Techniques and means of rendering first aid in combat conditions are continuously developing in the world. The skills and equipment of even the average infantryman of the US Army, his British and French colleagues can stabilize and prepare for the evacuation of the fighters not only with gunshot wounds, but also with quite serious mine-explosive injuries, with great blood loss. In Russia, only a few spetsnaz units possess such skills and equipment.
In modern field medicine, there is a concept taken from resuscitation: the “golden hour”. This is a period of time after injury or injury, allowing the most effective first aid and rescue the victim. But in modern combat, fast delivery to the hospital is not always possible. Therefore, the main task is to extend the “golden hour” with the correct actions as long as possible in order to have time to deliver the victim to the surgical table before irreversible consequences occur.
The life of a fighter is in the hands of a friend
According to official data of the Pentagon about the participation of the American ISAF contingent in Afghanistan for 2013 a year, the servicemen died only when they received wounds and injuries incompatible with life. In other cases, timely rendered first aid and subsequent evacuation made it possible to avoid deaths.
“Thanks to the fact that the wounded people were assisted during the first three to five minutes, their“ golden hour ”was quite enough to be evacuated to the hospital and handed over to the medical staff,” a representative of the Ministry of Defense, familiar with the problem, told a columnist for the Military Industrial Courier. “Although in 1993 in Somalia, in 2001 in Afghanistan and in 2003 in Iraq there were cases when the fighters did not have time to evacuate in time and they died from their wounds on the battlefield. The Americans drew conclusions. And they were the first to create a system of rendering first aid on the battlefield, when even when injured in the stomach, severed limbs, multiple injuries with a large blood loss, the “golden hour” was extended for the longest possible time, ensuring that the victims would be delivered to the hospital. ”
Developed not only techniques, but also means of rendering assistance. So-called tourniquet harnesses appeared, new hemostatic agents, which passed the way from powder to special applicators, impregnated bandages, etc. Not only the American military, but also the British, French, and Israelis actively introduced innovations of military medicine into their armed forces.
It's simple - do it once ...
“The recommendations for pre-medical assistance of the US armed forces indicate three phases of assistance. The first is under fire. The second is tactical assistance, when the threat to you and the victim has already been eliminated. Third - at the stage of evacuation. In the first phase, under enemy fire, only a tourniquet is applied. In the second, harnesses are checked and re-laid, hemostatic agents are used, a tight pressure bandage is put, it is determined whether there is a pneumothorax, and the respiratory tractability is checked. When injured in the chest, to prevent the development of pneumothorax, special patches with a valve or decompression needles are used, ”explains an employee of a Russian organization conducting special classes in tactical medicine.

In the Army and the United States Medical Commission, there is a regular medical orderly in each platoon, and СLS - two - four people for each unit. That is, in fact, there are one or two "life saving" for each section (the US offices, unlike the Russian ones, are divided into two fire sections).
“There are a lot of real videos on YouTube right now, like CLS are helping in combat. A good example is footage from Afghanistan, when paratroopers from the 101 air assault division are assisting a national army soldier hit by a mine. The victim's leg is almost torn off below the knee, both hands are badly damaged, the face has been seriously injured. Without assistance, he would die within minutes. But there is no panic. CLS and San Instructor act clearly as taught. Ten minutes later, the Afghan’s condition is stabilized, and he is ready for evacuation. And I want to emphasize that these are not special forces, but ordinary linear units, ”explains an employee of the organization.
In special units, one hundred percent of military personnel undergo a more advanced course of field first aid, including, in particular, the development of intraosseous access skills, used when peripheral veins "drop" due to significant blood loss and there is no possibility to put an IV.
Gentleman's Life Saving Kit
A typical first aid kit has now been formed, consisting of a so-called tourniquet harness, hemostatic means in the form of powder or a bandage impregnated with powder, as well as so-called Israeli dressing bags that each fighter has.
The harnesses, designed for maximum ease of application with one hand, first appeared in 2001.
“I personally know several variants of turnstile harnesses of different companies, but in practice they differ only in some details. True, “turnstiles” cannot stop the blood if there are injuries to the groin area and in the neck area, ”an officer from one of the special forces units from the Moscow Region shared his experience.
According to an employee of a company conducting tactical medicine, this problem has now been resolved, and so-called compressors are being used to supply foreign armies. They stop bleeding in difficult places by forcing air into special sinuses.
Now only the Esmarch harnesses remain at the disposal of the Russian military, and in rare cases (Alpha), Bubnov harnesses.
“Russian-made tourniquet harnesses are in single, one can say experienced specimens. We have not heard about any massive supplies, ”admitted an officer of one of the special units of the Russian Ministry of Defense.
But he made a reservation that, in addition to the turnstile, they also take the usual Esmarch harnesses into their styling. “Compressoria” we have not yet seen, and if necessary, if wounding in the groin, neck, etc., the usual harness will work very well, ”the source continued.
The first hemostatic powder purchased for the US armed forces after the start of the war in Afghanistan was QuikClot. It is made on the basis of zeolites, inorganic substances, called slang "clay", which, in contact with blood, formed a clot. The first generation of the drug also caused a small burn. The massive use of KvikKlota in the very first years reduced the death on the battlefield from blood loss (according to official data of the Pentagon) by 70 percent.
At the same time, doctors had claims to “clay”, since, in addition to blood flow, it often got into the body when the servicemen broke the bag with their teeth. This inorganic substance itself does not decompose, and there are serious questions about how to remove it from the human body.
A little later, there were products under the brand name "Celox" (Celox), based on the organic compound chitosan, which decomposes in the body. It is noteworthy that, until recently, Celox products, which the Pentagon did not allow to supply its military, were actively purchased by British, French, Australian and other military departments. At present, the ban has been lifted and Selox is actively pushing QuicKlot in the US market.
“Powder hemostatic is not always convenient to use in the field, it crumbles at the slightest wind. Sometimes it is impossible to fall asleep to the full depth of the wound. Often, two or even three or four packages are required, ”said a physician from one of the special-purpose units of the Russian Ministry of Defense expressing his opinion to the Military-Industrial Courier.
These problems have been known for a long time, because in addition to the powder, so-called applicators and hemostatic-impregnated bandages for wound packing are now supplied.
“We introduce the applicator into the wound and, simply pressing on the piston, squeeze the preparation in the form of a gel. With bandages a little more difficult - open access to the wound, put a bandage into the wound and press it for about five minutes, ”the source continued.
If, after the application of the hemostatic hemostat, the doctors had more work to clean the wound, now with the use of chitosan-based preparations, a gel-like clot is formed at the wound site, which is easily removed by the doctors.
It is worth noting that only in the units of the Ministry of Defense of Russia and the domestic drug Gemostop, which has rather contradictory reviews, is only occasionally used.
“On the one hand, this is our development, which in itself is already good. On the other hand, “Gemostop” is about “KvikKlot” of the first series with all its inherent flaws. And often the use of the drug causes serious burns, ”the Defense Ministry representative gave an expert assessment. While in combined-arms units, military units and special purpose units of the Ministry of Internal Affairs, Gemostop is treated almost as “future space technologies”, then for more advanced users, in particular, in the special mission centers of the Ministry of Defense, Gemostop causes only a bitter smile.
“We didn’t see it ourselves, but a fighter was severely wounded in the arm of the neighboring SOBR. Naturally, Gemostop was bombarded there. The result was a burn and as a result of sepsis. I had to amputate my arm, ”complained the officer of one of the SOBRs of the Ministry of the Interior.
Another important element of the first-aid kit is the so-called Israeli IPP, which, thanks to special plastic fastenings, allows you to make a good pressure bandage even with one hand. Israeli bandages are named because they were developed by an Israeli military medic.
“They come in different sizes depending on the size of a cotton-gauze pad. For example, the “9” number is used when a limb is lost or when it is wounded in the stomach, ”explained a medic from a unit of the Russian Ministry of Defense.
Initially, the IPP was developed for the Israeli army, then their production was mastered by a British company, and a little later by American manufacturers.
While "our all" - bandage and zelenka
"You are joking? Our homeland gives us only expired IPP and ordinary harness. We do not even have narcotic painkillers. Medical training classes are conducted in the same way as 20 – 30 years ago. Well, once showed "Gemostop." We, of course, have people who have completed courses and procured medical equipment for their money, but there are only such units, ”said an officer from one of the SWAT MIA.
Exactly the same situation in the special forces of internal troops. Surprisingly, because of problems with licensing, neither the special forces of the BB, nor the special forces of the Ministry of the Interior receive drug-based painkillers, such as promedol.
“We take ketorol or ketanov, and sometimes for their money in ordinary pharmacies. It happens, however, that tableted painkillers give out, ”continued the interviewee from the SOBR.
Do not forget that the special forces of the Ministry of Internal Affairs and the Air Force have the main burden of combating terrorism in the North Caucasus and the soldiers are injured there often enough.
The situation in the units and divisions of the Ministry of Defense of Russia is a little better, but if in the Special Forces brigades scattered throughout the country about modern means and methods of assistance, at best, they read or watched videos, then in special purpose centers and some other units about medical training They are taken very seriously and often in terms of equipment and skills they are not inferior to their Western colleagues. However, it is worth noting that almost everything you need is purchased for your money. Own efforts are organized and classes.
“At one time, they asked for help from the legendary Alpha, with whom they had previously worked. They did not refuse. We came to our base and held classes during the week. And with maximum efficiency. There were shooting, explosions, even pigs were taken to practice first aid skills, ”said a medical man from one of the special forces units.
According to the source, currently only in the CSF FSB have the necessary skills and abilities, and also have the appropriate equipment. But while in the Armed Forces of the United States and other Western countries, the introduction of new methods and tools began in the 2001 and was largely completed by the 2004 – 2005 years, in Russia in special units, all this only appeared in the 2008 – 2009.
“Alfovites immediately explained to us that the battle would go, all knowledge would disappear, skills would remain. Therefore, continuous training is necessary, but with this problem. We appealed to the medical department with a request to allocate time for us to practice in the morgues to install special needles for pneumothorax. Instead, a whole commission came to investigate what was happening. She was horrified that our ordinary fighters can do this. And when I learned that we are putting ourselves in the fields of the system for injecting solutions and sometimes even in bone, then such a scandal broke out: how do we allow ourselves to do this without medical education? We wrote a lot of papers, but there's no point. So I had to negotiate with the morgue in private, ”the medical officer of the special unit of the Ministry of Defense complained.
At the same time, many interlocutors of the publication admitted that in their first-aid kits often most of the drugs, PPIs, etc., were either almost expired or already permanently overdue.
The handiwork of the wounded themselves
“Now in Russia, only helostatic preparations of the Celox company have passed tests and received certificates, so they are supplied and they can be legally purchased,” one of the Moscow companies selling these drugs told a columnist of the Military-Industrial Courier.
All other means, starting from the IPP and ending with tourniquet harnesses, are mainly imported by the so-called merchants, private dealers.
“With few exceptions,“ merchants ”take medical supplies from stocks of foreign armies that have already been written off. For example, in the US Army, hemostatic powder is written off a year before the expiration of the storage period and is transferred for sale. We, the truth, "merchants" immediately warn about it. It happens, we take and overdue. As an example: the Israeli package costs 1,5 thousands of rubles, and with an expired shelf life they give us for five hundred. In principle, he is in vacuum packaging, what will happen to him? We buy everything for our money, ”admits an officer of one of the special units of the Ministry of Defense.
It is worth noting that we are talking about elite units and subunits of Special Forces, and in the army about the modern means and methods of providing assistance have not even heard.
“Now, the Central State Medical University and the Military Medical Academy are developing new techniques and are even beginning to implement. Our colleagues from the Ministry of Internal Affairs and the Air Force are also actively working. In general, we are still trying to catch up, ”a representative of the Ministry of Defense told the Military Industrial Courier.
According to Western experts, at the beginning of 2000-ies in military medicine there was a revolution in the methods of assistance on the battlefield, which passed by us. Let's hope that the gap can be eliminated.