“Better Get a Minor Wound — No One Will Help You”

A Russian military paramedic talks with IStories about poor medical training in the Russian army and what are the most dangerous wounds in the war with Ukraine

12 May 2023
“Better Get a Minor Wound — No One Will Help You”
Image grab from footage released by Russia Ministry of Defense on March 28, 2022 shows a field hospital in an unspecific location in Ukraine. Photo: EYEPRESS / Reuters

The head of the training center for tactical medicine of the Kalashnikov Concern Artem Katulin said in an interview with the pro-Kremlin RIA Novosti news agency that more than half of the Russian military died in the war with Ukraine not from life-threatening wounds, but because of improper medical care given to them. More than a third of the amputations, according to Katulin, were due to improper tourniquet applying. He also denied the likelihood of the Ukrainian military using narcotics to improve soldiers' effectiveness on the battlefield.

“Important Stories” asked a Russian military paramedic, a participant in Russia's war against Ukraine, to comment on Katulin's interview and share his experience.

“‘Maybe we'll get lucky.’ No way!”

Katulin told the whole truth. And it’s relevant not only for the military, but also for civilians. A simplest example: nobody teaches first aid at school at all. At the university, for example, we were also told about it only in passing, not detailed. If a person just falls down on the street, no one will come up. People don’t know how to check pulse, breathing, how to do indirect heart massage, or how to stop bleeding with improvised means. Because of this, more people die on the roads than in war.

Speaking about the army, in my ten years [of service], combat paramedics gave us full comprehensive training four times. But they only trained paramedics. As for the regular training in the army... Twice a year in the army there are classes where the paramedic shows us how to apply a splint from improvised means and how to apply bandages. And at the last class I attended, the paramedic didn't bandage properly. That is, the man himself does not know how to do it, and teaches others incorrectly.

And, as always, my favorite, “maybe we'll get lucky”. No way! The shrapnel comes in, you're fucked. It's got a lot of energy. And when it hits your body, this pulsating cavity, it increases the impact on all internal organs. Modern warfare has shown that a bullet wound is the best you can get.

Because lacerations are the most fucked up. And you can get a laceration even just by jumping off equipment or falling. All that hard grass and rocks can get under the skin and there will be inflammation. And, for example, in mine blast injuries, when you get a limb torn off, you have to do everything very quickly and competently. 

The bandages have to be changed all the time. You have to constantly make sure that the tissue doesn't become necrotic, that gangrene doesn't start, that you don't get blood poisoning. But the most important trick is a quick evacuation. No matter how good the first aid is, if you can't get the person to the hospital quickly, where he'll already have surgical care, he just won't make it.

“My medical kit was bought out of my own money”

Army first-aid kits — don’t get me started. What we were given on the front line was an ancient Soviet emergency bandage kit (although the Soviet one was still good, but the Russian one was crap) and an Esmarch tourniquet. That's the rubbery red shit being in the talcum powder for years. Soldiers were given this stuff plus one tube of Promedol [narcotic painkiller]. Are they fucking serious?

Many people have owned some fucking expensive first-aid kits, but no one knows how to use them all. For example, there are some shitty domestic hemostats [blood thinners] that burn the wound. And in addition to having to treat the wound itself, you then have to treat the burn. Or just not applying a pressure bondage properly can cause a lot of blood loss or dirt to get in, which can lead to infection and rotting.

Katulin correctly said that the best things are foreign. I used Israeli emergency bandage kits, and they are the best you can work with. All the tourniquets I had were American. I used not our “Hemostop” hemostat, but a foreign “Celox”. It's all made very good, but it’s very expensive.

For example, in Afghanistan and Chechnya there were a lot of casualties because of shrapnel, because they started using high-explosive weapons. And a lot of guys died back then because their groin artery was severed: at that time there was almost no way you could stop bleeding from it. It's deep, and very difficult to compress. Practically impossible. It's only recently some systems have appeared that can help to compress this artery. And they are very expensive. I saw disposable ones for two arteries for 52,000 rubles (≈$650). And no one in the army buys them, and no one knows how to use them.

My medical kit, which could help six people, cost 110,000 rubles (≈$1375). Nobody gave me that money. It was bought out of my own money, and my comrades contributed. That is, all the normal medicine in the military units is collected by people themselves, no one gives anything away.

Many people die not because they are killed, but because they are not properly treated.
Russian military paramedic

When I became an orderly, I had to learn on my own. I consulted with medic friends and combat medics. Then I taught other soldiers. Since my documents say that I am an orderly, I, for example, have no right to perform surgical interventions. That is, I have the right to give first aid to a soldier, but, for example, if I understand that an artery is damaged, I cannot just take a scalpel, cut, compress the artery, then just fix it all, tie it up, and prepare the person for immobilization. I am forbidden by law to do that. 

If I do that, he will be brought to surgery, and then I will get a complaint and will be sent to jail for having performed a surgical intervention without proper authorization (according to the interlocutor, there have been such casesEditor’s note).

“Soldiers should be taught to save themselves”

The first thing soldiers should be taught is to save themselves. I used to tell my comrades: “You’d better get a minor wound, get something harder, that's it, you're dead.” I just intimidated people with this “you're going to die,” “no one will help you, no one will come, no one will do anything if you can't do it yourself.” No one gives a fuck about a soldier, no one will do anything about him. This is the main problem with all these injuries. Many people die not because they are killed, but because they are not properly treated.

There is a red zone [the epicenter of the fight], a yellow zone [defensive fighting positions], and a green zone [from where the wounded can be transferred to a field hospital]. The red zone is where you could be directly wounded. And if you are seriously wounded and cannot help yourself, no one can help you in that zone. Few paramedics will stick their necks out there to get you out. 

That's why my comrades should always have a first-aid kit handy. And they have to be able to use everything there, to be able to help themselves first and only then the others. An improperly applied tourniquet means loss of limb at best, and death at worst. 

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And a lot also depends on the weather, on the time of year, where and how the wound was sustained, how long the person will be transported. So there's no such thing as putting on a tourniquet and that's it, a person can walk around with it indefinitely. There are a million techniques on how to help, but the problem is that people just don't know the base. Medical training should be on a par with firearms and physical training. It would be better [in the army] to be less preoccupied with regulations, appearance, and how to walk around the parade ground. What will happen when a soldier gets his leg blown off? He'll just die of fear [if he's still conscious] because he doesn't know what to do about it.

It is better to take small numbers, trained fighters who know what they have to do and how to do it. And not a stupid herd that just: “For the Tsar and the Fatherland!” They're equipped like they're on their last trip. Not everyone even got a gun. Soon it will be like in Soviet times: one has a rifle, the other have cartridges.

Oh, and all these rumors about “both Russians and Ukrainians are fighting high [on drugs]” are all bullshit. We tried to do such tests in practice. You can survive for two or three days, but then you just turn into a vegetable, so you need treatment, vitamins, sleep, normal food... In short, recovery is very long. Especially when you're wounded on drugs, you'll die faster, because the blood pumps faster, so the blood loss will be greater.

Yes, there are junkies everywhere. Some people do drugs just because they're scared, but not to be super berserk (the ancient Norse myths referred to berserkers as warriors who fought in a trance-like stateEditor’s note).