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The authors underwent an analysis of doctrine changes of battle-field surgery. The terminology is specified, the ways of improvement of effectiveness and quality of medical care for the wounded, taking into account the new doctrine, are formulated. In accordance with Federal law No 323-FZ of 2011.11.21 the termreduced specialized care*is suggested for description of medical care at medical forward treatment unit instead of equalfied aid.

Comparative evaluation of effectivennes and safety of the local hemostatic agents in the experiment. On the model side damage the femoral artery of pigs we performed a comperative test of modern local hemostatic agents (LHA): bandages on the basis of chitosanTseloks Goz(TG), eGemofleks Combat(GC),GemoBandazh)(GB) bandages on kaolin-basedCombat- Goz(CG), and the usual bandage 10 cm x 3 m (control group). 25 animals were divided equally into 5 groups. After 45 seconds of bleeding from 6-mm side wound of femoral artery was used LHA with a three-minute external compression and wound edges approximation. In the case of the continuation-bleeding wounds performed re-tamponade with the second package of the LHA. Hemostasis after applying the first packet never recorded in the CG group, occurred in I out of 5 animals in the groups TG and GC, 2 of 5 animals in the group GB and the control group (p0,05). Application of two packages LHA in the TG group, GB and the control group was effective in 3 of 5 animals and in groups CG and GC - in 2 of 5 animals (p0,05). Mortality did not differ significantly between the groups. Thus, the conventional bandage wound with ordinary tamponade in this model is not less effective than current LHA.

Pre-hospital care is one of the most important links in a chain of the military medical tenet. A survival of the most of severe casualties at the scene depends on a good quality and well-timed first aid and paramedic care. Based on the current state of medical equipment and training of the soldiers of the Russian and foreign armies, we summarized the data about the main medical products designed for pre-hospital care, briefly analyzed and compared their effectiveness to the foreign analogues. It is currently obvious, that fundamental changes in First aid kit modification and Medical Bags are warranted according to the reality and soldier's demands in combat operations. Proposals for modernization of military medical equipment were put forward.

Today self-expanding polymers are considered as the most promising as means for intracavitary hemostasis in case of continuing bleeding after trauma. Testing of domestic open-cell polyurethane foam composition "Locus" was carried out on the developed experimental model simulating liver trauma of V degree. After damaging 6 experimental rabbits were injected intraperitoneally with 80 ml of the composition. 5 experimental rabbits were included into to control group (haemostatic agent was not given). Estimated blood loss was 111-124 ml. The two-hour survival rate didn't differ significantly: 3 animals survived in the experimental group; 2 animal survived in the control. Despite the 3-4-fold widening of the foam, due to open cells it absorbed 72.6 +/- 8.3 g of blood. Thus, open-cell polyurethane foam intraperitoneal administration of the composition didn't provide a temporary intra-abdominal hemostasis in liver. In order to enhance the hemostatic effect it requires changing the formulation of the polyurethane composition. For a more accurate assessment of the results it is neccessary to perform additional researches on larger animals.

With the help of tests on 10 big biological objects (sheep) was studied a modern model of severe lateral damage (6 mm diameter) of femoral artery. Within 45 seconds blood loss was 432.5 +/- 258.2 ml. The usage of domestic local hemostatic agent--"Gemostop" based on zeolite and "Gemofleks" based on chitosan. The total three-hour mortality was 50%. Primary hemostasis was recorded only in 20% of biological objects, the final hemostasis in 60%. Thus, the model of standard 6-mm lateral damage of femoral artery with a free primary hemmorage during 45 seconds should be considered as. optimal for evaluating the effectiveness of modern hemostatic agents.

The aim of the given study was development of surgical tactics in case of femoral artery injury, caused by medium-calibre bullet, on the basis acute experiment on large biological objects. Experimental animals were shot into mid third of the femora by a rifle cartridge in 7,62-mm calibre (AK-47 made in 1943). The analysis of microstructure, made in 5 cross-sections performed every 1-centimetre way from the wound canal, showed that there were no any damages of arterial wall. Authors came to conclusion that the surgical debridement of the gunshot wound, made by a rifle cartridge in 7,62-mm calibre of AK-47, should consist of exsection of devitalized section of artery.

Ongoing intra-abdominal bleeding is the main life-threatening sequence of blunt abdominal trauma. The use of local hemostatic agents allows achieving fast and reliable hemorrhage control in case of parenchymatous organs injury. We investigated the efficacy of a dressing "Celox Gauze" in an experimental model of grade IV liver injury in large animals in the setting of coagulopathy. We used the following experimental model: 30-35% of blood volume was withdrawn followed by severe liver injury and hemostatic agent application. Laboratory tests were controlled in three endpoints. Hemostasis was evaluated in 2 days. "Celox Gauze" was effective for hemorrhage control in 100% of cases. All animals survived until the end of the experiment. Perihepatic packing with "Celox Gauze" applied is more effective to control hemorrhage than packing only. It has been noted lower volume of blood loss, lower decrease of red blood cells in animals of "Celox Gauze" group. We noted no adverse effects. Histological analysis showed the absence of any significant local hepatic damage. In whole the local hemostatic agent "Celox Gauze" has been shown highly effective in the model of parenchymatous bleeding. Additional studies with more number of animals are warranted to confirm our results.

A goal of this study is to review perspective technologies of surgical care to the wounded on the basis of an analysis of the experience in medical support in local armed conflicts and a study of the achievements of modern trauma surgery. The study is based on the analysis of personal experience, results of scientific researches being carried out in the Military Medical Academy and a comparison review of available papers and works in the field of our study. Perspective technologies of surgical care to the wounded are strongly dependent on the pre-hospital care: high technologies in personal medical equipment, special disposable devices used in case of life-threatening consequences of injuries and traumas during emergency medical care and advanced trauma management. The main innovation of the last ten years in war surgery is considered to be damage control surgery. Wide application of abbreviated surgical operations (the first phase of damage control surgery) makes the use of remote surgery (telesurgery) for treatment of the wounded more practicable. Increasing effectiveness of military surgeon education is based on the use of all possible achievements in education and information technologies. Feedback in surgical care to the wounded is supplied with analysis of its results in the medical Register of the wounded military.

External hemorrhage of extremities wounds is the leading cause of soldiers' death on the battlefield. In these cases control of massive arterial bleeding require not only prompt and effective measures, but also safety procedure. We assessed on volunteers the effectiveness, application time and pain intensity during the use of construction powerful quick-grip one-handed bar clamp. In results we found that the use of improvised quick-grip clamp for hemorrhage control in axillary and popliteal areas stops arterial blood flow in an extremity in all cases proven by Doppler ultrasound examination. Application time in axillary zone was 15.3 +/- 5.2 sec, in popliteal area--27.3 +/- 8.0 sec. In the groin area, the use of this improvised device was not effective due to technical characteristics (small distance between the main frame and the pressure surfaces). There do appear to be sufficient reasons to design the universal clamp for hemorrhage control from the wounds of junctional zones as well as proximal segments of extremities on Advanced Trauma Management stage and also for civilian prehospital emergency care.

The problem of temporary hemorrhage control is one of the most important issues of modern war surgery and surgery of trauma. It is a review of literature devoted to prehospital care in extremity major vascular injuries, embraced up-to-date domestic materials as well as the modern foreign papers in this area. The most important historical landmarks of temporary hemorrhage control system are considered. We paid special attention to the most usable methods and means of hemorrhage control which are utilized at the modern time: pressure bandages, tourniquets, local haemostatic agents. The comprehensive analysis of the contamporary haemostatic means concerning U.S. Army has done. The experience of foreign colleagues in development of prehospital care for the injured, creation and progress of new haemostatic methods, application of temporary hemorrhage control system is analyzed.