Battlefield medicine and Reform in Ukraine John Quinn, MD, MPH, Paramedic Prague Center for Global Health Institute for Hygiene and Epidemiology First Faculty of Medicine Charles University, Prague

Disclaimer The opinions, views and assertions expressed and contained throughout are solely those of the authors in a private capacity and do not in any way represent any governmental organization or department nor do they reflect any government agency policy, past or future. Research supported by Internal/external grants and third parties. The views expressed in this paper are those of the authors and do not reflect the official policy or position of the U.S. or Ukrainian Government.

Objectives Who we are and what we do Background to our work and research What we want to do Some of what we learned and observed Future Conclusion

Introductions John Quinn, MD, MPH, Paramedic Consultant for the Reforms Office of the Ministry of Defense of Ukraine Prague Center for Global Health (pcgh.lf1.cuni.cz) Institute of Hygiene and Epidemiology First Faculty of Medicine Charles University in Prague john.quinn@lf1.cuni.cz Canada Ukraine Foundation Emergency Medicine Specialist, Northwick Park Hospital in London Patrick Chellew, Paramedic Medical Consultant Remote and Disaster Medicine Specialist Medical ATO Report Consultant for the Reforms Office of the Ministry of Defense of Ukraine Olga Romaniuk Linguist and Researcher NATO Doctrine Translation Support

Clinical Policy

Disaster, Conflict and battlefield medicine Clinical Disaster, Conflict and battlefield medicine Policy

Setting Ukraine is at war with Russia Ukraine is in transition to a stable, sovereign state Public health crisis from war Prevention is the best medicine and state institutional capacity strengthening and resilience, accountability and transparency promote health MoD Ukraine can lead prehospital and battlefield medicine though evidence based research and practice Civilian and military

Partners for Success MoD Ukraine Ukrainian Resuscitation Council Volunteers / organizations NGOs State institutions / Regional Facilities ODC / NATO Partners OSCE US / Euro Think Tanks

Are TCCC data applicable in this conflict and to hybrid warfare prevent death on the battlefield prevent additional casualties complete the mission

TCCC Questions Does it help in this theater? Are these results valid? What LL are captured and are they replicable? Can data from the war in Ukraine be fed into the LL process for preparation of hybrid warfare?

Medical ATO Report Ukrainian World Congress UWC Medsanbat Canada Ukraine Foundation Reforms Office, Ministry of Defense of Ukraine

Goals and Objectives of the ATO Report Snapshot for aid and support Morbidity and mortality data and the evacuation chain warfighters, ministries, volunteers, civilians Healthcare infrastructure (primary, secondary and tertiary prevention) Surgical support and ad hoc arrangements CMEs, air evacuation, Rehab centers Progression of scope

What is war like when you don't rule the air? By July 17th, 2014 air support was virtually non-existent after the destruction of MH17 and restricted to medevac evacuation from rear located MFH Losses due to hostile fire included: 10 helicopters (five Mi-8s and five Mi-24s) seven combat planes (one Su-24, four Su-25 and two MiG-29) three transport planes (a An-26, a An-30 and an Il-76)

Changes on the battlefield since inception TXA Airway management Drones Many, many more …

Gaps Air superiority - communications - appropriately deployed Morbidity / mortality data capture Consistent MoD leadership that encourage best practices Capacity building (training and licensure) - sustainability Interagency interoperability (disaster preparedness) Alternate analysis Military Doctrine

Reforms Council

Data Capture

Conclusions Reform Office at MoD Ukraine MoD and LL process Prehospital / TCCC application and standard and research Ukraine is at war and people are dying of preventable death LL Process, NATO standards integration

Case #1 Ambulances Problem: Solution? Partners for success: ODC / US Mil / US DoS Delivery Gaps: leadership, monitoring and oversight ….

Case #2 - EMEDS Problem: DCS at point of injury Solution: Expeditionary Medical Support System Delivery: Gaps: where is it? Status: in storage

John Quinn john.quinn@lf1.cuni.cz +420608246032 cuinne@gmail.com Thank you Patrick Chellew chellew.patrick@gmail.com John Quinn john.quinn@lf1.cuni.cz +420608246032 cuinne@gmail.com