March 2024 | Global Response Medicine

February 24th marks the second anniversary of the invasion of Ukraine. GRM has been there for 722 of those days.

Responding to an urgent request by the Ukrainian government, GRM is supporting three cohorts of medical teams from the Military Medical Academy, Border GuardsUkraine and National Guards Ukraine, who are tasked with the care of war wounded patients at forward resuscitation facilities and serve as the lead medical trainers for their respective organizations.

During the program, these 15 medical professionals will explore best practice techniques, both in Europe and in the US, for managing complex traumatic injuries, including resource management, team management, and field diagnostics.

The program is tailored to the specific needs and requests of each organization.

Program Objectives

Explore best practice techniques for war-related injuries at leading international medical facilities
Implement the new skills and concepts learned, considering the local context
Help cohorts prepare to share their new kills and knowledge acquired during rotations by implementing TTT (Train-the-Trainer) modules
Learn the most efficient and up-to-date techniques and approaches in trauma management
Knowledge-exchange and immersion with foreign colleagues
Understand how a system of team trauma management works in other environments

Program Schedule

The training cycle as five rotations:

Rotation #1 took place in Ukraine in January 2024 and focused on Advanced Surgical Skills for Exposure to Trauma (ASSET).
Rotations #2-4 will be held in US and NATO facilities from March – June 2024.
Rotation #5 will take place in Ukraine and will focus on applying the new approaches, skills, and knowledge to the local context, ensuring we cover and gap in needs.

Curriculum

While the curriculum will be customized to the physicians’ needs, the following core topics will be covered:

Resuscitation
Trauma surgery
Field surgery
Mass casualty management
Amputation
Burn care

Rotations take place at leading institutions in Chicago, North Carolina, Philadelphia, Amsterdam, Kyiv, Budapest, and beyond.

Program Costs

With travel, equipment, and coordination, the cost of the program is $16,500 for each physician for a total of $247,500 for direct costs.

Expected Results

Save lives. Period.

Increased trauma skills for for front line medical professionals immediately means that more lives will be saved and less people will suffer life-altering injuries.

15 medical specialists will be trained on best practice techniques for complex injury management.

New knowledge and immersion at leading international centers working with military trauma.

Save more lives through capacity building.

The graduates will be prepared to work in a TTT format to share their new knowledge with the next cohort of Ukrainian medical professionals.

Increased knowledge in quantity & quality – the graduates will share their knowledge and provide training to future cohorts.

Establish partnerships with international medical institutions fostering multi-lateral relationships.

Contributing to the evolution of front line medical protocols.

“We need to make sure they don’t die, and reach the next point of evacuation.” – Oleksii, Physician

Why Not Both? Revisiting Tourniquet Practices Based on Lessons Learned From the War in Ukraine

Published in the Journal of Special Operations Medicine Spring (2024, Volume 24, Edition 1).

Full publication: Life Over Limb Publication_JSOM.

Abstract below

Jessica L. Patterson, MD; Robert T. Bryan, DO; Michael Turconi, BSc; Andrea Leiner, APRN FNP-BC; Timothy P. Plackett, DO, MPH; Lori L. Rhodes, MD; Luke Sciulli, NRP, ATP; Stephen Donnelly, MD; Christopher W. Reynolds, MS; Joseph Leanza, MD, MPH; Andrew D. Fisher, MD, MPAS; Taras Kushnir, MD, MPA; Valerii Artemenko, MD; Kevin R. Ward, MD;
John B. Holcomb, MD; Florian F. Schmitzberger, MD, MS

ABSTRACT
The use of tourniquets for life-threatening limb hemorrhage is standard of care in military and civilian medicine. The United States (U.S.) Department of Defense (DoD) Commit- tee on Tactical Combat Casualty Care (CoTCCC) guidelines, as part of the Joint Trauma System, support the application of tourniquets within a structured system reliant on highly trained medics and expeditious evacuation. Current practices by entities such as the DoD and North Atlantic Treaty Organization (NATO) are supported by evidence collected in counter- insurgency operations and other conflicts in which transport times to care rarely went beyond one hour, and casualty rates and tactical situations rarely exceeded capabilities. Tourniquets cause complications when misused or utilized for prolonged durations, and in near-peer or peer-peer conflicts, contested airspace and the impact of high-attrition warfare may increase time to definitive care and limit training resources. We present a series of cases from the war in Ukraine that suggest tourniquet practices are contributing to complications such as limb amputation, overall morbidity and mortality, and increase burden on the medical system. We discuss factors that contribute to this phenomenon and propose interventions for use in current and future similar contexts, with the ultimate goal of reducing morbidity and mortality.