Organizational and management aspects of medical and evacuation support for personnel of the Armed Forces of Ukraine at the pre-hospital stage in the conditions of the single medical space

Abstract

The full-scale Russian invasion of Ukraine has fundamentally transformed the organization of military medical support, exposing critical gaps in pre-hospital care delivery and medical evacuation systems. This article examines the organizational and management aspects of medical and evacuation support for Armed Forces personnel at the pre-hospital stage within the framework of a unified medical space. The research substantiates the conceptual foundations and organizational approaches to developing an effective system aligned with NATO standards while accounting for Ukrainian wartime realities.
The study demonstrates that organizing medical support requires particular attention to deploying medical evacuation stages, their distance from combat zones, and the capacity to provide necessary types and volumes of care within established timeframes. Analysis reveals a direct correlation between the timeliness of tactical field care at the pre-hospital stage and reduction in fatality rates from severe injuries. Provision of care within the first 10 minutes after injury reduces mortality by 50%, while delays beyond 3 hours decrease survival rates below 60%. This validates the NATO 10-1-2 principle: tactical field pre-medical and first medical aid within 10 minutes, primary physician care within 1 hour, and urgent qualified medical care within 2 hours.
The article substantiates the necessity of building an effective medical and medical-evacuation support system for the Armed Forces and Defense Forces according to international standards, incorporating: tactical field care and non-medical evacuation (CASEVAC) aimed at preserving lives of wounded in combat conditions; pre-hospital care at medical evacuation stages (MEDEVAC) aimed at preventing combat and non-combat personnel losses; hospital care by type, including rehabilitation and appropriate medical support. The research examines the Role-based system (Role 1-4) adopted from NATO doctrine, analyzing functional capabilities at each level and adaptation mechanisms for Ukrainian conditions.
Special attention is devoted to organizing stabilization points in brigades, which serve as the first echelon of qualified surgical care proximate to combat zones. These units perform expanded resuscitation measures including Damage Control Surgery/Resuscitation, intubation, central venous access, hemotransfusion, and anti-shock therapy. The study identifies critical problems: staffing medical companies with qualified personnel, normative regulation of stabilization point structures and functions, equipment provision for evacuation transport, and coordination mechanisms between military medical services and civilian healthcare facilities.
The article emphasizes that enhancing medical-evacuation support effectiveness under military emergency conditions requires research from the perspective of crisis management concepts, interdepartmental interaction, and defining efficiency criteria. The unified medical space, formed through integration of military and civilian healthcare systems, significantly increased resource capacity but necessitates gradual civilian medicine involvement, focusing on facilities and specialists experienced in treating gunshot and mine-blast injuries specific to combat operations.