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<article article-type="review-article" dtd-version="1.3" xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xml:lang="ru"><front><journal-meta><journal-id journal-id-type="publisher-id">seamed</journal-id><journal-title-group><journal-title xml:lang="ru">Морская медицина</journal-title><trans-title-group xml:lang="en"><trans-title>Marine Medicine</trans-title></trans-title-group></journal-title-group><issn pub-type="ppub">2413-5747</issn><issn pub-type="epub">2587-7828</issn><publisher><publisher-name>Research Institute of Industrial and Maritime Medicine of the Federal Medical and Biological Agency</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="doi">10.22328/2413-5747-2025-11-2-48-66</article-id><article-id custom-type="edn" pub-id-type="custom">SDFFQH</article-id><article-id custom-type="elpub" pub-id-type="custom">seamed-818</article-id><article-categories><subj-group subj-group-type="heading"><subject>Research Article</subject></subj-group><subj-group subj-group-type="section-heading" xml:lang="ru"><subject>Обзоры</subject></subj-group><subj-group subj-group-type="section-heading" xml:lang="en"><subject>Review</subject></subj-group></article-categories><title-group><article-title>Военно-морская медицина на распутье: время что-то менять?</article-title><trans-title-group xml:lang="en"><trans-title>Naval medicine at a crossroads: time to change something?</trans-title></trans-title-group></title-group><contrib-group><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0003-0480-0657</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Сильченко</surname><given-names>Е. С.</given-names></name><name name-style="western" xml:lang="en"><surname>Silchenko</surname><given-names>E. S.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Сильченко Евгений Сергеевич – начальник хирургического отделения Клиники военно-морской хирургии</p><p>194044, Санкт-Петербург, ул. Академика Лебедева, д. 6</p></bio><bio xml:lang="en"><p>Evgeny S. Silchenko – Head of the Surgical Department of the Clinic of Naval Surgery</p><p>194044, Saint Petersburg, Academician  Lebedev Str., 6</p></bio><xref ref-type="aff" rid="aff-1"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0002-4519-0018</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Суров</surname><given-names>Д. А.</given-names></name><name name-style="western" xml:lang="en"><surname>Surov</surname><given-names>D. A.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Суров Дмитрий Александрович – доктор медицинских наук, профессор, начальник кафедры военно-морской хирургии</p><p>194044, Санкт-Петербург, ул. Академика Лебедева, д. 6</p></bio><bio xml:lang="en"><p>Dmitry A. Surov – Dr. of Sci. (Med.), Professor, Head of the Department of Naval Surgery</p><p>194044, Saint Petersburg, Academician  Lebedev Str., 6</p></bio><xref ref-type="aff" rid="aff-1"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0003-1644-1014</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Дымников</surname><given-names>Д. А.</given-names></name><name name-style="western" xml:lang="en"><surname>Dymnikov</surname><given-names>D. A.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Дымников Денис Александрович – кандидат медицинских наук, заместитель начальника кафедры военно-морской хирургии</p><p>194044, Санкт-Петербург, ул. Академика Лебедева, д. 6</p></bio><bio xml:lang="en"><p>Denis A. Dymnikov - Сand. of Sci. (Med.), Deputy Head of the Department of Naval Surgery</p><p>194044, Saint Petersburg, Academician  Lebedev Str., 6</p></bio><xref ref-type="aff" rid="aff-1"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0001-9829-4681</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Любимов</surname><given-names>А. В.</given-names></name><name name-style="western" xml:lang="en"><surname>Lyubimov</surname><given-names>A. V.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Любимов Андрей Владимирович – кандидат медицинских наук, преподаватель кафедры военно-морской терапии</p><p>194044, Санкт-Петербург, ул. Академика Лебедева, д. 6</p></bio><bio xml:lang="en"><p>Lyubimov A. Vladimirovich - Сand. of Sci. (Med.), Lecturer of the Department of Naval Therapy</p><p>194044, Saint Petersburg, Academician  Lebedev Str., 6</p></bio><xref ref-type="aff" rid="aff-1"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0009-0006-5750-480X</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Куприянов</surname><given-names>С. А.</given-names></name><name name-style="western" xml:lang="en"><surname>Kupriyanov</surname><given-names>S. A.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Куприянов Сергей Андреевич – кандидат медицинских наук, старший преподаватель кафедры организации и тактики медицинской службы флота (с курсом тактики и боевых средств флота)</p><p>194044, Санкт-Петербург, ул. Академика Лебедева, д. 6</p></bio><bio xml:lang="en"><p>Sergey A. Kupriyanov – Сand. of Sci. (Med.), Senior lecturer of the Department of Organization and Tactics of the Medical Service of the Fleet (with a course in tactics and combat means of the Fleet)</p><p>194044, Saint Petersburg, Academician  Lebedev Str., 6</p></bio><xref ref-type="aff" rid="aff-1"/></contrib><contrib contrib-type="author" corresp="yes"><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Миннуллин</surname><given-names>И. П.</given-names></name><name name-style="western" xml:lang="en"><surname>Minnullin</surname><given-names>I. P.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Миннуллин Ильдар Пулатович – доктор медицинских наук, профессор, директор Института сестринского образования, заведующий кафедрой скорой помощи и хирургии повреждений</p><p>197022, Санкт-Петербург, ул. Льва Толстова, д. 6–8</p></bio><bio xml:lang="en"><p>Ildar P. Minnullin – Dr. of Sci. (Med.), Professor, retired Colonel of the Medical Service, Director of the Institute of Nursing Education, Head  of  the  Department  of  Emergency  Care  and  Injury  Surgery</p><p>197022, Saint</p><p>Petersburg, Lev Tolstoy Str., 6–8</p></bio><xref ref-type="aff" rid="aff-2"/></contrib><contrib contrib-type="author" corresp="yes"><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Уточкин</surname><given-names>А. П.</given-names></name><name name-style="western" xml:lang="en"><surname>Utochkin</surname><given-names>A. P.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Уточкин Александр Петрович – доктор медицинских наук, профессор, доцент кафедры военно-морской хирургии</p><p>194044, Санкт-Петербург, ул. Академика Лебедева, д. 6</p></bio><bio xml:lang="en"><p>Alexander P. Utochkin –  Dr. of Sci. (Med.), Professor, retired Colonel of the Medical Service, Associate Professor of the Department of  Naval  Surgery</p><p>194044, Saint Petersburg, Academician  Lebedev Str., 6</p></bio><email xlink:type="simple">utvm1468@mail.ru</email><xref ref-type="aff" rid="aff-1"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0009-0009-7777-856X</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Климов</surname><given-names>А. Д.</given-names></name><name name-style="western" xml:lang="en"><surname>Klimov</surname><given-names>A. D.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Климов Антон Дмитриевич – слушатель</p><p>194044, Санкт-Петербург, ул. Академика Лебедева, д. 6</p></bio><bio xml:lang="en"><p>Anton D. Klimov – student</p><p>194044, Saint Petersburg, Academician  Lebedev Str., 6</p></bio><xref ref-type="aff" rid="aff-1"/></contrib></contrib-group><aff-alternatives id="aff-1"><aff xml:lang="ru"><institution>Военно-медицинская академия имени С. М. Кирова</institution><country>Россия</country></aff><aff xml:lang="en"><institution>Military Medical Academy</institution><country>Russian Federation</country></aff></aff-alternatives><aff-alternatives id="aff-2"><aff xml:lang="ru"><institution>Первый Санкт-Петербургский государственный медицинский университет  имени академика И. П. Павлова</institution><country>Россия</country></aff><aff xml:lang="en"><institution>Pavlov University</institution><country>Russian Federation</country></aff></aff-alternatives><pub-date pub-type="collection"><year>2025</year></pub-date><pub-date pub-type="epub"><day>12</day><month>07</month><year>2025</year></pub-date><volume>11</volume><issue>2</issue><fpage>48</fpage><lpage>66</lpage><permissions><copyright-statement>Copyright &amp;#x00A9; Сильченко Е.С., Суров Д.А., Дымников Д.А., Любимов А.В., Куприянов С.А., Миннуллин И.П., Уточкин А.П., Климов А.Д., 2025</copyright-statement><copyright-year>2025</copyright-year><copyright-holder xml:lang="ru">Сильченко Е.С., Суров Д.А., Дымников Д.А., Любимов А.В., Куприянов С.А., Миннуллин И.П., Уточкин А.П., Климов А.Д.</copyright-holder><copyright-holder xml:lang="en">Silchenko E.S., Surov D.A., Dymnikov D.A., Lyubimov A.V., Kupriyanov S.A., Minnullin I.P., Utochkin A.P., Klimov A.D.</copyright-holder><license xml:lang="ru" license-type="creative-commons-attribution" xlink:href="https://creativecommons.org/licenses/by/4.0/" xlink:type="simple"><license-p>Данная работа распространяется под лицензией Creative Commons Attribution 4.0.</license-p></license><license xml:lang="en" license-type="creative-commons-attribution" xlink:href="https://creativecommons.org/licenses/by/4.0/" xlink:type="simple"><license-p>This work is licensed under a Creative Commons Attribution 4.0 License.</license-p></license></permissions><self-uri xlink:href="https://seamed.elpub.ru/jour/article/view/818">https://seamed.elpub.ru/jour/article/view/818</self-uri><abstract><sec><title>ВВЕДЕНИЕ</title><p>ВВЕДЕНИЕ. В статье рассмотрены особенности существующей системы оказания помощи раненым и пострадавшим в корабельных условиях и представлены возможные пути ее совершенствования с учетом современных трендов медицинской науки и передового опыта оказания помощи раненым в боевых условиях.</p></sec><sec><title>ЦЕЛЬ</title><p>ЦЕЛЬ. Проанализировать особенности действующей системы оказания первой доврачебной, первой врачебной и квалифицированной хирургической помощи раненым и пострадавшим на кораблях Военно-Морского Флота (ВМФ) Российской Федерации. На основании результатов исследования внести предложения по дальнейшему совершенствованию лечебно-эвакуационных мероприятий при ведении боевых действий на море.</p></sec><sec><title>МАТЕРИАЛЫ И МЕТОДЫ</title><p>МАТЕРИАЛЫ И МЕТОДЫ. Исследованы отечественные и зарубежные источники, характеризующие организацию оказания помощи раненым и пострадавшим в корабельных условиях, в том числе использованы наукометрические базы данных Google Scholar, eLIBRARY и PubMed, нормативно-правовые документы, размещенные в электронной базе Гарант. Поиск проводился по ключевым словам: морская медицина, медицинская служба, лечебно-эвакуационные мероприятия, первая помощь, продленная помощь, доврачебная помощь, квалифицированная хирургическая помощь, военно-морская хирургия, цельная кровь, лиофилизированная плазма, Tactical combat casuality care, Prolonged casuality care, hospital corpsman, fleet surgical team, prehospital care. Проанализированы 33 отечественных и зарубежных публикации по проблеме оказания помощи раненым и пострадавшим в корабельных условиях в период с 2008 по 2024 г.</p></sec><sec><title>РЕЗУЛЬТАТЫ</title><p>РЕЗУЛЬТАТЫ. Анализ доступных литературных источников позволил определить проблемные вопросы существующей системы оказания помощи раненым и пострадавшим в корабельных условиях и наметить пути ее возможного совершенствования в динамично меняющихся современных условиях действия флота.</p></sec><sec><title>ОБСУЖДЕНИЕ</title><p>ОБСУЖДЕНИЕ. Существующая система оказания помощи раненым и пострадавшим на кораблях, действующая в неизменном виде последние десятилетия, не отражает появление современных концепций и стратегий предоставления помощи в ограниченных условиях людских, временны́х и материальных ресурсов. Длительное время не пересматривался подход к материально-техническому оснащению медицинской службы кораблей. При этом к настоящему времени накоплен огромный опыт медицинского обеспечения войск в боевых условиях, которые зачастую совпадают с условиями оказания помощи на кораблях в условиях массового поступления раненых как по ограниченности ресурсов, так и по невозможности своевременной эвакуации на вышестоящие этапы оказания помощи. Это дает основание считать, что для определения дальнейших направлений развития системы оказания помощи раненым и пострадавшим на ВМФ необходима адаптация опыта медицинского обеспечения сухопутных войск с учетом корабельной специфики, а также внедрение современного лечебно-диагностического оборудования. Положительные изменения трудно достижимы без пересмотра программ подготовки личного состава экипажей кораблей и медицинского персонала корабельного звена. </p></sec><sec><title>ЗАКЛЮЧЕНИЕ</title><p>ЗАКЛЮЧЕНИЕ. Основные направления развития системы оказания помощи раненым и пострадавшим на ВМФ определяются адаптацией современных достижений науки, техники и передового опыта медицинского обеспечения сухопутных войск к корабельным условиям, совершенствованием материально-технического снабжения, подготовкой личного состава экипажей кораблей и корабельного состава медицинской службы, а также изменениями нормативно-правовой базы в области медицинской деятельности.</p></sec></abstract><trans-abstract xml:lang="en"><sec><title>INTRODUCTION</title><p>INTRODUCTION. The article considers the peculiarities of the existing system of assistance to the wounded and injured in shipboard conditions and presents possible ways of its improvement with regard to modern trends of medical science and advanced experience of assistance to the wounded in combat conditions.</p></sec><sec><title>OBJECTIVE</title><p>OBJECTIVE. To analyze the features of the current system of first aid, pre-hospital, first medical and qualified surgical aid to the wounded and injured on ships of the Russian Navy. Based on the study results, to make proposals for further improvement of treatment and evacuation measures during combat operations at sea.</p></sec><sec><title>MATERIALS AND METHODS</title><p>MATERIALS AND METHODS. Russian and foreign sources characterizing the organization of assistance to the wounded and injured in shipboard conditions were studied, including the use of scientific and metric databases Google Scholar, eLIBRARY and PubMed, regulatory legal documents in the electronic database Garant. The search was conducted by keywords: maritime medicine, medical service, medical evacuation measures, first aid, prolonged care, prehospital care, skilled surgical care, naval surgery, whole blood, lyophilized plasma, Tactical combat casualty care, Prolonged casualty care, hospital corpsman, fleet surgical team, prehospital care. We analyzed 33 Russian and foreign publications on the problem of providing care to the wounded and injured in shipboard conditions in the period from 2008 to 2024.</p></sec><sec><title>RESULTS</title><p>RESULTS. The analysis of available literature sources allowed us to define the problematic issues of the existing system of assistance to the wounded and injured in shipboard conditions and to identify ways of its possible improvement in the dynamically changing modern conditions of fleet operations.</p></sec><sec><title>DISCUSSION</title><p>DISCUSSION. The existing system of assistance to the wounded and injured on ships, which has been operating unchanged for the last decades, does not reflect the onset of modern concepts and strategies of assistance under limited conditions of human, time and material resources. For a long time, the approach to the material and technical equipment of the medical service of ships has not been revised. At the same time, by now there has been accumulated a great experience of medical support of troops in combat conditions, which often coincide with the conditions of assistance on ships in conditions of mass arrival of wounded both due to limited resources and impossibility of timely evacuation to higher stages of assistance provision. This gives grounds to believe that in order to determine further directions of developing the system of wounded and injured care in the Navy, it is necessary to adapt the experience of medical support of ground forces with regard to ship specifics, as well as the introduction of modern treatment and diagnostic equipment. At the same time, positive changes are difficult to achieve without revision of training programs for ship crews and shipboard medical personnel. </p></sec><sec><title>CONCLUSION</title><p>CONCLUSION. The main directions of developing the system of assistance to the wounded and injured in the Navy are determined by the adaptation of modern achievements of science, technology and advanced experience in medical support of ground forces to shipboard conditions, improvement of logistics, training of personnel of ship crews and shipboard medical service personnel, as well as changes in the regulatory and legal framework in the field of medical activities.</p></sec></trans-abstract><kwd-group xml:lang="ru"><kwd>морская медицина</kwd><kwd>лечебно-эвакуационные мероприятия</kwd><kwd>первая помощь</kwd><kwd>продленная помощь</kwd><kwd>доврачебная помощь</kwd><kwd>квалифицированная хирургическая помощь</kwd><kwd>военно-морская хирургия</kwd><kwd>цельная кровь</kwd><kwd>лиофилизированная плазма</kwd><kwd>tactical combat casuality care</kwd><kwd>prolonged casuality care</kwd><kwd>hospital corpsman</kwd><kwd>fleet surgical team</kwd><kwd>prehospital care</kwd></kwd-group><kwd-group xml:lang="en"><kwd>marine medicine</kwd><kwd>medical evacuation</kwd><kwd>first aid</kwd><kwd>prolonged care</kwd><kwd>prehospital care</kwd><kwd>skilled surgical care</kwd><kwd>naval surgery</kwd><kwd>whole blood</kwd><kwd>lyophilized plasma</kwd><kwd>Tactical combat casualty care</kwd><kwd>Prolonged casualty care</kwd><kwd>hospital corpsman</kwd><kwd>fleet surgical team</kwd><kwd>prehospital care</kwd></kwd-group></article-meta></front><back><ref-list><title>References</title><ref id="cit1"><label>1</label><citation-alternatives><mixed-citation xml:lang="ru">Семенцов В. 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