[:uk]On the Approval of the Volumes of Medical Assistance Provided at the Pre-Hospital Stage During Combat Operations and the Preparation of Security and Defense Forces for Deployment in Tactical Conditions.[:]

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Order of the Ministry of Defense of Ukraine No. 598 dated September 3, 2024 establishes a new procedure for providing medical assistance at the pre-hospital stage during combat operations and the training of security and defense forces in tactical conditions.

Main Objective of the Order

The document aims to regulate the scope of medical assistance provided at the pre-hospital stage by medical personnel of the defense and security forces in tactical conditions. This ensures the standardization of medical services and procedures carried out in field conditions during combat operations and training exercises.

Key Provisions of the Order

1. Approval of the Scope of Medical Assistance: The order approves a list of measures and medical services provided by medical personnel at the pre-hospital stage in tactical conditions. This list is attached as an annex to the order.
2. Changes to the List of Medical Services: Changes to the list of medical services provided by medical units in various roles of medical support are permitted within the framework of pilot projects initiated by the Ministry of Defense of Ukraine.
3. State Registration Procedure: The Department of Health of the Ministry of Defense of Ukraine is to ensure the submission of this order for state registration with the Ministry of Justice of Ukraine in accordance with the established procedure.
4. Entry into Force: The order comes into effect on the day of its official publication.

Attachments to the Order

The order contains two main attachments that detail the scope and types of medical assistance:

1. Scope of Medical Assistance at the Pre-Hospital Stage

This attachment establishes a set of measures undertaken by medical personnel aimed at the prevention, diagnosis, and treatment of patients in tactical conditions. Key aspects include:

• Definition of Medical Support Roles: Details the roles of medical support (R1, R2, R3, R4) and the conditions for their organization. Each role reflects the capacity of the medical unit to provide the corresponding volume of medical assistance.
• List and Description of Terms: Specialized terms and acronyms used in the document are defined to ensure their unambiguous understanding.
• Principles of Providing Medical Assistance: Describes the fundamental principles, algorithms, and methods of providing medical assistance across various medical support roles, including principles such as DCR (Damage Control Resuscitation) and DCS (Damage Control Surgery).
• Capacity of Medical Units: Establishes that the volume of medical assistance is determined by the capacity of medical units, with each subsequent role providing the capabilities of the previous one.

2. Annex 1 – Medical Services at Medical Support Roles

The table contains a detailed list of medical services and interventions provided at each medical support role (R1, R2F, R2B, R2E). Services are classified into several sections:

• Medical Services and Medical Interventions: Describes basic and specialized medical actions, such as initial patient examination, emergency assistance, surgical interventions, etc.
• Laboratory Tests: Lists possible laboratory tests at each role, including hematological and biochemical studies.
• Instrumental Examinations: Enumerates methods of instrumental diagnostics that can be performed at different roles, such as electrocardiography, radiological examinations, ultrasound examinations, etc.

Each medical service is marked with symbols indicating its mandatory or recommended nature for the corresponding role.

3. Annex 2 – Surgical Interventions Based on DCS Principles

This annex contains a description of surgical interventions performed based on the principles of Damage Control Surgery (DCS). Key points include:

• Characteristics of DCS: DCS refers to rapidly performed surgical interventions aimed at stopping bleeding and preventing contamination.
• List of Possible Interventions: Details the indications and specifics of conducting interventions for injuries to the head, eye, neck, chest, heart, abdomen, blood vessels, and fractures.
• Criteria for Performing Interventions: Defines the conditions and indications for undertaking certain surgical actions, taking into account the patient’s condition and tactical circumstances.

General Conclusions

Order No. 598 of the Ministry of Defense of Ukraine is an important regulatory act that establishes standardized volumes and conditions for providing medical assistance at the pre-hospital stage in combat conditions and the training of security and defense forces. This contributes to the improvement of the quality of medical support for military personnel, police officers, and other individuals involved in operations in tactical conditions.

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