Troops and Special Forces. Generally, surgeons start to on cadaver material. The teaching personnelof the participate in the outbreak of hostilities, when they have Military Field Surgery Department preliminarily develo- to provide medical care to the wounded under difficult ped a list of the most relevant emergency surgical inci- circumstances1, 2. Hence, there has been a recent trend sions performed in the provision of medical assistance to that special operations surgical teams provide medical the wounded as the Damage Control tactic (Table 2). care to seriously injured persons on a battlefield (Special Operations Surgical Team, SOST, Surgical Resuscitation Team, Surgeons considered the possibility of demonstrating their SRT).3 Such interventions require additional surgical and practical skills on animals. However, the anatomy of pigs is resuscitation training in the area of modern combat trauma. different and military physicians are not able to perform several extremely important surgical operations (tampo- OBJECTIVE nade of the pelvis, fixation of pelvic and limbs fractures, thoracocentesis in the second intercostal space, etc.). The objective of the study is to improve the practical Military surgeons trained at the operating theatre how to training of military surgeons of forward medical units perform such operations, like several others before. using new learning methods. The idea of the establishment of the course was to use MATERIAL AND METHODS a combination of typical surgicaltechniques and methods that form the technical basis of the Damage The authors compared the structure of emergency surge- Control tactic created to save the lives of the most ries in a level 1 trauma center to the ones performed in severe category of wounded. The aim of the training the North Caucasus (1999-2002). They also described fea- course "SMART" (Modern Methods and Algorithms for tures of the practical course "SMART" (Modern Methods the Treatment of Wounds and Traumas) is to show and and Algorithms for the Treatment of Wounds and to provide an opportunity for students to get practical Traumas) designed to teach trauma and military surgery. skills in the area of military field surgery. RESULTS OF THE STUDY The SMART course was launched in 2018. It takes place 3-4 times per year while the format of the course was Up to 90 surgeons train at the department and in the constantly being improved. The course started as a two-day clinic of military field surgery of Kirov Military Medical training course on injury surgery on "living" tissues. Then it Academy in various retraining programmes every year. expanded 3 full days of classes, combining short lectures The clinic also belongs to Saint Petersburg local health- and practical work of students on surgical simulators, large care system as a level 1 trauma center. The multi-func- living biological objects and cadaveric material. Medical tional character of the Academy enables students not professionals train their skills on such tools as surgical simu- only to gain theoretical knowledge during lectures, lator "Caesar" (Canada, CAE), "TraumaMan" (USA, Simulab seminars, clinical analyzes but also to provide assistance Corporation), "VirtuMan" (the USA, Simulaids, Inc.) and on to the victims. Based on the professional experience of specially designed Russian surgical simulators, large biologi- department's specialists in armed conflicts recent indi- cal objects and human corpses. The lecturers of the course cators point to the lack of professionaltraining in are professors of the Department of Military Field Surgery urgent situations among military surgeons. This is why who are also practicing surgeons of the trauma center with a traditional way of teaching had to be improved. combat experience. Other well-known specialists from dif- ferent institutions, including foreign trauma surgeons, Thus, the authors analyzed types of urgent surgeries for teach this course. victims in the clinic as a level 1 trauma center and other surgical procedures performed in forward medical units An approximate SMART course programme is presented in (medical detachment of special assignment) during the the table. 3. counter-terrorist operation in the North Caucasus in 1999- 2002 per year (Table 1). ∑Major General, MD, PhD (Medicine), Chief of Russian Military Medical Academy. It may be noted that the most common emergency sur- ∏Colonel (Ret), MD, PhD (Medicine), geries were laparotomy and thoracocentesis with pleu- Head of War Surgery Department, ral drainage. Surgical operations in special medical Russian Military Medical Academy. units (MOSN) constitute 46% of the total, the ones per- πLieutenant Colonel, MD, PhD (Medicine), Associate Professor of War Surgery Department, formed in the clinic account for 22.1% and 17.5% res- Russian Military Medical Academy. pectively. The most common surgeries in the clinic were ∫Colonel, MD, external fixation for limb bones (30.8%) and pelvis frac- Associate Professor of War Surgery Department, Kirov Military Medical Academy. tures (7.5%) which were not performed by the MOSN ªColonel (Ret), PhD (Law), during armed conflicts. However such surgeries help to Professor of the Institute of International and European Law Department, decrease the number of fatalities and complications Institute of Legislation and Comparative Law under the Government of the Russian Federation. among severely wounded people. Correspondence: Major General Evgeniy V. KRIUKOV, MD, PhD (Medicine), Given that military surgeons cannot perform all types Corresponding Member of the Russian Academy of Sciences, of surgical operations in trauma centers, the training Chief of Russian Military Medical Academy, 6 Akademika Lebedeva Str., VOL. programme was augmented with training on surgical RU-194044 St. Petersburg, Russia, 94/3 simulators, operations on larger animals (pigs) and classes E-mail: vmeda-nio@mil.ru International Review of the Armed Forces Medical Services 63 Revue Internationale des Services de Santé des Forces Armées