PREHOSPITAL AID FOR CIVILIANS IN FRONTLINE COMMUNITIES OF KHERSON REGION UNDER LIMITED ACCESS TO EMS: DEVELOPMENT AND JUSTIFICATION OF A MARCH-BASED TRAINING PROGRAMME

Abstract

Introduction. Frontline communities in Kherson oblast face persistent short-range drone threats that restrict civilian movement and disrupt emergency response. UN monitoring shows that FPV/short-range drones have become a leading driver of civilian harm in frontline areas, particularly in government-controlled parts of Kherson, and they also reduce access to essential services, including health care. WHO has documented numerous attacks on the health system in Ukraine, including incidents affecting medical transport, further undermining timely emergency care. Aim. To describe and substantiate an MARCH-principled first-aid training program for non-medical community members in frontline Kherson, designed to improve survival and community capacity for self- and mutual aid when EMS response is delayed or unavailable. Methods. A programmatic descriptive study was used: assessment of contextual risks to EMS access in frontline communities; modular curriculum design (scene safety and action algorithm; massive hemorrhage control; basic airway and breathing support; hypothermia prevention; communication and referral; scenario-based practice). The curriculum aligns with evidence-based bleeding control approaches (Stop the Bleed) and Ministry of Health of Ukraine guidelines, adapted to prolonged time-to-care conditions. Expected outcomes. Enhanced civilian readiness to act in the first critical minutes of trauma; increase in correctly performed skills (tourniquet application, direct pressure, wound packing, hypothermia prevention, safe evacuation); establishment of a community “first responders” network and protocols for interaction with EMS and local services. Conclusions. In settings where EMS access to certain localities is unstable or dangerous, MARCH-oriented first-aid training for laypersons is a feasible intervention that can reduce preventable deaths and improve community resilience. Further evaluation is needed to quantify effectiveness (pre/post-training, skill retention, field indicators) and to scale the program through training of trainers.