Naval medicine at a crossroads: time to change something?

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.

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.

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.

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.

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. 

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.

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