Page 139 - Journal of Special Operations Medicine - Spring 2016

Figure 1 A Ukrainian National Guard soldier demonstrates medical command structure provides.” There is a need
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tourniquet application during simulated combat first aid for leaders to be trained on evacuation preparation,
exercises under the guidance of a paratrooper from the US medical logistics management, rehearsals of treatment
Army’s 173rd Airborne Brigade during medical training in and evacuation, and communication. Focus and im-
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Yavoriv, Ukraine.
provement in medical infrastructure and logistics must
continue to improve at all levels of leadership. Treat-
ment and evacuation are continually hindered by lack
of supply. 3,5,8 When engaged in large-scale activities
involving a significant risk to life, synchronized co-
ordination of medical care from higher leadership is
imperative. 9

Considering these observations, it became clear that we
needed to expand the scope of training to include not
only individual soldier skills but also leader develop-
ment in medical operation planning. We developed and
implemented training for nonmedical leaders regarding
their roles in casualty management, specifically outlin-
ing the phases of prehospital care, standards of evacua-
tion, and the capabilities of different medical facilities.
We related these functions to understood responsibili-
military in the conflict zone reported that early in the ties such as supply and sustainment, intelligence, lo-
conflict, evacuation times were exceeding 24–48 hours. gistics, security, and communication. Throughout the
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In many cases, the response to a casualty situation was training, we reiterated that all leaders have a role in
simply to call emergency services and have local civil- the process, and that understanding the principles of
ian response personnel intervene. The New York Times evacuation and casualty-chain management is impera-
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recounted the retreat from Debaltseve, where wounded tive to the success of the mission and the safety of sol-
soldiers were completely abandoned on the side of the diers. These concepts were immediately reinforced with
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road. The Lancet reported on the near-total breakdown simulated tactical operations and refined by review and
of the Ukrainian medical system as recently as Febru- discussion.
ary 2015, citing poor supply of medical equipment and
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trained personnel among the primary causes. The ar- We observed substantial improvement in the ability
ticle also noted the inability of nongovernmental orga- of the unit leadership to conceptualize and implement
nizations, including Médecins Sans Frontières (Doctors standard medical evacuation procedures as part of their
Without Borders) and the World Health Organization, mission preparation. We believe this will significantly
to stem the tide without significant reinforcement of add to the capability of this unit to preserve the lives of
funds. When comparing these accounts to the medical wounded soldiers when they are called upon to defend
successes of NATO member states involved in the wars their country.
in Iraq and Afghanistan, a clear gap emerges. Much
work is required to begin closing that gap. Essential multinational aid in the form of medical re-
sources and training is being supplied by both national
At the individual level, basic medical training and out- militaries and nongovernmental organizations such as
fitting are greatly needed. Even with multiple entities Médecins Sans Frontières, the World Health Organiza-
currently engaged in delivering combat medical training tion, International SOS, Medsanbat, and Patriot De-
to thousands of Ukrainian soldiers, only an estimated fense. However, the overall effectiveness of this aid
5,6
10% to 15% of soldiers have basic first aid equipment has been hindered by limited strategic-level coordina-
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and standardized training. As keenly identified by the tion and leader training. We recommend that further
soldiers we trained, one of the major deficiencies limit- medical assistance include a focus on developing lead-
ing the improvement of evacuation times has been an ers to promote shared responsibility for treatment and
6,7
endemic lack of prior coordination and planning. evacuation of wounded soldiers. We further recommend
Similar observations have come from trainers in the that this training be institutionalized to foster sustained
war zone, who note the great impact that “sharing of improvement and refinement of medical practices. A
resources/training would have on the care and evacua- greater understanding and systematic implementation
tion of all the wounded in the ATO.” They specifically of these principles by leadership across all levels of the
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recommend that leaders “sort through the bureaucracy military structure would go a long way toward solving
to better enable and capitalize on the synergy a joint the medical crisis in Eastern Ukraine.

Improving Trauma Care on the Ukrainian Battlefield 123