乌克兰外科医生获得军事医学速成班-或管理新闻

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![](/media/202412//1733469939.43245.png)乌克兰外科医生崩溃 军事医学课程

最初由我们的姐妹出版物《普外科新闻出版

克里斯蒂娜 ·弗兰戈

圣迭戈——10月初的一个早晨，赫里奇医学博士

丹尼洛 ·哈利茨基 ·利沃夫国立医科大学的外科主任，

他站在他位于乌克兰利沃夫的医院的窗户前，拍了一段视频 大火在附近燃烧着，黑烟笼罩着天空。火焰

一枚俄罗斯火箭击中利沃夫附近的一个社区后爆发 急诊和重症监护的多学科临床医院。

它拥有1200张床位，现在是美国最大的功能医院之一

乌克兰在设施内，工作人员为大量的病人做好准备。

视频来自利沃夫的多学科临床医院的一个窗口 俄罗斯空袭a号机场后的紧急情况和重症监护室 附近的社区。

照片由医学博士Hnat Herych提供。

战前，该医院的工作人员为儿童和成人提供护理 一般情况：车祸，癌症，

阑尾炎2月2日一切都改变了。2022年24日，当俄罗斯军队

大量涌入乌克兰边境，发动了一场暴力战争 他夺走了20万俄罗斯和乌克兰士兵的生命

U.S.官吏近780万乌克兰人已经成为

难民，另外620万人在他们自己的国内流离失所 国家联合国事务高级专员办事处

人权组织报告说，有6200多名乌克兰平民已经死亡

截至去年10月，他已经受伤，9300人死亡。9.实际数字是

被认为要高得多，但适当的会计核算是不可能的 在战争期间。

入侵后几天内，乌克兰国防军占领了 来自医院的纱布和绷带将在前线分发。

赫里奇说。护士们问他，他们应该为病人做些什么

“不仅仅是受伤的病人，还有受伤的病人 普外科疾病，如急性阑尾炎、胆囊炎等

”他说。没有一个好的答案。

在过去的10个月里，医学博士说。赫里奇和他的同事们一直在研究 学习为平民和军人提供战斗护理的速成课程

病人自己也受到轰炸的威胁。他们一直在

借助于美国人、加拿大人和欧洲人的稳定轮换 内科医生和外科医生，其中许多人已经退役

并通过这个由美国非营利组织设立的旅行来到了乌克兰 组织全球外科和医疗支持小组（GSMSG）。

![](/media/202412//1733469939.4441488.jpeg)资料暂存器赫纳特 ·赫里奇和他的同事们给利沃夫的一个病人做了手术 多学科临床医院

现在是乌克兰最大的功能医院之一。

“我们现在面临着战前无法想象的挑战，”

博士说。33岁的赫里奇在去年11月接受采访时说。一天前，俄罗斯人 军队在乌克兰各城市之间发动了新一轮的空袭。在……期间

攻击，博士。赫里奇和他的同事们取消了选择性手术 把病人藏在医院下面的避难所里，那里有两个

手术室和一个有四张床的重症监护室。他们等到一切安全，然后他们 返回操作。

他在去当地一家儿童医院的路上与GSN进行了交谈

为在车祸中受伤的孩子做手术。“我两天前就开始工作了，”他说

上述的

健康基础设施的目标

入侵结束后，俄罗斯军队立即开始了一场行动

针对乌克兰的卫生基础设施。根据世界卫生组织的数据 俄罗斯人已经对乌克兰人发动了688次袭击

影响医院和诊所，

制药仓库、工厂和救护车。他们达到64 设施仅在前四周，据报道

*华盛顿邮报*资料暂存器赫里奇的医院从未被直接袭击过，但是

火箭弹的碎片已经落到了屋顶和门窗上 已经被爆炸打破了。

对卫生设施的袭击，加上乌克兰被摧毁

在供应链上，已经切断了对药物和其他药物的稳定获取 医药用品在多学科临床医院

建于1980年的急诊和重症监护室，工作人员开始工作 使用长期过时的设备，比如40年前的针头。我们

感觉我们可能是第一次或第二次世界大战，”他说

资料暂存器他补充说，在入侵之前，他的医院是一家

技术先进的设备与达芬奇机器人(直观的 手术）。

2022年3月13日，俄罗斯军队对一家军队发动了空袭 训练设施离利沃夫25英里。100名病人来自美国

他说，爆炸事件在接下来的几个小时内就已经发生了。“我们从来没有吃过

有100名受伤的病人需要直

进入手术室。“35人在这次袭击中死亡。

利沃夫的多学科临床医院

护理距离乌克兰与波兰边境约40英里，还有数百英里

离大部分的战斗只有几英里远。赫里奇和他的团队都有了 治疗了6000多名与战争有关的受伤患者，其中包括

314名平民和242名需要撤离的军事人员 外科学

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乌克兰的医生和护士在利沃夫照顾一名受伤的病人 当医院满运转时。

在东部受伤的人不断地向西移动，

当他们离前线越来越远时，他们会得到更明确的照顾。 东部的许多医院已不再全面运作。在利沃夫，博士。

赫里奇和工作人员照顾严重受伤的士兵 由改装为医疗用的客运列车运输

交通工具，一段可能需要几天或更长时间的旅程。受伤者

通常表现为耐多药感染的伤口。在 与此同时，他和同事的同事治疗被

炸弹或倒塌的建筑物，他们继续提供照顾 利沃夫的人口膨胀。

10月，博士。赫里奇来到了美国外科医生学会 在圣地亚哥的临床大会上，他做了一个关于

手术在乌克兰。他还有七名美国外科医生

自2022年3月以来一直在乌克兰轮换。面板描述了一个 造成大量严重伤害的战争

所有年龄段的人都受到文职人员的待遇。

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在去年11月的进攻中，俄罗斯击败了

医院的力量，医生。赫里奇和他的团队治疗一个受伤的病人 只有从大灯上发出的灯。

“这是一场真正的现代战争，因为双方都使用火炮系统，所以

我们有很多弹片造成的伤。”Herych指出。“直接 接触军队是一个真正的杀手，但我们也看到了病人 他们包括新生儿，小病人和老年病人。”

约翰 ·B ·斯泰森毡帽霍尔科姆，医学博士，美国国立卫生大学的外科教授 在阿拉巴马州的伯明翰，加入了美国。S.并在1985年服役

后来，他被部署到索马里，做了一名外科医生。在那里，他和他的团队曾经有过一次 连续工作48小时，照顾在受伤的人

摩加迪沙战役。回到美国后，他专注于工作

他在改善战斗伤亡护理方面的努力，并导致了巨大的变革 他在美国医学领域担任军事创伤研究部门的负责人

U.S.美国陆军外科研究所（USAISR），并最终获得成功 USAISR的指挥官和美国的创伤顾问。S.外科医生

将军在博士。在霍尔科姆的领导下，军队提供了帮助

向所有部署在战区的美国人提供止血带

止血敷料的使用。他彻底改变了破坏控制 复苏，采用全血治疗创伤患者。这个

他在索马里的工作中没有其他变化

他在战斗中的选择在电影《黑鹰降落》中出名 开始用全血药来复苏受伤的病人。

![](/media/202412//1733469939.4755914.jpeg)资料暂存器霍尔科姆和博士。纳塔莉亚 ·马塔利内茨，她领导着医院的

ICU小组，与德国的一家医院建立联系，进行远程医疗 咨询

在2022年春天，美国博士。霍尔科姆和GSMSG一起去了乌克兰 第一次，现在已经两次回来帮助培训当地的创伤外科医生了 关心他称乌克兰的冲突是一场“非常暴力的战争” 。那里

双方都有大量伤亡，军人和平民

方程式“所使用的武器与在其他冲突中使用的武器相同，

基于他有限的观点。霍尔科姆说。像在伊拉克和 他说，阿富汗的大多数伤者都是平民。但是

他们的伤势有所不同：在乌克兰，平民大多受伤

来自空袭和基础设施的崩溃，而不是来自 他说，这是一种简易爆炸装置。

“俄罗斯人正在炮击民用设施和医院，而且

以故意倒塌的建筑作为一种策略。你可以看到挤压伤 和隔间综合征。这是不同的。我们看到了一点

在阿富汗和伊拉克，但不是到这个程度。”霍尔科姆说。

他说，他还没有看到侵略者瞄准的冲突

就像俄罗斯人这样做的医疗设施。“我想我们所有人 当我们看到它的时候，内脏就会挨一拳。”

GSMSG：在冲突区域内建设生产能力

2014年，亚伦 ·爱泼斯坦，他当时是一名医科学生，现在是四年级学生 布法罗大学的普通外科住院医师-创立了GSMSG。资料暂存器

爱泼斯坦，之前曾在国家安全和国防领域工作过 中东在海外，他觉得有太多的援助组织来了

进入冲突地区，治疗病人或丢弃物资，然后离开 而不会给留下来的居民带来持久的利益。他

成立了GSMSG，为冲突地区提供医疗救济和培训， 目的是在当地人口中建立足够的专业知识

使他的组织在该地区过时。

该组织派出了初级保健和外科手术团队，其中包括

创伤/重症护理，整形外科，神经外科，血管，心脏和 胸部，在地面上旋转两周。从2022年3月开始，

该组织派驻了外科医生、内科医生、护士和医务人员

乌克兰他们教了高级创伤生命支持系统和停止流血事件

在全国各地为医疗人员和平民开设的课程，并在那里工作

医院、诊所和遥远的环境。他们还组织了远程 教育培训，领导极速研讨会在战斗护理和

翻译成乌克兰语。S.国防部战斗伤亡护理课程。

到目前为止，GSMSG已经培训了2万多名乌克兰人，其中包括

内科医生、护士、内科医生和外科医生。2022年7月，博士。爱泼斯坦

获得了美国国会勋章颁发的公民荣誉勋章 为他的工作，荣誉协会。

“我们的利基领域真的是培训和建设能力，”他说。 其他援助组织专门运送急需的物资。

“但我想说，特别是为了我们，我们把人力资本带到了 真正注重建设能力。”

在全血使用方面的一场革命

在越南战争期间，美国军方率先使用了

输血中的血液成分，胶体和晶体体，因此 增加可以从单一疾病中受益的患者的数量

无偿献血。因为本身就有“无偿的 ”意思在接下来的20年里，成分血液疗法 成为院前和医院环境中的标准设置。截止到最后

20世纪，全血被淘汰用于平民采购和 在美国的治疗方法。

同样，在乌克兰，全血也没有被用于复苏 十年政府已经通过法律使其非法

长期以来一直认为成分治疗是护理的标准

最好的利用是一个救命的人，但有限的资源。

然而，在阿富汗和伊拉克的行动中，美国军队

医疗力量面临着血小板短缺的问题。血小板有五天的时间

保质期很长，需要从美国运来。霍尔库姆的变体

上述的这种短缺重新导致了人们对他的经历的兴趣 在索马里使用全血。“当我们开始看

全血患者的结果，他们是一样好或更好，”他说

上述的2016年，美国。S.军事特种行动小组开始接收

低层O组全血在损伤点使用。从那时起， 全血已经成为美国军队的标准

在美国大约一半的一级创伤中心使用。

在乌克兰，博士。海奇和国际志愿者团队 在利沃夫医院开发了一种全血输血系统。

他们将研究结果提交给了乌克兰卫生部

两周后，他说服了政府公司修改了输血法。 乌克兰卫生部采取了一项使用整体的政策

在医院里抢救严重受伤的病人 院前设置。

“我想说，在平民世界里，这需要47次会议和大约18次会议

需要几个月的时间才能变成全血血。”霍尔科姆指出。资料暂存器 在战争爆发的时候，俄国人正在入侵

他们的国家必须在两周内改变这一现状。” 烧伤患者面临的挑战

在乌克兰的医疗服务机构中，有大量的平民和军人参加了治疗 史蒂文说。沃尔夫，医学博士，教授和

烧伤，创伤和急性护理外科部门的主任 德克萨斯大学医学分校。2004年到

2011年，博士。沃尔夫是烧伤中心的主任，后来又是主任 美国陆军外科研究所的临床研究人员

在圣安东尼奥/休斯顿，他在那里监督护理 在伊拉克遭受烧伤的军事伤亡人员

阿富汗

治疗烧伤患者一直是战争的重要组成部分

医疗保健，博士。沃尔夫说。自从火药发明以来，大约 他说，10%的战争伤亡都与烧伤或烧伤有关。平民和

军事人员因使用武器或建筑而被烧毁

火但这次剧变导致烧伤的风险也会增加

在居民的生活中。他们最终生活在不安全的建筑中，而且 用不可靠的热源来加热和准备食物。

资料暂存器沃尔夫和其他人曾在乌克兰的医务人员和前线工作 供应商了解如何处理伤口和保持伤口清洁。但是

让病人从受伤点变到更明确的过程

乌克兰的护理行动缓慢。在前线服役的受伤人员 通常离一家功能齐全的医院有几百英里远吗

没有快速进行疏散的交通系统。而这种情况则非常不同 从美国S.在伊拉克和阿富汗的军事经验

开发了一种有效的系统，将伤者移出冲突区域 然后在几个小时内进入德国，然后进入美国

国家在几天内。但在乌克兰，却并不存在这样的制度。这个国家的 交通路线被破坏，使车辆交通困难。

飞机不能飞进进进出出。许多受伤的人被送上了火车， 他们在哪里由平民和军事医生照顾，并最终

到达更远的西部城市的医院。可能需要四到五天

让病人从东部送到利沃夫医院。“我们还没有看到这种关心 二战以来乘坐火车和火车运输。霍尔科姆说。

这个系统可以挽救生命，但可能会增加伤口感染的风险 受伤的人在途中没有得到常规的护理。的标准

护理是在48到72小时内开始早期移植，

资料暂存器沃尔夫指出，但这在乌克兰并不总是可能的。有

严重延迟关闭伤口和开始移植，这将会 有长期的并发症，他说。

“每个人都在尽其所能，但你做做到 假设有人会出现在你的烧伤中心

在48小时内。”沃尔夫说。病人等待伤口护理的时间越长， 他补充说，他们所面临的问题就会越多。“他们将会有一个

糟糕的伤疤；将会有很多功能问题；有了

这将成为许多我们必须处理的美容问题。”

对乌克兰烧伤患者的长期后果尚不清楚。 目前，救护车车队帮助转移严重的伤员

病人到波兰，其中许多人随后被医疗药物治疗

在整个欧洲各地进行治疗、重建和康复治疗。在

利沃夫博士。赫里奇和他的团队都做过重建手术，但确实有 受伤的病人比现有的床位和服务人员要多。

这在未来几个月将会一个问题。沃尔夫指出。燃烧 病人需要多年的广泛护理。“可能是你的一半

身体或更多是一片大疤痕，有很多生理变化

将会发生。这些情况在大约一年半后就会稳定下来。这个

游戏开始时的烧伤护理是闭合伤口。有很长一段时间 之后的游戏。”

远程医疗开始发挥作用

不同的组织已经建立了一个远程医疗系统之间 乌克兰、美国和欧洲。远程医疗机器人，由

沃伦于五月在利沃夫建立了世界远程保健倡议

多拉克，医学博士，创伤和急性护理外科的医学主任

落基山脉的医疗中心。资料暂存器多拉克担任了26年之久 一名空军外科医生，成为创伤和创伤医学主任

兰德斯图尔地区医疗中心的主任。后来，他导演了 U.S.中央司令部的联合创伤系统，他在那里监督

2009年在伊拉克和阿富汗的创伤护理单位。

远程医疗帮助国外的医生与乌克兰人密切合作

医生来自华盛顿，罗科。阿蒙达，医学博士，神经外科医生 在加入华盛顿之前在军队工作了30年

他与利沃夫的一名神经外科医生合作进行了治疗

患者这两名外科医生制定了手术计划，但乌克兰人

医院缺乏手术设备。资料暂存器阿蒙达收集了14个浴缸 里面装满了神经外科设备，开车送他们去了新的纽瓦克 他将会见前往前往乌克兰的志愿者。

“我认为人们没有意识到乌克兰有多少人伤亡，”他说

资料暂存器阿蒙达。“这比我们在越南做的要多，比伊拉克和

阿富汗 ”

医疗用品的持续短缺

外科医生说，乌克兰受到基本医疗设施短缺的阻碍 这导致了严重的感染率，甚至

死医院没有绷带，药物，抗生素，血袋， 缝合线，负压伤口治疗装置，外固定器， 麻醉机为病人在运输期间，和血液加热 据在ACS会议上发言的外科医生说。

由于烧伤患者的数量较多，纱布仍然供应不足。 “要给有烧伤的人做伤口护理，就需要一个

一个月，你必须每天都换它们。你可以把事情用完 非常快，”博士。沃尔夫说。

医疗用品的缺乏是造成伤口感染的一个主要原因

率，博士。多拉克说。“如果你感染了一个病人，他们就会被感染 在一天结束时，和其他人共用一个房间

有它。如果你不能做感染控制的基本工作，那就会有问题 最终会出现更困难、更大的问题。”

在波兰边境，火车和卡车正在排队进入乌克兰 有供应，但这还不够。霍尔科姆指出。他呼吁

增加对乌克兰的医疗援助。“我很乐意向所有人提出一个请求 西方政府现在：提供大量的医疗服务，非致命的

援助乌克兰人的平民和军队。这是非常

重要的是，我们要帮助他们做到这一点。他补充说，武器援助是对 乌克兰应该继续。

国家康复中心

利沃夫医学协会正在努力建立一个全国性的国家 康复中心，被称为完整的，这将是相同的一部分 医院系统作为多学科临床急诊医院

和重症监护。完整的，将类似于美国。S.中心的 无畏，一个军事人员的康复设施

截肢，肢体外伤和严重烧伤。乌克兰的设施将 为军人和平民病人、成人和儿童提供护理

将提供术后，身体，心理和心理社会 支持它还将增加假体和机器人的产量 设备，并帮助患者学会使用它们。

该项目目前正在接受捐款。更多信息是 可在www。未破损的org.ua.

GSMSG正在寻找志愿者，之前有U。S.特种作战 有外科医生、麻醉师/crna、PAs/NPs，

重症护理护士或护理人员。任何有兴趣和他们一起工作的人

GSMSG被要求直接通过www联系该组织。gsmsg.org.

![](/media/202412//1733469988.4611335.png)

![](/media/202412//1733469988.4719346.png)Ukrainian Surgeons Get Crash Course in Military Medicine

Originally published by our sister publication [*General Surgery News*](https://www.generalsurgerynews.com/)By Christina Frangou

SAN DIEGO—One morning in early October, Hnat Herych, MD, PhD, the chief of surgery at Danylo Halytsky Lviv National Medical University,

stood at a window of his hospital in Lviv, Ukraine, and took a video of a fire burning nearby, its black smoke darkening the sky. The blaze

erupted after a Russian rocket hit a neighborhood near Lviv’s

Multidisciplinary Clinical Hospital of Emergency and Intensive Care. With 1,200 beds, it’s now one of the largest functioning hospitals in Ukraine. Inside the facility, staff prepared for an influx of patients.

**Video from a window of Lviv’s Multidisciplinary Clinical Hospital of Emergency and Intensive Care after a Russian airstrike on a**

**nearby neighborhood.**

Photo courtesy of Hnat Herych, MD.

Before the war, staff at the hospital provided care to children and adults with run-of-the-mill conditions: injuries from car accidents, cancer,

appendicitis. Everything changed on Feb. 24, 2022, when Russian troops poured over the Ukrainian border and launched a violent war that has taken the lives of 200,000 Russian and Ukrainian soldiers, according to U.S. government officials. Nearly 7.8 million Ukrainians have become

refugees, and another 6.2 million are displaced within their own

country. The Office of the United Nations High Commissioner for

Human Rights reported that more than 6,200 Ukrainian civilians have been injured and 9,300 killed up to Oct. 9. The actual figures are

believed to be considerably higher, but proper accounting is impossible during the war.

Within days of the invasion, Ukrainian defense forces commandeered

gauze and bandages from hospitals for distribution on the frontline, Dr. Herych said. Nurses asked him what they should do for patients in the hospital—“not just the patient with injuries, but the patient with

general surgery disease like acute appendicitis,cholecystitis and like that,” he said. There was no good answer.

Over the past 10 months, Dr. Herychand his colleagues have been on a crash course in learning to provide combat care to civilian and military patients while under threat of bombardment themselves. They’ve been assisted by a steady rotation of American, Canadian and European

physicians and surgeons, many of whom are retired from military duty and came to Ukraine on trips set up by the American nonprofit

organization Global Surgical and Medical Support Group (GSMSG).

[![](/media/202412//1733469988.4856167.jpeg)](https://www.ormanagement.net/aimages/2022/GSN1222_001a_3842_600.jpg)

**Dr. Hnat Herychand colleagues operate on a patient in Lviv’s Multidisciplinary Clinical Hospital of Emergency and Intensive Care, now one of the largest functioning hospitals in Ukraine.**

“We have challenges now that we could not imagine before the war,”

said Dr. Herych, 33, in an interview in November. A day earlier, Russian forces launched new waves of airstrikes across cities in Ukraine. During attacks, Dr. Herychand his colleagues canceled elective procedures and hid their patients in shelters below the hospital, where there are two

ORs and a four-bed ICU. They waited until it is safe and then they returned to operating.

He spoke with *GSN* as he was on his way to a local children’s hospital to operate on kids injured in a car crash. “I started work two days ago,” he said.

**Health Infrastructure Targeted**

Immediately after the invasion, Russian forces began a campaign to target Ukraine’s health infrastructure. According to the World Health Organization, the Russians have launched 688 attacks on Ukrainian

healthcare facilities to date, affecting hospitals and clinics,

pharmaceutical warehouses and factories, and ambulances. They hit 64 facilities in the first four weeks alone, according to reporting in the

*Washington Post*. Dr. Herych’s hospital has never been hit directly, but debris from rockets has fallen onto the roof, and doors and windows have been broken by the blasts.

The attacks on health facilities, combined with Ukraine’s destroyed

supply chains, have cut off steady access to medications and other

medical supplies. At the Multidisciplinary Clinical Hospital of

Emergency and Intensive Care, which was built in 1980, staff began to

use equipment long out-of-date, like needles that are 40 years old. “We were feeling like we were in the, maybe, first or second WorldWar,” said

Dr. Herych, adding that before the invasion, his hospital was a technologically advanced facility with a da Vinci robot (Intuitive Surgical).

On March 13, 2022, Russian forces launched an airstrike on a military training facility 25 miles from Lviv. One hundred patients from the

bombing arrived over the next hours, he said. “We never had the

experience to have 100 patients with injuries that needed to go straight into the operating room.” Thirty-five people died in the attack.

Lviv’s Multidisciplinary Clinical Hospital of Emergency and Intensive Care is about 40 miles from Ukraine’s border with Poland and hundreds of miles from most of the fighting, but Dr. Herychand his team have

treated more than 6,000 patients with war-related injuries, including

314 civilians and 242 evacuated military personnel who required surgery.

[![](/media/202412//1733469988.4983847.jpeg)](https://www.ormanagement.net/aimages/2022/GSN1222_016b_3842_600.jpg)

**Ukrainian doctors and nurses care for a wounded patient in Lviv when the hospital has full power.**

People who are injured in the east continually move westward,

receiving more definitive care as they get further from the frontlines. Many hospitals in the east are no longer fully operational. In Lviv, Dr.

Herychand staff care for severely injured soldiers who arrive after being transported by passenger trains that have been converted for medical

transport, a journey that can take several days or more. The injured

often present with wounds that have multidrug-resistant infections. At the same time, he and colleagues treat civilians who’ve been injured by bombs or collapsing buildings, and they continue to provide care for

Lviv’s swelling population.

In October, Dr. Herych came to the American College of Surgeons

Clinical Congress, in San Diego, where he gave a presentation about

surgery in Ukraine. He was joined by seven American surgeons who

have rotated through Ukraine since March 2022. The panel described a war that is causing a high number of severe injuries, spread across

people of all ages who are being treated by a civilian workforce.

[![](/media/202412//1733469988.5089726.jpeg)](https://www.ormanagement.net/aimages/2022/GSN1222_018a_3842_600.jpg)

**During the Russian offensive in November that knocked out the hospital’s power, Dr. Herychand team treat an injured patient with only the light from headlamps.**

“This is a real modern war because both sides use an artillery system, so we have a lot of shrapnel injuries,” Dr. Herych noted. “The direct

contact of the militaries [is] a real killer, but also we see the patients who are newborn, small patients and old patients.”

John B. Holcomb,MD, a professor of surgery at the University of

Alabama at Birmingham, joined the U.S. military in 1985,and was

deployed later as a surgeon to Somalia. There, he and his team once

operated for 48 hours nonstop, looking after people wounded in the

Battle of Mogadishu. After returning to the United States, he focused his efforts on improving combat casualty care and led massive changes in American medicine as the chief of military trauma research at the

U.S. Army Institute of Surgical Research (USAISR),and eventually

commander of USAISR and trauma consultant to the U.S. surgeon

general. Under Dr. Holcomb’s leadership, the military provided

tourniquets to all Americans deployed in combat zones and introduced the use of hemostatic dressings. He revolutionized damage control

resuscitations, adopting whole blood to treat trauma patients. This change grew out of his work in Somalia, when faced with no other choice in the battle made famous in the film “Black Hawk Down,” he began to use whole blood to resuscitate injured patients.

[![](/media/202412//1733469988.520954.jpeg)](https://www.ormanagement.net/aimages/2022/GSN1222_016a_3842_600.jpg)

**Dr. Holcomb and Dr. Natalia Matolinets, who leads the hospital’s ICU team, connect with a hospital in Germany for a telemedicine consult.**

In the spring of 2022, Dr. Holcomb went to Ukraine with GSMSG for the first time and has returned twice to help train local surgeons in trauma care. He described the conflict in Ukraine as a “very violent war. There are lots of casualties, military and civilian, on both sides of this

equation.” The weapons used are the same as those in other conflicts, based on his limited viewpoint, Dr. Holcomb said. Like in Iraq and

Afghanistan,the majority of injured people are civilians, he said. But their injuries differ: In Ukraine, civilians present mostly with wounds from air attacks and collapsing infrastructure rather than from

improvised explosive devices, he said.

“Russians [are] shelling civilian installations and hospitals, and

collapsing buildings on purpose as a strategy. You see the crush injuries and compartment syndromes. That is different. We saw a little bit of

that in Afghanistan and Iraq, but not to this extent,” Dr. Holcomb said.

He said he has not seen a conflict in which the aggressor targets

healthcare facilities the way the Russians are doing. “I think all of us kind of get a punch in the gut when we see that.”

**GSMSG: Building Capacity in a Conflict Zone**

In 2014,Aaron Epstein—then a medical student, now a fourth-year

general surgery resident at University of Buffalo—started GSMSG. Dr. Epstein, previously worked in national security and defense focusing on the Middle East. Overseas, he felt that too many aid organizations came into conflict zones, treated patients or dropped off supplies, then left without creating lasting benefit for residents who remained behind. He

founded GSMSG to provide medical relief and training in conflict zones, with the goal of building enough expertise among the local population to render his organization obsolete in the area.

The organizationsends primary care and surgical teams, including

trauma/critical care, orthopedics, neurosurgery, vascular, cardiac and

thoracic, for two-week rotations on the ground. Beginning March 2022, the organization posted surgeons, physicians, nurses and medics in

Ukraine. They taught Advanced Trauma Life Support and Stop the Bleed courses across the country for medics and civilians, and worked in

hospitals, clinics and far-forward settings. They also organized remote educational training, leading Zoom seminars in combat care and

translating into Ukrainian the U.S. DoD Combat Casualty Care course. So far, GSMSG has trained more than 20,000 Ukrainians, including

medics, nurses, physicians and surgeons. In July 2022, Dr. Epstein received a Citizen Honors Award from the Congressional Medal of Honor Society for his work.

“Our niche area is really training and building capacities,” he said.

Other aid organizations specialize in bringing in much-needed supplies. “But I would say for us, in particular, we bring the human capital to

really focus on building capacities.”

**A Revolution in Whole Blood Use**

During the Vietnam War, the American military pioneered the use of blood components, colloids and crystalloids in transfusions, thereby

increasing the number of patients who could benefit from a single

blood donation. Over the next two decades, component blood therapy became standard in prehospital and hospital settings. By the end of the 20th century, whole blood was eliminated for civilian procurement and

therapies in the United States.

Similarly, in Ukraine, whole blood was not used for resuscitations for decades. The government had passed laws making it illegal, reflecting the long-held idea that component therapy is the standard of care and the best use of a lifesaving but limited resource.

However, during operations in Afghanistan and Iraq, American military medical forces faced shortages of platelets. Platelets have a five-day

shelf life and needed to be shipped from the United States, Dr. Holcomb said. This shortage led to a renewed interest in his experience in

Somalia with use of whole blood. “When we started looking at the

outcomes of patients with whole blood, they are as good or better,” he said. In 2016,U.S. military special operations teams began receiving

low-tier group O whole blood for use at the point of injury. Since then, whole blood has become the standard for the American military and is used at about half of the Level I trauma centers in the United States.

In Ukraine, Dr. Herychand the international team of volunteers

developed a system for whole blood transfusions in the Lviv hospital. They took their results to the Ukrainian Ministry of Health, and within two weeks convinced the government to change the transfusion law. The Ukrainian Ministry of Health has adopted a policy of using whole blood to resuscitate severely injured patients in the hospital and

prehospital settings.

“I would say, in the civilian world, it takes 47 meetings and about 18

months to change over to whole blood,” Dr. Holcomb noted. “[Dr.

Herych] and colleagues in a time of war, when the Russians are invading their country, had an imperative to change that in two weeks.”

**Challenges for Burn Patients**

Ukrainian medical services see a high number of civilian and military

patients suffering with burns, said Steven E. Wolf, MD, a professor and the chief of the Division of Burn, Trauma and Acute Care Surgery at The University of Texas Medical Branch, in Galveston. Between 2004 and

2011, Dr. Wolf was the director of the burn center and later the director of clinical research at the United States Army Institute of Surgical

Research, in San Antonio/Houston, where he supervised the care of military casualties who had suffered burn wounds in Iraq and

Afghanistan.

Treating patients with burns has always been a large part of wartime medical care, Dr. Wolf said. Since the invention of gunpowder, about

10% of war casualties are burns or burn related, he said. Civilians and military personnel become burned as a result of weapons or building fire. But there’s also an increased risk for burns caused by the upheaval in the lives of residents. They end up living in unsafe structures, and warm themselves and prepare food over unreliable heat sources.

Dr. Wolf and others worked with Ukrainian medics and front-line

providers on how to manage wounds and keep themclean. But the

process of getting patients from the point of injury to more definitive care is slow in Ukraine. Personnel who are injured serving at the front are often hundreds of miles from a fully functioning hospital and have no speedy transit system for evacuation. That situation is very different from the U.S. experience in Iraq and Afghanistan, where the military

developed an efficient system to move the injured out of a conflict zone and into Germany within a matter of hours and then to the United

States within days. No such system exists in Ukraine. The country’s transportation routes are destroyed, making vehicular travel difficult.

Airplanes cannot fly in and out. Many injured people are put on trains, where they are cared for by civilian and miliary medics, and eventually arrive in hospitals in cities farther west. It can take four to five days to get patients to Lviv from the east. “We have not seen this kind of care on trains and transport by trains since WorldWar II,” Dr. Holcomb said.

This system saves lives but can increase the risk for wound infection if injured people do not receive regular care on the way. The standard of care is to begin early grafting on burn patients within 48 to 72 hours, Dr. Wolf noted, but that is not always possible in Ukraine. There are

significant delays inclosing wounds and initiating grafting, which will have long-term complications, he said.

“Everybody’s doing the best they can, but you cannot make the

assumption that somebody is going to show up in your burn center

within 48 hours,” Dr. Wolf said. The longer patients wait for wound care, the more problems they will have, he added. “They’re going to have a

bad scar; there’s going to be a lot of functional problems; there’s going to be a lot of cosmetic problems that we’re going to have to deal with.”

Long-term consequences for burn patients in Ukraine are unclear. Currently, convoys of ambulances help transfer severely wounded patients to Poland, many of whom are then taken by medevac

throughout Europe for treatment, reconstruction and rehabilitation. In Lviv, Dr. Herychand his team do reconstructive surgery, but there are more patients with injuries than available beds and services.

This will be problematic in the months to come, Dr. Wolf noted. Burn

patients require extensive care for many years. “It maybe that half your body or more is one big sheet of scar, and a lot of physiologic changes are going to occur. These stabilize out after about a year and a half. The

beginning of the game in burn care is closing the wound. There’s a long game that goes on after that.”

**Telemedicine Comes Into Play**

Different organizations have built a telemedicine system between

Ukraine and the United States and Europe. Telemedicine robots, sent by World Telehealth Initiative, were set up in Lviv in May by Warren

Dorlac, MD, medical director of trauma and acute care surgery at

Medical Center of the Rockies, UCHealth. Dr. Dorlac served 26 years as an airforce surgeon, becoming chief of trauma and trauma medical

director at Landstuhl Regional Medical Center. Later, he directed the U.S. Central Command’s Joint Trauma System, where he oversaw

trauma care units in Iraq and Afghanistan in 2009.

Telemedicine helps physicians abroad work closely with Ukrainian

doctors. From Washington, Rocco A. Armonda, MD, a neurosurgeon who spent 30 years with the military before joining Washington

Hospital Center, has collaborated with a neurosurgeon in Lviv to treat patients. The two surgeons set out operative plans, but the Ukrainian hospital lacks equipment for surgery. Dr. Armonda collected 14 tubs filled with neurosurgical equipment and drove them to Newark, New Jersey, to meet volunteers bound for Ukraine.

“I don’t think people realize how many casualties are in Ukraine,” said Dr. Armonda. “It’s more than we had in Vietnam, more than Iraq and Afghanistan.”

**Ongoing Shortage of Medical Supplies**

Surgeons said Ukraine is hampered by a shortage of basic medical

supplies, and this is contributing to rates of severe infection and even deaths. Hospitals lack bandages, medications, antibiotics, blood bags,

sutures, negative-pressure wound therapy devices, external fixers,

anesthesia machines for patients during transport, and blood heating

devices, according to the surgeons who spoke at the ACS meeting.

Gauze remains in short supply, given the high number of burn patients. “To do wound care on somebody with a burn wound, it is going to take a month, and you have to change them every day. You can run things out very quickly,” Dr. Wolf said.

The lack of medical supplies is a leading cause of the wound infection rate, Dr. Dorlac said. “If you get an infection in one patient and they’re [sharing] a room with someone, at the end of the day, everybody else has it. If you can’t do the basic stuff in infection control, there’s going to be more difficult and bigger problems in the end.”

At the Polish border, trains and trucks are lined up to get into Ukraine with supplies, but it is not enough, Dr. Holcomb noted. He called for an increase in medical aid to Ukraine. *“*I would love to make a plea to all of the Western governments now: Supply substantial medical, nonlethal aid to the Ukrainians for their civilians and military. It’s extraordinarily important that we help them do that.” He added that arms aid to

Ukraine should continue.

**National Rehabilitation Center Under Construction**

The Lviv Medical Association is working to build a national

rehabilitation center, called UNBROKEN, which will be part of the same hospital system as the Multidisciplinary Clinical Hospital of Emergency and Intensive Care. UNBROKEN will be similar to the U.S. Center for the Intrepid, a rehabilitation facility for military personnel suffering

amputations, limb trauma and severe burns. The Ukrainian facility will provide care to military and civilian patients, adults, and children, and

will provide postsurgical, physical, psychological and psychosocial

support. It will also increase the production of prosthetic and robotic devices,and help patients learn to use them.

![](/media/202412//1733469988.5531356.jpeg)The project is currently accepting donations. More information is available at [www.unbroken.org.ua](http://www.unbroken.org.ua/).

GSMSG is looking for volunteers with prior U.S. special operations

experience and who are surgeons, anesthesiologists/CRNAs, PAs/NPs, critical care nurses or paramedics. Anyone interested in working with GSMSG is asked to contact the organization directly at [www.gsmsg.org](http://www.gsmsg.org/).