Abstract. In the modern world, there is often a need to provide medical assistance to victims among the civilian population in emergency situations, during armed conflicts, by civilian medical organizations. In this regard, new organizational approaches are required to providing medical care to victims of firearms and resolving issues of the stages of providing medical care to patients with injuries, including gunshot wounds. Objective of the study: to establish modern features of the organization of specialized medical care to victims of military conflicts by medical organizations of the state health care system subordinate to the Ministry of Health of Russia and regional executive authorities Material and methods of the study. Based on the comparative retro- and prospective single-center study of the treatment results of two groups of victims with gunshot wounds of the upper extremities: with primary reconstructive surgery in a level 3 medical organization and staged reconstructive surgeries in general trauma departments, a different approach to organizing specialized, including high-tech, medical care for patients with injuries is proposed. Methods: analytical, comparative analysis, statistical, expert assessments. Results. In the group of victims who underwent primary reconstructive surgery, the number of which upon admission did not exceed the estimated capabilities of the duty team, the average length of hospital stay and the average healing period were shorter than those in the group of victims who underwent delayed reconstructive stage treatment. The need for repeated surgical treatment of wounds in the operating room was more than 2.5 times higher in the group with delayed reconstructive stage treatment. The number of early postoperative complications and the proportion of significant complications with the use of radical surgical tactics were higher in the group with delayed reconstructive stage treatment. Remote results were also better in the primary reconstructive treatment group. Discussion. The features of the course of the wound process and its outcomes in two groups of victims, the identified problematic aspects of staged treatment made it possible to propose an improved model for organizing medical care for patients with gunshot wounds to the extremities in local military conflicts by civilian medical organizations based on the primary reconstructive treatment method with higher results compared to traditional delayed reconstructive staged treatment, which makes it possible to make adjustments to the territorial planning scheme of healthcare facilities and the routing of patients with injuries. Conclusion. In the conditions of operation of a high-level trauma center in a frontline zone or a large settlement with a developed road network in adjacent territories in local armed conflicts, it is advisable to organize the evacuation of victims with gunshot wounds to the extremities, bypassing intermediate stages, to a trauma center that has the ability to provide high-tech medical care, while observing time parameters, which allows for a reduction in complications and an improvement in long-term results.