War Medicine Training a Challenge for Ukrainian Healthcare

France, Ukraine — Igor Deyneka, MD, a 40-year-old anesthetist and intensive care specialist in Rivne, Ukraine, and eight fellow countrymen attended the war medicine training that the Union of Medical Care and Relief Organizations (UOSSM France) provided in Metz, France (see: Ukraine: A French NGO Opens a War Medicine Training Center in Lviv). The doctor spoke with Medscape French Edition before returning to Lviv, Ukraine, where he will train fellow countrymen in triage and care of the wounded.

Medscape: Three months after the start of the Russian invasion on February 24, what are your most pressing medical needs today in Ukraine?

Deyneka: We have no shortage of doctors. We have them both on the front line and supporting from the rear. What we do need is for caregivers, and not just doctors, to be trained to practice in wartime, so they know how to manage “trauma,” how to react on a battlefield, and how and where to evacuate. We also need appropriate equipment for the battlefield, evacuation, and the hospital.

Medscape: What exactly are your equipment needs?

Deyneka: What we need the most, and this may surprise you, are tourniquets, which make it possible to stop bleeding so we can stabilize a patient, eventually move them, and then treat them. In the hospital, we also need small ultrasound machines, like the ones we had during this training, which are used along with a smartphone to detect internal bleeding and help us determine our course of action faster, whether we need to take the patient to the operating room to stop the bleeding or evacuate them quickly.

Medscape: Had you already had personal war medicine experience before the conflict that started this year?

Deyneka: Yes, during the war in the Donbas in 2015 to 2016. I was part of a team alongside a surgeon and a nurse anesthetist a few kilometers from the front line. We had to be able to act urgently, stop bleeding, and evacuate the wounded from the front line.

Medscape: What did you gain from this training by UOSSM France?

Deyneka: This training, which was based on the Syrian frontline experience of Raphaël Pitti, MD, training director at UOSSM France, gave us the opportunity to acquire new practical skills, which we will use on the front line or in our fight for freedom, but also to see what equipment may be useful to us, such as the ultrasound machines I mentioned.

Medscape: As a doctor, are you a target of the Russian soldiers?

Deyneka: In 2015, the place where our military medical teams were working was very close to the front, and that hospital was bombed. During medical evacuations, we were targeted all the time. Even when we put the “red cross” on our vehicles, we were targeted. Since the start of the Russian offensive on February 24, we haven’t felt safe anywhere in the country. The four major cities in the country have been bombed. The Russians deny our existence. They don’t consider us to be an independent nation but rather just other Russians who have supposedly gone down the wrong path. We aren’t fighting solely for our freedom; we are fighting for our very existence.

Medscape: What are the most common injuries that Ukrainian doctors have to treat?

Deyneka: It depends on the situation and the city. The Russians launch bombs and aim missiles or shrapnel [shells filled with ball bearings] at us, but in the eastern part of the country, people may also be wounded by firearms. We have to deal with explosion injuries, crush syndrome, and gunshot wounds. We have to cope with all of this at the same time. The difficulty is that things can be calm one minute, and the next minute we are having to handle the arrival of 50 or 80 casualties all at once at the hospital. Caregivers have to know how to react when these situations occur. It’s a challenge for the Ukrainian healthcare system and that’s why it is important for our teams to be trained in these techniques.

Medscape: Can you evacuate the wounded easily?

Deyneka: In the east, the Russians have air superiority, and we have to be at least 200 kilometers from the front to be able to consider evacuating by helicopter. Helicopters can’t take off or land closer to the front because they are too vulnerable. So, most often, transfers are carried out by land, mainly by train. We don’t evacuate the wounded out of the country, but Ukraine transfers them from the eastern to the western part of the country to place the wounded in safer locations. In the easternmost part of Ukraine, the Russians are bombing constantly, and it is not possible to evacuate the wounded, who are forced to live underground for several months.

Medscape: Do you feel ready to pass on the war medicine training you just received?

Deyneka: I have already been a trauma medicine instructor, but we have to develop a course appropriate for the situation in Ukraine. The actual trauma medicine is often the same, but we have to familiarize ourselves with the teaching methods. We have to adapt the training to be as effective as possible to train the most caregivers, so this knowledge will be passed on and used in the best way possible and so we can save the greatest number of casualties. If we achieve that, then this [training by UOSSM France] will be a success and a major assistance provided to our country by France.

This article was translated from Medscape French edition.

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