The ongoing war in Ukraine has shown the importance of both military and civilian surgeons maintaining their clinical readiness, according to Peggy Knudson, MD, FACS, Medical Director of the Military Health System Strategic Partnership−ACS, who moderated yesterday’s Special Session, SL03. The Ukrainian Crisis: Surgical Lessons Learned.
Surgeons on the panel discussed their efforts to assist Ukrainian surgeons and what they learned while managing injuries for both combatants and civilians in this humanitarian crisis.
From the start of the Russian invasion of Ukraine, US surgeons have been providing humanitarian relief. Aaron Epstein, MD, a surgical resident at the University at Buffalo in New York and founder of the Global Surgical and Medical Support Group (GSMSG), described his group’s efforts to treat the injured and educate medical personnel on the frontline. GSMSG was among the first non-profit groups on the ground, Dr. Epstein said, with surgeons and other volunteers arriving in Ukraine only 4 days after the war started. “And we’ve maintained a continuous presence since the war began,” he said.
Through bombings and missile strikes, GSMSG has provided combat casualty care training to more than 20,000 Ukrainians, including surgeons, medics, nurses, and laypeople, while at the same time attending to their own safety, as well as that of their trainees and patients.
The explosions that have become emblematic of the war have led to injuries of a different nature than those seen in the Iraq and Afghanistan conflicts. John B. Holcomb, MD, FACS, professor of surgery and surgical critical care at the University of Alabama, Birmingham, has provided aid and education in Ukraine. He noted that “there is not a typical war injury,” saying that many factors influence the type of injuries seen in this conflict. The blasts in urban environments have made shrapnel, burns, and infection a primary concern.
Dr. Holcomb, who operated for 23 years in the US Army, described some of the services and initiatives that he and his colleagues were able to introduce in Ukraine, including telehealth services that greatly improved medical communications, as well as the provision of whole blood, which has proven to be more effective in transfusion.
Steven E. Wolf, MD, FACS, division chief of burns, trauma, and acute care surgery at The University of Texas Medical Branch in Galveston, shared details of the burn injuries he saw during his time in Ukraine. The explosions from the war, including those generated from white phosphorous and uranium shells, tend to produce polytraumatic injuries such as hemorrhage, organ injuries, and fractures. These are more immediately pressing concerns in battlefield treatment than burns; however, burn injuries have a long-lasting impact. “Treating a burn isn’t the first thing you do, but it’ll probably be the last,” he said.
The specific educational needs of Ukrainian surgeons and medical teams for casualty care are addressed as opportunities present themselves, both on and away from the battlefield, according to Warren C. Dorlac, MD, FACS, medical director of trauma and acute care surgery at UCHealth Medical Center of the Rockies in Loveland, CO.
Nurses, medical students, residents, and faculty all were involved in the multipronged education trips that Dr. Dorlac and his team provided, which involved didactic sessions and frequent case reviews of the injured. And while the US-based volunteers went to Ukraine to teach, they also came away having learned much. “We went in with what we thought was important, but as anyone involved in combat training knows, you learn a lot yourself,” said Dr. Dorlac, who served for 26 years in the US Air Force.
A Ukrainian Surgeon Shares His Story
One of the most impactful presentations came from Hnat Herych, MD, PhD, a surgeon from Lviv, Ukraine, who described the difficulty in watching his fellow Ukrainian citizens experience devastating war injuries. Lviv is a city in the western part of Ukraine, away from the eastern front, but Dr. Herych’s large, modern hospital is one of the best equipped to handle the mass injuries of civilians and combatants.
More than 6,000 patients with war injuries have been received at his hospital, Dr. Herych said. Unfortunately, there has been no discrimination when it comes to severity or target of attacks, and “soldiers, newborns, and older patients are experiencing the same types of injuries.”
War-related challenges for providing treatment have included the arrival of mass casualties simultaneously, increased demand for blood transfusions, and the logistics of managing evacuations. However, the war has prompted advances in Ukrainian medical treatment, including the use of whole blood, which was previously illegal. “With the help of friends from Ukraine and the US, we started using blood transfusion even while it was illegal,” Dr. Herych said. The ministry of health came to allow the use of whole blood after seeing the positive results in patients.
Dr. Herych also spoke on the difficulties of communicating about medical treatment, infection control, and continuing treatment while Russian attacks target infrastructure, homes, schools, and hospitals. He stressed that the war is not over—just recently, Russia launched missiles across the country, including in Lviv. Dr. Herych showed footage of explosions across the city, visible from his hospital.
However, Dr. Herych concluded with a hopeful thought. “The surgeons here in this meeting room who come to Ukraine are true heroes,” he said. “They are an example of how people can support a nation that is fighting for their freedom, their democracy, and their independence.”