In Ukraine, unlike most European countries, there has never been a public professional association that would bring together military doctors. Such a project was implemented only a few months ago – with the formation of the Public Organization “Ukrainian Association ‘Medicine for the Defense Forces’” (UAMDF). The initiative encompassed healthcare professionals not only from the Armed Forces, but also all the Defense Forces as a whole: the Border Guard Service, the Ministry of Internal Affairs, the Security Service of Ukraine, the Defense Intelligence, as well as civilian doctors who treat the wounded.

Ukrinform spoke with Vasyl Horoshko -- the UAMDF President, Doctor of Science (Medicine), winner of the Borys Paton National Prize, Head of the Resuscitation and Intensive Care Unit for Medical Evacuation and Pain Treatment at the Main Military Clinical Hospital, Medical Service Colonel -- about the Association, its cooperation with the civilian healthcare sector and with international counterparts, as well as the formation of a new school of thought on military medicine in Ukraine.

– Ukrainian Association “Medicine for the Defense Forces”. What is this story about?

– First of all, UAMDF is a community that brings together military doctors from the sectors of security and defense, as well as civilian doctors who take care of the life and health of Ukrainian defenders on a daily basis. The main meaning of our work lies in the exchange of professional knowledge, the promulgation of effective methods of treating war wounded patients, assistance in teaching and learning related specialties, and advanced training.

We are striving to get engaged in our community the greatest possible number of professionals who take care of wounded patients at all stages - from evacuation from the battlefield through to rehabilitation treatment.

The association is designed to become a platform for military and civilian doctors to coordinate their efforts, hold conferences, training sessions, and discuss complex clinical cases. Everything is aimed at achieving the main goal, that is improving the quality of treatment and rehabilitation of wounded defenders of Ukraine.

– How does this work in practice?

– We hold regular educational events where doctors, especially those working on the front lines, share their professional experience. We discuss the latest techniques, create educational modules. Of course, due to security issues, most of the events take place online, but we also provide training courses offline.

– And what issues are given focus during these trainings?

– We are trying to embrace every critical situation we encounter in practice. For example, I as an anesthesiologist can say that in our hospital, special focus is given to one of the most crucial moments – when new wounded patients arrive. This is the stage where medical staff must always be ready to perform emergency interventions, for example, cardiopulmonary resuscitation (CPR). And since in most inpatient units there is no anesthesiologist on standby to immediately begin basic or advanced resuscitation, it is nurses and doctors who must have the necessary skills to independently perform chest compressions, lung ventilation, defibrillation or administer medications during resuscitation measures.

Therefore, we periodically conduct training sessions to ensure the personnel are in constant clinical readiness to act in situations involving circulatory or respiratory arrest. Besides, we provide systematic updating of technical skills, particularly through practicing algorithms for peripheral vein catheterization, insertion of a nasogastric tube, intramuscular and intravenous injections, as well as vascular access care.

Regular simulation sessions are held for both doctors and paramedics. Nurses practice all basic manipulations in accordance with modern standards, and doctors constantly update their knowledge of clinical protocols for the treatment of acute pathological conditions - from traumatic shock to acute respiratory failure.

These issues are of extreme importance, given that we are constantly gaining new practical experiences and skills, and update treatment protocols accordingly. Every participant in such events is awarded points for continuous professional development, and, most importantly, confidence that they will act appropriately at a critical moment.

- How frequently does the Association hold such events?

- Despite our organization being quite young, we have a busy work schedule. For example, a five-day training course for anesthesiologists on “Hostile Environment Surgical Training. Anaesthetics (HEST-A)” has been recently held at the Bohomolets National Medical University.

The event was assisted by the medical humanitarian organization “The David Nott Foundation” in coordination with the Ministry of Health of Ukraine. It was attended by 29 anesthesiologists from across the country, in addition to Ukrainian Military Medical Academy interns.

This educational course provided training in anesthetic care under scenarios involving disaster relief management, the use of chemical weapons, mass casualties, respiratory tract infections, burns, obstetric and pediatric trauma, as well as field anesthesia.

The Association is scheduled to convene the inaugural congress of Ukrainian military paramedics in late November. This, we are hopeful, is going to become a landmark event, dedicated to the unification and professional growth of combat medics, paramedics, male and female nurses, and other healthcare professions serving with the Ukrainian Defense Forces. The idea behind this gathering is to set up a professional dialogue platform to provide additional impetus to the development of professional standards and the formation of a modern Ukrainian school of thought on military medicine.

It will also focus on consolidating best practices, improving the level of professional training, and implementing best practices on providing healthcare service under combat scenarios. The forum’s results will hopefully contribute to higher quality and more effective treatment of wounded Ukrainian defenders.

– Are foreign colleagues interested in your experience?

- Yes, and very much so. After all, we are not theorists, but are working under conditions of real-world war of the 21st century. Our foreign colleagues (associations of military doctors have long been active in many European countries, by the way) study our protocols, especially regarding evacuation from the “red zone” (a dangerous or hostile area, often one with significant enemy activity, where special precautions or actions are necessary – Ed.) bleeding control, and wounded patient stabilization.

Our representatives attend international conferences where they present Ukrainian experience. Foreign colleagues find it extremely interesting, because they do not deal with real combat injuries, so our knowledge, experience, and expertise are something fantastically unreal to them, and they study them with great care.

– And what exactly is of most interest to them?

– Our approach to pain treatment, for example. In many countries, this discipline development is only at the inception stage, and we have created a holistic system of pain treatment - from the moment of injury through to rehabilitation. In our hospital, for example, a service for pain treatment has been operating for almost ten years now.

Since 2015, we have been implementing techniques of regional blocks, infusion pumping, and multidisciplinary pain management to minimize the use of narcotics. At first, a significant number of colleagues were quite skeptical about this, but when they saw that wounded patients were recovering faster, they began to adopt this experience.

– You probably find it most difficult dealing with phantom pains after amputations?

– Yes, it is a true trial. A patient feels pain in a part of the body that is no longer there. We use drug combinations, neurostimulation, and mirror therapy. It’s essential that patients are not left alone with themselves. Because phantom pain is not just a signal from the nerves, it is the pain of memory.

Therefore, in this matter, we are closely engaged with psychiatrists and psychologists - pain also has a psychological nature. If it is not controlled, a patient experiences injuries again and again, and this fuels post-traumatic stress disorder (PTSD). And when the pain is relieved, the patient begins to sleep, eat, and tries to establish a fulfilling life. Sometimes it is enough not to completely eliminate the pain, but just give the feeling that it is under control, and this restores strength, promotes the desire to move on. It is this comprehensive approach - physical and psychological - that is of most interest to our partners today.

- You recalled 2015, the inception of Russia’s war of aggression. What changes have occurred in Ukraine’s military healthcare sector since the Anti-Terrorist Operation (ATO) and Joint Forces Operation (JFO) campaigns?

- In 2014, we started up with enthusiasm and zero support. Everything was lacking - equipment, first-aid kits, evacuation equipment, even basic knowledge of tactical medicine. We were learning from our own mistakes. Then NATO healthcare standards appeared; they were translated into Ukrainian, adapted to the current realities, and massive training of soldiers and healthcare personnel began. And after 2022, our military healthcare system became multi-level: from the battlefield to patient stabilization point, evacuation brigade, hospital, rehabilitation center - each stage works as part of a single mechanism.

Today we have a generation of doctors with unique combat experience. Take, for example, the level of tactical medicine. While previously tourniquets were applied to almost everyone, now there is an understanding that it is critical to assess the severity of a case and, where appropriate, it is better to perform tamponade, restore blood supply. This means that the quality of training has improved, resulting in in a decrease in deaths from blood loss, a significant decrease in wounded patients losing their limbs due to inappropriate use of tourniquets.

– You said that the UAMDF is also open to civilian doctors. Do military and civilian medicine already share a common field?

– The war has actually eliminated old barriers. Civilian clinics are now also accepting patients with war wounds, provide rehabilitation treatment, and military doctors relay the experience that was previously absent in civilian practice. Essentially, an integrated professional community has appeared in Ukraine, bringing together doctors from the defense forces and the civilian healthcare system. We are even developing unified protocols for treatment, anesthesia, and post-surgery patient management.

And it is there, in my opinion, where the Ukrainian Association of Medicine for the Defense Forces should take on an important communication role. It should be the platform that unites doctors from all branches of the Defense Forces and of all disciplines. Because we will we be able to talk about the country's true defense capability regarding medicine only when military and civilian healthcare sectors act as one.

Ivan Stupak led this conversation.

Photo: Pavlo Bagmut