This document discusses premedical aid in extreme situations and combat conditions. It defines two types of medical assistance for victims - prehospital aid provided at the scene, and hospital aid provided after transport. For prehospital aid, it distinguishes between care provided in shelling sectors with active enemy fire versus shelter sectors with some protection. The document provides algorithms for initial examination of victims and outlines the limited interventions recommended for shelling sectors, such as controlling bleeding and airway issues, versus more involved first aid permitted in shelter sectors like bandaging wounds and splinting fractures. Overall it aims to establish guidelines for basic first responder care under austere and dangerous field conditions.

1. Disaster and Military Medicine
Department
“PREMEDICAL AID IN
EXTREME SITUATIONS”

2. “PREMEDICAL AID IN EXTREME
SITUATIONS”
Topic 1.
PREMEDICAL AID IN EXTREME AND
COMBAT CONDITIONS AS A
DISCIPLINE. INITIAL EXAMINATION OF
THE VICTIM
Lesson №2

3. TYPES OF MEDICAL ASSISTANCE TO
THE VICTIMS AND THEIR
REQUIREMENTS
1. Prehospital types
2. Hospital types

4. I.Prehospital types
• Premedical
• Pre-clinical
• First medical aid

5. II. Hospital types
• Qualified
• Specialized

6. PREMEDICAL AID
PREMEDICAL AID – is a complex of simple
medical measures, which is carried out at the
place of being injured in the order of self-help
and mutual assistance, as well as by people who
do not have medical education, because of their
official duties, must have basic practical skills in
rescuing and saving human life, in critical
condition.

7. General principles of providing
premedical aid
1. All actions during the provision must be quick and adequate.
2. To stop the action of the damaging factors (to pull out from water, to remove from the
burning building, from the building with gas accumulation, to extinguish the burning
clothes).
3. To estimate the status of the victim quickly and competently:
- to find out circumstances by which a human was injured or suddenly became ill;
- to define time and place of nascence of the trauma. (especially when the victim is
unconscious);
- to determine the status and severity of the victim during the review presence of bleeding, or
fracture.
4. On the basis of the examination of the victim determine the method and sequence of
provision of medical assistance.
5. Find out what resources are needed to provide with premedical aid according to specific
conditions and opportunities.
6. Provide with premedical aid and prepare the victim for transportation.
7. Organize transportation of the victim to medical establishment.
8. Carry out surveillance for the injured or suddenly ill before sending to a medical
establishment.
9. The first medical aid must be conducted not only at the place of occurance, but also on a way
to medical establishment.

8. THE FOLLOWING SECTORS ARE
DISTINGUISHED UNDER BATTLE
CONDITIONS:
• SHELLING SECTOR (Under Fire)
• SHELTER SECTOR

9. SHELLING SECTOR (Under Fire):
direct fire zone with a significant risk
of a gunshot or other wounds.

10. SHELTER SECTOR: a place protected from direct
enemy shoot by elements of the natural (hills,
slopes) or artificial origin (walls, houses,
protective engineering structures). It is implied
that the shelter sector can at any time become a
shelling sector. Accordingly, the volume of
premedical care is reduced.

11. THE VOLUME OF PREMEDICAL AID
in the shelling sector (Under Fire):
1. Changing from the position on the abdomen in
to the position on the back;
2. Temporary arresting of external bleeding (neck,
limbs);

12. THE VOLUME OF PREMEDICAL AID
in the shelter sector
1. Control of arresting of a bleeding, and if necessary
– temporary arresting of a bleeding;
2. Primary examination of the wounded (definition of
signs of life);
3. Rapid examination from foot to head (finding
available damage);
4. Regain the patency of the upper respiratory tract;
5. Hermetization of the chest wounds;
6. Fixation of fractures and cervical part of vertebral
column;
7. Preparation for transporting the wounded in safe
zone.

13. CONDUCTING PRIMARY EXAMINATION
Algorithm CABC
• C – critical bleeding
• A – passage of the airway
• B – breathing
• C – blood circulation

14. This M.A.R.C.H.
Approach used in TCCC
• Massive hemorrhage – control life-threatening
bleeding.
• Airway – establish and maintain a patent airway.
• Respiration – decompress suspected tension
pneumothorax, seal open chest wounds, and
support ventilation/oxygenation as required
• Circulation – establish IV/IO access and
administer fluids as required to treat shock.
• Head injury/Hypothermia – prevent/treat
hypotension and hypoxia to prevent worsening of
traumatic brain injury and prevent/treat
hypothermia.

15. M.A.R.C.H.

17. THE AID IN THE SHELLING SECTOR
(Under Fire)
THE AID IN THE SHELLING SECTOR
(Under Fire) – is an aid that is provided on a place
of getting an injury, in the event of a rescuer and the
injured staying under enemy fire.
The risk of additional damage from enemy fire is
extremely high for both the victim and the rescuer.
Therefore, medical assistance in the shelling sector
provided only by order of the commander, since the
main priority in the battle is the execution of combat
mission. In some cases, when a tactical situation
allows, the decision is taken by the doctor on his
own.

18. ALGORITHM FOR PREMEDICAL AID IN
THE SHELLING SECTOR (Under Fire)
(SELF AID)
1. Tell the unit commander that you are injured.
2. Take a look at the wounded area.
3. If you are injured in the limb and you see the
blood - put on a tourniquet.
4. Tell the unit commander about the possibility
of moving.
5. Get your permission and move to the shelter
area if you can move around.
6. If you can not move, then notify the
commander and not moving.

19. ALGORITHM FOR PREMEDICAL AID IN
THE SHELLING SECTOR (Under Fire)
(MUTUAL AID)
1. See a wounded soldier - establish a voice contact with
the wounded, find out about the place of injury and the
possibility of movement.
2. If the wounded does not answer - go to paragraph 5.
3. Tell the wounded to lay his own harness (if necessary).
4. If he can move independently, instruct him to move
around your team and provide him with a fire cover.
5. If he can not move on his own, order him not to move.
6. Submit information to the unit commander about the
inability of the wounded to move.
7. Get an indication of moving for the wounded.

20. 8. Put out the wounded under the fire cover.
9. Set whether of the wounded injury is incompatible
with life. If you do consider the wounded is dead
and return to the shelter yourself.
10. If there are no injuries incompatible with life –
establish the presence of bleeding from the limb
(extremities).
11. Disassemble the wounded. If there is bleeding from
the limb – apply a tourniquet.
12. In the first place, use a tourniquet of the wounded,
in the absence of one's own.
13. Move the wounded in the shelter sector by
command and under the fire cover with the
removal of the wounded.

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22. THE AID IN THE SHELTER SECTOR
THE AID IN THE SHELTER SECTOR - is a
help that is provided by emergency rescue
workers when the risk of contact with the enemy
is eliminated or minimized.
The availability of medical equipment and
equipment is still limited. The evacuation time
can range from a minute to several hours. The
amount of premedical aid in shelter sector
aimed at hiding a deeper assessment of the
situation and treatment of the victim.

23. ALGORITHM OF PREMEDICAL AID IN
THE SHELTER SECTOR (MUTUAL AID)
1. Check the reaction of the injured to stimuli (consciousness-voice-
pain-lack of reaction), as well as the presence of respiration and
pulse in the carotid artery.
2. If there is no reaction - consider the wounded dead and do not
provide help.
3. Check the overlay harness and determine the need for it.
4. If there is a need for a tourniquet, and the bleeding continues,
then tighten the tourniquet more strongly. Specify the time to
overlay the tourniquet.
5. Check the wounded for other visible bleeding (especially from the
limbs and neck) and stop them.
6. Check the chest for injury, especially axillary and supraclavicular
areas.
7. If the chest injury is present, close all wounds with an airtight
dressing.

24. 8. If you are wounded without consciousness, either
with a person's injury, or burns, then ensure that the
airways are passable - there is a nasopharyngeal air
duct.
9. Conduct a primary examination of the wounded
(from head to toe) to identify other injuries. If they
are, then put a bandage.
10. Put the wound on the limb, attach a compressing
bandage, a loose tourniquet.
11. If the bleeding is restored - tighten the tourniquet
again.
12. Enter anesthetic and antibacterial agents.
13. With fixed fractures and wounded limbs, fixing
two adjacent joints.
14. Put the injured in a stable position.

25. Stable or recovery position

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• https://www.youtube.com/watch?v=A7o0JQLIs3A
• https://www.nhs.uk/conditions/first-aid/recovery-
position/