UkraineMedicalandHealth

Report
Summer2015ATO
Update

PatrickChellew
MedicalConsultant
Dr.JohnQuinn
MedicalConsultant
OliaRomanluk,M.A.
Translator/Assistant
PhotoCredit

ExecutiveSummary
ThefragilestateofUkraineisslowlyregainingsovereignty,defendsmostofitsterritoryandisatwarwith
RussiaandRussianbackedinsurgents.Theevolutionofwarfareinthisconflicthasbeenintermittentand
theupticksandlullsinviolenceandkillingmayprovetobeanequalingtideoffrozenconflictahellscape
bufferzonetopromoteRussianforeignpolicyandcorruptbusinesspracticesatthecostofhumanlife.As
thesedetailsunfoldandpolicymakersdebate,Ukrainianwarfightersandothernationvolunteersareatrisk
ofdeathfrompreventableinjury.TacticalCombatCasualtyCare(TCCC)haslandedinUkrainethanksto
theeffortsofvolunteersandnowtheUnitedStatesofAmerica,theNorthAtlanticTreatyOrganization
(NATO)andmemberstatesTCCCissavinglifeinUkraine.Thisbriefreportfromthefieldservesasa
snapshotupdateofwherebattlefieldmedicineisinthisconflictcurrently,whereintheevacuationchain
kinksandweaklinksremainandconcludeswithdetailedanalysisandpolicyrecommendationsfordonor
countriestoconsiderwiththeirengagementwithUkrainianMinistryofDefence,MinistryofHealthand
MinistryoftheInteriortomaximizebenefitandminimizehumandeath.
KeyRecommendations

1. ContinuedsupportandcrosstrainingandinteragencycollaborationofTCCC
andd
evelopingRole1&2Capabilities
acrossallbranchesofserviceand
echelons(enlistedpersonnelandcommissionedofficers).TheUnitedStates
holdsthemedicalandclinicalstandardforallthingsTCCC
.
2. RotaryandFixedwingmedicalevacuationsupport
3. Groundevacuationandpreplanningsupport.
4. MedicalStandardizationPromotion
5. FitforpurposeRoleIIImobilehospital(i.e.CaliforniaDMAT)forimmediate
deployment
6. ExpeditionaryMedicalSupportSystem(EMEDS)Training
7. LegalReform
8. LiaisonandencouragementinTCCCledElectronicMedicalRecord(EMRs)
9. FinanceandFunding
10. ReformsCouncil,
11. Paramedicine
12. MedicalSupportEquipment

Introduction
DuringtheMaidanProtestsinearly2014itwaspainfullyobviousthatasystematicapproachtocareunder
fireandallthingsbattlefieldmedicinewereseverelylackinginUkraine.WithRussianfueledAntiMaidan
protestseruptingintheeastofUkraineinMarch2014,
RussiasendinginsoldiersonFebruary27,2014to
seizeCrimea
andtheuseoflethalweaponsintheprotests,rescueworkers,policeandmilitaryunitswere
increasinglyundereffectivefire,takingcasualtiesandhadneitherthemeansnorthetrainingtoprotect
themselvesormitigatepreventabledeathsinthegrowingconflictareaswithdeadlyRussianbacked
weaponssystems.ThisreportreviewsbattlefieldmedicineassetsinEasternUkraineandconcludeswith
keyrecommendationsforwhatobjectivesremaintoenableUkrainetodefenditssovereignborders,prevent
deathonthebattlefieldandultimately,completethemissionofleadingapeacefulUkraineintothe
internationalcommunitysovereignandindependent.

Background
OnApril4th,2014,TCCCwasfirstintroducedinUkrainetomembersoftheUkrainianRedCrossandother
guestswiththehopeofdevelopingatrainingprogramforcivilianrescueworkersandtheUkraineMilitary
withthefutureintent,tohopefully,beledbytheMinistryofDefence.Theclasswastointroducetheconcept
ofTCCCandtaughtbyDeputyDirectorofCaliforniaEMSAandTCCCinstructorDanielSmiley.The
introduction,inretrospect,wasagreatsuccessandnewideaswerepoisedtoshatteroldwaysthis
transitionisstillunderwayandrequiredcontinuedsupportforyearstocome.

Astheprotestsescalatedintofullonwarfareandthelackof
careunderfire
and
evacuationcare
became
evermoreobvious,thepushwasontoquicklyintroducemodernprehospitalequipmentandtrainingforthe
civiliansandmilitarypersonnelnowworkinginwhatcametobeknownastheAntiterroristOperation(ATO)
(alsoreferredtointhisreportasthe
ContactLine
).

PhotosbelowshowthethefinaldaysofMaidaninFebruary,2014.Medicwithabagofmedicineandlittle
inthewayoftrainingorequipmenttodealwithmassiveandmultipletraumaticinjury.

InstitutskayaStFeb2021,2014(
PhotoCredit:PatrickChellew)

IntroductiontoTCCCInstructorDanSmiley,
April4,2014
(PhotoCredit:PatrickChellew)

TheATO:Summer2015
Owingto100sifnot1000sofvolunteers,supportgroups,directandindirectmedicalandoperational
supportfromNATOandNATOmemberandalignedcountriesandthemedicsintheATO,medical
standardshaveincreaseddramaticallyacrossthemedicalevacuationchainsincethefirstmedicaland
healthassessmentcarriedoutinpartnershipwiththeUkrainianWorldCongressinSummer2014(please
seefurtherreadingsectionofthisreportforthiscitedreportsandmanyothers).Thisreportwillnowoutline
bysector(A,B,C,andM),whatmedicalassetsaredeployed,individualreportsoffieldmedicnowtrainedin
TCCCanddescribecurrentcapabilitiesasoflateAugust2015.

ATOSectors,A,C,BandM

SectorA,59thMFH
59thMFHtoreceivedanewfacilityfromCanada

CanadaisproudtobeattheforefrontofinternationalsupporttoUkraine.Thismobilefieldhospitalisa
durable,transportablestructurethatcomescompletewith20beds,powergeneratorsandafunctioning
heating,coolingandventilationsystem.Thestructurewillbeprimarilyusedforsurgeriesandother
proceduresthatrequireasanitaryandsafeenvironmentinareasaffectedbyconflict.
http://www.international.gc.ca/media/aff/news-communiques/2015/07/21a.aspx?lang=eng

ShchastyaCityHospital(LevelII)onthecontactline,SectorA
LadaVvedenska
atShchastyaCityHospital
NotmanyinjuredinShchastya,butwoundedfromsurroundinglocationsusuallygostraighttoNovoaidar.In
bothShchastyaandNovoaidartheyhaveassignedmembersofthe59thMFH.
Mostmedicalequipmentcomingfromvolunteers.

Suppliesindemand,gauze,tape,headachemeds,highbloodmeds,elasticbandages.
CurrentEvacfromthelinetoShchastyaHospital,thanoperationifrequiredforstabilization,priorto
movementtoNovoaidarwheretheycanbemedevacbyairtoKharkivorbygroundtoSvatovo(59thMFH)
andthenbygroundtoKharkivifnecessary.

Oftenwarfightersdon'tcallforevacuation,butcasevactheirinjuredfromthescenetothehospital.Most
evacsfromShchastyaandNovoaidarhospitalsareperformedbytheambulancebrigadefrom59thMFH,as
theyhaveanequippedvehiclewithasurgeonandanesthesiologistforCCT.
TCCCusuallyonlytourniquetandbandage,asthedistanceisclosetoShchastyaHospital.

ShchastyaCityHospitalP
hotoCreditPatrickChellew

NewlydonateddigitalXray

ShchastyaCivilianHospitaloutpatientsurgerytoremovefrag
PhotoCredit

NovoaidarCivilianHospital,LevelII
PhotoCreditPatrickChellew
Howsitgoing?Working.
Receivesamilitarypatientsabouteverytwodays.Traumapatientsandgeneralmedicalsuchas
pancreatitis.
EquipmentcurrentlyrequiredatNovoaidarHospital
UniversalXraycomplex50INDIFSCOP01
Operatingtable
Staticshadowlesslamp,610reflectors
Ultrasoundwith2probes3.55withcontinuouswavedoppler
(4)Autoclave100
(2)ECGmachineUCARD100,3channels
Operatingset
(2)DefibrillatorwithamonitorDKIN10Axion
(4)Distillers(10litres)
EKG/ECGpatientmonitorwithpulseoximeter,bloodpressure,CO2
(2)Dryheatsterilizer
(2)Nebulizer
Echoencephalograph
(3)Electricaspirator
(2)Transportoxygenbottleswithmanometers,10liters
(3)Dentalchair

Andriy,Medic22nd
battalion,SectorA
UsedtobeinSectorB,nowSectorA:
InSectorBtransporttothe66thcouldtakeupto1.5/hrs.Sometimesthe66thMFHwouldsendavehicleto
meetthemandtheyreloadedthepatientatarallypoint.NowinSectorA.NoIV,noneedforthemgiven
shortETA,fewdoneearlierinSectorB.HaveIsraelibandages,Celoxgauze.Usedboth.
Israelibandageforfraginjuryoflowerarm,firstusedregulargauze,bleedingcontinued,appliedIsraeli
Bandage,bleedingstopped,removedtourniquet.EvacuationtoNovoaidarDistrictHospital,20/km,30/min,
thenemergencysurgery,airevacuationifbygroundwiththe59thMFHambulances.
Needdecompressionneedlesandchestseals


SergiyFilippov,Medic92nd
Brigade,Shchastya,SectorA
Almostneverusesthebag,asthepatientsweregoingstraighttothehospital,butusedtheskills
SeveraltimesusedsuctionandBVM,oneofthemonacivilianpatientwiththromboembolismhave
performed23intubationsandareinneedofrefillofkeymedicalgoodsduetoperformingseveralIVs,and
multipleassortedbandages.

P
avloGoruk59thMFH,HeadofAnesthesia,ReanimationandIntensiveCare,
SectorA.
Thesituationthereisnotverycalmfromunitsreportingontheground.Thebagisconstantlyusedinforward
groupsandevacuationgroups.Addedsomemedications,achesttubewithsteelguide.AlwaysdoIVs.
Manysubclavians.AlwaysgiveTXA.Manychesttubes.Nodecompressions,theydochesttubesinstead.
Intubationsallcriticalpatientsgetintubated.
Usedsuction,saysitwasnotpowerfulenough(thewhitesuctionunit)Usedccollarnumberoftimes.
Traumashearswereveryusefulandconvenient.Alsoverygoodopinionofthebagitself,itspouchesare
perfectforfieldwork.Couldnotgiveanyfurtherdataaboutthenumberofpatientsorprocedures.

SoftskinambulancehitbysmallarmsandRPGfirenearTr'okhizbenka

Luhans'ka oblast, Sector A, late July, 2015. Two occupants suffered minor
injury.
Photo Credit

Ednote:OverthesummermonthsintheATOandasofAug20thonemedic
KIAandthreesuffereddebilitatinginjuryincludingonefemalemedicwho
lostaneyeandtwolegs.

OlesGarashchukNeurosurgeon
,59thMFHS
everodonetskHospital(LevelIII)
HasseengoodworkwithCATs,IV'sandothercareforcriticalbleeding.Fewercasesofcelox/quikclotuse.
POORairwaysprotection,thereforeALLseverebraininjuriesareadmittedwithaspirationsyndromeduring
prehospitalevacuation.AlsocombatmedicsalmosthasNOdecompressionneedles,andhaveveryhigh
psychologicalthresholdfortheirapplication.Manyevenofbrigadedoctorsknowonlythetheoryof
intubationandpleuraldrainages.Lackofneckcollarsandsplints.Themainideaistobringtheinjuredtothe
hospitalASAP,notthinkingaboutHOW.Manyofthemneedrepeatedtraining.Recentlyhehadtwogood
casesfrom24thbrigadewithexcellentcareforblastinjuryofbothlowerextremitieswithmultiplefractures
andvascularinjuries.Requestinguptodatemilitaryneurosurgeryguidelinesandtrainingforexistingstaff.

Oksana,callsign"Mama"
,NationalGuardMedicalUnit,SectorA.
EvacuationusuallytoSeverodonetsk,thentoKharkiv.
TCCC:
IV20,using18g,hospitalasksatleast16g
TXAusedontenpatients
WoundpackingOnsevenGSWpatients
SAMavailable,notused,onlyfortraining
2intubations,patientoutcomebothsurvived

Passinginfoonpatientstothenextcrewoverthephone.UsingAPCormedicalAPCfromthefrontline.


GSWupperarm,exitwoundbetweenscapulainjuryoccurredat1850.PatientarrivedtoOksanaat1930:
InitialBP60/40.IV/NS,TXA1/gm,mesaton(
Phenylephrine)
toraisebloodpressureanddexamethasone.
DeliveredtohospitalwithBP90/60,abletoambulateintothehospitalonhisown.Patientdiagnosedby
hospitalstaffwithhemothorax.

Injuriestobothlegs,tworubbertourniquetsapplied,woundsbandagedpriortocontact.Patientinsevere
painfromtourniquet,askedtoreleasetourniquets.TwoCATswereplacedlower,IVestablished,TXA.
Rubbertourniquetshadtobecutoff.Patientoutcomesavedbothlegs.Openfracturesofbothlegs,one
femoral,onelowerlegfracture.Patientoutcomeonelegsaved,oneamputated.Nalbuphineinjection
given.

Femalecivilian,stepontripwire.Multiplefragmentationinjurybutonlyenteredintosubcutaneoustissue,no
activebleeding.Alert,couldanswerquestionsabouthername,age.BP200/100.Astherewereno
medicationstolowerBPavailable,medicspokeandcomfortedpatient.Patientoutcomeok.

FieldIntubations
:
1blastinjurypatient,unconscious,couldnothearlungsounds,butwithpulse.Intubatedandventilated
withBVMfor30mins.
2patientwithabdominalfraginjury.IV,TXA.
Bothtimesonemedicwasperformingtheprocedureandtheotheronewaslisteningtolungsoundsand
checkingtheabdomen.Thiswasthefirsttimethemedicintubatedlivepatients,previouslyonlytrainingon
manikins.

Patientexample:a30yearoldpatientwithfractureofthelefttemple.Reactingtopain.Rightsideofthe
bodyparalyzedasaresultofinjury.

PTSD.Soldierwitnesseddeathofhiscombatbuddies.Hadnoteatenfor3daysperhisunit.Oksanaand
herfriendtookhimforawalk,buthewasnotparticipatinginconversations.Latertheystartedtalkingabout
theirbadexperienceswhichseemtostimulatehisparticipationintheconversationandsharedhis
experiencewiththem.Afterthewalkpatientaskedtoeat.

OnecaseofanothermedicgivingTXAIMinsteadofIV.

Patientwithfraginjurytotheleg.Hadatourniquetapplied,abandageputonandtourniquetreleased,then
administerednalbuphineIM.Themedicleftforamomentandwhenreturned,patienthadremovedthe
bandageandwaswatchinghimselfbleedingsayingitwasacoolpicture.

SoldiersdonotgetenoughCLSsupplies,andoneunitwaskeepingtheirrubbertourniquetsandold
bandagesinbackpacks,nottousethembecausetheywereobligedtoturntheminafterwards.
TheAPCmentionedearlierandshownbelowbelongstooneunitsowhentheunitleavesthefrontlineon
rotationitisgoingtotakeitwiththem,evenifthereplacementunitisnotanarmoredevacvehicle.

NationalGuardArmoredMedicalAPCSectorA

MajorreceivinghospitalofSectorA:Shchastya,Novoaidar,S
everodonetsk,Svatove,Kharkiv.
MedevacflightfromtheATOtoKharkivareflowntotheKharkivStateAircraftManufacturing
Companyairportandthanabouta10minutedrivetotheKharkivMilitaryHospital.

SectorC65thMFH
ArtemivskCentralRegionalHospital(LevelIII)
Noteshereprovidedby:SvitlanaMelnykova,chiefadministrator
ReorganisingdepartmentofanesthesiologyandICU,tenderannounced.RequireERequipment:ultra
compactpatientECGmonitor,ventilator,biochemicalanalyzer.Noinformationonprehospitalcare.
Supplementedwithstafffromthe65thMFH,
MedicalRapidResponseSquad
"Hippocrates"
&
Pirogov


ArtemivskHospital
PhotoCreditPatrickChellew

Patientfirstchanceofairliftcomesafterthe65thMFHinArtemivskatanearbysoccerfield.There
isnoholdingarea.Patientsareunloadedfromambulance,evaluatedbyflightcrewandthenloaded
intoahelicopterforevacuationtoKharkivorDnipropetrovska.P
hotoCreditandmorephotos

Elena,volunteerin
ArtemivskCityHospitalSectorC.
Thesenotestakenafterbeingshelledforthreedays.
IVsseldom,usuallyminorinjuriesonlygetbandagesand
tourniquet
.SeenseveralCATsaswellasrubber
tourniquet
(bothonthesamepatient)aswellasCATlike
tourniquet
ofUkrproduction.
Sheherselfbuys
tourniquets
fromAVPharma,Kyivmanufacturer(180/UAH)andgivesthemtosoldiers.
SaysSichtourniquetisinconvenientbecausethewindlassclipisdoneinformoftworingsandishardto
useonehanded.CATreceivedonpatientwascleanedandgivenbacktomedic.
ThereweresomeIVsdoneonpatientsfromDebaltsevo,alsoreceivedonewithIVfromPopasna
ReceivepatientsfromLuganskoe,Gorlivka,Popasna.ManyinjuredfromIEDs.Onlytwoofthemwere
operatedinArtemivskrecently,therestaresenttoKharkiv(infofromJuly,2015).EvactimetoKharkiv4/hr
byground,about50/minbyair.

Mostpatientstheyhavenowarecardiac1012adayandmanypatientswithfoodpoisoning(upto20each
day).ManysurgeonscomingfromKyiv,Lvivetctoassistfor12month.Noprehospitalairwaymanagement
knowntoher.Knowsathospitalpatientsgetintubated,chesttubes,cric.
Thereischancesomeproceduresweredoneonprehospitalstagebutshecan'tknowbecausewhena
criticalpatientarrivestherearetoomanypeoplearoundthemcuttingoffclothesetcetcforhertogolook.

Pirogov
medicalcompanyhasmanyIgels.Elenaalsobought5togiveoutbutproblemwithBVMs.
EachblockposthasaUAZ452("Tabletka")evacvehicle,somaybethereasonwhynotmuchaidisdone
priortohospital,astheygetthereratherquickbutalsosaystheyaretreatingwithdiesel.

65thMFHinChasivIarCivilianHospital(LevelII)ChasivIarHospital,newequipment.

MilanaCherednychenko
MD
ReceivepatientsfromfieldandArtemivsk.Notmuchinfoonprehospital,advisestheyreceivesomefieldIV
andmedicatedpatients.Evacuationtohospitalisbymilitaryunits.NewEquipment:ultrasoundfrom
volunteers,equippedambulance,somemedications.EvactoKharkivalmosteveryday,3.55hdrive,
usually4h.Fourvehiclesforevac.Needs:labs,plusallequipmentlistedearlier.Cannotoperateno
surgicaltools(DidreceivesomeequipmentlateJuly,2015.photoabove).Problemwithclothesforpatients
tshirts,shorts,footwear.Hadabout950patientsin3months(bothmedicalandtrauma)
About60%severe,cannotkeepthemforlongandsendtoKharkivabout40%staythereandthenreturnto
duty.

FieldCareSectorC

NikolaienkoLaroslav,Medic17th
TankBrigade,SectorC
usedSAMsplints(whicharereusedhere),
surgicalkitandseveralburndressings.Hadtogowork,notimeforotherquestions.

ZhylinTaras,Medic57th
MotorInfantryBrigade,SectorC
Hehadtakenourcoursetwice,inKyivandinArtemivskandhastwoMedsanbatbags,onehegavetorecon
andcantcontactthemforobviousreasons,butguaranteesthebagisdoingverygood,theotherone
stayswithhimallthetimeand"hesleepswithitandcaresforitlikehiswife"
TCCCSkillsUsed:
SomeIVs,usedallIsraelibandages.BattleofDebaltseveheusedTXAonapatientwithabdandliver
injury,couldnotevachimfor2.5/hrsandcreditstheTXAwithsavingthepatientslife.Patientlater
dischargedfromhospital.
Nofieldintubations.

54thRecon
Battalion,Medic,SectorC
StationednearDerzhynskalmostnoinjuries,onlyusedsurgicalkitforlacerationandsomeIsraelibandages

MartyshchukDmytro,17th
tankbrigade,SectorC
Everything'scalmattheirpositions,hasnotusedthebag,Onlyonecaseoffoodpoisoning,startedIV.

PhotoCredit

SectorB66thMFH
66thMFHattheRailroadHospitalinKrasnoarmiis'k(LevelIII)
BattleofMarinka,June3rd2015
http://www.unian.info/war/1084840battleragesformarinka25ukrainiansoldiersreportedwounded.html
http://www.osce.org/ukrainesmm/162116
HeadofthereanimationunitVasylOstapiuk.
Doingwell.
Equipmentcomingfrombothstateandvolunteers50/50.Portableventilatorfromvolunteers.
Requireadditionalportableventilators.TheyhaveUnivent754andfewothersbutnotenough.Oftenusinga
staticventinavehicle.

TCCC:someIVsbutnowtheydon'tgetpatientsdirectlyfromthefield,butusuallythelocalhospitalswhere
theyhavetheir66thMFHbrigadesassistinglocalstaff(Selidove,Kurakhovo,AvdiivkaHospitalLevelII).
Evacauationtimesfromlocalhospitalusuallylessthan1.5/hr.

66thTraumaBay
PhotoCreditPatrickChellew
66thReceivingareaandstaging

RailroadHospitalSurgicalTheater(66thMFH)

PhotoCredit

SelidoveCivilianHospital(LevelII),ReceivingHospitalforPiskiarea(SectorB)
Conversationwiththeheadnurse:Goingwell.
Equipment:havereceivedalotofaidfromvolunteers:humanitarianaid,twoECGs,functionalbeds,dry
heatsterilizerandtwoelectricscalpelsfromVernyshZhyvym(ReturnAlive)volunteergroup.Couldnot
nameothergroups,butweresayingtheaidwasmostlyfromvolunteers,notNGOsorgovernment.
Alsogoodonmedications.

CouldnotanswerquestionaboutTCCC,werealwaysjumpingtowhattheyaredoingintheirhospital.
Ifreceivingmilitarytraumatakingoutfrags,sometimesdoingoperationsandimmediatelysendingpatients
to66th.Ifcritical,stafffromthe66tharesenttooperate.

SelidoveHospitalStats:
8000peoplereceiveinpatientcare.DuringATOthenumberincreasedby37%comparedtothe
prewarperiod20132014.
Everyfourthhospitalizedpatientisadisplacedperson,military,oranoncombatantresidentfrom
ATO(about28%)
In2015(by01.06)morethan2000displacedpeople,militaryandnoncombatantsseekedmedical
aidinthehospital,amongthem:
about1000military(513inpatientcare,72%operated)
555noncombatantsfromATO
Morethan20000displacedpeopleregisteredinhospitalambulatories.Morethan1900displaced
peoplehadmedicalexamandxray.
ThetotalnumberofdisplacedchildrenwhoseekedaidinMTFsofthecityduringATOis1220,
morethan300wereillandotherwasadmittedforinpatientcare.

Morethan500displacedpregnantwomenandATOresidentsseekedmedicaladvice,365ofthem
wereadmittedintotheCentralCityHospital,320womengavebirth(fromJunetoDec2014202
cases,119in2015).

AvdiivkaHospital,SectorB(LevelII)
Closetothefrontlinesandhasrepeatedlybeen
hi
tbyshelling,
Theyvepreparedplacesinthe
corridorincasetheyareshelledfromDonetsk.Duringshellingstheyoperatewithheadlamps.

PhotoLateJuly,2015
PhotoCredits

MarinkaCivilianHospital

PhotoCredit

MarinkaCivilianHospitalwasbadlydamagedduringtheBattleofMarinka,June3rd,2015.Itwas
shelledagainAug.24,2015sustainingadditionaldamage.
PhotoCredit

ShellingdamagetoKrasnogorovkaHospital,SectorB,Aug24,2015.
PhotoCredit

Piski,SectorB,neartheDonetskAirport,frontlineambulancestagingarea
PhotoCredit

Viktor,anesthesiologistfrom93rd,3rd
battalion.
(nothiminphoto).
24/7ondutyundera"bridge",5mintoanyblockpost.Evacuationto66thMFHinKrasnoarmiysk
3040/mins.EvacuationtoSelidovewhereateamofsurgeonandanesthesiologistareavailable20/mins.
EvacuationfromtheredzoneisdonewithalightarmouredDiscoveryLandRover(fromvolunteers).Atthe
sametimeanambulancecomesoutofPershotravenske,toreconunderthebridge.Theyreloadthe
casualtyandspeedupto130Km/hrtoSelidove.Otherroads(e.g.toTonenke)muchslower.
CriticalpatientsgotoSelidove.Usingcausalitycard,Infoontheinjury,diagnosisetcareeventuallypassed
to66thanddocumentsaresentwiththepatienttoSelidove.
FivemonthsinATO:
KIA:1011
WIA:50(usuallyextremities)
30%moderate,
5%critical.
EverybodygetsIV.
12hadTXAforsuspectedinternalinjury(1g/200ml)
12litresofbloodsubstitutesforcriticalpatients
Severalsubclavians
45intubation


VolunteerCCTambulance,
PrivateMedicalBrigadeRapidResponse(

)inSectorB
PhotoCredit

SectorM61stMFH,NewlocationVolodarske,DonetskOblast

The61stMFH
NewChief
,
TarasDmytrovych
InAugust,2015the61stagainmoved,thistime

from
Kuibysheve
toVolodarske.Theystilldonotreceive
patientsstraightfromthecontactline.TheycontinuetoreinforceVolnovakhaandMariupolhospitalswitha

surgeon,traumatologist,anesthesiologistwherethewoundedaresentfirst.Onlythosenotmedevacoutand
requiringfurthertreatmentcometothe61st.
Theyhaveonevascularsurgeonbasedatthe61st,whogoesouttoVolnovakhaorMariupolandcanbe
thereinabout30/mins.
Problemrequiressectormedicalchief'spermissionforeverything,can'tevenassignasurgeontoMariupol
withouthispermission
TalkedtohisdocinVolnovakhabuthehasnoinfoyet,onlyassignedtothislocationtwoweeksagoand
hasseennoinjuriesasofyet.

The61stwasoncepostedoutsideoftheATOinKuibysheveatthecivilianhospitalandpreviouslystationed
innowoccupiedDonbaswheretheytookpatientsfromTheBattleofIlovaisk,lastsummer,August10,2014
September2,2014.Updateinfofrom
Radainvestigativecommission:About1,000soldierswerekilledin
Ilovaiskbattle.AccordingtoofficialMoDdata,only366troopswerekilled,whileanother429werewounded.
Moredataavailableat:

UNIAN:
http://www.unian.info/war/1115460radainvestigativecommissionabout1000soldierskilled
inilovaiskbattle.html

VolnovakhaCivilianHospital(LevelII),SectorM
Militarydocsfromthe61stMFHareworkinginthelocalhospitalwiththehospitalsequipment.Theyhave
theirownexpendables,whicharemostlyprovidedbyvolunteers.Currently,theyneedcreamsfrom
radiculitis,hemorrhoidalsuppositories,nasalandeardrops,sprays,neurorubine.

TCCC:
tourniquets,bandages,nalbuphine.Haven'tseenanythingelseincludingIVs.
Evac:scheduledasallemergencyconditionsaretreated(orburied)here,onthebaseofCentralRegional
Hospital.TheclosestLevel3hospitalisKuibysheve,the61stMFH,1.5hdrive.Emergency,airevacto
Dniproafterstabilization,20minsdrivetohelicopter,1/hrflight.
Numberofpatients:1020therapeuticpatientsaday,12surgicalaweek(appendicitis,paraproctitisetc),
36injuredaweek,12fracturesaweek.Need:portablecavitaryultrasoundandanesthesiologicaldevice

MariupolEmergencyCareHospital(LevelIII),SectorM
Chiefadministrator,SergiyEvgeniovych:
Receivedsomeaidfromvolunteers,forexampleXray,andTarasDurbakFoundation,butmostlyitwas
"junk".Generallylessaidnow.Needs:angiography,,dryheatsterilizers,ultravioletbo
xesforequipment(for
e.g.Panmed,producedinUkr),steamsterilizers,Xrayfilm(Kodakgreensensitivexray),
electrocoagulationdevice.Lesstraumapatients.Couldnotsaythenumbersandthetimesofevac,theyare
gettingpatientsfromthefield,butthemilitarydonottellthemaboutthetimeofinjury.Wounded
arebrought
bythevariousbattalionsfeldshers.HaveenoughTXAfortwomorewars.Fivedocsfromthe61stondutyin
thehospital.

FieldCare,SectorM
OlexandrFedan,Medic79th
Brigade,SectorM
Onlyminorinjuries:cuts,2nddegreeburns,bruises.

RostyslavPavlenko,Azov
MedicalUnit,SectorM,ShyrokyneJune,2015
Patientwithtraumaticfootamputation.Bandages,fluid,TXA.Usedsoftlittersfromthebag,foundthemvery
usefulbecausetheyaresmallandeasytocarryaround.Nowthelittersaregone.Mostlyfraginjuries.IVs
areveryfrequentandiftherewasnooccasiontodothemforaweekhetakeshisguyssomewhereoutside

topracticeoneachother.FewotherusesofTXA.EachguyhasTXAwiththem,everybodyhastheirfluid
prepared,lineandcathetertapedtoplasticbags.Mostlyusebags,ifrunoutofthemplasticbottles,butfind
theminconvenientwhenridinginavehicleandmayneedtosqueezethebagandholdontosomethingat
thesametime.1intubation,unsuccessfulcode.Headinjuryfromagrenadelauncher,forabout20mins
theyworkonthepatient,butitwasinvain.SeveralNPAs
Noneedledecompressionsnoneedsofar.Butdoestakehisguystopracticeskillsinthemorgue.
Doesnotapplysplints,because"inthehospitaltheywillhavetocutitoff.Sojustfixateit".
EvactimetoEmergencycarehospitalinMariupol40/miniftheycantakethepatientfromthepointofinjury
immediately.1/hwithcertaindelays.

CombatMedicwithmedicbag,contactlineSectorM,Shyrokyne

Andry,Surgeon,
ReconUnit,SectorM
MoDpeopledon'tunderstandwhatIFAKarefor,theyaremakingIFAKswithnotourniquet,noPDneedle
oranyusefulstuffandgivingthoseuselesssocalledIFAKstothesoldiers.Irefusedtotakethem.Two
weeksago(earlyJuly,2015)hadacasewhenheliterallyhadtofightwiththemedicfromRightSectorto
injectthepatientwithTXA(someonetaughttheRSmedicnottoinjectdrugsintothevein).Theinjured
soldierlostaleg,partofabowel,butsurvived.

Ruslan,SokilSF
(MoIA),SectorM
HisguyswereattendingaonedayCLSclassfromRescuerGrouptobringingtheirnewguysuptospeed
onmedical.Noinjuries.SoonwillbetakenoutofATO.

Battlein
Starohnativka,DonetskOblastSectorM.Aug10th,2015P
hotoCredit
6KIA,72WIA,Infofrom
Hospitallers
,RightSectorMedicalGroup.MostoftheWIAAndKIAcamefromthe
72ndMechanizedBrigade.PatientstransportedbygroundtoVolnovakhaCivilianHospitalandthenthe
seriousMedevactoMechnikovainDnipropetrovska.
(Editornote:UkrandRUforcesusethetermCargo
200forKIAandCargo300forWIA)

Aug26,2015.AnotherparticularlynastynightinSectorM,combatoutsideVolnovakha.Fightlastedall
night,6UkrservicemenKIA,over10WIAmanyfromthe93rdBrigade2ndBattaliongrenadiers.TotalKIA
forSectorM:
7KIAofwhich5wereKIAnearProkhorovka,1nearStarohnativka.

Aug27th,2015.Renownneurosurgeon,YuriSkrebets()from
Mechnikova
Hospitalwas
injuredinfightingnearVolnovakhainStarohnativkaworkingasacivilianmedicinthecombatzone.
Transportedandtreatedat
Mechnikovaforthreefraginjuriestotheneck.

ExpeditionaryMedicalSupportSystem(EMEDS)

PhotoCreditPatrickChellew

USAProvides$7.6MillionDollarMilitaryFieldHospitaltoUkraineonAugust18,2015(notdeployed
asofAug24).
TodaytheUnitedStatesofficiallytransferredtotheGovernmentofUkrainea$7.6milliondollar
expeditionarymilitaryfieldhospitaltohelpenhancethecountrysabilitytotreatsoldiersinjuredinongoing
operationstodefendUkrainessovereignterritoryagainstaggressionbyRussianseparatistcombined
forcesineasternUkraine.ColonelCarolNorthrup,DefenseAttachattheU.S.EmbassyinKyiv,presented
thefacilityonbehalfoftheGovernmentoftheUnitedStatesataceremonyinZhytomyr,Ukraine,Colonel
AndriiVerba,DirectoroftheMinistryofDefenseMilitaryMedicalDept,andYaroslavLahuta,Deputy
GovernorofZhytomyrOblast,accepteditonbehalfoftheGovernmentofUkraine.
KnownintheUnitedStatesastheExpeditionaryMedicalSupportSystem(EMEDS),thefieldhospitalisa
light,lean,resuscitativecarefacilitythatcanbeforwarddeployedtoproviderapidmedicalsupportfora
broadrangeofmilitaryoperations.Itcanbeusedtotreatwoundedsoldiers,stabilizepatients,andprepare
casualtiesformedicalevacuationtofacilitiesthatcanprovideahigherlevelofcare,aswellasprovide
primarycare,dentalservices,andforcehealthprotection.
Thefacilityisdesignedtobemannedby30medical/medicalsupportpersonnel.Itcanprovidecareforup
to3,000troops.Itconsistsof4tents,takesabout24hourstoerect,andcanoperateinanaustere
environmentforupto10daysuntilresupply.
TheEMEDsfacilityandassociatedmedicalequipmentandsuppliestransferredtodayarevaluedat
approximately$7.6million.U.S.militarypersonnelaretrainingtheirUkrainiancounterpartsonhowtomake
fulluseofthefacilitythismonth.
http://goo.gl/rnLTcJ


AirEvacuationATO

Noevacuationbyairfromfrontlinepositions,alwaysafterinitialtreatmentatacivilianhospitalorMFH.All
hospitalsonthefrontlinesuchasChasivIar,
AvdiivkaandShchastyaareexcludedfromairevacuationand
patientsarefirstmovetoahospitalawayfromthecontactline.Fixedwingevacuationstillrestrictedto
DnipropetrovskandKharkivairportsalthoughthereareseveralsuitableairportsawayfromthecontactline.
HelicopterflightcrewscomefromDniproand
Kramatorskairports.

SometimesUkraineHelicopters
http://ukrcopter.com/en
isusedbuttherelationshipbetweenMoDandthis
companyisnotclearandtheyareonlyuseintermitantly.Therearepeoplenowlookingintothisrelationship
withtheMoDanditturnsoutthehelicopterareleasedfromtheUkrainiangovernmentandUkrcopterthan
renovatestheMi8foruseintheirservice.TechnicallyUkrcopterMi8isfarsuperiorthananyhelicopter
availablewithintheMoDinventory.

AnothertroublingissuewiththeMi8,someofitspartsaremanufacturedinRussiaincludingtherotor.

UkraineHelicoptersCCTcapablehelicopters.

UkraineMedevachelicoptersarestillnondedicatedanduseforotheroperations.Equipment
consistsofwhatthemedichasprocuredthroughdonations

PhotoCredit

PhotoCredit

Mi8FlightMedicinATO
Tetanya
Equippedprettywell,mostlyduetotheeffortsofpeople,notthestate.Theamountofworkisrather
moderate,butnowtheyalsohavemoreboysinDniproworkingonthemedevacs.Fromtimetotimewe
haveseverecases(AV,unstablehaemodynamicsandsoon)butmostofthemalreadycomefromhospitals.
Wouldlovetoworkclosertothefield,butsofarit'simpossible.Thesystemofcommunicationbetweenus
needstobedestroyedandbuiltupagain.Itwilltaketimeandenthusiasm.Butingeneralwiththebattle
activitylikethiswearedealingwithitnottoopoorly.

Editorsnote:18aircrafthavebeenshotdownduringthewar,10ofthehelicopters,fiveofthemMi8.
http://www.matthewaid.com/post/95467830636/ukrainianairforcehaslost18combataircraftin

PhotoCeloxDamagedExtremity
ReportedcaseofpouringCeloxintoawoundresultinginseveredamagetothenerveandvascularsystems
andtheextremitywaslateramputatedatthe
leftupperlimbneartheshoulder.
Photoconfirmed,storyis:
PackedceloxintothewoundduringtransportationfromArtemivskHospitalto
KharkivMilitaryHospital.Celoxused812hrsafterinitialinjuryandduringtransportwhenthewoundbegan
tobleed.Transporttimeapp:3.54hrs

PhotoCredit

MedicalSuppliesandSupportingOrgs
NongovernmentalmedicalsuppliesforbothmilitaryforcesandcivilianhospitalsintheATOcomeinfroma
varietyofNGOssuchasWHO(Dr.
DoritNitzan
don@euro.who.int
)
andtheInternationalRedCross,ICRC
(CamilloOscarAvogadri
cavogadri@icrc.org
),
DoctorsWithoutBorders/MdecinsSansFrontires
,
civic
organizations,governmentsandsuperbvolunteergroupslikethelocallybased
SupportArmyUkraine
(
)
ukrarmy.org
(whichhasasubgroupthatspecificallyfocusesonhosptailsinthe
ATO),thereisalsoUSAbased,SaveLivesToday
http://www.savelivestogether.org/aboutus/
thatsupplies
medicalequipmenttothearmyandothergroupsuchasUSUkraineFoundation
http://usukraine.org
/and
theLelekaFoundation:
https://www.facebook.com/lelekafoundation
,ComeBackAlive
https://www.facebook.com/backandalive
whoalsodistributesandisattemtpingtoorganizedonationsinthe
ATO.Tensofmillionofdollarworthofmedicalequipmentnowcomesthroughtheseroutes.Thisamount
hasbeenmorethanimpressive,butcoordinationbetweengroupsisalmostnonexistent,withduplication,
unevendistribution,hoardingbysomegroupsandthedevelopmentofparallelsystemsthatcompetewith
thearmedforcesfordonatedsuppliesorfailtoproperlycoordinatetheiractivities.WHOhastakenaleadin
helpingtocoordinatedonationscomingintocountryforcivilianhospitals.Butwhatisrequiredisleadership
andadedicatedPoCfromwithintheMoDandtheMoHformedicaldonationstomilitaryunitsandcivilian

facilitiesintheATOandthebetteruseofsocialmediatohighlightandpromotedonationsbythemilitary.
TheMoDdoescurrentlyhaveasiteinUkrainianwithinfomationaboutdonations:
http://mil.in.ua/

PersonalProtectiveEquipment(PPE)andFortifications

PhotoCredit

PhotoCreditPatrickChellew

Althoughthereisnowaytoquantify,theadditionofmoderncombatPPE(muchofitthroughvolunteer
efforts)andthebuildingoffortificationandtrenches,itcanbeassumedthishashelptolowerthecasualties,
especiallyconsideringsomeofthemostintensedaysofshellingthatEuropehasseensinceWWIIhas
occurredalongthefrontlinesoftheATO.Butequipmentremainsinconsistentandinsomecaseunits
engageincombatnotwearingissuedPPE.

Volunteerprovidersofprehospitalmedicalcareforthemilitary
ThethreemajorcivilianprovidersofprehospitalmedicalcaretothewarfightersintheATOare:
Pirogov

(26.0725.08)711patients,surgical295,Evacuations12ofwhich5senttoLevelIII.
Hospitallers

(OMBR)(OftenprovidesinterfacilitytransportwithCCT)
Therearedozensofsmallergroupssomesupportingtheirhometownbattalionorvolunteergroups.

Recentdonationsuppliedtoafrontlinehospital.Linktophotoandalistofotherrecentequipmentprocured
by

themedicalgroupofSupportArmyUkraine.

MoDMedicalCombatSuppliesIFAK

Manyunitscontinuetohaveminimalkitwhichoftenonly
consistsoftheseSovietstylemodelswitharubbertourniquet
andtwobandagerolls.Thisonebelongstothe25thAirborne
Brigade.PhototakenlateAug.2015.
PhotoCredit

Therubbertourniquetisshippedfromthemanufactureinboxesofonehundred.Inthebox
thetourniquetsarepackinplasticbagstopreventtheoilusedtomaintaintheelasticityof
thebandfromdamagingtheshippingcontainer.Onceinthefielditispopularlywrapped
aroundariflebutt.Howeverthetourniquetonceremovedfromtheoil,rapidlylosesit
elasticityandwilloftensnaponuse
.
PhotoCredit

VintageemergencysovietrussianarmymedicalfieldknifeinUkrainianIFAK
insteadoftraumascissors.

TheNewMoDissuedUkrainianIFAKisanimprovementover
theold,butishighlycontroversialgivenitsuseofeitherthe
rubbertourniquetoracopyoftheCAT,withoneproducedby
AVPharma
http://avpharma.com.ua/
thatreportedlyfailsin
somereportedcas
es(onthefirstuseintrainingsessions)and
nowundergoingimprovementsandtesting.Thekithasno
decompressionneedleorchestsealandcontainsthepopul
ar
semisyntheticopioid,agonistantagon
istanalgesic
,
NalbuphineorsometimesButorphanol,
amorphinantype
syntheticopioi
danalgesic
.
UkrainianIFAK
Contents
Mechanicaldeviceforbleedingcontrol
Chemicalbandageforbleedingcontrol
Analgesicinautoinjector(
NalbuphineorButorphanol)
NPA(currentlynotincluded)
Antibacterialpillsamoxicillinw/clavulanicacid
Deviceforcuttingclothesandboots(currentlyrussianarmy
medicalfieldknife)
Gloves
Bluemarker
Tape
Pouch
Bandaging
PhotoCredit

Therearenowanestimated45000IFAKdistributedbutmanyarenotintheATO.Standardsvaryfromthe
NATOIFAKasseenon
Medsanbatwebpage
totheUkrainianIFAKandmanyvariationsinbetween.
Orderingmedicalsuppliesfromthemilitaryisstillaverycomplicatedandtimeconsumingprocedurethat
musttraversethroughalongchainwhereitcouldberejectedbyanyoneintheloop.Militarymedicsfindit
muchmoresimpler,butnot100%reliable,toreceivesuppliesfromvolunteerorganizationwhichalsohave
itemsnotavailableintheMoDinventorysuchasCATtourniquets.

MentalHealthPTSD
Therearecurrentlynomodernmilitarystandards,manyoftheprovidershavelittleexperiencewithwartime
PTSDandtheirarenooperatingstandardsandlittleinreportingguidelines.Whatisrequired:

InternationalstandardsuchasWHO
http://apps.who.int/iris/bitstream/10665/85119/1/9789241505406_eng.pdf
orNICE(UK)
https://www.nice.org.uk/guidance/cg26
Experienceprovider(nonecurrently,oftenpickbecauseofmentalhealthbackgroundor
willingnesstohelp)
Anewmodernprogramwithdevelopmentstages
Collectionofdata

Goals
Training,especiallyrequiredatthefieldlevelandintheMFH.

MedsanbatTrainingUkraineMilitaryMedicalAcademy

ThediagramaboveisaMedsanbatrenditionofwhatthecycleoftraumaintheUkraineMoDmaywantto
fashionasitrecreatesthesystembasedonbestpractices.Medsanbathasbegunaseriesoftraining
involvingbothMedsanbatinstructorsandinstructorschosenfromtheMoDstafftomovethetrainingaway
fromcivilianinstructorstothemilitary.
TCCCTeachersAcademynowextendedto16days.Fourdayspermodule.Attheendofthe
trainingthe"students"nowmustcompleteanexam.Currentlythereareeightteacherswiththe
Academythatcantrainnewinstructorsandeightwhocandeliverlecturematerial
Medsanbatandtheacademyinstructorshavedevelopedanewtrainingstandard"TCCC
SanitarInstructor(Paramedic)integratedintotheircurrentcurriculum.Themanualisalmostready
forpublicationwithafirstrunof500copies.
ThetrainingteamnowcomprisedofmilitaryandMedsanbatinstructorswillstartanothertrainingfor
100militarydoctorsattheHorodokMilitaryBasenearKyivonJuly28thandanotherAugust17th,
2015.
InOctoberVinnitsaMedicalCollegeinvitesMedsanbattopreparedcollegeinstructorsformilitary
medicineclasses.

Note:InSeptember,threeteachersofAcademygoestoEstoniaforadditionaltrainingattheEstonian
MilitaryAcademyofTartu.

JointTrainingwithMoDandMedsanbatinstructorsofMoDdoctorsinHorodok
TheTeamLeaderfortheacademyis,MichaelBadyuk,headoftheDepartmentofOrganizationofMedical
SupportoftheArmedForces.TheteachersMedsanbathavetrainedandarenowworkingonUkrainian
standardsfortacticalmedicineandinclude:
IrinaSereda
EdwardLevchenko
SofiaRudynskaya
OksanaMikita
AndreiMaksimenko
VladimirFurdik
GudchenkoEkaterina

U.S.Army
paratroopersfromthe173rd,2DBattalion
(Airborne)503D,Infantry(TheRock
)
continuetraining
includingTCCC,evacuationcare,preventative
medicineandmedicalpreplanninginYavorivwiththe
UkrainianNationalGuard.The173rdhavebeenin
UkrainesinceApril,2015andwillexpandtheirtraining
toMoDwarfightersthisFall,2015.
PhotoCredit

Britishmilitarypersonnelhavestartedtraining
membersoftheUkrainianarmyinskillsincluding
tacticalmedicineinthecityofMykolaivandthe
Zhytomyrregion.
PhotoCredit

*Additionaltrainingand/orequipmenthascomefromIsrael,Turkey,Canada,NATO,Estonia,Poland,DanSmileyCal
EMSA,USMilitaryandvariousvolunteerorprofessionalgroupsfromaroundtheworld.

MechnikovCivilianHospital,Dnipropetrovska,LevelIVTraumaCenter

MechnikovHospitalcontinuestobethecenterofexcellence.Asoflate
Augusttheyhavereceivedandtreated1589warfightersfromtheATO.
Theyhavealsocontinuedtoimprovetheircenterwithnewand
sophisticatedequipment,muchofitthroughdonationsfromlocaland
internationalsupport.
PatientsarrivingattheDnipropetrovskaAirport
fromtheATOaretriagedwiththecriticalstransportedtoMechnikovand
minorpatientstoDnipropetrovskaMilitaryHospital.

TheDirectorofthehospital,SergRizhenkoalsomaintainsaFacebook
pagewherethetreatmentandtheactivityofthehospitalcanbefound
inbothEnglishandUkrainian.
https://www.facebook.com/rsa010963?fref=ts

AdditionalinformationonotherATOsupportinghospitalscanbefound
inpreviousreportsorinthe
MedicalSupportforATO
mapbyclicking
thehospitalsicon.
PhotoCredit

Mechnikovoperatingtheaterwithn
eurosurgicalmicroscope

PhotoCredit

ATOAmbulances
AftertheBattleofDebaltsevetherewasandcontinuestobeasurgeofsoftskinambulancearrivingin
country.Distributionandcontrolseemstobechaotic,mostarrivingwithoutequipment,distributiontoa
numberofsourcesandusedforanythingincludinglogisticalsupport.Theworstexampleseenwasan
individualinKramatorskwearingmilitaryfatigueswhoappearedalreadyundertheinfluence,pickingup
alcoholinadonatedambulance.VeryfewarmoredambulancesareavailableintheATO.Additionalinfoon
thedeliveryofambulancestotheATOwillbeincludedinthenextreport.


TCCCmaterialandmedicalpublicationstranslatedintoUkrainian

CurrentlythereareonlythreesourcesavailableforTacticalMedicineandothermedicalliteratureand
publicationstranslatedintoUkrainian:
Medsanbat
http://www.medsanbat.info/materials/page/2/
AmericanUkrainianMedicalFoundation
http://aumf.net/
UkrainianResuscitationCouncil
http://www.urc.org.ua/

Thereisanextremelyhighdemandandconsumptionofthismaterialandadditionalsourcesoffunding
shouldbeexploredandsupportforAUMFtocontinuetotranslateandpublishmanualsuchasthe
EmergencyWarSurgery
nowavailableforfreedownloadofftheirwebsite.The
UkrainianResuscitation
Council
sponsoredthefirstNAEMTcertifiedTCCCcourse,hasthecoursecurriculuminUkrainianbutthe
price(4800/UAH)exceedswhatmostaverageUkrainianscanafford,howeverthepricewasreduced50%
foractivedutymilitarymedics.

Medicaltrainingforthewarfightersandvolunteersfromvolunteerorganizationsandfour
preexistingagencies.
AtthebeginningoftheconflicttherewerenoTCCCprovidersinUkraine.Nowthereareaboutadozenplus
volunteerorganizationsconductingtraininginTCCCandmilitarymedicinewithsomeofthemalsoproviding
equipment.Themainprovidersare:
Medsanbat
TrainingCenter44
WhiteBerets
UkrainianResuscitationCouncil
(providerofACLS/BLSnowalsoNAEMTTCCC)
PatriotDefence
DoctorsforUkraine
MedPatriotUA
TacticalUkraine
(MilitarytacticsandTCCC)
SpecialTrainingCenter
(mostlyCPRandFirstAid,butsomeTCCC)
MalteserreliefserviceinKyiv
(mostlyCPRandFirstAid,butsomeTCCC)
RedCrossUkraine
(mostlyCPRandFirstAid,butsomeTCCC)

Thereisfiercecompetitionbetweensomeoftheorganizationsfordonationandsponsorsoftenresultingin
anantagonisticrelationshipswithlittleornosynergies.Therearealsoindividualsattemptingtotraintheir
militaryunitswithlimitedsuccessandsometimespresentingtheirtrainingasUkrainianTCCCwhichfails
tofollowTCCCstandards.ParamilitarygroupsAzovandRightSectornowalsoprovidesomeTCCCtraining
totheirforces.Thereisareluctancebysomevolunteerstotrainandsupportmilitarytrainersastheycannot
betrustedorwedoitbetter.ThefewinstructorswiththemilitaryfinditalmostimpossibletoreceiveIFAK
fromvolunteergroupstoconducttheirowntrainingwithoutthehelpofciviliantrainersgroups.Insome
casesIFAKaregivenwithnooraslittleastwohoursoftraining.
http://dailysignal.com/2015/05/04/inukrainethetriumphandtragedyofbattlefieldmedicine/

NewstoWatch
MoDhasestablisheda
ReformsCouncil
http://www.mil.gov.ua/ofisreform/

YaroslavLevchenko
(
yalevch@ofisreform.org.ua
),adoctorfrom25thbriagadewhoservedintheATOisoneoftheleadsalong
withJuriyPirusaprojectmanager(
jp@ofisreform.org.ua
)andPavloKaiuk,PhD,DeputyHeadofthe
ReformsCouncil
pk@uapmbc.com
TheprogramissupportedbyDeputyDefenseMinister,YuriGusev.The
intentistotakepeoplefromthebusinesssectorandincorporatethemintotheMoDtobuildandmanage
systemsandbringuptheefficiencyandoperatingstandardsoftheMoDwithmodernbusinessstandards
andtechnology.

ImmediateRisks
Atthedraftingofthisreport,anotherceasefirehasbeenimplementedandappearstobeholding,butfor
howlongitisnotclearandifitdoesholdtheseprogramsintheirinfancyareindangeroflosingthe
momentumnowcurrentlyseen.AllsectorsintheATOcontinuetoshareequalriskofnewadvanceor
incursionbyRussiaandRussianbackedarmedforces.Mariupolisatgreatriskofbeingunderprolonged
siegewithindigenouspopulationthatmaybesplitinloyalty,ormorelikelysusceptibletohybridwarfareand
supportingsubversivegroups.Geographically,riskofnewadvancementandpotentialassetallocationis
nearimpossibleandallareasmustbepreparedforanypotentialpatientsurgeincludingthoseareasnotin
theATObutatrisksuchasmajorurbancentersandterritoryborderingRussia,occupiedCrimea,
TransnistriaandBelarus.

Ofcourse,winteriscloseandwillbringfreezingtemperaturesandprecipitation.Theseandmanyother
exacerbatingfactorswillgreatlyimpactanalreadyweakandtenuousmedicalevacuationchain.Future
deploymentsofpersonnelandmedicalsupportassetsmustbeconsideredaccordingly.Asageneralnote,
surgicalsuppliesthroughouttheATOandatthebarelyfunctioningcivilianmedicalfacilities(oftentimes
jointlyoperatedwithMoHandMoD)arelowinsomeinstancessurgicalsuppliesandsupportare
nonexistentexceptthroughvolunteers.Thecurrentresupplyandprocurementprocessesrelytooheavily
onsupportfromdonorsandvolunteerswhichisinconsistentandsometimeshasduplicationofinadequate
efforts.

TCCCandBloodonthebattlefield
Afollowuptothecomponentofbloodonthebattlefieldfrompreviousreportsisneeded.Inwinter2015,
inconsistentaccesstobloodandbloodproductsacrossMFHsdeployedandothersurgicalsupportcenters.
TheDnipropetrovskMechnikovfacilityconsistentlyleadingonmedicalbestpracticesupportingthetheater
ofoperationsofferedbloodandbloodproductstointernationalstandards.However,duetologistical

concernsandcapability,downrangebloodandbloodproductsisnotreadilyavailable.Avolunteer
hematologistreportsfromthefieldthatnobloodisgivenattheMFHsasofApril2015,butisnowgivenat
theMFHinArtemivskandtheRailroadHospitalinKrasnoarmiysk.

AsweknowfromtheTCCCguidelineswhenbloodandbloodproductsarenotavailableHextend,Lactated
RingersorPlasmaLyteAareusedforfluidresuscitationtheseareNOTreadilyavailableatsurgical
supportcentersandsomeMFHs(NaCl0.9%onlyinmanylocations,notalltemperaturecontrolled).With
this,asnotedintheTCCCguidelines,theresuscitationfluidsofchoiceforcasualtiesinhemorrhagicshock,
listedfrommosttoleastpreferred,are:wholebloodplasma,RBCsandplateletsin1:1:1ratioplasmaand
RBCsin1:1ratioplasmaorRBCsaloneHextendandcrystalloid(LactatedRingersorPlasmaLyteA)
(TCCCGuidelines2014).AttheMFHstheseresuscitationcriteriaarenotbeingcarriedoutasofApril2015
duetonoaccesstobloodandbloodproductsofferedinthefieldandonlyincentralhospitalsandcenters.A
thoroughbloodandbloodproductfeasibilityassessmentatMFHsdeployedandinpreparationtodeploy
mayshedlightonthegapsandoperationconcernstomaximizebloodandbloodproductbenefittothe
injuredwarfighter.

SpecificDisease
Ukrainehasneverbeenahotbedofinfectiousdisease.However,twocasesofpoliowereisolatedand
confirmedinUkraine.1Thisisduetoa50%coveragewiththepoliovaccine.TheseratesaresimilartoSyria
in2012wherepolioalsomadeacomeback.Weanticipatethesenumberstogrowexponentiallyiflessis
doneonapublichealthandpublichealthinfrastructurefrontattheMoHwithsupportoftheMoDinhardto
reachareasintheEast.ThesecaseswereconfirmedintheWestofthecountry,possiblypatientsthatwere
displacedfromtheEast.

Healthcareinfrastructurearealsoburdenedfromtheexplodingsilentbombofnoncommunicabledisease
(NCD)andfoodpoisoningthenumberoneissuenowseenatmanyATOhospitals.Asmentionedmany
timesinpastreports,whethertheviolenceandwarfightingactivityebborflow,themostcommonrequestto
MoDmedicsandnursesfromdisplacedpeoplesareforNCDsprescriptionmedicationslongrunout(i.e.
hypertension,cardiovascular,diabetesetc).IfandwhenthispresentinUkrainefindspeaceorstaysalong
frozenconflict,NCDswillbeamajorhealthcareburdenforthepopulation.

Conclusions
BasedonrecentexperienceintheATO/contactlineregionsandthroughthedatareviewed,thebattlefield
medicalstandardsinUkraineforwarfightershasincreasedinstandard,availabilityandsupplyline
considerablysincemid2014.Muchhasbeendone,agroundswellofsupporthasofferedlifesavingtraining,
equipment,MFHsandnewthinkingforUkraine.However,muchmoreremainstobedoneandbattlefield
medicalcareinUkraineisstillinitsinfancy.Preventionisthebestmedicineandstateinstitutionalcapacity,
accountabilityandtransparencywillleadtobestoutcomes.

TheneedforcontinuedinternalpressureoncentralinstitutionssuchastheMinistryofDefence,Ministryof
HealthandMInistryofInteriortocontinuetransitionintomoderncapacityandstandardarerequired.With
this,volunteersandvolunteerphilanthropicinstitutions,alongwithrelativelyrecentlystartedlocalNGOs
needtostepupandlendtheirexpertisetorebuildtheseinstitutionsandforegotheirowndevelopmentof
parallelandduplicatesystemsandallowforthesestateinstitutionstoeventuallymanageandlead.Itshould
1

http://www.independent.co.uk/news/world/europe/polioinukrainetwochildrenparalysedasfirstcasesofvi
rusineuropesince2010recorded10483388.html

benotedthatstateinstitutionsintheATOhaveproventheirabilitytoadaptandberesilientinthefaceof
shocksandadversitythepaceinKyivcontinuestobeslow,cumbersomeandattimeslargelyineffective
andisoftenonlymovedbythepressureexertedbyvolunteersandtheirsupportorganizations.

Indeed,keyleadershipforbattlefieldhealthandmedicalpracticewillresideonlywithinstateagency,not
privateorhumanitarianorganizationswithoutpublicmandate.Indeed,privateenterpriseandhumanitarian
organizationshaveagendasandmaynothavethestate'sbestinterestwithintheiroperation.Sourcesof
fundingwithsuchagencycanbequestionable,thebackingoffringegroupsisnottransparentandaconflict
ofinterestmayberife.

Withthisabovementionedadvancementsinstateinstitutionsandtheircapacity,thefragilestateofUkraine
willbecomemorestableonthestabilityspectrumonlythroughallowingthesestateinstitutionstolead,to
organizeandcoordinateandtopracticeevidencebasedpractices.Thiscanbeenhancedthroughthe
support,guidanceandmaterialsupportofferedthroughNATOandNATOmemberstates.WithPresident
PoroshenkodeclaringthenewUkraineMilitaryDoctrineisbasedonthedurationofthreatfromRussiaand
demandsfullcompatibilityoftheArmedForceswithNATOstandards,thereisaclearmandatetomove
forwardandbringtheUkrainearmedforcesmedicalsystemuptointernationalstandards.Thisreport
focusesonhealthcareandbattlefieldmedicalsupport,buttherearemanyotherstreamssuchasstate
capacity,ruleoflaw,democracypromotion,civicactionandothersthatwillalsoincreasestabilityforthe
EuropeannationofUkraine.TransparencyofstateinstitutionsandapolicyofpreventionmayleadUkraine
intoamoreindependentandstablenationalstate.Keyrecommendationsbasedonthemedicalandclinical
evidencereviewedarefoundindetailbelowwithsimpleexplanationandreview.

KeyRecommendations:

1) ContinuedsupportandcrosstrainingandinteragencycollaborationofTCCC
andd
evelopingRole1&2Capabilities
acrossallbranchesofserviceand
echelons(enlistedpersonnelandcommissionedofficers).TheUnitedStates
holdsthemedicalandclinicalstandardforallthingsTCCC
.Thisconflictis
different.ResearchinTCCCideology,equipmentandalgorithmsmustbetestedacross
conflicts.Thesetraininginitiativesareagreatwaytosavelife,astheyareagreatwayto
sharebestoutcomes,investigateandresearchnewmethodsthatmayprovide
evidencedbasedpractice.TheneedforaTCCCreviewboardbasedonNATOandUS
MilinUkraineisneeded2 .
a) Prosthesisandrehabilitationsupportandcoordination
i)
thiswasaprogramUSMilhadanditprocessisongoing

2) RotaryandFixedwingmedicalevacuationsupport
:NATOandNATOaligned
countrysupportforthefurtherdevelopment,advancementandstandardizationoffixed
wingandrotarywingedmedicalevacuation.MuchhasbeendoneinUkraineforthese
2

MinistryofHealthandtheCabinetofHigherEducationapprovedtheadditionofanewcourseof
emergencymedicineincludingcomponentsofTacticalMedicine(TCCC):
http://www.medsanbat.info/domedichnadopomogavekstremalnihsituatsiyahnavchalnaprogramadlyastu
dentivmedikiv/

supportefforts,however,thislinkintheevacuationchainisstillveryweak.The
considerationofofferingassetsandtrainingformedicalevacuationshouldbeadvanced
andenlarged..

3) Groundevacuationandpreplanningsupport.
Theevacuationchainontheground
isanotherdeservingcontinuedsupport.TheUS173rdAirbornetraininginYavorivhas
startedtoaddressthisissueintheirtrainingwiththeUkrainianNationalGuardandisto
beaddresswithfuturetrainingswiththeunitsfromtheMoD.Preplanningisvirtually
nonexistentatthefieldlevelandplanningathigherlevelsisquestionablycomplicated
or
notinclusivewithsupportingservicesandmaynotalwayslookatthebigpicture.Criticalcare
transportisoftendonebyvolunteersandwhendonebyMoDassetstheequipmentisoftenoldor
nonexistentormustbeborrowedfromanexistingMFHcachedepletingalifesavingresource
potentiallyrequiredforthenextcriticalcasualty.Medicaltreatmentduringevacuationfromthe
frontlineistoooftensolvedwithspeedandwithnoevacuationpreplanningdonepriortoan

emergency.Thelackofpreplanninghasquestionablyresultedinthedeathsandinjury
ofmanycivilianvolunteermedics.

4) MedicalStandardizationPromotion
:thecrosslinking,promotionandfacilitationof
internationalrecognizedmedicalcertificateandlicensurecoursefordoctors,nursesand
physicianextenders.Thisshouldincludeandisnotlimitedto:
a) AdvancedCardiacLIfeSupport(ACLS)
b) AdvancedTraumaLIfeSupport(ATLS)
i)
InternationalTraumaLifeSupport(ITLS)
c) ExtendedFocusedAssessmentwithSonographyinTrauma(eFAST)
d) AdvancedMentalHealthCourseforwarfightersandbattlefieldexposure
e) introductionandpromotionofWHOrelatedmedicalpracticestandards,USAMA
andUKbasedNICEguidelinesforsurgery,internalmedicineandanesthesia(to
expeloldSovieteramedicalpractice).UkraineisaEuropeancountryandits
futurewillbeahybridofEuropeanandotheradvancedresourcerichcountry
medicalpractices.

5) FitforpurposeRoleIIImobilehospital(i.e.CaliforniaDMAT)forimmediate
deployment.
TherehasbeensignificantpushbackfromtheUkraineMoDtoreceivethis
facility,tofacilitatetrainingofstaffandoperateduetoquestionoffundingfor
maintenanceandtofullyutilizesuchalargefacility.Theneedforsuchacomprehensive
facilityisgreatlyrequiredinthistheaterofoperations.Therearemorethantwenty
civilianhospitalsspreadacross600/kmofthecontactline,plushelicopterlandingfields
andairportsthatlacktheequipmentandfacilitiestomanagepatientsastheyare
evacuatedupthechain.Allciviliansandcombatantspatientsareseeninthesecivilian
hospitalsandtheMFHsthatexistinstaticpreexistingMoHfacilitiesandeveninthe
backoftrucksandoftenbycivilianvolunteersmanywithlittlemilitarytraining.Landing
fieldsandairportslacktheequipmentandsheltertohousepatientwaitingforair
evacuation.ThecivilianhospitalsdoreceivesupportfromMoDmedicalstaffbutthey

arrivewithlittleoftheequipmentrequiredtodotheirjobandrelyontheexisting
equipmentavailablewhichisoftenoldorfailstomeettheneedsofgoodbattlefield
medicineandtoooftenrelayonvolunteersforsupportandadditionalequipment.Dueto
thenatureofcurrentRussiaandRussianbackedinsurgentactivity,thesestaticunits
maynotbeneitherUkraineMoHorMoDcontrolledinkeyregionsandatanytimeaccess
fortheentireatriskpopulationcouldbebarred.Theneedfordefinitiveindependentand
standalonesurgicalandoutpatientcapabilityisstillrequiredwithresponsivelogistical
support.Duetothetimelagandscheduleofdeployingsuchafacility,thetimetoactis
nowifitistobeavailableforwinter2016.Bloodandbloodproductsupportmaybea
majorfactorwiththistrainingandguidance.
6) ExpeditionaryMedicalSupportSystem(EMEDS)Training
Asuccessstorythat
continuestogrowastheATOcommunitylearnsaboutthetrainingandfacility.The
socialmediaresponsetothetrainingandtheadditionofthisassethasbeen
extraordinary.Questionscontinuetocomeinaboutthefacility,thepossibilityof
additionalMFHandhowonemayarrangeattendanceinfuturetrainings.Astimegoes
onColonelHartzellandhisteamwillbepleasantlysurprisedastothepopularityoftheir
Role1&2capacitybuildingtrainingandthequalityofthestudentsinattendance.The
enthusiasmandattendanceforthistrainingisonlylimitedbythelackofcommunications
withintheMoDandtheinabilitytoopenattendancetomembersofallarmedforceand
branchesandotherrelevantgovernmentalagencies.
7) LegalReform
:thepromotionoflegalreformtoapproveandenhancethemedical
licensureprocessformedicalpractitionersfromthemilitaryandciviliansectorstosecure
interoperabilityinwartimeandinpeace.
a) EmergencyMedicalTechnician(EMT)certificationtobestandardizedacrossthe
militaryandciviliansector.theguaranteeofmilitarytrainedandcertifiedmedical
practitionersmustbetransferabletothecivilianworld
b) SynchronizationwithMoD,MoHandMoIoperationalrequirementsandlegal
reformwiththelegalframeworkofEU,ECandNATOandjurisdiction
c) ContinuedsupportwithMedicalDoctrineenforcement

8) LiaisonandencouragementinTCCCledElectronicMedicalRecord(EMRs)
from
USMilltoMoD/MoH.TCCCledsoftwareforpatientcareintheformofEMRsthatare
usedinMoDandtheMoHoperationalarenas.

9) FinanceandFunding
:allocationofspecificresourceandfundingtosecurethegains
madethusfarandadvancefurtherTCCCandbattlefieldbestpracticesarerequired.
Specifically:
a) TCCCtranslations,trainingmaterials(mannequins,tourniquets,trainingpressure
/israelibandages,evacuationcarematerials(SKEDCO,TALONetc)and
airway/tensionpneumothoraxequipment.

b) Focusedfundingtospecificunits,organizationsandMoD,theUkraineMilitary
MedicalAcademy,medicalcollegesanduniversities,MoHandMoIdepartments
withconcretemetricsofsuccessandwaypointsforfurtherfunding.
c) EnsuringandencouragingtransparencyofallfundingandinstitutionstoEUand
NATOstandards.

10) ReformsCouncil
,aprojectofDeputyDefenseMinister,YuriGusev,isastepinthe
rightdirection.
Projectmanagement
isthedisciplineofcarefullyprojectingorplanning,
organizing,motivatingandcontrollingresourcestoachievespecificgoalsandmeet
specificsuccesscriteriaandisexactlyrequiredtopulltheMoDoutofitssovietstyle
mentalityandineffectiveorganizationthatdependsononeindividualatthetoptomake
alldecisions.

11) Paramedicine,
mustbeinstitutionalizedwithintheMoD,MoIA,BorderGuards,MoH
andcivilianstructuresliketheUkrainianRedCrossandvolunteerorganizations.This
canonlybeproperlycompletedwiththedirectsupportoftheMoH,teachingandtraining
institutionsandimmediatelegislationtolegalizeaprocessalreadypracticedwithout
formalguidelinestoprotectthepatientsandhealthcareproviders.
FromabroaderSYSTEMSperspectiveanapproachthatisconsistentwithEMS
planningtoincludethefollowing8elements:
SystemOrganization,Management,andMedicalDirection
ManpowerandTraining
Communications
ResponseandTransport
HospitalsandCriticalCareCenters(Ietrauma,STEMI,Stroke)
Datacollection,evaluationandQuality
PublicInformationandEducation
DisasterMedicalResponse

TheBIGlistcanbeveryoverwhelming,thislistisnotexhaustive.Soaprioritizedlistwith
concreteactivitiesiseasiertostartandidentifysolutions.Medsanbathavespentmuch
timewiththisandhaveoutlineswhatfurtherneedstobedonefortheMoDandMoHto
jointheseactionstogether.AllcompletedwithaphilosophicalEMSsystemsplanning
component,prioritizingthelist,andthenstarttodevelopmeasurableobjectivestobegin
achievement.

12) MedicalSupportEquipment
:
a) ArmoredHumveesforCASEVACtheassetsprovidedaregreatandaforce
multiplier,thiscanbeduplicatedbutwithtraining.
b) Armoredtrackandnontrackvehicles(MRAPs)(40)foruseofmedicalsupport
operationstoimprovesurvivabilityonthebattlefield.
c) Medevacupgradesinbothrotarywingandgroundtransportwithcorresponding
training.

d) Advancedmedicalcommunicationssuite(land,airandsea)multipleunits.The
communicationthroughouttheATOhasimprovedbutthesimplecell/mobile
phonesremainsakeycommunicationtoolandamajorbarriertomedicalsupport
operation.
e) GabionHescobarriers(90,000squaremeters)thereareHESCOSand
makeshiftHESCOSinusethroughouttheATO,supportwiththisimproves
survivabilityofwarfightersandthecivilianpopulationintimesofmajorassault.
f) AdditionalnonlethalassistancehasalreadycomefromNATOandotherNATO
alignedcountriesandhasbeenmetwithgreatsuccess.Forthesakeofthis
reportnocommissionordescriptionofanynonlethalassetsarereviewed,
however,allsupportofferedtodatethathasbeendeployed,hasofferedmajor
advancementfordefencecapability.Considerationofadditionalnonlethal
assistanceshouldinclude:
i)
Morecounterbatteryradarsystems
ii)
Moreunmannedaerialvehicles(UAVs)
iii)
MoreelectroniccountermeasuresforuseagainstopposingUAVs

DisclaimerandConflictsofInterest
Theauthorsofthisreporthavenoconflictsofinterest.MedicChellewismedical
consultantforMedsanbatandDr.QuinnitsMedicalDirector.Thesereporteddataare
basedonmultipleATOvisitsandreportsfromcolleaguesinthefield.Theauthors
commentsandopinionsareentirelyoftheirownanddonotreflecttheviewsof
Medsanbat,anydonororpartnerorganization,theUSgovernment,anyofitsaffiliations
ordepartmentsoranyassociatedpolicywithinanygovernmentofanykind.The
authorsopinionsareentirelytheirownanddonotreflectofficialorunofficialpolicyor
opinionofMedsanabtorthatofitsguarantors.

ENDQUALITATIVEREPORT

Addendum:InformationischangingrapidlyasTCCCisembracedthroughoutUkraine.

Therewillnowbefivetrainingcentresformobilizedsoldierswhichwillincludeintheirprogramavariant*of
TCCC
*AmajorissuetoenabletheMoDtoadheretoTCCCislegislationandfinance.

179thPoltava
169thDesna
184thStarychi(Lvivregion)
240thZhytomyr

JointtrainingcenteroftheAirForceinVasylkiv(Kyivregion)nonumber
MoDiscreatingatrainingunitofmilitarymedicsinthe169thcenterinDesna.
MoDpreparedanoutlineforservicemenaboutmedicalaidprovision.
and"StandardofSanInstructorTraining"
78saninstructorstogothroughthreemonthsoftrainingthatwill"meetNATO"standardsand
thenbegintrainingMoDforces.

Alsopreparedandpublished"Standardoftacticalmedicinemilitarypersonneltraining"and
"Standardofsaninstructortraining"(Thiswasmentionedinreport,linkbelow)

AddedthelinktothenewMoDtrainingmanual(mentionedinreport)"StandardpreparationofICT3
(Edition2)Preparationofasoldier
tacticalmedicine"(NotavailableinEnglish).
http://www.medsanbat.info/download/%D0%A1%D1%82%D0%B0%D0%BD%D0%B4%D0%B0%D1%80%
D1%82%20%D0%BF%D1%96%D0%B4%D0%B3%D0%BE%D1%82%D0%BE%D0%B2%D0%BA%D0%B
8%20%D0%B2%D1%96%D0%B9%D1%81%D1%8C%D0%BA%D0%BE%D0%B2%D0%BE%D1%81%D0
%BB%D1%83%D0%B6%D0%B1%D0%BE%D0%B2%D1%86%D1%8F.pdf
http://www.5.ua/suspilstvo/UnavchalnomutsentriSukhoputnykhviiskhotuvatymutsaninstruktoriv92708.ht
ml

32doctornursebrigadeswerecreatedaswellashospitalreinforcementteamsandmobilemedicalsupply
teams.

MapsandDataLinks

MedicalSupportforATO

SituationMapATO

DailyNumbersfortheATO

ActioninATO
fromSocialMediapost
s

GraphCredit

MapCredit

MODcasualtynumberswhichdonotincludevolunteerssuchasvolunteermedics.

ReferenceMaterial
LinktoMedicalATOMap
(requirespermissionfromPatrickChellewtoaccess)

SituationMapAug16,2015.Latestmapcanbefound:
http://mediarnbo.org/?lang=en


AlldatainthetableaboveonlyuseofficialnumbersfromATOPressCenterreportspublishedbymedia
centerofNationalSecurityandDefenseCouncilofUkraineat
http://mediarnbo.org
AsofAug24th,2015
closeto
2,100UkrainianwarriorsKIA,7,320WIA.AsofSept7th7,962peoplehavebeenkilledand17,811
woundedintheconflictinUkraine,accordingtotheUnitedNations,with1.5millionpeopleinternally
displaced.ManyorganizationsincludingtheUNbelievethesenumbersareconservativewiththeGerman
Intelligenceagencyputtingthenumberashighas50,000.TheGermanFAZ(FrankfurterAllgemeine
Zeitung)reportthat,the"BND"calculatesthatupto50,000Ukrainesoldiersandciviliansdiedinthe
Donbass.
http://www.liveleak.com/view?i=155_1423400634#TlG8VC6L9WqZO7wj.99

InfographicsUAputstheUkrainianwarfighterdeathtollat1610asofSept7,2015.Datawascollectedfrom
multiplesources,includesvolunteersandthegraphshowstheregionstheycomefrom.

http://i.piccy.info/i9/b75ac3094899797a818f40f390445907/1441556995/303461/809276/casualties_06_09_2
015_eng.png

AMoscownewspaperreportedthatRussiahadlostnofewerthan2,000deadinthefightinginUkraine
andanother3,200seriouscasualtiesbyFebruary1,2015,astorythatstayedupuntilKremlincensors
removedthoselinesfromthearticlelestitcallintoquestionVladimirPutinsconstantrefrainthatthereare
noRussiansoldiersfightinginUkraine.Therehasbeennootherdataavailablesincethenandthisdatais
alsocontroversial.

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http://liveuamap.com/en/
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andPatrickChellew

SnapshotAssessmentATOTacticalFieldCareandBattlefieldEvacuation,
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ChellewandJohnQuinn

UkraineWarfightingactivity:epidemiologicalsnapshotassessment,March2015,Medsanbat:Patrick
ChellewandJohnQuinn

UkraineWarfightingactivity:Epidemiologicalsnapshotassessment,April2015,Medsanbat:PatrickChellew
andJohnQuinn

SummerATO:TacticalFieldCareandBattlefieldEvacuation,Sept2015,Medsanbat:PatrickChellewand
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NewsArticle,TCCCStandardsforUkraine:
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Triumphandtragedyofbattlefieldmedicine
http://dailysignal.com/2015/05/04/inukrainethetriumphandtragedyofbattlefieldmedicine/

Nalbuphine
https://en.wikipedia.org/wiki/Nalbuphine

Butorphanol
https://en.wikipedia.org/wiki/Butorphanol

Cargo200=KIA/Cargo300=WIA
https://en.wikipedia.org/wiki/Cargo_200_(code_name)

ColVerba,
MedicalDirectoroftheUkraineDepartmentofDefense:Firstaidkitsareonlyhalfofmilitary

http://life.pravda.com.ua/person/2015/08/14/198596/

MedicalBattalion"Hospitallers"foreachlife(video)
http://www.radiosvoboda.org/media/video/27208690.html

BattleofMarinka

https://en.wikipedia.org/wiki/Battle_of_Marinka

Problemsinthe25thAirborneBrigadewithuniformsandtheissuanceoffirstaidkits,YuliaSzeged.
http://censor.net.ua/photo_news/349286/problemy_v_25oyi_vozdushnodesantnoyi_brigade_s_zamenoyi_for
my_iz_tkani_2701_i_vydacheyi_aptechek_yuliya

BattleofMarinka,June3rd2015
http://www.unian.info/war/1084840battleragesformarinka25ukrainiansoldiersreportedwounded.html
http://www.osce.org/ukrainesmm/162116

ATOHeadquarters:Ukrainiantroopsin"M"sectorsufferseriouslosses,UNIAN08/27/15:
http://www.unian.info/war/1115859atoheadquartersukrainiantroopsinmsectorsufferseriouslosses.html
ComeBackAlive,FBpostingontheneedforbetterorganizationanddistributionofmedicalsuppliesinthe
ATO.
https://www.facebook.com/backandalive/posts/529696653854443

TheBattleofIlovaisk.
August10,2014September2,2014
https://en.wikipedia.org/wiki/Battle_of_Ilovaisk

TheBattleofIlovaisk:ATurningPointinRussiasWaronUkraine.TheInterpreter.
http://www.interpretermag.com/thebattleofilovaiskaturningpointinrussiaswaronukraine/

ListoftheKnownDeadfromTheBattleofIlovaisk(ReferedtoastheIlovaiskKettle)
http://dnpr.com.ua/content/familiigeroevpogibshihvilovayskomkotlepolnyyspisok

VsevolodSteblyuk

MYTHSANDREALITIESOFMILITARYMEDICINE(Ukraine)
http://censor.net.ua/resonance/349347/mfi_ta_real_vyiskovo_meditsini

TacticalKitsforTacticalMedicineRecommendationsforcombatmedicbagsandIFAK.Medsanbat.
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akticheskieryukzakiukladkidlyavoennyihvrachey/

AircraftshotdownduringthewarinUkraine.NotincludingthecivilianflightMH17,
Malaysianairlinerin
DonetskOblastonJuly17killingall298peopleonboard,including80children.
http://www.matthewaid.com/post/95467830636/ukrainianairforcehaslost18combataircraftin

StatesponsoredmedicineintheATOshamefulBohomolets
http://www.radiosvoboda.org/content/article/27210672.html

Separatists muffle Ukrainian army's communications

http://www.stripes.com/news/europe/separatists-muffle-ukrainian-army-s-communications-1.365591

PetroVyshyvanetscontradictsDefenseMinistrywhoaskvolunteersnottobuymedicalequipmentforATO
inhisFacebookpost:

https://www.facebook.com/Petro.Vyshyvanets/posts/1636132493335664
fakty.ictv.ua(Video)
Woundedin
Shyrokyne,trappedforfivehours,selfaidtourniquetsavehislife
SergRizhenko,Director
MechnikovHospital
http://www.hromadske.tv/society/poraneniiushirokinomuboyetsvryatuvavsobizhit/

CatherineDorokhin,volunteerTCCCtrainercomplainingaboutthequalityandavailabilityofmedical
suppliesfromtheMoDtotheATO.Sept1,2015
https://www.facebook.com/catscup/posts/883798041695682

UKRAINEREPORTSTWOCASESOFPOLIO,FIRSTOUTBREAKOFTHEDISEASEINEUROPESINCE
2010WORLDHEALTHORGANIZATION//Reuters
https://twitter.com/flashnord/status/639063605552529408

President Poroshenko: New Military Doctrine is based on the duration of threat from Russia and demands
full compatibility of the Armed Forces with NATO standards
http://www.president.gov.ua/en/news/novavoyennadoktrinavihoditztrivalostizagrozizbokuro35907

MinistryofHealthandtheCabinetofHigherEducationapprovedtheadditionofanewcourseofemergency
medicineincludingcomponentsofTacticalMedicine(TCCC)
http://www.medsanbat.info/domedichnadopomogavekstremalnihsituatsiyahnavchalnaprogramadlyastu
dentivmedikiv/

TestingofaUkrainiantourniquetproducedbyAVPharma
http://avpharma.com.ua/
https://www.facebook.com/photo.php?fbid=1614266135464993&set=pcb.1614266335464973&type=1&thea
ter

PutinwonhiswarinUkraine
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395_story.html

UkrainianmilitarydoctorsundergotraininginIsrael
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WinterOnFire:Ukraine'sFightforFreedomTrailerANetflixDocumentary
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CallmeDoc
.VideobyUkraineTodayTV:
https://youtu.be/6RMl648h2lU
Interviewswithfrontlinemedics
andsomeclipsoffieldcare/fighting.