Beyond the threshold of change
Viktor Nikonov’s article “On the Threshold of Changes”, published in “NVO” No. 11 for 2014 a year, with reference to representatives of the Russian Defense Ministry described the successes of military medicine in restoring the consequences of “a certain sequence of events destructive for the Russian Armed Forces, Serdyukov – Makarov reforms. ” While serving in 1997 – 2008 years at the State Research Testing Institute of Military Medicine of the Ministry of Defense of the Russian Federation (GNIII BM RF Ministry of Defense) at positions ranging from a senior researcher to the head of a research testing department, I was able to track down the accumulation of problems in the organization of medical care in the course of constant reform The Armed Forces of the Russian Federation. The reasons for this, as well as suggestions for solving the existing problems, I will try to present below.
AMBITIOUS PROGRAM
The head of the Main Military Medical Directorate (GVMU) of the Ministry of Defense of the Russian Federation, from 1993 to 2004, was Colonel-General of Medical Service Ivan Chizh, who paid great attention to the technical re-equipment of the military unit of the medical service. Thus, according to the technical tasks of the GVMU leadership in 1995 – 2004 years, the State Scientific Research Institute of Extreme Medicine, Field Pharmacy and Medical Technology of the RF Ministry of Defense (since 2000 - GosNII VM RF RF) developed and tested various armored medical machines (BMM) based on BMP, BTR-80 and MTLB, as well as special vehicles on the chassis GAZ-66. All of them passed troop tests, were recommended for acceptance for equipment, but were not put into production due to removal of the GAZ-66 from the conveyor.
In 1995 – 1996, at the meetings of the management of the State Medical University, the issue of developing and creating new deployment tools to equip the stages of qualified medical care based on container bodies of fixed and variable volumes was discussed. Research and development work was carried out to create technical means of a medical service for a military unit of the Armed Forces of the Russian Federation, taking into account the identified problems of medical support for military operations and the experience gained during operations in Abkhazia and the Chechen Republic.
The design and manufacture of prototypes of the new technology was entrusted to NPP “Project - Technique”, which in 1999 produced a prototype of an operational (OP) module based on a variable volume QC 4.3 KK and sent it to conduct military tests in the MOSN of the Leningrad VO. In April, 2001 of the year was also commissioned for the military tests of a modified prototype of the anesthesiology and resuscitation (A & R) module based on variable volume spacecraft KK4.3, which was demonstrated to the members of the Russian Security Council and the head of the General Staff of the Russian Armed Forces Army General Anatoly Kvashnin at an exit meeting in the Krasnodar Territory and received high praise.
In August, prototypes of preoperative (PO), dressing (PR), pre-dressing (PP) modules and docking modules (CT) based on a fixed-volume QC 4.2 were commissioned; State tests of the Operational and Resuscitation Department (ORO) of MOSN, according to the results of which the personnel of the detachment gave a good assessment of the conditions of habitability and work in container bodies, made a number of observations on the operational characteristics, instrumental and instrumental equipment, introduced a large number of dlozheny to improve the operation and re-equipment of functional modules medical supplies.
Based on the analysis of deficiencies, comments and suggestions made during the testing of prototypes, the GVMU Military Scientific Committee and the Scientific Research Testing Center for Medical Equipment and Field Pharmacy of the GosNII VM RF Ministry of Defense submitted for consideration the guidance of the GVMU on conducting a comprehensive research project on creating functional modules military medical supplies to equip the stages of qualified medical care with promising deployment tools based on fixed and variable volume spacecraft.
At the end of 2001, the Chief of the Main Affairs Directorate, Colonel-General of Medical Service Chizh approved the execution of work on this topic, which was called “Tabun”. In the course of its implementation, for the period from 2002 to 2007, employees of GosNII VM RF Ministry of Defense together with the team of the Scientific and Production Enterprise “Project - Technique” developed, manufactured and tested 14 types of specialized modules, classrooms, laboratories, etc.
After the appointment of Colonel-General Medical Service Igor Bykov to the post of Chief of the Main Directorate of the GVMU, further development of the technical re-equipment of the Russian Armed Forces medical service was continued in the direction of improving the organization of management of units and subdivisions of the medical service while ensuring the armed forces of the Russian Federation with oxygen and medical gases.
The work in the second direction was to completely solve the problem of providing medical oxygen to the troops medical service both in peacetime and in wartime. As a result, we managed to create several modules, including the oxygen mobile medical modules MKM-K and MKM-B with wiring, respectively, oxygen and air. The products underwent troop and state tests and were recommended for acceptance for equipping the medical service of the RF Armed Forces.
During this period, three units were equipped with sets of basic functional modules: experimental products for conducting military and state tests were received at the Moscow Regional Military District, Moscow Regional Military and Moscow Military Districts developed and re-equipped with modern (at the time of delivery) medical devices and devices of domestic production .
The advantages of medical modules in QC of constant and variable volume for equipping the stages of qualified medical care were obvious. The leadership of the Ministry of Defense of the Russian Federation made a decision to purchase two sets for equipping the Mosen, located in Siberia and the Far East of the country. But then the fun began.
Field deployment and deployment means of medical care is one of the most vulnerable places in the organization of the medical service of the RF Armed Forces.
Photos provided by the author
Photos provided by the author
"Sly" Tender
An unknown enterprise, now bankrupt, does not quite understandably win a tender for the purchase of medical equipment by the Central Administration of State Administration in full compliance with Federal Law No. 94-FZ from 21 July 2005 of the year. The result is the production of functional modules for two units with gross deviations from the working design documentation and the disturbance that is not transmitted by ordinary words after familiarizing them with the acting head of the Main Medical Department Colonel of the Medical Service Anatoly Kalmykov.
However, this is only a special case. With the beginning of the “Serdyukov-Makarov’s reforms”, the whole system of developing and creating new medical equipment, developing methods of organizing medical support for the troops using the new technology and new organizational structure, purchasing the necessary medical equipment for the military unit of the medical service began to collapse. And the need for the existence of the military medical service for some time, too, was denied.
Was destroyed GosNII VM MO RF. What is now left of him, especially in the development of medical technology and the organization of medical support for the ground forces, is a pathetic parody of a research organization.
The GVMU Military Scientific Committee, whose staff worked on the problems of the theory of development, preparation and application of the medical service of the Armed Forces, elaborated recommendations for improving the structure, improving the forms and methods of application, developing military medical equipment, researching other topical issues in the interests of the GVMU, was eliminated.
The system of procurement of medical equipment, equipment and special medical equipment was perverted. As an example - the purchase of ersatz-auto-dressing on the chassis of the car "KAMAZ", manufactured in the image and likeness of the AP-1976, which was mass-produced from 66 of the year. This dressing room did not pass either military or state tests, was not tabelized in the Armed Forces, but was presented as the latest achievement of military medical thought in many exhibitions. Although not really appropriate for its purpose.
And there are many such examples.
TURNS PROBLEMS
What are the main problems of military medicine today?
Firstly, there is no methodology and system for personnel selection of officials and managers of the medical service for appointment to senior and middle management positions. But in the Soviet Army, the candidacy for the post of head of the Main Directorate of the GVMU (TSVMU) of the USSR Ministry of Defense was considered and approved at meetings of the Politburo of the Central Committee of the CPSU.
Secondly, there is a lack of research and teaching materials on the organization of medical support for units and subunits of the RF Armed Forces in the event of conducting combat operations against formations of regular armed forces of a potential enemy. In the motorized rifle division there was a separate medical battalion (OMB), to which the wounded and sick from units and divisions of the division were delivered. After providing qualified medical assistance, they were evacuated to military hospitals of the army and front of the army and further to the rear of the country. At present, there are no field hospitals by definition, some type of medical hospital exists, but the role and place in this chain are not defined and are not entirely clear.
Great hopes are pinned on MOCH! I will say right away - do not hope, not a single detachment will justify these hopes. The fact is that the NIRovskiy works on the creation of a modern field hospital at the hospital level were discontinued during the “Serdyukov – Makarov” reforms, because Anatoly Serdyukov made the “most effective managerial decision” to purchase kits for field hospitals in Germany. The fact that the German "feldgospital" has a lower limit of operating temperatures –17 оС, was of no interest to anyone. As well as other nuances, in particular, the engineering preparation of the hospital deployment site to a perfectly smooth state (chassis - ordinary cars - container carriers) and laying rolled steel coatings on the ground to ensure the stability of the container on soft and moist soils.
As a result, no MOSN is ready to perform its tasks for its intended purpose due to incompleteness of the main functional modules, the heterogeneity of the internal equipment of the functional modules, the absence of an oxygen supply system and / or oxygen-enriched air mixtures, the absence of the MOSN, and in all the RF Armed Forces, field facilities placement of personnel. Simply put - a unified tent fund that meets the requirements of all types and types of aircraft. And the most important thing is that the design and development of the MOSN Information and Diagnostic Network, which was supposed to provide communication, collection, analysis and transmission of medical information from all stages of medical evacuation of a military unit, from bottom to top and vice versa, as well as to ensure the medical work of the detachment, was not completed.
There is also no systematic provision of the medical service of the military unit with medical devices and devices, no hardware and software for the prevention, diagnosis and treatment of the most common and uncharacteristic diseases among the Armed Forces personnel.
In the Soviet Army, the entire material and technical base of the medical service was more or less unified. Now, in accordance with the requirements of the Federal Law No. 94-FZ, it is purchased for the troops that is, as a rule, not a modern “high-tech” medical equipment. So, working in 2008 in the composition of the commission of the Main Department of the State Medical Investigation Board for the Medical Service of the Siberian Military District and ZabVO, in one of the parts I made a comment about the incompleteness of medical kits and emergency care packages. The fault of the medical personnel of the part was not in this - the content body did not single out the applicant. In their defense, the nurses said that in the fall of 2007, a new, modern electrocardiograph was received. Asked to show. Yes, indeed, the device was what is called “fresh from the factory.” That's just his model was modern counterparts of foreign production beginning of the 80-s of the twentieth century. But it cost very cheap and that is why it was purchased. Apparently, the words about the pricelessness of human life, which we keep saying all the time, are a beautiful excuse for our officials. Money is more expensive.
OXYGEN FEED
It should be noted the lack of a system for providing troops with oxygen and / or oxygen-enriched air mixtures (with an O2 content of at least 90%) during wartime. If in peacetime it is possible to provide oxygen to procurements from civilian producers, then in wartime it will become a big problem. Difficulties with transportation, the inevitable rise in prices and the lack of autonomous units for the extraction of oxygen that existed in the USSR Armed Forces, will lead to irretrievable losses among the wounded due to the inability to provide anesthesia or mechanical ventilation during surgical interventions, which has already occurred during the fighting in Chechen Republic in 1995 year.
To solve this problem, at the end of the 90-s, on the instructions of GVMU, the staff of GosNII together with the team of the SKB EO at the IBMP RAS developed a set of technical means for providing the medical services of the RF Armed Forces with oxygen, creating a number of equipment samples. All devices and devices have been registered in the system of Roszdravnadzor, they have the necessary certificates of conformity, they are purchased and used in diving departments of the Troops of the Ministry of Internal Affairs and the Ministry of Emergency Situations. Only officials of the Ministry of Defense, for whose money these products were developed and created, refuse to accept for the equipment of medical units and units and to purchase them. And not because these products in some ways do not correspond to the technical task or medical parameters, but simply do not want, knowing full well and understanding the tremendous need of the military unit in these devices and devices.
The reason, apparently, is simple - having equipped the units and units of the medical service with equipment for the production of oxygen and oxygen-enriched air, the Russian Armed Forces medical service will itself produce oxygen-air mixtures. Accordingly, it is necessary to stop buying oxygen on the side.
POWERFUL TEAMS
We also lack the planned system of modernization of mobile medical complexes of the military unit. It is believed that the medical service of the Armed Forces of the Russian Federation has five MOSN equipped with modern deployment tools that can perform the tasks. Unfortunately, this is not the case.
Of the five units, only one has a headquarters module (MS); module of the department of logistics and technical support (MTTO) of the MPMU; power supply units (BE4.2), water-gas preparation (BVG), sterilization (BS), preparation and maintenance of medical equipment, devices and apparatus (BMPA) and psycho-physiological rehabilitation (BPR); prescription and stock modules, technological and auxiliary.
Moreover, all the modules and blocks are experimental products, transferred to the detachment after the tests, and they have some drawbacks that are not eliminated due to the termination of financing. Simply, the officials from the 3 control of the Main Department did not like them, because they did not give the opportunity to realize the development of "their" joint-stock company with "unlimited irresponsibility."
Only one - and this is another detachment - has an oxygen mobile medical module MKM-B on its equipment. In addition, in this detachment, all container bodies are experienced products, equipped with outdated medical equipment and need to completely replace the entire fleet (the products were sent to the detachment for testing in 1999 – 2004 years).
I don’t have reliable information about what went right into the Central and Eastern Military Units in 2008, but I doubt that these products are of high quality workmanship and probably already need major repairs, or rather, deep modernization.
It should also be pointed out that a new “Methodological guide for organizing the work of the MoES during the deployment of fixed and variable volumes in QC” has not yet been developed, although this task was assigned to the MEDA in 2007 year.
There is no system of education and training of detachment personnel for the rules of operation of material and technical means. The detachment deployment exercises are conducted at best twice a year, but most likely not more than one. They are trained on working products, because there are simply no training container bodies. Nobody even thought about the need for their presence, the teachings are transformed into training sessions.
Not resolved issues of organizational staffing and timeline equipment. Each squad must be equipped with a truck crane of at least 25 tonnes - for unloading and loading containers from vehicles and trailers and their installation on the deployment site.
There are no modules for sanitary and hygiene and recreation, for the duty shift of doctors and nurses in the operating, intensive care and laboratory and diagnostic departments.
In all KK detachments, the installation of centralized wiring for the supply of oxygen-air mixtures and the internal information network system need to be refined.
It is also advisable to replace the KK transport base with the KamAZ chassis with the Ural, and every 5 – 6 years - replace the instrument-based equipment with new devices (existing ones - transfer them to stationary hospitals of districts or sell at residual value). It is extremely necessary to introduce a number of additional posts into the staff of the detachments, and in wartime - a commandant company and an engineering platoon to select and prepare the site for deploying the detachment and organizing its defense. It is advisable to organize and air defense detachment on the march and when working on the spot.
PURE FIELD
It is necessary to pay close attention to the issue of providing units with field deployment and deployment of medical aid stages. The solution to this problem began in the 1995 – 1996 years, with the result that it was possible to create and manufacture two prototypes of pneumoframe structures for the mobile complex of the regiment first-aid station (PC WFP) under the symbol PSM-5 (of rubberized fabric). However, in the course of military tests, various shortcomings of these products were revealed, an improved version of the PSM-6 was created. The appearance of products made from aramid fabrics improved, but other drawbacks remained - great weight, increased styling after collapsing the structure (residual air in the circuits), the flow of fabric during rain, translucency in the dark when the internal lighting is on, the need for power supplies for pumping pumps during deployment and the absence of solid floors.
In the course of state tests PSM-5 and PSM-6, almost all doctors expressed the following opinion: “we will throw a disposable product, in the case of real work, after the first deployment, we will work better in TSU or CSS tents”. Another nuance - in 2004, the cost of only the tissue part of the central module PSM-6 without internal equipment was 1,5 million rubles. Today is certainly more expensive. And this product is again going to be purchased for the needs of the medical service ...
But even in the 2007 – 2008 years, the Nizhny Novgorod design and production and information center Omnimed has, on its own initiative, designed and prepared for the production a tent with an outer frame, which today most closely meets the requirements of military medics. For example, tents CM. PCN 36 and CM. PCN 52 designed with the possibility of installing local ballistic protection, can dock in various combinations with QC through the end and side locks, have a lower height and a hard floor.
I ask dear readers not to think that I am lobbying this or that company. I missed all these products through tests with my hands. The military doctors do not have movers and scaffold workers; they have to load all the property - unload - deploy it themselves, and after all they have to get up to the operating table after that! What can the surgeon do if his hands tremble after unloading, and he still has to stand at the operating table ?! What quality of medical care can we talk about?
MEANS OF EVACUATION
Since the 1970-s, it has been engaged in the creation of medical evacuation facilities for the injured. Including the Mi-8MB and Il-76 "Scalpel" in the "operating-reanimation" variant were developed, manufactured and tested. Disadvantages - the implementation of surgical interventions is possible only on the ground. An unacceptable level of vibrations interferes with the air.
For the military unit of the Russian Armed Forces medical service, the main task was, is and will be the search, collection and evacuation of the affected personnel on the battlefield. The second most important task is the possibility of ensuring the safety of life of the person being evacuated and ensuring comfortable transportation conditions for the subsequent stages of medical aid. And in the first and second cases, the situation today is very bad.
In the medical company of the brigade (regiment), it was supposed to have a sanitary-evacuation platoon of three sections, 3-4 BMM in each section. For motorized rifle units - on the chassis of wheeled armored personnel carriers, for tank - based on BMP, MTLB (BMD for Airborne Forces). The crew of the vehicle is 4 people (commander, driver-orderly, two orderlies-porter), in total in the platoon - 45–55 people and 12–15 pieces of equipment.
The question immediately arises: where to get this technique? But it must be made according to certain requirements. And where to get personnel for staffing crews?
Search and removal of the wounded during the battle - hard work, requiring good physical development, courage, courage, medical knowledge and skills. What is the weight of a modern soldier in full gear? Offhand - 90 – 95 kg (this is with the growth of 170 cm and weight 68 – 70 kg). What should be the physical data of a medic? Yes, he himself must be growing 175 – 180 cm and weigh 78 – 85 kg, and it is desirable to be practically healthy. What normal commander will give such a soldier in the sanitary command?
Further, how do you, dear readers, think for how long the fighting will be enough - if they appear in the units - BMM? In my estimation, if after the first battle there are half of the cars on the move, this is not bad. The enemy will not understand what is crawling across the field, and seeing the sign of the Red Cross, he will aim precisely at him. Even not to burn, but to deprive a Santransport course is better than to destroy a tank: so many wounded people will not receive timely assistance and will not return to the system.
Today we do not have in the military unit of the means of search, collection, removal and removal of the affected personnel. Sanitary stretchers, of course, are available in sufficient quantities, but under fire with them you do not resemble. It is necessary to develop and create technical tools that facilitate the work of orderlies in the search and evacuation of the wounded and sick.
EXIT EAT
What are the suggestions for eliminating the aforementioned deficiencies that the author can offer? In short, they boil down to the following.
First, to ensure continuity and optimize the management of the medical service of the power ministries and departments in matters of medical documentation, standardize the provision of medical assistance to servicemen and their families, the organization of material and technical supply to develop a federal law on the Main Military Medical Department of the Armed Forces of the Russian Federation with the subordination of the medical services of the power ministries and departments to his chief for medical support of personnel in military service in security forces in the peaceful and military nye time. Moreover, all the main regulatory documents for structures where military service is envisaged should be enacted by orders of the Supreme Commander-in-Chief of the RF Armed Forces.
Secondly, to decide on the selection, preparation and appointment to leadership positions of medical service officers who are able to demonstrate innovative thinking, creative initiative, diversified and knowledgeable, able to deal with any issue or problem, assess the importance and make a competent and qualified decision. It does not take into account the presence of a candidate of academic degrees or titles. The applicant may have a lot of knowledge on the topic of the thesis, but there may be problems with the ability to think creatively.
Thirdly, it is necessary to recreate the Military Scientific and Technical Committee at the Main Military-Technical Directorate and restore the Research Testing Center of military medicine, medical equipment and field pharmacy to its previous status, identifying it as the main developer of the new military-medical equipment and medical equipment of the troops. At the same time, the Department for Analysis, Long-Term Planning and Development of the Medical Service of the RF Armed Forces should become one of the departments of the center.
Fourthly, it is necessary to organize research work on the damaging factors of modern ammunition in the following directions: determining the capabilities of the medical service to provide medical aid to the wounded while using modern means of destruction with conducting field testing on mannequins, models and experimental animals; and determining the sustainability of mobile medical complexes and technical means of the medical service for the deployment of field medical institutions to the effects of the damaging factors of modern weapons. It is also necessary to resume and complete R & D according to the technical, software and hardware, complete set-up equipment and the organizational and staffing table of the MOCH based on the body-containers of constant and variable volumes.
Fifth, it is necessary to improve the management system of the medical service of the military unit (single accounting and reporting, tablization of computer equipment and communications equipment), the creation of a system to provide the Russian Federation medical service with oxygen and / or oxygen-enriched air mixtures, and to organize the development and production of armored medical collection machines and the evacuation of the wounded from the battlefield (TK for this type of equipment must be developed now).
And finally, it is necessary to introduce a regular planned system of modernization of mobile medical complexes for the deployment of field medical institutions.
All of the above is only a small part of the problems of organizing military healthcare. It is, of course, impossible to cover and foresee everything, but these problems must be solved in advance.
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