One of the biggest appeals of becoming a paramedic, for me, is the sheer diversity of places and settings in which paramedics can be useful. Recently, I was humbled while participating in Medics 4 Ukraine’s mission to deliver trauma training to those living and working amidst the daily reality of gunfire and artillery shells.
This small charity is incredibly active, achieving force-multiplying effects through the hard work and dedication of its founders. As part of their mission, they send groups of healthcare professionals to help build trauma care knowledge near the frontlines. While each trip is unique, there is a common thread of medical professionals deciding that Russian aggression and artillery shells won’t deter them. This determination runs from local facilitators through to UK-based professors, all driven to enhance the care received by injured locals and soldiers, to provide medical supplies, and to let Ukrainians know that they are not forgotten.
Traveling to the frontlines is never comfortable but spending 20 hours on a coach is one way to get to know a new team. The discomfort of cramped and itchy seats is soon forgotten when listening to the stories of the people living along the Dnipro River. Everyone has been directly impacted by the recent occupation. Our host went from tailor to prisoner, and our interpreter was only spared imprisonment because she was a single mother. Not that this prevented a forced entry and interrogation by gun-wielding soldiers in her own house. I will never have the words to express the feeling of being face to face with people whose children were put on a truck or a train and disappeared with the Russians, all contact lost. Is it any wonder they have the anger and despair to carry on the fight, refusing to accept any settlement that gives an inch to the Russians? Despite it all, they were welcoming, generous, and possessed a sense of humour to rival the driest British wit. There was something very civilizing about trying to put on your trainers while artillery was going out and coming in and being offered a shoehorn to help. It’s the little things that keep the world spinning sometimes.
We learned as much as the students, which is often the case when teaching. Conversations with instructors who have been out there before made it obvious how rapidly Ukrainian medics are learning about war-related injuries and immediate care. Their appetite for clinical scenarios, triage exercises, and feedback kept us all sharp and on the ball! For us, it was a chance to stretch our clinical reasoning, to understand WHY the algorithms exist and how they need to adapt to a new environment and healthcare system. It’s been said that we’re often fighting the last war, and you can see it in some of the drills that, since Afghanistan, now seem almost gospel in pre-hospital trauma algorithms on both sides of the Atlantic.
In Ukraine, the superiority in force protection, air power, and resources that make MERT teams in helicopters and PEDRO possible doesn’t exist. Nor do the resources for a trauma system like the one that ran in Camp Bastion. What do you do as a combat medical technician if your patient has a limb blown off at 6am and you’re still the only medical care they can get at 6pm? When was the last time any of us worried about converting a tourniquet pre-hospital? Or about how permissive hypotension works when you’re a one-person resuscitation team, with only salty water available as volume replacement, maybe a finger probe as your only monitoring, and more than 12 hours to go? It’s obvious that the rapid times into surgery we are used to are a privilege.
The doctors and paramedics I taught alongside brought with them lived experience from the Bosnian war, Afghanistan, and work in remote corners of Africa, together with being instructors on PHTLS, TECC, WEM courses, and similar programs. As much as this galvanized the learning and motivation of our students, the greatest impact on them was simply that someone cared enough to leave their house and help. We can’t all simply drive into Ukraine, but we can all do something. In Ukraine, we were aided by locally founded charities like Light House of Revival, who are doing amazing work helping people rebuild their homes. Medics 4 Ukraine is always hard at work trying to get medical education, medicine, and trauma kits to the people who need them.
To those I went out there with, thank you for making me a part of it. I have returned with a renewed appreciation for the system I am part of and for my career. To those I taught, you taught me just as much! Stay safe, stay warm as winter comes, and know that we are thinking of you. Слава Україні!
Alex Gaspar – Clinical Lead in Critical Care