1. 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

2. 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.

3. 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

4. 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
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

5. Clinical
Policy

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

8. 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

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

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

11. 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?

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

14. 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

16. 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)

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

18. 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

19. Reforms Council

20. Data Capture

22. 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

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

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

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