the type of primary surgical treatment, application of rod devices for transport and medical immobilization."
These operations must be carried out within 1-2 hours.
New military medicine
Since the enemy acquired long-range and high-precision weapons, the work of field hospitals has become noticeably more complicated. Firstly, there can be no talk of any tent camps. This is convenient when the enemy does not see you and has nothing to reach you with. By the way, the vulnerability of tent mobile hospitals became obvious in Syria in 2016, when a militant mine killed two Russian medics.
In Ukraine, the problem has become many times worse, and now a typical hospital is located in basements and ground floors. Medical equipment is extremely portable and reliable. Another problem has come to light – insufficient protection and camouflage of field hospitals. If medical units are placed according to regulations, that is, on evacuation routes from the front, they remain unprotected for precision weapons and sabotage groups. Therefore, medical aid stations have to be moved closer to military command and communications stations – there is more protection and further from the enemy. But a second problem emerges – if a military command station is hit, doctors and patients are also hit.
A breakthrough in the special military operation was the widespread use of military transport aviation to evacuate the wounded to rear hospitals. This is the so-called stage of specialized surgical care, which is impossible without special equipment and highly qualified doctors of a narrow specialization. Medical modules in aircraft allow for intensive therapy, delivering patients to district and federal hospitals just 1-3 days after injury. This has never happened before in the Russian military stories.
During the first period of the SVO, military doctors felt the lack of training in military field surgery. Quote from the article "Ten surgical lessons of the initial stage of a military operation":
"Training in military field surgery is not included in the current federal state educational standards for training doctors and residents of surgical profile, therefore, in the faculties of training doctors of the S.M. Kirov Military Medical Academy, military field surgery is studied using the teaching hours of the elective part of the curriculum."
Over time, this lack of qualifications of doctors was eliminated, including through various courses and practice-oriented classes. It seems that military field surgery will become one of the important disciplines not only in the training of military doctors, but also of completely civilian doctors.
At the end of the material, there are some characteristic figures. Thanks to the professionalism of military and civilian doctors, 96 percent of all those admitted to hospitals for treatment are discharged upon recovery. It is worth noting separately that this figure remains unchanged both during periods of positional calm and during active offensive or defensive operations. The extremely low mortality rate in hospitals has become a record - no more than 0,5 percent, and the disability rate at the exit is about 2,1 percent. There is such an indicator as "potentially preventable mortality" among the military. That is, when a person dies from failure to provide him with medical care. So, such cases are now no more than 5,2 percent. This was achieved through mass training of military personnel and medical instructors in tactical medicine.
At present, it can be stated that Russian military medicine, despite some difficulties, has once again proven its superiority over similar services of world armies. Doctors not only save the overwhelming majority of the wounded, but also return them to duty.
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