Ukraine: 'this is how to provide first aid to a person injured by firearms'

First aid to people wounded by firearms: the Security Service of Ukraine has published a series of educational lessons on tactical medicine – pre-hospital first aid

This knowledge in wartime conditions can help save a person’s life at the front.

The video, training for military personnel involved in the clashes, was released by the newspaper Pravda, as in reality the firefights are mainly involving civilians.


Video tutorial 1. Helping an injured person under fire

In this video, special forces from the Security Service’s Special Operations Centre ‘A’ explain how to help a wounded person under fire and show how to prevent further casualties during combat missions.

There are two types of assistance to a wounded person under fire: self-help and mutual aid.

In order to provide mutual aid to the wounded, it is necessary to act as follows

  • evade fire
  • find a safe shelter.

It is then necessary to assess the severity of the injury and the condition of the victim, then give him/her instructions, depending on the situation:

  • return fire
  • find the nearest safe shelter and move towards it,
  • establish self-help if the victim is able to do it alone.

If the injured person cannot move or is unconscious, a plan must be developed to reach him.

The only thing that can be done in the ‘under fire’ assistance phase, if the tactical situation permits, is to stop massive bleeding by applying a tourniquet.

You can learn more about the signs of a massive haemorrhage, self-help, rules for applying a tourniquet in the ‘under fire’ phase, ensuring airway patency, moving a wounded person from the battlefield to a shelter in the first SBU video.

Video tutorial 2. Assisting the wounded gunshot victim in tactical conditions and examining the first aid kit

After the wounded have been moved from the area under fire to a safer location, assistance under tactical conditions is required.

The Security Service of Ukraine has suggested what should be in each soldier’s first aid kit and how the rescuer of a wounded person should act before starting to provide help according to the MARCH algorithm.

The MARCH algorithm determines the priorities and order of actions in providing assistance to the wounded.

It is used when fighters are no longer under fire and can concentrate on saving their comrades.

What should be in a fighter’s first aid kit:

  • paramedic scissors,
  • medical gloves,
  • tourniquet,
  • swabs – gauze with and without a haemostat,
  • bandage to stop bleeding,
  • nasopharyngeal cannula for the respiratory tract,
  • occlusive adhesive to close wounds,
  • thermal blanket,
  • eye bandage
  • Pill-pack, which contains an antibiotic and anti-inflammatory drugs,
  • tissue patches,
  • ‘wound card’ and a permanent marker.

In the video you can also learn more about:

  • organisation and control of the security perimeter,
  • disarming the wounded,
  • conditions for postponing evacuation,
  • placing a first aid kit and a turnstile on the equipment.
  • designation of the composition of the first aid kit.


Lesson 3. The MARCH algorithm. M – Firefight and massive bleeding

In this video, the SBU explains how to control massive bleeding in an injured person, because a person can die within minutes from rapid blood loss.

The SBU explained what a soldier’s actions should be when rescuing a comrade.

In particular:

  • how to correctly perform a visual and tactile test of the wounded person,
  • how and when to apply a tourniquet,
  • when to use tamponade,
  • when to apply a bandage,
  • how to diagnose shock

Lesson 4. The MARCH algorithm. A – Airway patency

After stopping massive bleeding, the next stage of care is to check the injured person’s consciousness, reaction to voice, reaction to pain.

If he/she does not respond to any of the stimuli, it is necessary to check whether the injured person is breathing.

To do this, the helmet strap must be unfastened and the oral cavity examined for foreign bodies.

If there are any, they must be extracted by turning the injured person’s head to the side, as shown in the manikin video.

More details on the rescuer’s subsequent actions – opening the airway, positioning a nasopharyngeal airway and transferring the injured person to a stable position – in the SBU lecture.

Lesson 5: The MARCH. R – Breathing

Having ensured the patency of the casualty’s airway, it is necessary to check the respiratory indicators and administer aid in the case of chest trauma.

Firstly, the rescuer must assess the casualty’s breathing:

  • determine the respiratory rate in 10 seconds (the norm for an injured person is 10-30 breaths per minute),
  • determine the depth of breathing by placing the hand on the lower part of the chest,
  • determine the symmetry of breathing by placing both palms on the lower parts of the chest on both sides.

Next, the fighter should examine the chest and back of the injured.

How to do it correctly, as well as when to use an occlusive adhesive, what help to provide during a pneumothorax (accumulation of gas (most often, air) in the pleural cavity with a simultaneous increase of pressure in it) and how to act to prevent hypothermia (lowering of body temperature) – in the SBU lecture.

Lecture 6: The MARCH algorithm. C – Blood circulation

In this phase, it is necessary to perform a traumatic exposure and check for non-critical bleeding in the injured person and stop it.

It is also necessary to verify the effectiveness of the previous means of controlling massive bleeding used in phase ‘M – Massive bleeding’ of the MARCH algorithm.

Another important element of this phase is the testing of the pelvis for the presence of fractures and its fixation.

The SBU explained how to check for signs of shock in a victim following injury, help in case of a pelvic fracture, and apply bandages correctly to wounds.

Firearms, lesson 7. MARCH Algorithm: H – Head trauma, hypothermia and preparing the casualty for evacuation

The last step in caring for an injured person according to the MARCH algorithm is to check for the presence of a craniocerebral injury and the first actions in case of detection.

Next, we must prepare the injured person for evacuation and activate the PAWS algorithm.

To detect the signs of a brain injury, it is necessary to check

  • head for bruises, bruises and fractures,
  • bruises around the eyes – if they are present without signs of trauma to the nose, this indicates a severe head injury,
  • symmetry of the pupils (asymmetry is a sign of TBI),
  • pupil reaction to light by closing and opening the injured person’s eyes with the hands – their pupils should shrink if there is no head trauma. If there is no light, you can use a torch, but do not point it directly into the eyes of the injured person: move the beam to another object nearby.

The SBU also talked about:

  • completing assistance to prevent hypothermia,
  • completing the casualty card,
  • PAWS algorithm: analgesia, antibiotics, wounds and fracture splints.

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