Prehospital Lessons From the War in Ukraine: Damage Control Resuscitation and Surgery Experiences From Point of Injury to Role 2

Abstract

The ongoing war in Ukraine presents unique challenges to prehospital medical care for wounded combatants and civilians. The purpose of this article is to identify, describe, and address gaps in prehospital care, casualty evacuation, and medical evacuation throughout Ukraine to share lessons for other providers. Observations and experiences of medical personnel were collected and analyzed, focusing on pain management, antibiotic use, patient assessment, mass casualty triage, blood loss, hypothermia, transport immobilization, and clinical governance. Gaps identified include limited access to pain management, lack of antibiotic guidance, inadequate patient assessment and triage, access to damage control resuscitation and blood, challenged transport immobilization practices, and challenges with clinical governance for both local and foreign providers. Improved prehospital care and casualty and medical evacuation in Ukraine are required, through increased use of empiric pain management, focused antibiotic guidance, enhanced patient assessment and triage in the form of training, access to prehospital blood, and better transport immobilization practices. A robust and active lessons learned program, trauma data capture, and quality improvement process is needed to reduce preventable morbidity and mortality in the war zone. The recommendations presented in this article serve as a starting point for improvements in prehospital care in Ukraine with potential to change prehospital training for the NATO alliance and other organizations operating in similar areas of conflict. Graphical Abstract

Dried Plasma for Major Trauma: Past, Present, and Future

“…Large casualties, as seen in the current Ukraine war [163], and as expected in future conflicts when air superiority will not be assured, or during operations in remote, extreme, and austere environments [164], will prohibit immediate evacuation. Therefore, there is a need for blood products, like dried plasma, that can be easily scaled on demand, and exhibit long-term storage with limited-to-no cold chain requirements [165].…”

Pulmonary Embolism of the Small Branches of the Pulmonary Artery as a Result of Combat Trauma: Review of the Literature and Analysis of a Clinical Case

“…Війна, яка триває в Україні, створює надзвичайні виклики догоспітальній медичній допомозі пораненим учасникам бойових дій та цивільним особам. Наразі більшість зусиль спрямована на виявлення та усунення прогалин у догоспітальній допомозі, евакуації поранених та медичній евакуації по всій Україні [3]. Створений унікальний алгоритм медичного сортування великої кількості поранених, надання допомоги при крововтраті, гіпотермії, проведення транспортної іммобілізації та знеболювання.…”