Evacuating wounded troops is a perilous and necessary job on any battlefield. Now the Ukrainian army is taking a hard look at its battlefield medical practices—and searching for ways to improve.
The medical situation is awful, to put it mildly.
Field hospitals are poorly maintained, and the journey from the front line is long and hazardous. The Ukrainians’ losses in armored vehicles and helicopters is also cutting into the army’s ability to get its wounded troops out of danger.
That’s according to new report by the Ukrainian World Congress and the Ukraine Ministry of Defense. It’s not comprehensive, but based on a 12-day study of the army’s medical evacuation and care procedures in what Kiev terms the zone of Anti-Terrorist Operations, or ATO, in eastern Ukraine.
“Ukraine definitely has its work cut out for it to even begin to meet basic standards for adequate military combat medical capability,” according to Patriot Defense—a pro-Ukraine activist group that provides medical supplies to soldiers—in a summary.
One of the most serious problems is that many wounded soldiers don’t receive medical care until far too much time has passed. A soldier can wait an average of 20 minutes to one hour before receiving any first aid at all.
The average time before a Ukrainian soldier reaches a field hospital is a shocking 12 to 18 hours, the summary stated.
For the most serious injuries, this can be a death sentence. By contrast, NATO armies train to rapidly evacuate wounded soldiers to a field hospital within a so-called “golden hour,” when chances of survival are highest with surgical care.
The Ukrainian military trains some of its medical teams to reach the golden hour, but the training is inconsistent, and not all teams have this knowledge.
U.S. and NATO armies in Afghanistan heavily use helicopters for evacuations. In 2009, then-U.S. defense secretary Robert Gates rushed medevac birds to Afghanistan in an attempt to improve evacuation times. It was a success. The average length of time between an injury and arrival at a hospital dropped from 100 minutes to 42 minutes.
But Ukrainian helicopters are few and far between.
“Helicopters used for medical evacuation, what’s left of those not already shot down by Russian forces, are not fit for their purpose for numerous reasons,” Patriot Defense stated.
Special forces units face more difficulties. Since commandos often fight behind enemy lines, without clear routes of escape, they have to be able to perform emergency surgeries far from their bases.
But Patriot Defense pointed out that the “special forces medic role with advanced trauma treatment capabilities in the field is non-existent.”
Nor are there any armored medical vehicles. The field stations that exist—and their supplies—have trouble coping with inclement weather. Namely, when it rains, the field stations leak.
One thing the U.S. military learned from years of fighting in Iraq and Afghanistan is the crucial role that tourniquets have in saving lives—to the point of distributing the devices to as many soldiers as possible. In Ukraine, tourniquets and first-aid kits are scarce—fewer than one percent of soldiers have personal first-aid kits.
As for what Ukraine can help make the situation less awful, the report makes several recommendations. More medical equipment, of course—particularly hemostatic dressings to staunch bleeding.
The military needs about 20 mobile ultrasound machines, and the field hospitals need to be redone, modernized and waterproofed. And there needs to be more training, with focus on getting the wounded to care during the golden hour.
The report also recommends the army buy or adapt four armored vehicles to serve as medical taxis, and purchase civilian medical helicopters for air evacuations.
Finally, the Ukrainian military should talk to the separatists. If during the fighting, there are wounded soldiers trapped in the field, the two sides need to open up lines of communication—and try to get those wounded troops out.