In a war where hospitals have been routinely targeted, never has emergency medical aid been more important.
Paul is a Consultant in Emergency Medicine at Brighton and Sussex University and has been in Ukraine with the frontline medical aid charity UK-Med since the middle of March; part of a team of over thirty surgeons, doctors, nurses, paramedics and logistics staff currently working in both the east and west of the country.
Here we share notes from his personal blog on what it’s like to work with medical teams on the frontline (written in April 2022).
“Last month, the Ukraine Dnipro team travelled to one of the towns closer to the front, to carry out some practical training with twenty or so members of ambulance stations around the city.
Here in Ukraine, the ambulances have doctors, paramedics and sometimes nurses, and some of them have been in the business of pre-hospital care for many years.
“Hearing about what they were dealing with, though, on a daily basis towards the north and east of the town brought it home, what it means when a shell hits those apartment blocks or city halls.”
In the well-worn common room, we started with introductions. As we went round the room of 20 people, myself and David Anderson, an experienced ED nurse, realised that this was going to be a bit of a tough nut to crack.
The crew were wary. They have been picking up people from falling buildings, people shot or blown up, living in a city at war and, well, what did these two guys from UK-Med have to offer an ambulance crew right in the firing line? And by ‘the firing line’, that would not just be a phrase in their case.
We could see that some of the ambulances parked outside had bullet holes in them. Yes, indeed, what training could we give them?
Still, we started out by asking them about cases they had seen recently, were there any issues that had troubled them in treating trauma? After a short silence, one of them started off, ‘What would you do about bleeding at the base of the neck?
Then someone else, ‘What can you do about someone who isn’t breathing and all you have is ketamine when you want to intubate them?’
These ambulance staff were facing really difficult problems. All we could do was honestly acknowledge that there are no answers sometimes for some of these dilemmas. Sometimes you just have to make do. Gradually, over an hour or so, we all realised that although there were differences in our environments, differences of kit, the situation of just having to make do was sometimes just the same for all of us and that for us too there are situations there are no protocols for and you just have to fly by the seat of your pants.
We were asked a lot of very intelligent, informed questions, but we found that really, they just wanted to talk. Talk about their recent experiences. In their ambulance service, just as with us at home, they had until recently been dealing with people who were unwell, sad, intoxicated, elderly people needing hospital admission, the normal spread of cases our own ambulances staff see. Now over the past month they had been exposed to all the terrors of shelling and destruction in their beautiful city and they had not had the space or the time to really talk about how this was.
“The crew were wary. They have been picking up people from falling buildings, people shot or blown up, living in a city at war”
After a while we went on to practise on a mannequin and used this to discuss other issues of care: how to put a pelvic sling on properly, ways to check for broken ribs. More stories came out: what they had done last week, what happened two days before, or a fortnight before when 18 people were blown up in a building not far away. It was sobering stuff.
The day we had arrived there it was quiet and the fighting was too far away just then for shelling to reach the area of town we were in. Hearing about what they were dealing with, though, on a daily basis towards the north and east of the town brought it home, what it means when a shell hits those apartment blocks or city halls.
On the way back to Dnipro, thinking about the session, David and I reflected that, well, there were a few things we had discussed that they didn’t know, but that this was more of a chance to for them to talk, to open up a bit about some of the things they were dealing with and that this was at least as valuable as anything we were able to give them in terms of information. Spending a morning with a team from the UK, having us listen to them talk about their working lives, acknowledging that yes, it is really difficult, but they were doing a cracking job. That was the win.”