By Anonymous
I have been asked by several people about the medical care on the front line of Ukraine where I work in a medical capacity, so I thought I would write out a response to answer the most common questions.
Tactical care is very different from civilian care, and from care in a clean environment. If anyone has any additional questions or is interested in working in tactical medicine, feel free to ask!
Medical care in this environment is strictly based on the TCCC [US military tactical combat casualty care] guidelines of MARCH-PAWS - management of massive hemorrhage, airway, respirations, circulation, hypothermia and head trauma. Later comes pain management, antibiotic administration, wound care and splinting. The most common injury I've treated is concussions, patient presentation varying from mild to severe (headache, pain, confusion, retrograde amnesia, loss of hearing, vision disturbances and vomiting, to passing out).
The zero line is where direct clashes are happening. When a patient is injured, they are moved off the 'X', and a rapid trauma assessment is performed by battlefield medics. If the patient cannot be moved immediately, they are directed to apply self-aid, such as applying a tourniquet, if possible. The call is made for an armored vehicle to evacuate the patient (CasEvacs). Evacuation times vary from hours to days. Patient outcome is dependent on this.
One thing to note is that the battlefield medics are not paramedics; they have received minimal training (maybe 9 days - 3 weeks). Some are simply people who are willing to do this incredibly dangerous job, with no medical training. They carry a light pack equipped with items such as tourniquets, chest seals, hemostatic bandages, a bag-valve mask, and combat pill-packs (Meloxicam, Moxifloxacin and Tylenol). In an ideal situation, the combat medic would be using supplies from the casualty's own individual first aid kit (IFAK), and pill pack. Unfortunately not all IFAKs are fully equipped. (Recently I was asked to provide tourniquets for soldiers who did not have any at all!)
Some battalions are working to training all soldiers to at least the Combat Lifesaver Level (CLS), so that they will have the knowledge and skills needed to save someone, if they are in a situation where a combat medic is unavailable. This also helps to reduce the risk that medics are exposed to, and thus helping them save more lives.
From the CasEvac vehicle, the patient (or patients, often more than one) is transferred to a MedEvac ambulance team, about 2-5 kilometres back. This transfer of care ideally should happen in 90 seconds or less, but I never worked one that went that quickly. There are always delays; amour/weapons that must be removed and secured, triage of patients, logistics, etc. In the ambulance, the patient undergoes another rapid trauma assessment.
Tourniquets are reassessed, converted/reduced if indicated, wounds are packed, clothes/shoes removed, IV/IOs started, meds given, vitals collected. Ambulances are equipped will most ALS standard equipment and meds, excluding monitors and oxygen. There are a few with these capabilities, reserved for the most critical patients.
The patient is delivered to the field hospital (stabilization point), and transfer of care report given. The stabilization point is set up similar to a level one trauma ER, complete with x-ray and surgical capabilities. Trauma surgeons, nurses, Anesthesiologists, and orderlies work tirelessly to assist and stabilize patients here. The patient is assessed further and emergency surgery is performed, if indicated. Once the patient has been stabilized, they are transferred to hospitals in the rear. If they are stable enough to be discharged, but still have sustained minor wounds or concussions, they go through either IV therapy (for concussions) or follow-ups, at the Med Point clinic, which is further in the rear of the front. For concussions, a medication regimen designed to minimize brain trauma is administered for 5 days. Patients receive Magnesium sulfate, amino acids, Dexamethasone and Dexaketoprofen (similar to Ibuprofen but given IM or IV). Most medications are packaged in glass ampules. The Med Point is also equipped to offer wound care, consults, drug/alcohol testing, prescriptions, POC STD/STI testing, and some treatments.
Not all frontline injuries are traumatic. Some are panic attacks, when a soldier is completely exhausted from the constant decision-making and lack of sleep. There are STI's [sexually transmitted infections], a result of prostitution in some areas of the frontline. And then some are common sports injuries such as sprains, which occur frequently on the training ground.
In all these frontline patient treatment areas, there is no running water. Power is provided by backup generators and batteries. Hand sanitizer, wet wipes, bottled water, and sometimes chlorohexidine, are available and everyone does the best they can to stay clean. Despite best efforts, this is an incredibly dirty environment. Dirt and sand get in everything. Someone had asked if I could use a water filtration system, but there just isn't any water source for this. Someone else donated camping shower bags, but again, this hasn't been used. Bottled water is reserved for drinking and handwashing; no one is using these for a shower because there just isn't enough. Shifts are 24 hours, and sometimes when the shift is over, the power at the house is off, so therefore, no water there, either. These outages last all day, from about 9 in the morning to 4 or 5pm.
At the moment I am taking a short break. I was so thankful for running water! I actually threw out most of my socks and some of my clothes, because they were just so dirty.
Thank you for your continued support.
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The author is a qualified and experienced medical practitioner working at a front line location in Ukraine. If the reader wishes to contact them, please go via the contact details on this website and we will convey any messages without guarantee of response.