ORGANIZATIONAL AND ALGORITHMIC PRINCIPLES OF PREHOSPITAL CARE IN TACTICAL CONDITIONS

Abstract

Modern high-intensity armed conflicts are characterized by a significant number of sanitary losses, the majority of which occur at the prehospital stage. Analysis of combat experience, particularly that of the Russian-Ukrainian war, indicates a profound shift in the injury profile compared to 20th-century conflicts. There is a distinct predominance of blast and fragmentation injuries – often the result of combined artillery fire and drone strikes – accompanied by massive hemorrhage, thoracic trauma, and complex damage to major blood vessels. Despite advancements in surgical techniques, uncontrolled bleeding remains the leading cause of preventable mortality in tactical environments, necessitating a paradigm shift in immediate medical intervention. This article summarizes contemporary organizational and algorithmic approaches to prehospital care, taking into account international Tactical Combat Casualty Care (TCCC) and Tactical Emergency Casualty Care (TECC) standards. The evolution of primary casualty assessment protocols is analyzed, moving beyond the traditional civilian "ABC" to the military-focused MARCH-PAWS and modified CABC algorithms. Special attention is given to the national “KOLESO” algorithm, which serves as a simplified yet effective tool for high-stress environments. These protocols prioritize the "Platinum Ten Minutes," emphasizing that the speed of critical hemorrhage control directly dictates the physiological viability of the casualty during subsequent evacuation phases. The role of modern personal protective equipment (PPE) and standardized individual first aid kits (IFAKs) is examined as a transformative factor in survival rates. The study demonstrates that while modern armor reduces lethal thoracic and abdominal penetrations, it simultaneously increases the prevalence of severe limb injuries and traumatic amputations. This shift reinforces the necessity for advanced hemostatic agents, such as third-generation combat gauze and hightensile pneumatic tourniquets. Furthermore, the article identifies the physiological impact of "Care Under Fire" versus "Tactical Field Care." It explores how the integration of intraosseous access and the early administration of tranexamic acid (TXA) within the first hour of injury significantly improves hemodynamic stability. It is demonstrated that the effectiveness of casualty evacuation (CASEVAC and MEDEVAC) is directly dependent on the quality of stabilization at the point of injury (POI). The concept of "prolonged field care" (PFC) is also addressed, as modern electronic warfare and air superiority often delay traditional evacuation windows, forcing non-medical personnel to manage stabilized patients for extended periods. The necessity of universal training for all personnel in self-aid and buddy aid (SABA) principles is substantiated not merely as a skill set, but as a strategic asset. By decentralizing medical capabilities, the military can mitigate the "golden hour" constraints. In conclusion, reducing preventable losses in tactical conditions requires a holistic integration of standardized algorithms, high-tech medical supplies, and a rigorous, repetitive training cycle that mimics the psychological stressors of the modern battlefield.