“Every life saved is part of the Victory”. Report from the tactical medicine training

This is my fourth tactical medicine training and the second one at the CoLeSo training center.

I'm a little arrogant and condescending to the participants because I no longer have the excitement of a beginner — I know what awaits us. A lot of theory and a lot of practice. The latter is undoubtedly more interesting, but I'm already passive here. A few months ago, I was able to put down a tourniquet in 30 seconds (and even before that, I was so trained that I could do it in 12 seconds as if I were playing). Sitting, lying, standing. To myself and my neighbor. I was always one of the first to finish the exercise.

But no! This time, 40 seconds had passed, and I was still finishing the tourniquet on my right arm. If I had been wounded and was applying the tourniquet myself, I would have fainted from blood loss. Some of my classmates (today there are fourteen of us, civilians — ed.) have already managed and are shouting out the time: 10:42! 10:43. In a real situation, it is necessary to write down the time at the tourniquet for the medics who will examine the wounded later. But our situation is imaginary, so we shout out the time.

Instructor Anastasiia checks: if the tourniquet is tightened too much, the pulse on the arm will disappear. You also won't be able to put your finger between the sticky tape (the main part of the tourniquet — ed.) and your arm. If there is a gap, you have to tighten it. And it hurts, it really hurts. But what can you do: this is the fastest and most effective way to stop the bleeding.

My self-confidence quickly turned to shame when they announced the percentage of correct answers in the questionnaire we filled out before the class. They were interested in general knowledge: how often a person without consciousness breathes; how and when to lay them on their side; when to apply a second tourniquet; what are the signs of shock, etc. I answered only 60% of the questions correctly.

Maksym, 26, and Mariia, 17, have 80% each.

“Isn't this your first time at a first aid training?” theinstructor asks them.

They shout something affirmative. I remain silent.

Repetition is the basis of learning

Olha Omelchuk has been a sanitary instructor in the Armed Forces of Ukraine since 2014 and is the founder of the KoLeSo network of tactical medicine training centers. In addition to Kyiv, there are also centers in Zaporizhzhia, Mykolaiv, Vinnytsia, and Kryvyi Rih. She says that at first, they created training only for the military, but now they are open to civilians. These courses are held daily and are free of charge. Since March 2022, more than 37,000 people have taken the classes.

The whole world, including Ukraine, uses the TCCC guidelines. It is the gold standard for providing first aid on the battlefield. Its key component is the MARCH algorithm. This is a simple acronym for memorizing the necessary steps in order of priority to save the life of a wounded soldier. It stands for the following:

• M – Massive bleeding;
• A – Airways;
• R – Respiration;
• C – Circulation;
• H – Hypothermia.

To make it easier for Ukrainians, they came up with the word “KoLeSo” (a wheel in Ukrainian – ed.) as a substitute: the consonants correspond to “blood”, “lungs”, and “heart”.

This does not contradict international guidelines, but it is easier to remember.

I talk to Olha before the start of the training.

“The worst thing, and this is not just a problem for our centers, but for everyone who teaches first aid, is that if a person doesn't continue to practice after the course, they will forget everything in a while,” she says. “So you need to practice your skills until they become automatic, to train them constantly. It has to be like driving: you sit down and don't think, you act automatically. A person who has seen a tourniquet applied at least once will do it sooner or later, but will lose some precious moments, while a wounded person can bleed out within three minutes.”

That's why KoLeSo has been running daily online evening workshops for six months now. In a live Zoom with an instructor to whom you can ask questions. A group of people gathers and repeats the material from the training bases for an hour. Then, for another hour, the person trains at home on their own with tasks from the instructor. You have to go through at least three workshops, but you can do more – even 100. Then you move on to the second module, which is offline – practice and an exam. With systematic training, a blindfolded person (literally) will be able to apply a tourniquet or perform a tamponade. After the second module, the center issues a certificate.

To take part in the online workshop, you need to go to theKoLeSo Facebook page, and a post with a link to the Zoom will be pinned at the top.

Olha says that even soldiers from the frontline join such Zoom meetings. There is a dangerous myth: if a soldier is at war, he is already trained. This is not always the case. One of the KoLeSo students forced her husband on the front line to watch these online workshops when she discovered that she knew more than he did. She was shocked that he did not minimize the risk of death.

“Everyone has to pass the basic level: from the youngest soldier to the general. So that in the first minutes after being wounded, everyone can equally help themselves and others,” Olha is sure. “There is another myth. ‘If someone is wounded on the battlefield, we call for a medic.’ In fact, in such a situation, in the first minutes after being wounded, you need to rely primarily on yourself or a fellow soldier who is nearby. Professional medical personnel will examine the wounded, but this will happen later.”

She emphasizes that the knowledge gained can also be useful in civilian life. For example, during car accidents. An ambulance will never arrive in the first three minutes.

“We must be able to save each other. Today, every life saved is part of the Victory!”

The lower to the ground, the later in the ground

The training takes place near one of the Kyiv metro stations. It's an ordinary government building with several small rooms. Today, border guards are practicing in one of them, and we, civilians, are in the wide corridor. Four men and ten women are under windows covered with wicker nets. Opposite us is Anastasiia, the instructor. She is a thin blonde woman with a bunk behind her, a shelf with old training tourniquets, different types of bandages, and dummy wounds.

We will spend six hours together. This is the fourth time I've written down theses in a notebook – there is always something new and unknown: for example, here I learned about the “conscious tourniquet”; that the wound should be tamponaded in the direction of the heart; a fracture can be guessed by sound (like snow rustling).

We start with the theory. Someone uses a phone, someone uses a laptop. After each theoretical block, we practice. We do tourniquets for ourselves: on the arm, on the leg. We do the same for our partner.

Anastasiia, like all the instructors at all my training, emphasizes a crucial nuance: the tourniquet must be of high quality. I once saw a Chinese one unpacked in front of me, and the gate cracked immediately.

“A bad tourniquet gives the illusion of rescue, but in reality it kills,” says Anastasiia.

One of the men jokes: “You can even tighten a fake tourniquet around your mother-in-law's neck and she will survive.”

Finally, my favorite part – a small exam. We enter a semi-dark room with sandbags, needles, and camouflage nets. We are divided into pairs. The “wounded” lie down on the bunks, while the “rescuers” touch their noses, close their eyes, and spin around: they train their vestibular system. After that, their heads are spinning. The instructor gives them a task:“Your fellow soldier has a bullet wound in his right leg, what do you do? Tell me!”

“I'm in the yellow zone, I'm not in danger, so I run up to him, put on gloves (this is a fundamental point: you never know what diseases someone else's blood hides – ed.), take his weapons and communication equipment, tighten the tourniquet…” everyone mutters the procedure and Anastasiia checks.

“It's not tight enough, in three minutes he will be dead! Whose tourniquet did you use, your own? And if you get wounded, where will you get it? Remember: we can only save the wounded with their first aid kit. Attention – you are wounded in the left arm!”

Everyone leaves their partners behind and pulls the tourniquets for themselves. Suddenly we hear the sound of shooting: Anastasiia turned on the ‘red zone’, which means you are under fire. We fall down and now we are pulling the tourniquets while lying down. Those who raised their heads high were “killed”.

“The lower to the ground, the later in the ground,” I recall a common truth from my first KoLeSo training.

Then there were all sorts of things: the wounded were also moaning, trying to get into character, and some of the rescuers “took pity” on them: “Can't you stop yelling?” One “wounded” man who pretended to be unconscious was not even noticed in the large room. So if it was real, he would have died.

Coming to the training on the advice of a psychotherapist

There are small breaks between other blocks, where we learn how to tamponade wounds, make bandages, check airways, and recognize signs of shock. I communicate with the participants.

Yaryna is 35 and serves in the Armed Forces. She whispers that tactical instructors came to their unit, showed them something, and let one person put up a tourniquet, and that was it. And she wants to learn.

The two girls, 18-year-old Vika and 17-year-old Mariia share that they want to learn basic skills and help people in any situation.

“This is my second course,” Mariia’s two pigtails are fluttering. “I don't know yet, but maybe I'll become an instructor.

26-year-old Maksym's eyes are burning with interest – he wants to learn as much as possible. In a month, he volunteers for the Offensive Guard. He takes all the courses he can find. His future unit asked him to do so. The guy already knows how to fly drones, has participated in tactical training exercises, and has shot in shooting ranges. He saw the KoLeSo advertisement when he was leaving a neighboring building where he was attending paid first aid training.

“It's even cooler here – I can already see that they explain things better, understand what they are talking about. Whereas at the paid courses, they were just collecting money,” says Maksym. “You have to know how to save the wounded, because people's lives depend on it. It is better to learn in advance because anyone can be mobilized. And you need to practice a lot.”

I turn to another guy. Andrii has long hair pulled back in a ponytail, fluffy eyelashes, and a mustache like a lead singer of some funk band from the 70s. He is meticulous and “correct” in everything, approaching life rationally.

“I can't say that I have a great desire to go to the front, but I admit that I will be mobilized, and I will turn 27 in June. I want to be ready.”

The guy is also taking various courses: flying a high-speed FPV drone, tactical medicine training twice, and now he has to learn how to shoot.

After his first KoLeSo training, Andrii ordered original items for his combat first aid kit from an American website. But they didn't sell him all of them, because some of them are not allowed to be used in the United States. So he wrote them a tearful letter saying that he wanted only original products with the longest shelf life. He explained that he was a guy from Ukraine and would use a decompression needle and hemostatic. The store responded to this letter and agreed to sell.

Today, Andrii brought a whole box of medical supplies for the instructor to help him choose the best ones for his military first aid kit after the training. The young man laid out his “treasures” on several chairs at once. Many items were repeated: for example, there were three pairs of atraumatic scissors used to cut the wounded's clothes; and several shields in case of eye injuries. Andrii will give the extra items to the fighters he knows.

I interview 22-year-old Alina, a strong girl with very long, sharp nails. She is a biologist by training and works as an administrator in the contact center of a medical clinic.

“I came on the advice of my therapist. I have had the idea to go to war for a long time. So the therapist advised me to take a course in tactical medicine, to learn how to shoot, to understand whether it's for me or not.”

Acquiring skills and wishing you won’t need them

Tamara is 41 and a parishioner of the church in Boiarka. Together with the chaplains, she volunteers to visit the military from her town at the front. She often takes risks, so she decided to learn how to behave during shelling. Her beautiful face is tired.

We find ourselves paired together. We bandage each other's neck, groin, and armpits.

“Do you think there will be a women's mobilization?” sheasks quietly. “I see that it's coming.”

Oleh is the oldest of today's students. He is 63 and has a graying crew cut. The man takes notes diligently, and tampons and bandages conscientiously.

He is a volunteer with the Estonian Refugee Council. Everyone from the organization was required to take the training, so here he is. The man often visits “hot spots”. A week ago, he was near Kupiansk.

“The way they teach here is good and interesting, and I will advise my family to attend,” hesays carefully.

Two middle-aged women, Nataliia and Daryna, who are friends, decided to take the training for themselves.

“This is a useful thing even for civilians. Because we've all heard the word ‘tourniquet’ but don't know how to use it. I was twice in a situation where a person had an epileptic seizure and no one knew what to do. And recently, a shell hit next to our house and people had shrapnel wounds,” says Daryna. “We heard a lot of good things about KoLeSo, but it's so hard to get an appointment, there are always no places. This time we were lucky.”

Nataliia is happy that she learned something today, but now she wishes she wouldn't need these skills.

Mykola, 27, wearing a cap on the back of his head, happily tells us that he came to practice. This is his third training session, not counting YouTube videos.

“I can be mobilized at any time, so I'm here.”

Varvara, 18, and Daryna, a year younger, come running in from the street with coffee, flushed from the cold.

“I'm from Makiivka, Donetsk region,” says black-haired Varvara. She is a student studying international business. “The city has been occupied for a long time, and I knew all along that sooner or later I would go to war to get my home back. Now is the active phase of the war and I thought I should go now. Human resources are running out.”

“I'm from Kyiv,” Daryna says, hesitating at first, but gradually her voice grows stronger. “I have many friends from the occupied territories, my mother is a volunteer, I help her, and I talk to the military a lot. I also concluded that I wanted to go to war.”

Standing between them with a recorder, I suddenly forgot that I was a journalist. I tilted their heads to me, hugged them, and whispered with difficulty,“Girls, you are so good, but you are so young…”