Page 138 - Journal of Special Operations Medicine - Spring 2016

An Ongoing Series

Closing the Gap

Improving Trauma Care on the Ukrainian Battlefield

Stephen K. Stacey, DO; Peter H. Jones, PA-C

ABSTRACT

Since early 2014, Ukraine has been involved in a vio- The authors deployed with the 173rd as the task force
lent social and political revolution that has taken more surgeon and physician assistant. We oversaw the deliv-
than 7,000 lives. Many of these deaths were due to lim- ery of medical training to NGU soldiers and medics,
ited field medical care and prolonged evacuation times which primarily focused on trauma first aid and evacu-
because the Ukrainian military has been slow to adopt ation care. When we began training, we discovered
standard combat medical processes. We deployed with that the Ukrainians were motivated but seemed to have
the US Army’s 173rd Airborne Brigade to train soldiers a somewhat fatalistic view of the medical care being
in the National Guard of Ukraine (NGU) on combat delivered to soldiers wounded during the conflict in the
first aid. We discovered that a major deficiency limiting East. Several soldiers had seen their comrades die while
the quality of trauma care and evacuation is an endemic waiting to be evacuated from the point of injury, often
lack of prior coordination and planning. The respon- with wounds that would have been amenable to treat-
sibility for this coordination falls on military leaders; ment had the soldier been cared for in a timely manner.
therefore, we delivered medical operations training to
officers of the NGU unit and observed great improve- Their outlook on the current status of trauma care was
ment in medical care sustainment. We recommend sys- illustrated in a conversation we had with a veteran
tematic leader education in best medical practices be Ukrainian sergeant. He had been to the conflict zone
institutionalized at all levels of the Ukrainian Army to and had both heard and seen firsthand how his com-
foster sustained improvement and refinement of trauma rades would languish for hours without definitive care.
care. During a field training exercise on tourniquet applica-
tion for hemorrhage control under enemy fire, he asked
Keywords: trauma; evacuation; training; Ukraine; education intently how long the tourniquet could remain applied
before the limb could no longer be salvaged (Figure 1).
We discussed that there is a wide range of time in which
limbs have remained viable, but that permanent injury
Since March 2014, Ukraine has been involved in a vio- from tourniquet application will seldom occur if they
lent social and political revolution. Russian-aligned meet the evacuation target of 60 minutes to higher level
separatists in the Donbas region have taken up arms in of care. Considering the stories he had heard and his own
an effort to retain their Eastern ties while the Ukrainian experience with the wounded and dying, he responded
military has sought to maintain its sovereign borders. with understandable disbelief that such rapid evacua-
Over the past year, this conflict has taken more than tion could be routinely possible. We stressed the neces-
7,000 lives. At the request of the Ukrainian govern- sity of preparation, emphasizing that failure to consider
1
ment, the United States sent paratroopers from the US medical actions until after an injury is sustained endan-
Army’s 173rd Airborne Brigade, headquartered in Vi- gers lives. At that point, he led the group of trainees in
cenza, Italy, to train elements of the National Guard expressing that prior planning simply is not done.
of Ukraine (NGU). We arrived in April 2015 and be-
2
gan delivering a training program analogous to initial Although anecdotal, these soldiers’ grim assessment
entry training for North Atlantic Treaty Organization of the situation is shared by many others and is not
(NATO) member states. unfounded. Medical volunteers assisting the Ukrainian

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