In Afghanistan, Australian combat casualties could expect to be treated effectively at point of injury then speedily evacuated by helicopter to a nearby medical facility for expert treatment then on to another facility in Germany for advanced care.
In Ukraine, it’s very different.
Because of the nature of the battlefield, with ubiquitous drones and artillery, safe and speedy casualty evacuation may not be possible and much more primary care must be delivered at point of injury.
Aspen Medical chief medical officer Dr Katrina Sanders said combat casualties in Ukraine often suffered from poly-trauma because of the prolific use of heavy weapons. Those providing initial treatment were not working in a sterile operating theatre under bright lights.
They are delivering that care on the ground under threat of drone attack.
“The ability to get the patient to definitive care is much harder. The patient who has been injured is having to be treated at the point of injury for quite a long time before they could be evacuated to a health system or to another country,” she said in a presentation at the recent Land Forces conference.
“That completely changes what has to occur at point of injury. There is no scope of practice for wartime care or wartime surgery for nurses or doctors who haven’t been trained in combat scenarios.
“The civilian health sector is right in the fight. The doctors and nurses who never trained and never expected to be in these situations are automatically thrust into it. There are civilian patients in the system as well.”
Aspen Medical is a privately owned Canberra-based global health services company, with operations in Australia, Indo-Pacific, Middle East, US and Ukraine. During Australian operations in the Middle East, Aspen personnel provided training in combat first aid to personnel heading into theatre.
Its involvement in Ukraine comes by way of a partnership with the US Department of Defense on a variety of research and training programs, including wartime casualty care.
That includes 2-3 day courses in Poland for Ukrainian clinicians, mostly civilian doctors who hadn’t had a day off in two years.
Aspen is also collaborating with the University of Colorado in a study of the impact of PTSD in Ukraine.
Dr Sanders said Ukraine had a military health system, a civilian health system, plus lots of NGOs, all well intentioned.
But the information from Ukraine is that this is completely uncoordinated, she said.
“People are doing their very best and the only way it is working is through local relationships. There really is no framework or system for integration. That is one of the key lessons that we are certainly hearing from Ukraine.”
At the same time, civilians are still experiencing the full range of routine health conditions in a health system geared for wartime.
“I am thinking what are the health impacts in 20 years when there has been no cancer screening, no cardio-vascular screening at all. We are talking about nearly 100,000 amputees. There is no great rehabilitation system in Ukraine,” she said.