On the issue of legal regulation and methodological support for the activities of joint medical teams of FMBA of Russia

INTRODUCTION

The implementation of the National Security Strategy of the Russian Federation involves the development, adjustment, and implementation of a set of diverse state programs aimed at ensuring safety and sustainable development of the country.¹ This applies in full measure to the development and improvement of medical personnel and resources of the Federal Medical and Biological Agency (FMBA)² of Russia, enhancing the quality of medical and sanitary services provided to workers in industries with particularly hazardous working conditions, as well as residents living in service areas. Special attention is given to preserving and strengthening public health, extending professional activity and overall life expectancy. In this context, enhancing the level of timely response, as well as the effectiveness and efficiency of preventive measures, localization, and mitigation of medical and sanitary consequences resulting from incidents, accidents, disasters, natural calamities, and other emergencies of different nature becomes particularly important³.

Current challenges demand continuous enhancement of the capabilities of medical units of the FMBA in the context of ensuring national security [1–4]. Key priorities remain improving the quality of medical care provided and ensuring readiness for efficient responses to terrorist attacks, armed conflicts, and major emergencies.^4 5 6 7 The likelihood of terrorist attacks and armed conflicts accompanied by a significant number of casualties remains high. Victims belong to various population categories and require timely specialized medical care and organized medical evacuation, which should be carried out to specialized stationary treatment facilities using different modes of transport [5–10].

Mobile medical formations, specifically joint medical teams (JMTs), play a crucial role in addressing the medical and sanitary consequences of large-scale emergencies and armed conflicts.⁸ Such units primarily provide urgent medical care and conduct medical evacuation of victims, wounded, and patients while adhering to routing principles [5–11]. Practice has confirmed the effectiveness of JMTs but also highlighted the need for their improved normative and methodological support. Optimizing the management system of subordinate organizations of the FMBA of Russia and establishing effective interaction with government authorities requires refinement of the legal framework regulating the activities of JMTs. Therefore, studying the current state of normative regulation and methodological support for their activities becomes particularly relevant. Additionally, an analysis of existing approaches can contribute to the development and modernization of the medical assistance management system in emergency situations as a whole [12–16].

In this study, our aim was to develop proposals for improving the legal framework and methodological support for the creation, preparation, deployment, and operation of FMBA JMTs.

MATERIALS AND METHODS

We used normative and methodological documents of the FMBA regulating the activities of JMTs, including FMBA orders No. 60 dated 28.02.2022, No. 35 dated 29.02.2024, and No. 1263 dated 25.04.2022, as well as the draft Regulations on the Organization and Coordination of Activities of JMTs of FMBA of Russia (2023), developed by the Center for Strategic Planning and Management of Medical and Biological Health Risks. Additionally, reports from district medical centers (DMCs) of FMBA were analyzed, covering the formation, deployment, and operation of JMTs (February 2022–April 2025) during the Special Military Operation (SMO). The study also included data from surveys in the form of questionnaires assessing the condition of formation and functioning of JMTs. The questionnaires were filled out by medical experts directly involved in the work of these teams, including those who participated in responding to medical and sanitary consequences of emergencies, terrorist attacks, and military conflicts.

The formulated objectives were achieved by a set of methods, including a formal and legal analysis of normative documents, a content analysis of texts identifying gaps and contradictions, expert evaluations involving 192 medical professionals. The latter were divided into two groups: Group 1 (n = 116) comprised individuals with practical experience working in JMTs, while Group 2 (n = 76) comprised specialists involved in forming the teams but not participating in actual emergency situations. Statistical data were processed using the SPSS Statistics 23.0 software package and Microsoft Excel 2010. Statistical data processing allowed identification of patterns in assessments of the normative regulation and methodological support for JMTs. When developing proposals for improvement, methods of logical and informational modeling, as well as analytical methods ensuring systematic generalization of the obtained results, were employed. The study covers both legal aspects of regulating the activities of JMTs, as well as organizational and methodological issues related to the preparation, functioning, and management of JMTs in various types of emergency situations.

RESULTS

At the initial stage of the study, we assessed the level of satisfaction of medical professionals regarding the current state of normative regulations and methodological support for the activity of JMTs. The results of expert evaluations indicate that, according to contemporary requirements for safety and operational conditions of JMTs, the current normative and methodological framework regulating the order of creation, preparation, deployment, and functioning of JMTs is less than optimal (Table).

Only 24.0% of the experts assessed the current normative and methodological framework as fully supporting the activities JMTs. More than 66.6% of the respondents (31.2% from Group 1 and 35.4% from Group 2) indicated limited or partial compliance of documents with the current requirements. Notably, 79.3% experts from Group 1, who have had the practical experience of working in JMTs, believe that existing norms and methodologies do not adequately meet the needs of such teams. At the same time, 47.3% of experts from Group 2 evaluated the normative and methodological support positively, confirming the influence of practical experience on objectivity.

Difficulties in assessment noted by 6.9–13.2% of the respondents can be explained by insufficient practical experience before the SMO. Then, JMTs were occasionally deployed for small-scale emergency response efforts, preventing most specialists from gaining adequate and objective experience in such conditions.

Completely different conditions emerged during the SMO course for testing the quality of normative and methodological documents. Large-scale, prolonged, and multifaceted employment of JMTs in combat zones enabled a substantial number of medical personnel to gain substantive experience, including practical verification of provisions outlined in regulatory documents. It was precisely this hands-on experience that became a reliable criterion for evaluating the comprehensiveness, clarity, and applicability of these documents.

The experience gained by JMTs during the SMO revealed gaps in the existing documentation. Only 15 (12.8%) experts involved in forming squadrons for the SMO reported complete and clear normative provisions regarding structure, goals, establishment process, and functionality. Meanwhile, 59 (51.3%) experts pointed to a partial coverage, 24 (20.5%) mentioned the lack of essential documents, and 18 (15.4%) found it difficult to respond. A significant proportion of the experts expressed the need for comprehensive regulation: 164 (85.4%) supported the idea of developing and validating an all-inclusive policy document. On the contrary, only 13 (6.8%) saw no need for such changes, while 15 (7.8%) remained undecided. Similarly, 143 (74.5%) experts backed amendments to FMBA Order No. 126⁹ dated 25.04.2022, concerning the creation, usage, and function of JMTs in handling the aftermath of emergencies, terrorist attacks, and armed conflicts, including integration into general therapeutic-evacuation systems for injured and ill military personnel. Among those who opposed and abstained were 29 (15.1%) and 20 (10.4%) experts, respectively.

DISCUSSION

The data obtained allow us to conclude that FMBA JMTs are becoming increasingly important in the system of medical and sanitary provision for dealing with the consequences of emergencies, terrorist acts, and armed conflicts.

According to the information presented by V.I. Skvortsova, Head of the FMBA of Russia, throughout its participation in the SMO (02.2022–04.2025), medical teams assisted 143,000 injured military personnel, with 12,000 undergoing surgeries.¹⁰ These figures highlight not only the scale of engagement of FMBA medical units but also indicate a qualitative change in the type of medical care provided. As emphasized by V.I. Skvortsova, “the structure of medical assistance has changed, with surgical interventions now being the primary focus.”¹¹

In 2024, the volume of medical care provided by FMBA medical professionals increased by 65%, and the number of surgeries more than tripled compared to previous years.¹² This trend reflects both the rising load on the FMBA medical staff and resources and the enhanced operational readiness and functional sustainability of these teams. Notably, medical “special forces” of FMBA, according to V.I. Skvortsova, participated in nearly all major emergency incidents in Russia in 2024, highlighting the expansion of JMT functions and their integration into the national emergency response system.¹³

Extensive and sustained deployment of JMTs during the SMO uncovered deficiencies in their normative and methodological support. Most experts with practical experience in JMTs rated the normative framework as requiring further development and improvement. Serious concerns arise due to the absence of clear provisions in the current regulations defining the procedure for creating, preparing, functioning, equipping, and managing JMTs.

FMBA DMCs have demonstrated particular importance. It is on their basis that JMTs are formed. However, Order No. 208 of the FMBA of Russia dated 30.07.2020, which defines their functions, does not officially assign DMCs a role in the formation, training, and management of JMTs.¹⁴ This creates organizational and legal uncertainties and reduces accountability for the readiness of such teams. It is noteworthy that 80.7% of the experts supported assigning DMCs functions such as organizing the creation and training of JMTs, providing methodological support for their activities, monitoring readiness, and ensuring their deployment in emergency situations.

Another significant gap is the legal regulation of medical evacuation. Agency Order No. 126 dated 25.04.2022¹⁵ provides for the formation of mobile medical teams to deliver medical care outside assigned territories; however, it does not regulate the procedure for medical evacuation. According to S.V. Markov, by early 2025, specialists from the Burnazian Federal Medical Biophysical Center alone had evacuated over 32,000 patients, including more than 7000 by air transport [6].

On the basis of the data obtained from the application of JMTs in the SMO and emergency situations, several practical steps may be recommended:

• establishment of typical organizational structures for JMTs tailored to the profile of emergency (chemical, radiation, biological, terrorism, warfare);
• determination of composition and equipment standards for medical brigades;
• development of protocols for functioning, including organization of medical care and evacuation along routing principles;
• codification of technologies for training and professional coordination;
• clarification of regulations for creation, replenishment, and storage of reserve medical supplies and other property;
• integration of information technology and telemedicine into JMT operations;
• formalization of accounting, reporting, and notification systems.

CONCLUSION

The conducted research confirms the significance of FMBA JMTs as one of the key components of the overall medical support system in emergency situations, terrorist acts, and armed conflicts. Their practical application, especially during the SMO, demonstrated not only their ability to promptly respond and effectively provide medical care and perform medical evacuation for victims, the wounded, and sick individuals, but also the need for systemic improvement of normative regulation and methodological support for their activities.

The analysis of the normative and methodological framework of JMTs revealed certain discrepancies between its current state and modern requirements. Specifically, there is a lack of clear regulation regarding the creation, preparation, application, and functioning of medical teams; ambiguity in task distribution and DMC functions concerning JMTs; and virtually no normative support for medical evacuation — a key element of JMT operations. Based on the data obtained, the necessity for a comprehensive improvement of the legal and methodological foundation of JMT activities has been substantiated. This entails the development and approval of a uniform Model Regulation for consolidated medical teams, amendments to FMBA Order No. 126 dated 25.04.2022, incorporating tasks related to medical evacuation, assigning DMCs responsibility for forming, preparing, and managing JMTs, and developing detailed methodological recommendations standardizing organizational structure, equipment, and readiness criteria for JMTs.

Implementation of these proposals can enhance the timeliness, efficiency, and resilience of the medical support system for victims, the wounded, and sick individuals. It will create conditions for more adaptive and effective operations of JMTs within a unified modern system countering threats to the security of the Russian Federation.