Management of mild traumatic brain injury in terms of war of drones: expectations and reality. Do we always stick to guidelines?

Due to the great influence of post-soviet medicine, a large number of medical workers in Ukraine still work with TBI according to protocols that are very different from world practice, focusing on intravenous administration of drugs without an evidence base. And this is what mTBI patients expect from medical service.

In our brigade, we abandoned soviet practices and implemented guidelines from https://health.mil/. Over the course of several months of use, we identified both the advantages and disadvantages of these guidelines in the conditions of a full-scale invasion and limited human resources. Due to the enemy's fire superiority in artillery and aviation, as well as the use of a large number of UAVs on both sides, cases of mTBI are even more common than before. Now we are not talking about 3 mTBIs during a year, but about 3 mTBIs during one combat mission, 5-7 days. We are also faced with the fact that explosions occur at very short distances from fighters, 1-5 meters, a large number of people suffer at the same time, who cannot be evacuated quickly enough. Thus, we are faced with the impossibility of early assessment for MACE, the impossibility of rapid dispatch for recovery, and the need to provide pharmacological assistance remotely to maintain minimal combat readiness. We face little to no response to acetaminophen in pain management, the lack of compliance in patients who have to follow the progressive return to activity protocol. There is also questionable ethics of long cognitive examinations of patients who have just returned from positions after several consecutive injuries.