Military Surgery with Emergency Surgery - V.Ya. Bilyi 2004

Preface

Dear reader!

Military Surgery with Emergency Surgery is an academic discipline that belongs to the category of special clinical fields, building upon courses in military field surgery and disaster medicine. This discipline integrates the organizational Methods of disaster medicine with the approaches of classical military field surgery regarding the Pathogenesis, Clinical presentation, diagnostic methods, and Treatment of modern trauma in peacetime and wartime emergencies.

Such a combination is being introduced into our country's educational literature for the first time, prompted by the following considerations.

Over the last decades of the past century, a global trend has been observed: an increase in the number of man-made accidents, disasters, and natural calamities in peacetime, along with a rise in the severity of their medical and sanitary consequences. In the post-World War II period, there have been Changes in the weaponry used in combat operations, The Nature of individual military conflicts, the volume of casualties, and the methods of organizing surgical care for wounded soldiers. New scientific directions, concepts, and terms have emerged, which are used in modern medicine in general and military medicine in particular. For instance, the new concept of an "emergency" defines the disruption of normal living and working conditions for people at a facility, territory, or Water area caused by an accident, disaster, catastrophe, natural calamity, or other hazardous event in peacetime or wartime, resulting in human fatalities or significant material losses.

As a result of emergencies, the number of affected populations is steadily growing. Furthermore, the majority of peacetime injuries require Surgical treatment, with severe, multiple, poly-trauma, and combined injuries prevailing. The level of traumatism across the regions of Ukraine is steadily increasing and significantly exceeds the casualty rates of local military conflicts from the previous century. For example, in 2001, 2.3 million people were injured in the country, and about 40,000 died from injuries. For comparison, 14.5 thousand servicemen died during 10 years of combat operations in Afghanistan.

Under everyday conditions in Ukraine's medical institutions, about 26,000 surgical specialists perform over 2 million surgical interventions, which fully meets society's needs for surgical care. The system of surgical care in our country during routine conditions has evolved over decades and takes into account the demographic, geographical, and ecological features, as well as the infrastructure of the state's economic complex in peacetime.

At the same time, in the event of large-scale natural disasters and peacetime catastrophes, the healthcare system designed for routine operations is unable to provide adequate surgical care to A large number of victims simultaneously. Problems arise regarding the shortage of medical personnel trained to provide emergency care to victims; medicines, medical and sanitary-economic equipment; special vehicles suitable for medical evacuation; and medical facilities ready to receive victims and provide them with necessary care. There is a need to attract significant additional medical forces and resources from areas located outside the emergency zone. These tasks are performed by the State Disaster Medicine Service of Ukraine, which functionally combines the capabilities of the state's existing medical potential, including the military medical service. The State Disaster Medicine Service of Ukraine has experience in eliminating the medical and sanitary consequences of numerous emergencies in Ukraine. Its formations have participated in international exercises and actually provided medical assistance to the populations of Turkey (1999), India (2001), and Iran (2003) affected by catastrophic earthquakes.

Military medical science systematically summarizes the experience of modern wars, armed conflicts, and major terrorist acts in other countries.

The Study of casualties, the conditions of providing surgical care to emergency victims in peacetime and wartime, and the existing systems of medical care Organization has revealed a commonality of many problems that are equally relevant to emergency surgery and military surgery.

First of all, this concerns the pathogenesis of the injured and wounded. The nature of injuries in both victims of technological and natural emergencies and the wounded in the theater of operations primarily consists of Polytrauma, The Structure of which includes multiple, associated, and combined injuries.

Secondly, the conditions in the emergency zone and the theater of operations, as well as the number of casualties and wounded, do not allow for adequate surgical care at the site of injury; instead, they necessitate medical evacuation and triage. Mobile, movable formations, units, and facilities are established to provide surgical care.

For definitive treatment and rehabilitation, the bed capacity of virtually the same stationary health care facilities of the state is also utilized.

The treatment and diagnostic process in peacetime and wartime emergencies, as well as in combat operations, involves the same surgeons and other medical personnel who routinely work in healthcare institutions of the Ministry of Health of Ukraine, departmental hospitals, and clinics, and who during peacetime and wartime emergencies are integrated into the formations of the State Disaster Medicine Service, the Civil Defense Medical Service, and mobilized into the military medical service during wartime.

All this makes it possible to formulate unified principles for organizing surgical care, conduct a methodologically uniform Analysis of the pathogenesis, Clinical Features, diagnostic methods for modern trauma, and treatment of victims in peacetime and wartime emergencies.

This work examines the organizational foundations of providing surgical care, the conceptual apparatus of medical-tactical characteristics of emergencies, emergency surgery and military surgery, principles of providing surgical care, types of medical care, and the specifics of their provision in peacetime and wartime emergencies. The work contains essential information regarding the specifics of Diagnosis and surgical treatment techniques for Traumatic Shock, modern wound illness, bleeding and Blood loss, combined injuries, Crush syndrome, thermal injuries, infectious complications of mechanical and combat injuries, HEAD trauma, injuries to the spine and Spinal Cord, chest, abdomen, pelvis and pelvic Organs, and extremities.

This textbook, prepared by the academic and pedagogical staff of the Department of Military Surgery at the Ukrainian Military Medical Academy in cooperation with researchers from the Ukrainian Scientific and Practical Center for Emergency Medical Care and Disaster Medicine, as well as the I.Ya. Horbachevsky Ternopil State Medical Academy, reflects modern principles of organizing surgical care and complies with the curriculum "Military Surgery with a Course in Emergency Surgery" and the educational and methodological tasks for training students of higher medical educational institutions of Ukraine.

Sincerely, Professor V.Ya. Bilyi