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MedicalATO

AssessmentReportUpdate:
Fall/Autumn2015andWinter2016
ContactLine/AntiterroristOperation(ATO)MedicalSupplement20152016

TheFutureisNow

Authors:
PatrickChellew
JohnQuinn
OliaRomaniuk
IvonaKostynaPTSD

Languages:
English,Ukrainian

IntendedAudience:
UkrainianMinistryof Defence(MoD),UkrainianMInistryofHealth
(MoH), Ukrainian State of Emergency Services of Ukraine / Ministry of Disaster
Services,MinistryofInternalAffairs(MoIA),NATOMemberStatesandPartnernations.

Classification:
OpensourcedocumentafterApril15th,2016.


MedicalATOFall/Autumn2015andWinter2016
ExecutiveSummary

Ukraine is at war with Russia and Russian backed militants executing hybrid warfare in a
sovereign European state. The Ukrainian warfighter has greater access to intermittent basic
medical training and support, but many core systems level change at the Ukrainian Ministry of
Defence (MoD) and Medical Directorate require assessment and change. Systems throughout
the MoD and ancillary institutions that support warfighting, defence and basicstatesovereignty
areinfluxandrequireafocusedeffortfortransparentandaccountableaction.

Based on the data reviewed this period, and based on recent institutional shocks across key
medical and defense agencies in Ukraine, novel and pragmatic approaches will be required
from partner and key stakeholders to encourage reform, promote NATO processes and
standards alignment and to better serve the warfighters and citizens of Ukraine. In short, the
immediate needs remain medical best practices and standards, institutionalized systemic
training, sustainable access to advanced medical equipment, oversight and monitoring of all
medical projects and a systems level approach to all logistical and clinical components of the
evacuation chain. In the longterm, systems approaches that address command and control /
mission control across the MoD to encourage a more internally transparent and empowerment
for decisionmaking amongst midlevel staff, accountableresourceallocationandbestbusiness
andclinicalpracticesmustbeestablished.

With the above mentioned advancements and the closing of lingering gaps in institutions and
their capacity, the fragile stateofUkrainewilljumpforwardintostabilitythroughevidencebased
policy. These advances are enhanced through the support, guidance and material support
offered through NATO and NATO member states. Ukraine Military Doctrine is based on the
duration of threat from Russia and demands full compatibility of the Armed Forces with NATO.
This report focuses on healthcare and battlefield medical support, but there are many other
streams such as state capacity, rule of law, command and control, democracy promotion, civic
action and judicial reform that will also increase stability and affect warfighter effectiveness.
Transparency of state institutions and a policy of prevention will guide Ukraine into a more
independentandstablenationalstate.


MedicalATOFall/Autumn2015andWinter2016

TableofContents

Summary
Methodology
Background

Section1EvacuationChaininSectorB(8)
CurrentFightingintheATO
AvdiivkaContactLine
CareinTheZero
EvacuationfromAvdiivka
AvdiivkaEvacuationGaps
MedicsofAvdiivka
VolunteerMilitaryAmbulances
MilitaryAmbulance
EvacuationChainfrom
Avdiivka
OcheretyneHospital
66thMFHin
Krasnoarmiisk
TheEvacuationChainfrom
Avdiivka
Trainevacuationofthewoundedfrom66thMFHtoDnipropetrovsk
MechnikovHospital,Dnipropetrovsk,NATOLevelIVHospital,TraumaCenter
DnipropetrovskMilitaryHospital
TheFinalStepDistributionofinjuredwarfighterfromDnipropetrovskandKharkiv
MainMilitaryClinicalHospital
HospitalnaStreet,Kyiv

Section2TheATO(26)
SectorBMedicReports
SectorA59thMobileFieldHospital
SeverodonetskMultiSpecialityHospital
SectorC65thMobileFieldHospital
SectorC,WIAVolunteerMedic
SectorC,VolunteerMilitaryMedics
SectorMMariupoland61stMFH
BattleofIlovaiskFieldCareandEvacuationfromtheIlovaiskKettle
,August2014
MedicalCommandandControlMissionControl
OSCEintheATO

Section3Equipment(45)
Logistics
VolunteerEffort
Helicopters
HospitalsoftheATO


MedicalATOFall/Autumn2015andWinter2016
IgotyoursixAvdiivkaFOB
TheEMEDS
PeripheralHemorrhageControl:UkrainianTourniquets
AmbulancesofUkraine
RoadsinDisrepairLandEvacuationRoutes
BlackMarket/DarkMarket:anEnvironmentforCorruption

Section4Reforms(67)
TheFailureofMilitaryLaw
MedicalLegalReform
MilitaryReformMoDConclusions
GovernmentalReformsProjects
NationalReformsCouncil
ReformsOffice

Section5HealthandWelfare(77)
PostTraumaticStressDisorderTheInvisibleConsequenceofWar
InfectiousDiseaseandtheConflict
AlcoholandDrugAbuse
SurgicalRehabilitation
ExclusionisnotaSolution
ArmyRadio/TV
FrozenConflictHealthandWelfareofUkraine

Section6Training(112)
TacticalCombatCasualtyCare(TCCC)Past,presentandfuture
CurrentDevelopmentsinUkraineMilitaryMedicine
InstitutionalChanges
WomenandTCCC
MilitaryTraining
CivilianTraining
InternationalMilitarytoMilitaryTraining
NATOTrustFund
CompositionofUkraineMilitaryMedicine

SummaryandKeyRecommendations(130)

Conclusions(136)

ArticlesMention(138)

Bibliography(163)


MedicalATOFall/Autumn2015andWinter2016

Acknowledgements(166)

Disclaimers(166)

Authors(167)

ListofAbbreviations/
SelectedDefinition
(168)

InterviewwithGeneralVerbaHeadofUkraineMilitaryMedicine
(170)


MedicalATOFall/Autumn2015andWinter2016
Summary

Ukraine is asovereignnationstatestrugglingtotranscendpostSovietandrigidInstitutions,pan
political corruption flanked by an occupying Russian force in two large regions in the East and
the lost peninsula of Crimea. Ukraine is not in a simple crisis the situation rocks the core
foundations of European liberal democracy, the Westphalian World Order and sticks the
fundamental question that the European Union (EU), the North Atlantic Treaty Organization
(NATO) and partner nations now face about the responsibility to protect state sovereignty and
not experienced since the Balkan War and arguably, World WarII.Theavoidanceofexistential
confrontation with Russia and Russian forces has pushed the EU, NATO and USA into an
antechamber of impotence eager to avoid conflict at all costs, leading to nothing but further
violence and trampling of security, growing human suffering and an environment for escalated
conflictbetweenworldpowers.

This report serves as a supplement and updated medical and health assessmentofthecivilian
and military medical health services in and around the Antiterrorist Operations (ATO) / Line of
Contact / Contact Line and the development of military medicine in Ukraine from November
2015 to April 1st, 2016 and changesobserved sincethehostilitiesbeganinMarchof 2014.The
data presentedinthisreportarebasedoninpersonsite visits,personalandonlinesurveys, site
visits by proxy, structured interviews, firsthand accounts and open source data related to
warfighting activity and the evacuation chain. These assessment series have been funded by
the Ukrainian World Congress (UWC), the Humanitarian Initiative of Elena and Viktor Pinchuk,
Medsanbat and by private donations.Thesereportsandall datareceivedwouldnotbepossible
without the many volunteers, activists, warfighters and hospital staffs to obtain the most recent
andrelevantinformationavailable.

Despite obvious ceasefire violations throughout the start of the first quarter of 2016, this
assessment also highlights the endemic graft, nepotism and corruption that plagues the
battlefield, the medical preparation, training, implementation and overall provision for all key
actors (i.e. Ukraine Ministry of Defence (MoD), Ministry of Health (MoH), Ministry of Interior
(MoI), Ministry of Disaster Preparedness etc). It is the goal of this report to help guide thenext
step and future programming for local and international donors to focus efforts for further
capacitybuildingmeasurestomaximizevalue,benefitandsustainability.

Overwhelmingly, Ukrainian battlefield medical provision and the military and civilian health
systems require a renewed effort of collaboration, militarytomilitary (M2M) connections, lethal
and nonlethal support, strategic and lowlevel mentorship exchanges and persistent
partnership encouraging best practices. The fragile state of Ukraine faces many challenges to
success in maintaining its sovereignty. No new state is expected to weather and cushion such
violent economic and social shocks exacted by Russia and Russianbacked interventions
withoutsupportandguidancebypatientkeyallieswillingtostaythecourseofsustainablepolicy
of partnership. In sum, a persistent, stable and clear policy line of support from partner states
andademocraticandopen,fairandlegitimatemarketbasedeconomyarefacilitated.


MedicalATOFall/Autumn2015andWinter2016

Policy supporting institutions within Ukraine MoD, capacity and capability will be successful by
supporting a balance of command and control in unified field and air operations, support of
reforms, the immediate enactment of necessary legislation and the establishment of a fair and
balanced judicial/legislative system. Ukraine MoD and its operational units must seize, retain
and exploit the initiative to be at a constant relative advantage against apersistent,wellarmed
and determined enemy. Further conclusions relate to some of the corefunctionsthatUkrainian
MoD may benefit from a complete review and restructuring of Command, Control,
Communications (also referred to as Mission Control), Information Technology (IT) / computer
and software entrepreneurship, Intelligence, Surveillance and Reconnaissance (i.e. C4ISR)
upgradesandinternaltransparency.

Methodology
This report will follow an ATO/Contact Line section with updates to the key medical
infrastructure, recent incidents and anyothergathered information.Objectivityhasbeenapplied
to as much data gathering as possible to remove bias or other effectorsonthereportingofthis
data. The data gathered in this report are based on inperson site visits, personal and online
surveys, site visits by proxy, structured interviews, firsthand accounts and open source data
related to warfighting activity and the evacuation chain. Due to the nature of healthcare
provision at a military and civilian level in Ukraine, incidence, prevalence and basic morbidity
and mortality data for warfighting activity is very limited across branches of service and
volunteers,andcertainlywithcivilians.

Background
As of February 15, 2016 the UN estimated casualtyfiguressincethebeginningofthe conflictis
more than 30,000. That includes at least 9,160 killed and 21,000 injured. The figures include
civilians,Ukrainianmilitarypersonnelandmembersofarmedgroups.

This report will follow an ATO/Contact Line section with updates to the key medical
infrastructure, recent incidents and anyothergathered information.Objectivityhasbeenapplied
to as much data gathering as possible to remove bias or other effectorsonthereportingofthis
data.


MedicalATOFall/Autumn2015andWinter2016

Section1
EvacuationChaininSectorB

Nosurgeon,doctoror mediccanreversethedeathof a
warfighter.
Prevention is key to limiting the effects of
battlefield injury. Good preplanning, logistics,
protective vehicles and the ability to rapidly react
appropriately is key to a successful operation and
reducingbattlefieldcasualties.
Or
as General George Patton once said:
No bastard
ever won a war by dying for his country. You won it
by making the other poor dumb bastard die for his
country.

CurrentFightingintheATO
Since the implementation of the Minsk II unconditional ceasefire from 15th of February 2015
much of the fighting these days is confined to alengthofthecontactlinerunningfromZaitseve
to Marinka. An approximately 160/km stretch of territory that encompasses farmland, rural
villages, industrial towns including
Avdiivka with its large Coke plant
, small cities and the
eastern borders of occupied
Donetsk, once a major city and
industrial center with a population
before the conflict of
944,552
.
Along this section of the contact
line there are several consistent
hotspots, Marinka, Pisky and
the area bordering the Donetsk
airport from Pisky to Avdiivka,
plus recently increased fighting
activity around Zaitseve to the
north of Donetsk. This 160/km
stretch can be reduced to about
2030/km where there is currently
sporadic
probing/harassing
attacks that increase to deadly
serious fighting/shelling on a
regularbasis.

The fighting directly impacts two


Mobile Field Hospitals (MFH), the
66th in
Krasnoarmiisk and the
65th in
Artemivsk
.
Both of these
MFHs have a myriad of lessons


MedicalATOFall/Autumn2015andWinter2016
learned and experiences to offer in an audit or full review of casualty and damage control
surgery pragmatic approaches and in improving health care for the warfighter in the ATO. The
65th MFH is the closest receiving hospital to the contact line in the ATO. They were severely
impacted during the Battle of Debaltseve in winter 20142015, where Russian forces took over
the key railroad junctionconnecting, Luhansk,DonetskandRussiaanoffensiveRussianforces
concludedaftertheinternationallydeclaredMinskIIceasefire.

Currently, the 66th MFH in Sector B and the hospitals/clinics and teams they resupply and
reinforce with militarystaff,nowtreatthemajorityofbattlefieldinjuries intheATO. Mostof these
patients arriving at the 66th MFH are eventually transferred to Mechnikova Hospital or the
DnipropetrovskMilitaryHospitalbothinDnipropetrovsk.

Due to the nature of this conflict and of Russian hybrid warfare, any area and location can
flareup at any time. For example, various areas near Mariupol experience serious attemptsby
Russian forces to probe orbreachlinesofdefencesuchastheBattleinStarohnativka,Donetsk
Oblast (Sector M).OnAug10th,2015,wherethekilledandwounded(KIA,WIA)exceeded100.
Or the ongoing struggle over Shyrokyne on the Black Sea near Mariupol where the intensity
continues to spike and recede. As of early March, there have been more than 375 Ukrainian
soldiers killed and 1,500 wounded since the startoftheMinskIIonFebruary15,2015.Thereis
anecdotal evidence that wounded in action figureisaconservativenumberand doesnotreflect
those nontraditional injuries such as accidents, alcohol and drug abuse, post traumatic stress
disorder (PTSD) and lighter injuries that are treated and released back to their units, nor the
volunteers that are not considered to be part of the fighting forces and not officially associated
withcasualtyandmortalitydatafromMoD/MoIA.

AvdiivkaContactLine

AviewofDonetskcityfromashelldamagedresidentialhighriseTheNineinAvdiivkaandtheentrancetoAvdiivkaCoke
/ChemicalPlant(AKHZ)whichismanagedby
Metinvest
andownedby
RinatAkhmetov
.Photos:Chellew

Avdiivka, Population: 35,128, is a city of oblast significance in Donetsk Oblast of Ukraine. The
city is located in thecenteroftheregionjustnorthwestfromthecityofDonetsk.Avdiivkaisbest
known for its major employer, Avdiivka Coke Plant and managed, as are many of the major


MedicalATOFall/Autumn2015andWinter2016
industries in the Donetsk and Luhansk Oblasts, by the company Metinvest which is owned by
RinatAkhmetov,aUkrainianoligarch.

During the conflict, Avdiivka has been and continues to be periodically shelled and probed by
forces bordering the city. As of March 25th, 2016 and the last seven weeks prior, a Forward
Operating Base (FOB) on the edge of the city has been the recipient of continuous attacks
allegedly coordinated by Russian Special
Forces per intelligence units on the ground.
Volunteers report that in the last 48 hours prior
to this date Ukrainian Armed Forces suffered
two KIA and twenty WIAwithsteadyincreaseof
hostilities. Buildings located on the borders of
the Avdiivka suffered the majority of damage
(i.e. windows broken, walls damaged byshells).
Some people still live in these damaged
buildings and in many parts of the city, such as
at the Avdiivka Coke Plant, civilian life
continues. Occupied Donetsk can be seen from
many of the buildings in Avdiivka. Many of its workers previously live on the territories now
occupied and they moved to the Ukrainiancontrolled territory to avoid crossing thecontactline
everyday.SomeevencurrentlyliveonthepremisesoftheAvdiivkaCokePlant.

In Avdiivka the southeastern flank of the city runs along the contact line which traverses
Highway E50 in the occupied territoriesandinsome casesascloseas4kmfromthemedicaid
station. Russian forces have been slowly encroaching across the highway as it appears they
attempt to flank the FOB that blocks the main road into Avdiivka from the occupied territories.
Russian forces use the elevated highway positions for their spotters and the concrete
underpasses for hard cover. Interestingly,a coaltrainstilltraversesthisroutefromtheoccupied
territory and almost directly under a firing position of Russian andRussianbackedForces.The
train delivers coal to the Coke plant and additional locations in the west. The trains are also
allegedly utilized for smuggling operations to move goods fromUkraineGovernmentControlled
Areas (GCAs) to nongovernment controlled areas (NGCAs) and occupied by Russian and
Russianbacked forces. It is beyond ourscopeandfocusofthisreportbuttheburgeoningblack
market control by corrupt local police and military units is another concern and will be briefly
discussed in the legal section of this report. It should be noted that one key component of a
Russian foreign policy in a frozen conflict is the establishment of these nongoverns spaces
andthelackofbusinesstransactiontransparencythataccompanies.

Aglimpseofwhatit'slikeinthegreyzoneoralongtheATOcontactlinecanbefoundinNolanPetersonsarticle
intheDailySignal
IsThisRealLife?.
OrtheNewYorkTimespieceonAvdiivkaCokePlant
AUkraineFactory
ThatCantClose,andWorkersWhoWontQuit
byAndrewRoth.FormorephotosoftheNine,two,ninestory
buildingsontheedgeoftheAvdiivka

DestructionbyterroristsoutskirtsAvdeevka
:byInformationResistance.

10


MedicalATOFall/Autumn2015andWinter2016
CareinTheZero
Casualties are moved off the contact line, known as the The Zero with a tourniquet and
sometimes a bandage and transferred to the medics who then treat and transport 25/Km to
Ocheretyne Hospital. The roads are of inferior quality, tertiary at best causing many delays.
Sometimes transport is directly to the
66th MFH in Krasnoarmiisk an hour plus away, weather
and logistics depending. No rotary winged medical evacuation transportareavailablethisclose
toTheZeroduetoRussianaerialdenialweaponssystemsinplace.

One of the Avdiivka medics illustrated the situation best of the local hospital inAvdiivka:Iwas
told at the beginning military people discussed a possibility to locate a medical unit of the
brigade here. But there was heavy fighting and artillery shelling the risk too high... and
sometimes the hospital serving military is a target itself. An earlier interview in the summer of
2015 with other medics advised that this hospital was partly damaged by artillery and was at
that time supplemented with militarymedicalstaffing. Oneconclusionmaybethatthosemilitary
medics were redeployed to another location but civilian operations continue, with extremely
limited resources and nearly no access to the medical evacuation chain (transport,
communications or advanced emergency medical, resources and training). As of April, 2016
militarymedicalstaffhaveoncemorereturnedtoAvdiivkaHospital.

The medic goes on to say that recently the hospital was used a few times to provide
emergency help to wounded soldiers before evacuation to the 66th military hospital when the
battalion medical unit did not have an ambulance to evacuate wounded to their regular
facilities. Avdiivka city still maintains a civilian ambulance service and it canstillbedispatched
through the National 103 emergency dispatch system but not to frontline locations where it is
incumbent on the soldiers to evacuate a patient to a rally point for transfer to a higher level of
care or if an ambulance is not available to Avdiivka civilian hospital. When the 103 system is
activated all requests for service within the city require the city ambulance return transport to
their local base hospital in Avdiivka. Avdiivka Hospital functions with about 20% of its normal
staff.

EvacuationfromAvdiivka
Volunteer medics are not allowed to go to The Zero, so military evacuate their casualties to a
rally point. From Butovka Mine to Avdiivka it takes about 4 mins if you drive really fast. Then
patients can be transferred to volunteer/military medicalserviceattheaidstationinAvdiivkafor
further evacuation of about 25/km to Ocheretyne Hospital. The Ocheretyne Hospital is
reinforced with military doctors but they are under equippedandunabletoperformtotheirskill
level. No damage control surgical capabilities are resourced at this facility, and there are no
supportforblood/plasmacapabilities.

Further evacuation to 66th MFH in Krasnoarmiisk is about one hour by road, the fastest
transport time was about fortyfive minutes. The 66th MFH is the first location that has plasma
and blood products. Patients usually stay there for 12 days and after stabilization are sent to
Dnipropetrovsk and Kharkiv by rotary wing air ambulance transport (helicopter), ambulance or

11


MedicalATOFall/Autumn2015andWinter2016
highspeed train (if flights are impossible because of weather conditions). Trains used are
regular passenger trains, litter patients are placed in the free space near seats no specially
equippedcarformedicalpurposesatthistimeisinuse.

Average time from the pointofinjuryto66thMFHis1.5hours.Significantpartofthetimeislost


due to the poor condition of the roads. The DonetskKostiantynivka highway is in pretty good
shape but the small roads leading to it are bad. Basic infrastructure remains a major liability
anddelayintheevacuationchain.

Sectionsoftheroadsareinextremelypoorconditionreducingspeedssometimesdownto5/km.Photo:Chellew

AvdiivkaEvacuationGaps
A recent example of the complexity of the situation and the need for better preplanning
occurred whenasmallmobilegroupofsoldiersthatcombatcorruption, smugglingandfunctions
independently from other military units, took a position in the city. They do not normallyhavea
stationary post so they stand for few hours at anylocationbutclosetostationaryblockpoststo
recheck vehicles traversing various roadblocks to determine if the static positions comply with
their duties and standards. Due to the specificity of their work, there is a chance they did not
haveacontactwiththelocalmilitaryunits.

While stopping and checking vehicles on


e of the soldiers of this special unit was struck by a
drunk driver at their checkpoint. ThecityambulancefromtheAvdiivkaHospitalwasaccidently
dispatched to find a soldier suffering from a head injury, altered mental status,chestinjuryand
fractured lower legs. Instead of receiving treatment en route to an appropriate higher level of
care, the warfighter was transported back to the local hospital where thestaffsplintedthelegs,
started an IV and administered pain medication. Another ambulance was summoned from the
military medical volunteers and the patient was loaded andthentransporteddirectlytothe
66th
MFHinKrasnoarmiisk.

At the 66th the patient treatment included rapid sequence intubation (RSI sedated and
intubated) and immediately flown toKharkivwithaTraumatic BrainInjury(TBI).Theoutcomeof
this patient at this time is unknown. But the maze of systems, low level of preplanning,
inadequate training and poor communication between units, so in the case of a simple

12


MedicalATOFall/Autumn2015andWinter2016
emergency, resulted inthedelayedtreatment/transporttotheeventualsuperiorcarereceived at
the66thMFHandlaterKharkivMilitaryHospital.

MedicsofAvdiivka

Shelldamagedresidentialstructure.

RoofdamageandaviewoftheAvdiivkaCokePlant

Picture:ASAPRescueambulanceonleft,themilitaryambulanceofthe58thbrigadeontheright,bothstationedin
Avdiivka.PhotoChellew

VolunteerNonMilitaryMedics
Supported by a rotation of volunte
er medics including at times doctors and surgeons suchas
the renown Mechnikov neurosurgeon, Yurii Skrebets. At other times theyworkinpairsoftwo,a
driver and a medic, often for several weeks straight or until another volunteer can found to
replace them. There are no standards in place but they on t
he whole,recognizeTCCCastheir
standard. Skills vary and in most cases they have no real legal authority to perform, or
standards to protect them or their patients. The demand for their service is high, many have
been injured, several killed but their are no official governmental statistics kept. They require a
constant stream of donations which ebbs and flows during escalations on the front. Usually
receive onsite housing, food, but no pay, often equipped with superior medical hardware and
softsupplieswhencomparedtotheregularmilitaryunits.

13


MedicalATOFall/Autumn2015andWinter2016
Olga,callsign"Vesna",
medicwithASAPRescueinAvdiivka
Has no medical background, attended Medsanbat course in March 2015 (Kyiv Main Military
Hospital). Also attended several days of some training in Yavoriv. Stationed in Avdiivka for the
last 4 months, with some breaks. Respected by and works with the 58th brigade. There is no
pressurefromthelocalmilitaryunitsforthevolunteerstoleavetheATOatthislocation.

RecentCare
IVs regularly,butnottoeverypatient.IVsarepresetwhengoingona call.Tranexamic
Acid (TXA) used 23 times. Educated her battalion medical chief about TXA, he has
changedpracticeandkeepsitinhisbag.
Advancedairwayneverrequired,butwouldtryto.
Tourniquets usually already done by soldiers. Medics often practice tourniquet
applicationwiththesoldiers.
Has casualty cards but has no time to fill them, as medic usually works on a patient
alone.
On Feb 5th treated two burns patients from a fire secondary to landmine detonation.
Both suffered 2nd3rd
degree burns. Unfortunately, they had stored extra diesel fuel
inside the vehicle. One suffered hands and arms burns, the other hands, legs and face
burns. Soldiers were evacuated through the chain and arrived in Dnipropetrovsk the
sameday.

MilitaryvehiclefromFeb5thblastandfirewithtwoWIA.PhotoCredit:TSN

Casualties
Inautumn12perweekonaverage
Now(Feb07,2016)about24,ByendofMarchcasualtiesalmosteveryday.
Most casualties in this area are explosive injuries, often from theirownexplosives.Now
frequentshellingsareexperiencesandtheyseemorefragmentationinjuries.

14


MedicalATOFall/Autumn2015andWinter2016
AvdiivkaVolunteerMilitaryAmbulance
ASAP ambulance in Avdiivka is manned by volunteerstosupport themilitary.Theircurrentwell
stocked ambulance in Avdiivka is from Italy, hasO2,ventilator,heatingsystem,pulseoximeter.
No ECG. Medications are stored inside their building while not on calls to prevent freezing.O2
isrefilledinArtemivsk(Bakhmut).
Noarmouredambulancesinthearea.
No armed escort for volunteer ambulances andtheyarenotcombatantssonoweapons
allowed.

ASAP Rescue has worked together with the Medical Corps since the beginning of the year.
ASAP has ambulances andMedicalCorpsgoodsupplychain.InZaytsevoandMaiorskMedical
Corps usually goes to the The Zero inanSUV.Mostincidentsareusuallyatnight,asdaytime
is usually calm. Medical Corps has a surgical bus and a mobile dental clinic at their logistical
centernearZaytsevo.

Supplies
Service is volunteers so they are supplied by volunteers. Made some requests for a refill of
bandagesfromMedsanbat.

Communication
No specific radio frequency for medics and no means of direct coordination withthemilitaryfor
volunteer medics.
Ilya Lysenko, call sign
Khottabych, the head of ASAP is in discussion to
createaseparatemedicalfrequencyforboththecivilianandmilitarymedics.

Avdiivka Military Ambulance


Medical Chief
, 58th Mechanized Infantry Battalion, 16th
MechanizedInfantryBattalion.

A dentistbyprofession.Thepreviousbrigadewasthe53rd, 2ndbattalionandthey usedto have


apediatricianasitsmedicalchief.

TwomilitaryambulancesinAvdiivkaprocuredfromalocalciviliansourceinPoltava.
GreenmedickitfromtheBritishgovernment.

15


MedicalATOFall/Autumn2015andWinter2016

Supplies
Well supplied through MoD for basic medical equipment. IFAKs from MoD 120% provided
issued to soldiers and some kept in storage. Soldiers wear them on body armour. Issued
standardrubbertourniquets.

Twomethodstoreceivemedicalsupplies:
1. Go to the brigade location and take from their storage same day. Have many of the
itemsinstock.
2. Make a request to Kharkiv if all the paperwork is included receives requesteditemsin
12weeks.
If the medications requested are not available, an analogwillbeprovided,whichmaynotbeas
goodbutstillwillhelpwiththeproblem.

NoIOs,glucometers,Quikclot,traumashears(eitherknivesorregularscissorsavailable)

58thMedications
Problem with cough/cold medications. Issued enough for 30% of the personnel, but a single
doseisnotenoughsothepercentagesuppliedissmallerthantheiractualrequirement.
Requires sedative medications since many soldiers are doing multiple shifts in a row and the
psychological tension is high and they may not be able to get proper rest for several days in a
row.
No flu/pneumonia patients everybody withfeverisevacuated immediately.Inaddition,theunit
is spread about in multiple locations therefore, they do not gather in largegroupsreducingthe
spread of respiratory ailments. Nalbuphine in individual aid kits isafirstlinetreatment.Soldiers
apply a tourniquet and then administer IM nalbuphine too frequently. Cases of nalbuphine
abusearealsoknown.

16


MedicalATOFall/Autumn2015andWinter2016
58thCasualties
Notmuchuntilrecently(March2016),usemostlybandages.
Casualtycardsareissued(system).

58thAmbulances:
BroughtfromthecivilianambulanceserviceinPoltava,thanregisteredasmilitary.
PoorlyequippedandhaveO2equipmentmanufacturedinthe1960s.
O2isrefilledinArtemivsk.
Usesoftskinambulance"Tabletka"(UAZ452)togotothefrontline.
Have askedanditwasconfirmed thatMTLB
(amphibiousarmouredtrackedvehicle
)will
beassignedtotheirunitforevacuationpurposessometimeinthefuture.
Militarymedicshaveweapons.
Military fuel is available but is low quality and, therefore, cars frequently break down. If
theychosetobuyregularfuel,itwouldbeattheirownexpense.
Have seen HMMWVs about100weredeliveredtothe80thairborneand arefrequently
seeninthearea.

Photos:MoD.NewUkraineMTLBinKherson. Deliveryof100HMMWVtoUkrainebyUSMilitary.USEmbassy

AidStation/StorageRoom
Located on the 1st floor of 90%abandoned civilian apartment building. Has room for triage,
multicasualtysituation.
Thebuildinghaselectricityandwatersupply.Heatingsystemwasrepairedafewdaysago.
Generators available, but are too noisy, produce large volumes of smoke and consume too
muchfuel.

AlcoholAbuse
Problems with alcohol abuse are diminishing as higher fines are implemented and lowering
salaries to 500 UAH per month. Their unitdoesn'thaveportablealcoholtesterssotheyneedto
take people to the hospital to check blood/urine and confirm officially whether they are
intoxicated.NationalGuardinArtemivsk(Bakhmut)alsohasbreathanalyzers.

17


MedicalATOFall/Autumn2015andWinter2016
WoundedinAction(WIA)
Many of the casualties were injured by (Ukrainian) tripwires/landmines. Maps of minefields are
not popular and when one unit replaces the other they often have no idea of where the mines
arelaid.

October2015
SixsoldiersinjuredbyantipersonnelOZMmines.

February 2016
Two soldiers injured by OZM. One of them was large (130 kg). The smaller
soldier had a traumatic amputation of both lower extremities and died from blood loss. The big
soldier suffered serious injuries of lower extremities and multiple fragmentation injuries to the
upper body.Theevacuationwas doneundershellingandtheyfirstpulledoutthesmallersoldier
(who turned out to be dead or died soon afterwards). Extrapeoplewererequiredtopull outthe
large soldier. They had difficulty tightening the tourniquets enough given his largerthannormal
legs. On exam it was found that he had poor venous access complicated by blood loss and
edema in his hands. No IO devices were (or are) available. Eventually, the soldier died before
getting to the hospital, where doctors still spent another 30 minutes attempting to resuscitate
him.

OZN,boundingfragmentationantipersonnelmine

EvacuationChain:
Avdiivkato
OcheretyneHospital

Ocheretyne Hospital
, small Level I+
hospital reenforced with staff from the
66th MFH and within2830/kmsreach
of various frontline positions. Military
patients seen at this facility and
requiring extended or a higher level of
care aretransferredtothe66thMFHin
Krasnoarmiisk, a distance of 37 km or
about 60minute drive. Theydohavea
small surgicalroomwithbasicsupplies
(sterilizers, scalpels, clamps, suture

18


MedicalATOFall/Autumn2015andWinter2016
sets for the primary treatment of wounds etc). They only perform minor surgery with a local
anesthetic given they are not authorized by lawtousethehospitalsdrugs.Licensingofmilitary
doctors to use control substances is an issue at any civilian hospital. So far the issue with the
law has not beenaddressedtoourknowledge.Additionally,thereislittlespaceatthisfacility for
themilitarytostoreequipment,northevehiclestomoveequipment.

Currently staffed with about 60 people, including 27 doctors. However, in April the staff will be
reduced to six doctors as the current staff finishes their oneyear mobilization and as of yet
there are no replacements. Unstable patients are oftenbroughtherefirst giventhestaffmaybe
abletoprovideskillsthetransportcrewslacksuchasadvancedairwaymanagement.

Since they moved to this location on the 10th of November 2015 till midFebruary they have
treated twentysevenWIApatients,includingtwoinJanuaryandnineinthefirsthalfofFebruary
(0117). Most patients come from the Avdiivka area and not Pisky given the roads from Pisky
are poor and the road from Pisky to Selydove isin muchbettercondition.Patients usuallyseen
sufferfromshrapnelwounds.Onaveragetheytreat2030patientsperdayforvariousillness.

Currentneeds
:12LeadECGandafewlaptopsalongwithsurgicaltools(thelaptopstheyhave
belongtostaffandarebroughtfromhome).

OcheretyneHospital

19


MedicalATOFall/Autumn2015andWinter2016

OcheretyneHospital
SurgicalRoom

66thMFHin
Krasnoarmiisk:
TheEvacuationChainfrom
Avdiivka

66th MFH, Sector B.


The66thisthebusiestMFHin theATOtakingWIAfromtwooftheATOs
hottest spots, Pisky/Avdiivka along the north/western flank of Donetsk and Mar'inka to the
south/west of Donetsk.
Located at the Railroad Union Hospital in Krasnoarmiisk. CT scan is
not available at any area civilian hospital. Transport time is about one to one and a half hours
from the front line area. It receives both critical and minor patients. The 66th MFH wasthelast
to arrive in Feb 2015 but has consistently proven tobeone ofthebest.DeployedfromLvivand
with staff from the Lviv Military Hospital it arrived in the ATO during the final days of fightingin
Debaltseve. It receives support not only from volunteers in the ATO, but sustenance from
citizens in its hometown of Lviv and assistance from the Lviv Military Hospital. Today most

20


MedicalATOFall/Autumn2015andWinter2016
disposable supplies arrive through the MoD logistical system but some supplies such as
clothing, disposables for equipment previously donated by supporters and some drugs are
supplied through volunteer sources. Much of the modern equipment came through their
homegrown sources as the existing equipment in the hospital is old and has long passed its
normally accepted operating life. Could use CT scan, CArm, portable xray and portable
ultrasound along with replacementofmuchoftheantiquatedequipment.Thehospitalissoonto
beclosedastheRailroadHospitalandbefullyunderthecontrolofthe66th.

Prehospital carevaries,withafewconsistentmedicsandlotsofambulancedriversthatarrive
with only a tourniquet including one recent case where the patient arrived with a cyanotic leg
secondary to the tourniquet that was left in place. AfewmedicsarrivewithIVsandTXAwhere
applicablebutoverallnotenoughaidisprovidedinthefieldbythelargepercentageofcrews.

66th crews rotate from the Lviv Military Hospital where the hospital itself has received much
international attention and support through peer interactions and in training and supplies.
Recently some of their staff participated in a cadaver and live tissue training in Yavoriv for
Ukrainian doctors and surgeons and conducted with support fromtheUSEmbassy,KyivOffice
of Defence Cooperation (ODC) and a team from EUCOM/DIMO. One of the surgeons with the
66th described the training as extremely professional andexcellentforthosedoctorsworkingin
orsoontobedeployedtocombathospitalsintheATO.

Recently an article in censor.net waspublisheddescribingacenterfortrainingmilitarydoctors,


health workers, and combat medics under Tactical Combat Casualty Care program, which is
used by the armed forces of NATO member countries, begin operating in the 66th mobile
military hospital subordinate to the Eastern Operational Command. Staff said it was pretty
muchasingulareventandmostofthetrainingreceivediscompletedbackinLviv.

Ambulancerecentlyarrivingat66th
MobileFieldHospital

Soldierofthe90thwithathoracicinjuryunloaded
fromaTabletkaatthe66thMFH.March24,2016.
Photo:Yana
ZinkevychFB

21


MedicalATOFall/Autumn2015andWinter2016
Evacuationfromthe66thMFHin
Krasnoarmiiskto
Dnipropetrovsk

Bygroundtransportarecloseto2hrs,byair40minutesandaboutanother40minutesfortransferto/fromlandingsites.

From the 66th there are now three modes of evacuation, helicopter, ground ambulance and
recently added a passenger train. Fastest is of course by helicopter, at about 40 minutes but
gaps to decrease time and unnecessary movement still need to be addressed by command
staff.

From the 66th critical patients are either air evacuated or transported by either ground
ambulance or train to Mechnikov Dnipropetrovsk Regional Clinical Hospital or occasionally by
helicopter to Kharkiv Military Hospital. Stable patientsareusuallytransportedtoDnipropetrovsk
Military Hospital. None of these hospitals have landing pads on site and all require patients to
be transported to/from a nearby airport or as in the case of 66th, a field. The approval and
construction of landing field at each one of these hospitals is another priority not addressedby
MoD. The process for ordering a helicopter is arduous with no guarantee that one will be
approved,norarethereanytriggersforautomaticdeploymentofairresources.

Transport by road runs about two and half hours. The timeissimilarbytrainexcludingthetime
it takes to move the patients by ambulance to and from the trains stations, but the ride on the
train is by far more comfortable, can accommodate a larger support staff and avoids dealing
with poor road conditions on portions of the roadstraveledbyambulances.Helicoptertransport
is, of course, the fastest but times are slowed as the patients are delivered by ambulance to a
field in Krasnoarmiisk.OnceatDnipropetrovskAirport,theyareslowlyunloadedandplacedinto
anambulanceforatwentyminutetransporttothehospital.

Trainevacuationofthewoundedfrom66thMFHtoDnipropetrovsk

KrasnoarmiiskandDnipropetrovskTrainStations

Train evacuation was first introduced on Jan 28, 2016, when weather conditions did not allow
regulargroundorairevacuation. TwentysixsoldiersweretransportedtoDnipropetrovskMilitary

22


MedicalATOFall/Autumn2015andWinter2016
Hospital. Staff varies from one to three dependent on the extent of care and may include one
surgeon,oneanesthesiologistandanurse.

AndrewKotovskysFacebook

InterCityTrainEvacuation

There is information that the trains from Krasnoarmiisk to Dnipropetrovsk will have one car
assigned for medical evacuation (an open sleeper car oracarontheIntercityfast train).These
cars are supposed to have medical equipment and anesthesiologist, surgeon, therapist or
general practice doctor, anesthesiologist, nurse, surgical and medical nurse depending on the
numberofcasualties,theirstabilityandtimeofevacuation.

HighspeedtrainsfromKrasnoarmiisk.
KrasnoarmiiskDnipropetrovskKyiv#
73304:416:5712:50daily
KrasnoarmeiskDnipropetrovsk#
825,14:3217:20dailyexceptWednesdays
ForTrainstationlocationseereferences.

MechnikovHospital,Dnipropetrovsk,NATOLevelIVHospital,TraumaCenter
SobornaSquare,14,Dnipropetrovsk,(),Ukraine
Mechnikov Hospital continues to be the center of excellence. As of late March 2016 they have
received and treate
d over 1600
warfighters from the ATO. They continued to improve their
center with new and sophisticated equipment, much of it through donations from local and
international support.
Patients arriving at the Dnipropetrovsk Airport from the ATO are triaged
with the criticals transported to Mechnikov and minor/stable patients to Dnipropetrovsk Military
Hospital.InthelastweekofMarch,MechnikovreceivemorethantwentycriticalATOpatients.

MassiveturnoutforMechnikovHospital,Dnipropetrovsk,LevelIVtraumacentersblooddrive.2/24/16

23


MedicalATOFall/Autumn2015andWinter2016
DnipropetrovskMilitaryHospital

KomsomolskayaSt,63,Dnipropetrovsk,DnipropetrovskOblast,Ukraine.

Injured warfighters on arrival at Dnipropetrovsk Airport


are triaged critical and immediate
surgical patients are transferred to
Mechnikov Hospital and all others are usually transferredto
Dnipropetrovsk Military Hospital. Burn
victimmaybetransferredtotheDnipropetrovskBurnand
Plastic Surgery Centre. Patients arriving in the city by ambulance or train are typically
transferreddirectlytothemilitaryhospital.

The Dnipropetrovsk Military Hospital located in the center of the city and onceoneofthegems
within the the military medical system. It still remains a shadow ofitsformerselfandfindsitself
mired in ongoing controversy and legal battles. Its new website has a long list of medical
equipment to function at it's necessary capacity. In 2005 the questionable sale offourhectares
(40,000/sq/m) of the hospital for about 12,000 USD (based on 2005 exchange rates) occurred
during the tenure of then Minister of Defence, A
natoliy Hrytsenko
. This transfer was later
contested leaving ownership in question and little done during the last ten years to supportthe
hospital and its infrastructure. At the start of the war the hospital could only be described as
horrendous (J. Quinn: Ukrainian World Congress Report). Subsequently, volunteers/donorsdid
invest 20 Million and the MoD,15 Million UAH into the facility. Unfortunately,
the
Supreme
Economic Court of Ukraine, which in the order of appeal, February 12, 2016 canceled the
previous decision of the Economic Court of Dnipropetrovsk (05/18/2015)andAppealEconomic
Court of Dnipropetrovsk region (10/19/2015) in thecase904 /2552/15,whichdecidedonthe
claim of the State Property Fund (third party the Ministry ofDefenceofUkraine)toVTBwhich
would have returned to state ownership of this integral
property of the military camp
DnipropetrovskMilitaryHospital.

24


MedicalATOFall/Autumn2015andWinter2016
The final step Distribution of injured warfighter from Dnipropetrovsk and
Kharkiv
Patients after receiving care in Dnipropetrovsk and
Kharkiv are then transferred to either the Main Military
Clinical Hospital (MMCH) in Kyiv or one of the other
regional centers
The Main Military Clinical Hospital
provides highly specialized medical care, five Regional
Military Medical Centers provide specialized medical
care and further 14 Military Hospitals and 1 Military
Medical Clinical Center for Occupational Pathology
which provide further specialized and qualified medical
care. At this point, most of the patients that require
extended care are transported by an
Antonov AN26
medical aircraft to the main military hospital in Kyiv or one of the regional centers in Vinnytsia,
OdesaandLviv.Thisaircraftmeetsinternationalstandards.

MainMilitaryClinicalHospital
HospitalnaStreet,Kyiv
The Main Military Clinical Hospital
provides highly specialized medical
care and is alsoatraininginstitutionfor
the
Ukrainian
Military Medical
Academy. The hospital was first
established onJune10th1755.Itisthe
crown jewel of the military medical
system which sits on a beautiful
campus within the central area of Kyiv.
It like many of the institutions in
Ukraine lacked good governmental
support but had not seen the decline as did some of the peripheral institutions. It has received
donationsthroughavarietyofsupportanditsneedsareoften addressedfirst.Awalkthroughits
sprawling campus which includes the historic
Pechersk Fortress and the semiunderground
Kyiv Fortress Museum or Kyivska Fortetsya, a19thcenturydefensebuilding,isawalkthrough
history.

25


MedicalATOFall/Autumn2015andWinter2016

Section2TheATO.
UpdatesfromSectorsB,A,CandM.

Thecapabilityofafightingforcerestsuponmaterielandmorale.Firstand
foremostincreatinghighmoraleisthe
moral
qualityofthedefencesystem.
GlenGrant,CentreforCivilMilitaryRelations,USA.CACDS

AfewMedicReportsfromSectorB
Alexandr Fomenko MD, Pediatrician, Senior Medic 53rd Separate Mechanized Brigade,
2ndBattalion,SectorB.Oct5th,2015
Mostlyrequirescough/coldmedicines,liketea,nose/throatsprays,forseasonalillnesses.
Last week had 40 soldiers with colds and hightemperature,isrunningoutofmedicine, onlyleft
for a week or so. Has better supply of trauma equipment, but estimates that in a month hewill
run out of saline, IV lines, syringes. Every patient gets IV access in case of shock. Has
antibiotics.Noinpatientcare,minorinjuriesstay,othersaretransportedto66thMFH.Withinlast
week had five injured. Right now was doing some surgery, arm damaged, not amenable to
tourniquet, he sutured the injury and transported the patient to 66th MFH. The situation is
calmer,nolargecaliberfire.Stillhavesmallarms.
Most of the injuries are mine explosive, because "guys have to go out from time to time and
sometimes are not careful enough". His battalion is new and new people are stillcomingsohe
doesn't even know how many people he has and will have. But they would really use medical
trainingifsomeonecouldcometheretodoit.Invitedtocomeandseehowtheyaredoing.

A soldier of the 93rd was injured on a tripwire at the FOB Butovka Mine resulting in 15/cmof
arterial damage to his leg. Selfapplied tourniquet and evacuated to Vodyane, where medics
bandage and establish IV. Then evacuated to Selydove Civilian Hospital, followed by the 66th
MFHandfinallyDnipropetrovskbytrain.Expectedtomakeafullrecovery.

StateEmergencyServiceambulanceinKramatorsk.HasEKG,O2,appearedtobewellstocked
on a quick visual exam. However when seen in
Kramatorsk they didn't have a medic on board, the
ambulance was used to pick up somebody from the
trainstation.

SectorA59thMFH
Sector A now know as the Lugansk Sector, hasbeen
relatively calm compared to Donetsk and Mariupol,
but continues to experience episodes of mining by
subversive reconnaissance groups, shelling, grenade
launchers and small arms fire such as the
shelling

26


MedicalATOFall/Autumn2015andWinter2016
with a grenade launcher
at CP29 on Bahmutka Rd near Novotoshkivske west of Lugansk on
February 26, 2016, and the destruction of a military vehicle of the 80th Airborne, killing three
and wounding two on March 1st, 2016 also near Novotoshkivske. Most of the fighting is
experienced near the towns of Kryms'ke, Tr'okhizbenka, Zolote,Novotoshkivs'ke,Orikhoveand
the strategic town of Schastya with its DTEK Lugansk Thermal Power Plantagainmanagedby

LiveMapUAMarch3,2016

Metinvest which is owned byRinatAkhmetov.Mostofthecontact linealongthe northernsector


of Lugansk is stretched along the Donets River. The areas south of the river and east of
Luhansk is where the contact line leaves the river and drops south towards Donetsk. Here
soldiersexperiencesomeofthemostintenseepisodesoffightingintheLugansksector.

SeverodonetskMultiSpecialityHospital

In the Lugansk Sector injured warfighters are often


transported to the closest hospital then after, either
transported to Severodonetsk MultiSpeciality Hospital
or if stable to the 59th MFH at Svatovo Civilian
Hospital. The 59th MFH is slated to be moved to
Severodonetsk MultiSpeciality Hospital in the very
near future which will increase the likelihood that the
facility will be better utilized as the primary evacuation
point for those injured along the front line and
additionally move cache resources closer to areas of
greater need. Severodonetsk MultiSpeciality Hospital for all intents and purpose has been the
mainmilitaryreceivinghospitalinthesectorandtheofficialdesignationislongoverdue.

27


MedicalATOFall/Autumn2015andWinter2016
Severodonetsk is located close to and north of the SiverskyDonetsRiver,andisapproximately
110 km (68 mi) to the north, northwest fromtheoccupiedOblastcapital,Luhansk.Itisnowthe
acting administrative center of the Luhansk Oblast. ItwascapturedbrieflyfromlateMaytill July
22, 2014. To the north of the city is a major employer, a large and significant industrial area in
thetownofRubizhnewhichincludeschemical,refineryandfertilizerproduction.

Severodonetsk MultiSpeciality Hospital now functions as a Level III hospital and can be
considered the best hospital in theLuhanskOblast.Ithasanearbyairportsuitableforfixedand
rotary which is now managed by Ukrainian military elements. Currently, the airport is still only
used by helicopters. Severodonetsk Hospitals location and proximity to the frontline areas, its
size and theabilitytomovepatientsbybothfixedwingandrotaryaircraftmakesitabetterfitfor
a frontlineMFH.Itscapacityincludes640beds,6ICUbeds,10bedsforcardiology,10neonatal
ICUbedsand30pediatricbedspediatricsandthehospitalrunatabout80%occupancy.

Severodonetsk Hospital currently could use more surgical equipment, modern ultrasound,
angiography and specifically Carmrotationalangiography.Itdoeshaveacacheofwholeblood
consisting of two units of each blood type. Additional blood supplies can be obtained through
the civilian network but takes about two hours to eventually receive from the local blood bank.
One factor that slows the distribution of additional blood products is there is noformalprogram
between the civilian and military doctors, thus requiring the military staff to go through their
civiliancounterpartstoorderthebloodforthem.

Since May 2015 the Severodonetsk Hospital has treated approximately 2500 warfighters of
which 500600 required immediate surgical intervention. Over the last two months they have
treated 81 penetrating injuries with 15 of them GSW and the other 66 the result of
fragmentation/blastinjuries.

28


MedicalATOFall/Autumn2015andWinter2016
OlesGarashchukNeurosurgeon,59thMFH
SeverodonetskHospital(LevelIII)
Most patients arrive with external bleeding control, IVs inplacebutalargepercentageofthose
comatose with head injury end up with aspiration pneumonia from poor airway management.
Transport times to Severodonetsk on average are between 11.5/hrs but transports from areas
to the east and bordering Russia can take as long as 56 hours.Thoseareahospitalscloserto
the Russian border,
Schastya and
Novoaidar
are supplemented with military doctors which
usually treat injuries first and critical patients can be medevaced by helicopter from Novoaidar
(for more info on
Schastya and
Novoaidar hospitals see:(
UkraineMedicalandHealthReport
Summer 2015 ATO Update).

The addition of a prehospital training program for warfighters in


the area and managed through the Severodonetsk Hospital is a strong recommendation from
someofthemilitaryhospitalstaff.

Oct 29th, 2015 An ammunition dump exploded on the outskirts of Svatovo and exploding
ammunition was scattered throughout the area and the city. The 59th MFH is located next to
Svatovo Hospital. The hospital was evacuated and the 59th received minor damage. The 59th
treated four minor patients (3 military, 1 civilian).Oneciviliankilled intheincident.Laterrevised
withadditionalmilitarydeathlocatedintherubble.

Feb 29th, 2016. An unarmoured


HMMWV
vehicle was hit by shell
fragments resulting in the injury of three warfighters near the villageof
Tr'okhizbenka,Luhans'kaOblast

PhotoCredit:NataliiaMeshcheriakova

Feb 29th, 2016. Members


of 1st platoon of 2nd company of the 80th airborne brigade hit an
antitank mine on an unimproved road while traveling in an American manufactured armoured
HMMWVnearToshkivka.Threesoldierskilled,twoinjured.Photoontheleft.

Right:Onscenetreatmentofanexplosiveinjuryfromthe28thBrigadenear
Shchastya.VideoinArticlesMentioned.

29


MedicalATOFall/Autumn2015andWinter2016
65thMFHSectorC
65th MFHislocatedin thecityof
Bakhmut,(formerlyArtemivsk)
in the Artemivsk Central District Hospital. This hospital can be
considered a Level III facility given it has CT access and full
surgical abilities supplemented by military medics. It receives
both critical and minor patients and of all the Mobile Field
Hospitals it is the closest to the combat areas. The civilian
hospital always had great local support and maybe one of the
bestfacilitiesintheNorthernregionoftheATO.

Air evacuation by helicopter from a soccer field is usually to


Kharkiv but they use Dnipropetrovsk as well. Bakhmut was also briefly occupied from May to
July 2014. Like Mariupol, Bakhmut is dangerously close to the contact line. Theareahasbeen
shelled and will be readily shelled if another push is attempted out of Debaltseve, or Zaitseve
located southeast of the city, or Popasna in the neighboring Luhansk Oblast. The area is also
supplemented by the National Guard Medical Unit and previously by Pirogov Volunteer Mobile
Hospital(seesectiononPirogov).

The MFH hospital is the closest of four MFH to thefrontlineswithcontactline locationsaslittle


as 25/km away. It was severely impacted last winter during the Battle of Debaltseve and now
regularly receives casualties from several locations including Zaitseve, Maiorsk, Popasna and
Luhanske. There is also a military reenforced hospital in neighboring Chasiv Yar about 25
minutes away from Bakhmut. The Chasiv Yar location is off the highway and not very
convenient. There is now some discussion to move the military staff in Chasiv Yar to
Kostyantynivkatosupplementthecivilianhospitalthereandplacingthemclosertothefrontline.
TherewasalsorumorsthattheEMEDSwouldalsobemovedtoKostyantynivka.

In February of 2015 we visited this area during the Battle of Debaltseve and again in April. It
was noted at that time the large influx of ambulances. They were in various degrees of
readiness withmanyjustusedtoshuffle/storesuppliesandpersonnelandsomeusedasprivate
transport of some individuals including one instance of a clearly intoxicated individual
purchasing alcohol. Later we understood that many of these vehicles were pushed out of the
city to more strategic locations only to be brought back in. Then later again pushed outtotheir
currentlocations.

Image:APPhoto/PetrDavidJosek

30


MedicalATOFall/Autumn2015andWinter2016

SectorC,WIAVolunteerMedic,
Jan.31,2016
.
Medic and soldier injured when the
ambulance comes under mortar fire while
evacuating wounded at a checkpoint. The
joint civilianmedicteam ofASAPandMedical
Corps were dispatched to Maiorsk to
transport a soldier injured from shelling.
Within a minute after arriving on the scene
they too were shelled by mortar. MC medic
"Pechenka" was injured, sustaining frags
injuries in her forearm. She was evacuated
through the 65th MFH in Artemivsk and later
totheMilitaryHospitalinKyiv.
The Renault medical vehicle was damaged
but not destroyed. The vehicle was later
moved to Kharkiv where it has now been repaired. The vehicle came through the Charity
FoundationSestraMyloserdia(SisterofMercy).Thefollowingishersto
ry.

Julia"Pechenka",
ASAPRescueMedic
Background:
Studied biochemistry at her university with a desire to later work as a
pharmacology researcher. Her efforts began as a
volunteersupplyingfoodandlogisticstofront
line troops. Later she attended a session at a Medsanbat TCCC class (March 1014, 2015).
Later attended additional classes onmedications,thenvolunteeredtoprovideparamedicalcare
in the ATO. Since the summer of 2015 has workedasamediconanambulanceandadental
assistant in a dental volunteer service for soldiers in the ATO. She like many othersvolunteers
on the front line have little or no military training. Occasionally returns to Kyiv to continue her
studiesatheruniversity.OnJanuary31,2016shewaswoundedinactionnearMaiorsk.

The incident happened in Maiorsk at a roadblock on the contact line where the situation is
always tense. Assisting in the dental facility in daytime and working night shifts covering
Maiorsk, where the majority of the time there were no injuries but which often experiences
harassing fire. When shellingsdooccurallearsturntoradiotokeepthemselvesapprisedofthe
current situation. On the day of the incident the medic received a call from a battalion
commander on her private phone. The commander knew her and knew they were there and
asked them to proceed to Maiorsk to evacuate a critical casualty. The crew called their logistic
center by phone given they were out of range for radio communication and advised they were
en route to pick up a patient near a checkpoint that received incoming fire resulting inacritical
casualty.

Upon arrival at the rally point she informed the military commander that they were waiting in
their ambulance and within 1 minute shelling with 120/mm mortar began at their location. After

31


MedicalATOFall/Autumn2015andWinter2016
four minutes the military commander was calling her again but this time she didn't answer her
phone and the shelling stopped, but only after receiving four strikes at their location. One shell
exploded about 4 metersawayfromtheirambulance.Thefragmentationriddledtheambulance,
flattening tires, blowing out windows and damaging the engine, thus rendering the vehicle
useless. Although she had protective gear, she was not wearing any of it the time of impact.
She received fragmentation injuryin forearm,foreheadandbarotraumafromtheblast.Although
she felt she suffered a concussion, military doctors never confirmed her opinion. She also
injuredherlegwhenexitingherambulancetofindcover.

The medic speculates that the enemy overheard their cell phone conversation and deliberately
targeted them in an attempt tohitboththemandthemilitaryvehicleevacuating thepatientfrom
the red zone. (There are reports that bounties exist on Ukrainian warfighters and that killing a
medicwillbringyou25,000/UAHorabouta1000USD).

The medic feels it was the driver of their ambulance that saved her by yelling forhertogetout
of the ambulance and directed her to the military bunker nearby. Inside he pointed out to her
that she had blood all over her face. She first examined her head, provided selfaid and then
noticed there was blood coming out of her forearm where she located two smallentry wounds.
She applied chlorhexidine and a pressure bandage to the wounds on her extremity. They then
moved to their regular place nearby and she disinfected the wound again, plusgave herself an
antibiotics injection. The previous driver she worked with could perform some aid but this one
was new and although had a "medic certificate" from Sisters of Mercy he couldn't do anything.
The military saninstructor attheirlocationwasuselessgivenhehadbeendrunk forthelasttwo
days. While waiting for evacuation she also examined another patient struck by the impact of
airborne debris, a stone to his facejustunderhiseye.Hewassentbacktoduty afterexamand
treatment.

The critical patient they were originally dispatched to assist was evacuated bythevehicleused
to move him out of the red zone, bypassing the crew who was now disabled and directly to
the 65th MFH. He died en route from a head injury received during the earlier shelling at the
frontlinecheckpoint.

The medic was not immediately evacuated because of the ongoing fighting and stayed at the
location for the night. At some point the medic noticed her arm was turning blue because of
poor circulation and applied a heating pack to restore circulation. In the morning she was
evacuated by her organization, ASAP Rescue to the 65th MFH and eventually for treatment in
Kyiv Military Hospital. Shewill takeaboutamonthoffforrestandrehabilitationandreturntothe
contactline.

32


MedicalATOFall/Autumn2015andWinter2016
SectorCVolunteerMilitaryMedics
ASAP Rescue has basically merged with another volunteer group, Medical Corps. Their
organizations maintain relatively good
ambulances donated through volunteer
sources. Ambulance crews include two
people, a medic and a driver. All personnel
are issued protective gear (helmets, body
armour) but sometimes the size is not quite
right. They have radiosbutwhentheyexceed
their operatingrangetheyresortto cellphones
for communication. They usually do not have
direct communicationstothemilitary,butoften
supplied with phone contact to local commanders. ASAP is upgrading to more effective radios
for interoperations communication. When a new crew comes in, ASAP always meets them to
inservice them to their SOP and local contactinfo. ASAPandMedicalCorpsarebasedattheir
logisticalcenterinZaitseveareawhich placesthematfrontlineRallyPointsusuallywithinfifteen
minutesofanotification.

UsedtobestationedinArtemivsk(Bakhmut)butleftitforanumberofreasons:
Toofarfromthefrontlines
Central district hospital sold the building eliminating their only option in Bakhmut for
vehicles,warehousingandliving.
Therearefewmilitaryambulancesavailablegiventoalackof"willandskills".

Ambulances are now stationed intheirlogisticalcenterinZaitsevewhichhasliving,showerand


warehousing. There is a dental facility and a mobilesurgery withsurgeon andanesthesiologist,
an underground bunker and another military bunker nearby. Ambulances are deployed to
forward locations near roadblocks in Zaitseve, Maiorsk and Avdiivka. 57th brigade is located
nearbyandsupportsthem.

EvacuationfromtheContactLine
Artemivsk (Bakhmut) is about 30 minutes on average. Highest speed transport is about
120/kmperhour.
Usuallytakesabout15minutestogettotheinjured.
They have access to a military radio so information about injuries arrives about 1530
minutesbeforethecallisreceivedthroughnormalchannels.
Evacuations are usually to Artemivsk, secondary receiving facilitiesstaffedbymilitaryor
alsolocatedinChasivIarorDzerzhynsk(Toretsk,renamedin2015).

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MedicalATOFall/Autumn2015andWinter2016
PatientCare
:
Tourniquets are usually done by soldiers, but they find they are often unnecessary and
releasethem.
Redrubbertourniquetsaremostfrequentlyseen.
The crews always mark tourniquet time / useofnarcoticpainmanagement(nalbuphine)
ontheforehead
OftengiveIntravenousinjections,butnotIVcatheters(althoughtrainedtoperformthem)
Cspine,pelvicsplints,splints
Warmblanketsandteawithsugarifabletotakefluidsbymouth.
Jokestorelievenervousnessandcalmpatientsdown.
Woundpackingandpressurebandages.
Exams (strip and flip), as soldiers don't always give good reports/exams of their
casualties.
Nocasualtycardsusedbythemorthemilitary.
ASAPRescuehasamedicallogbook.

RecentNotableCase
Vehicle rollover. Patient looked good, no obvious trauma, the military only called them just in
case, no emergency was suspected. Patientfoundtobepale,diaphoretic,shiveringandthirsty.
Exam found a hard spot on the abdomen. Pulse rapid and weak. Initiated emergency
evacuation. No IVs were started, as thehospitalwasclosebybutonarrivaltothe65thMFHit
wasdeterminedthepatientwaspositiveforanabdominalbleed.

Gaps
One reason IVs are not performed along with other procedures is that volunteers are not
allowed to perform certain procedures since paramedics legally don't exist. Often doctors at
the hospital or military commanders are critical and question and challenge volunteers who do
attemptinvasiveprocedures.

Military Equipment and Training.


Still sees Medsanbat backpacks on the frontlines. Military
ambulances, where available, are in poorandoftenunequipped conditionandunfittotransport
patients. The military bunker in Maiorsk is in poor shape and the excuse is '"this waswhatwe
got from the previous unit". But stronger logs for the roof could be easily procured from the
nearbyforest.

People willing to embrace TCCC and good best practices are usually young feldshers/medics
and they are rather an exception than a rule. Would be best to have motivated people with
desireandopportunitytolearn.

34


MedicalATOFall/Autumn2015andWinter2016
PirogovVolunteerHospital/Medics
Pirogov was restricted by the Ministry of Health
(MoH) from performing medicine in the ATO. On
February 6, 2016 the MoD/MoH authorized
Pirogov to return to the ATO. Unlike an ordinary
volunteer, a doctor must have legalpermissionto
work in another hospital.Otherwisehe/shewillbe
criminally liable. At that time that Pirogov left the
ATO they packed up their extensive collection of
donated equipment and stored much of it inKyiv.
Currently they have not to our knowledge
returned to the ATO but are expected to do so.
Previously they maintained ambulances in
Artemivsk and a Forward Surgical Unit in Popasna near the Donetsk Airport. The following
information was obtained from other nonPirogov staff when askedtocommentonwhyPirogov
wasforcedtoleavebutothervolunteergroupsremainedintheATO.

Although Pirogov was considered to be staffed with some of the best medics in the ATO they
were a bit controversial. They were based in Artemivsk and would not change their location.
Well supplied with vehicles, fuel, good medics/doctors and medications and withexcellentfund
raising capacity. Difficult to become part of their team with a very tough entry program
including the inclusion that all potential volunteers/employees are requiredto submittoahealth
exam.Mostoftheirstaffhadapreviousmedicalbackground.

Apparently had a reputation of not willing to share their large cache of equipment andsupplies
with other groups in the ATO. When one transport provider asked to borrow some of their
vehicles they refused to do it. Were asked to backup the only crew in Avdiivka, again they
refused. Their inability to be flexible alienated them to both the military and other volunteer
organizations. So when the order came out for volunteer organizations to leave ATO, nobody
stoodupforthemeventhoughmanyoftheirstaffwerewellregardedintheATO.

Toourknowledgenoothermajormedicalgroupwasforcedtoleave.

Miscellaneous
Back in August there was a MOH / MOD conference in Artemivsk, with Dr Olga Bogomolets,
Korchynska, Medical Chiefs, Military Commanders and others. One of the questionsdiscussed
was creating some kind of personal soldier card with blood type, known allergies, previous
trauma, vaccinations, etc all stored in a small thumbdrive. Not much support from the military
staff.

35


MedicalATOFall/Autumn2015andWinter2016
SectorMMariupoland61stMFH
Mariupol. It is a major industrial city with its main
employer Ilyich Iron and Steel Works managed by
Metinvest which is owned byRinatAkhmetov.Itisthe
tenthlargest city in Ukraine and the second largestin
the Donetsk Oblast.
Population: 461,810. It was
captured by Russian forces in 2014 and later retaken
on June 13, 2014 by government troops. Since then
Mariupol was made the provisional administrative
centerofDonetskOblast.
The city remained peaceful until the end of August,
when
an offensive
by proRussian forces from the
east came within 16 kilometres (10 mi) of it. A
ceasefire between the two sides was agreed to on 5th of September, halting that offensive.
Despite this ceasefire, minor skirmishes continued on the outskirts of Mariupol in the following
months. To protect the city, government forces established defence lines on its outskirts,
deployed heavy artillery, and large amounts of army and national guard troops.
An
assaulton
Mariupol was launched again on 24th of January 2015 by the
Russian forces. In February 2015 Ukraine Armed Forces push the
RussianforcesbacktoShyrokine.
Sporadic fighting continues to this day throughout Sector M with
periodic surges of activity seen specifically in Hnutove, Talakivka,
Shyrokine in the south of Sector M and impacting Mariupol Hospital
and also seen further north in Hranitne and Starohnatyvka, where the
wounded are evacuated to Volnovakha Hospital. The National Guard
Medical Unit also has a presence in this area and maintains several
armoredvehiclesforevacuation.

The top hospital in Sector M is


Mariupol Emergency Care Hospital (Level III),
managed by
Chief Administrator, Sergii Orleanskyi and reinforced with staff from the 61st MFH. Critical
patientsinMariupolareairliftedfromtheMariupolAirporttowhereithas nowbeenreportedthat
both helicopter and fixed wing are now used from this location. The overall condition of the
hospital is a depressing example of what is seriously wrong with the healthcare system in
Ukraine. In a major industrial city where industries such as Ilyich Iron and Steel Works which
employs 60,000 people and another industrialgiant,thePJSCAzovstalIronandSteelWorks,it
is beyond comprehension that a hospital infrastructure has beenalmosttotallyignoredby,civic
leaders, industries and the Ministry of Health and can exist in what should be a modern
european industrial city with an appropriate health care system. (see more: Hospitals of the
ATO).

36


MedicalATOFall/Autumn2015andWinter2016
The61stMFH

Chief
,
TarasSobko
In August 2015 the 61st moved from Kuibysheve to Volodarske. They usually do not receive
patients straight from the contact line. Most military patients are seen in Volnovakha and/or
Mariupol hospitals which are reinforced with a surgeon, traumatologist, anesthesiologist. Only
those not medevac out and requiring further treatment come to the 61st. They have one
vascular surgeon based at the 61st, who goes out to Volnovakha or Mariupolandcanbethere
in about thirty minutes. Requires Sector Medical Chief's permission for everything, Unable to
assignasurgeontoMariupolwithouthispermission.

AzovandDonbassBattalionreplacedwithMarines
At the end of the summer 2015 the Azov and Donbass Battalions were withdrawn from
Shyrokyne and replaced with Marines of the Naval Forces of the Ukrainian Army. Both Azov
and the Donbass Battalions were early recipients of TCCC training and supplies and have
fought in many ofthemajorbattlessincetheoutbreakofwar.Withtheirdeparture fromthefront
lines goes much of their medical experience and medical supplies. An example of the medics
from the Donbass Battalion abilities was seen in the Battle of Ilovaisk, August 2014 and is
described in an interview below with Sergii Mishchenko, Donbas battalion shooter/sanitar
(shooter/medic).NowamemberofNGOSpravedlyvist.

His background consist of Feldsher training. Attended CLS/TCCC training in June 2014, later
after the Battle of Ilovaisk, a Medsanbat course. In June of 2014 received medic bags after a
training in Novi Petrivtsi at a National Guard military base.Thebagswereusedandstillremain
withtheirteaminrearlinesoftheATO.

SupplementalHistoricalReport

Battle of Ilovaisk Field Care and Evacuation from the Ilovaisk Kettle
,
August2014

On 7 August 2014, The Battle of Ilovaisk began when the Armed Forces of Ukraine and
paramilitary units attempts to capture the important railroad hub in the city of Ilovaisk from the
Donetsk People's Republic (DPR) that would ultimatelycutoffthecityofDonetskfromLuhansk
and the supplies that flowed in from Russia. Government forces were able to enter the city on
August 18th, Russian reinforcements crossed the border into Ukraine and encircled the
Ukrainian forces. After days of encirclement, government forces made an agreement with the
Russians to allow them to retreat from the city. This agreement was not honoured, and many
soldiers died, hundreds were wounded and many others were captured trying to escape the
ambush.

On August 18, 2014 the Donbas Battalion entered Ilovaisk Their medical team pulled up the
rear but when the main body was cut off and surrounded they weredividedfromtheirunit.The

37


MedicalATOFall/Autumn2015andWinter2016
medical crewconsistedoftwofeldsherlevelmedicsandaboutfiveshootersanitars.Therewere
additional medics but their combat skills were required and they could not be used to
supplement the medical group. Most of them did not have much medical training and critically
lacked knowledge on extended care as they were soon to be surrounded and unable to
evacuate their wounded for twotothreedays.UnknowntothemtheonlyMDintheareawasDr
Vsevolod Stebliuk a pathologist, who was part of National Guards Myrotvorets Battalion and
stationed in a building nearby. He later subsequently evacuated with some of the last patients
beforetheyweresurroundedandcompletelycutoff.

There were no known MDs in the areasothesanitars/medicsorganizedandmanagedtheiraid


station. It was established in the kitchen of a school building pictured below, where after the
shellings began in earnest they moved into the basement. At one point during a lull in the
fighting the insurgents contacted them over their compromised radio and asked for medical
assistance with some of their casualties. Sergii
volunteered to cross the line and administer
medical aid. While therehediscoveredthatthey
held an injured Ukrainian soldier. He traded two
vials of Ceftriaxone and care rendered for the
releaseofhisinjuredcompatriot.

Up till August 25th evacuation was done to


Volnovakha about 100/Km away. At the time,
little aid was provided by the staff of the local
civilian hospital in Volnovakha. Most patients
were reloaded into other transports and sent to
the 61st MFH in Zaporizhzhia region and then
Dnipropetrovsk for additional care. During this time they treated and transported about ten to
fifteenpatientsadayfromtheirlocationinIlovaisktoVolnovakha.

August 25th26th saw the start of intense fighting. Regular Russian forces nowpushedintothe
area on August 25th, cutting routes and eventually surrounding Ukrainian forces on August
26th. The medics were cutoff,withthelastevacuationtoVolnovakhaoccurringonthisdate.By
August 29th, with no relief, without resupply they had run out of ammunition and much of their
medicalsupplies.

They were forced to surrender, along with their aid station with the hope that Russian forces
would care for their patients. After one day in captivity and given the Russian forces did not
have the capacity to handle the patients, the Russians agreed to release the patients, their
medics and regular Ukrainian Armed Forces, but not any of the warfighters with the Donbass
Battalion. The surviving fighters of the Donbass Battalion were held prisoners for six months
beforetheirnegotiatedrelease.

38


MedicalATOFall/Autumn2015andWinter2016

CNNVideo

Released from Russian captivity on August 30th, the medics with their eight seriously injured
patients made their way to Mnohopillia, where they found a small aid station manned by two
Ukrainian Armed Forces medics. From there they moved west 180 km to the 61st MFH in
Rozivka, Zaporizhzhia region. They arrived at the 61st late that evening to find forty other
patients, but at least from here medevac helicopters were brought in for evacuation of the
seriouslywoundedtoDnipropetrovsk.

During the battle the medic wentthrough their


cache of bandages and resorted to tearingup
sheets, then boiling them for improvised
sterile wound dressings. Some suturing was
done, TXA was unavailable at the time, pain
management PRN and all their serious
patients were given IV and fluid until they ran
out of supplies. Just prior to their deployment
to the ATO, during their medical training in
Novi Petrivtsi, in June of 2014 the use of IV
antibiotics in trauma was stressed by the two
American medic instructors. So when
preparing their medical equipment for deployment the medic stocked up on IV Ceftriaxoneand
to lessen the weight of the medics equipment, distributed vials for each soldier tocarryintheir
ownkit.

Now trapped in Ilovaisk and forced to provided extended care, they administered maintenance
doses of IV Ceftriaxone to all their trauma patients. One patient with abdominal trauma
developed
peritonitis acute abdomen, fever, pallor, unresponsive to
IV Ceftriaxone. He died
about five hours before evacuation.
Aftertheirescapeandevacuationonlyonepatientdiedand
none developed infections except the fatality who had hidden the fact, and they later
discovered,hesufferedfromdiabetes.

The diabetic patient suffered a gaping wound to the thigh and subsequently develop
inflammation that advanced to wet gangrene. Though they administered prophylactically and
eventually a maximum dose of IV Ceftriaxone of four grams per day witho
ut a glucometer,

39


MedicalATOFall/Autumn2015andWinter2016
glycemic control, medicine and surgical intervention the patient succumbed to the secondary
effects of his injury. They later discovered from relatives that the patient had been worried he
would not be accepted into his unit with a preexisting medical condition so he kept this
information to himself and did not inform the medics of hisdiabetesevenafter developingwhat
wouldbecomeafatalcomplication.

One casualty with arterial bleed from arm had a tourniquet applied, then with the bleeding
controlled they packed the wound and release the tourniquet. They started an IV and
administered IV Ceftriaxone. The injury occurred on August 29th andtheyarrivedatthe61stin
Rozivka late night on the 31st. The soldier recovered and the arm was saved after surgical
intervention.

Among their patients were several burns. One patient with burns of 2nd and 3rd degree
encompassing 30% of his body and several others with lesser burns incurred while escaping
from a burning APC. By thesecondandthirddaytheywereunsureonadministeringcaregiven
their little experience with extend care. Treatment was restricted to
panthenol dressings, pain
management and IV NaCl. Then in the following days,fluidPOandlotsofwatermelonfromthe
neighboringfarmswereadministeredtokeeptheirpatientsurineoutputup.

Painmanagement
Used lidocaine and butorphanol in the field. Tried to take the latter from soldiers, so that only
sanitars would have access. One patient received ceftriaxone plus lidocaine IV by an
inexperiencedSanitarandsufferedadversereactions,butdidrecover.

Many people developed addiction to butorphanol while recuperating in the hospital, volunteers
supplied whatever soldiers asked for and some would ask forbutorphanolandinjectedthreeto
fourdosesadayforanyminorpain.Theywerelaterplacedintoclinicforaddictiontreatment.

40


MedicalATOFall/Autumn2015andWinter2016
MedicalCommandandControl/MissionControl

Illustration:UkraineMoD2014WhiteBook

The illustration above is the basic infrastructure of the Armed forces in Ukraine. It hardly takes
into account with respect to Medical Mission Control, medical synchronization of assigned and
attached medicalforcesandtheabilitytopullinalltheagencies,thuscomplicatingmedicalcare
and evacuation in the ATO.Thedeploymentofunits fromtheBorderGuards,localandregional
Militia Units (police), SBU, MoIA National Guard Units and their medical service, the MoH,
civilianhospitals,disasterservices(DSNS)alongwithregional andlocalauthorities,airportsand
medic volunteers, presents a confusing assortment of agencies that traditionally have little
abilitytocooperateinnormalsituations.Thereisasystem ofmedicalevacuationwithintheMoD
in place now, which is a major improvement over evacuations that once took days and it does
move patients from point of injury to the MFH, in most cases, in hours and then quickly to a
static hospital.Butitisasystemfullofoldandnewequipmentindisconnectedjuxtapositiondue
to poor preplanning, communication and lack of a unified command structure. A system full of
ambulances with little equipment often manned by poorly trained medics, nonmedical
helicopters, dilapidated hospitals with antiquated equipment within a confusing system without
one central medical command, devoid of a centralized medical communication system and
reliant on a chain of multiple notifications or authorizations that stretches in some case all the
waybacktoKyiv.

The only established protocol ineffectforthedeliveryofapatientisbasedonthesoviet military


system where if a soldier is injured he is to be moved off the front undergoing buddy aid and
delivered to aBattalionAidStation,thatintheory,ismannedbysaninstructorordoctorwiththe
technical ability and tools to perform their mission. From this location the wounded would be
moved to the company's medical unit by military ambulance for further evaluation by a doctor

41


MedicalATOFall/Autumn2015andWinter2016
and surgeon and then if required, to an MFH.Currentlyatthispoint,theCompanyMedicalUnit
is replaced by a frontline civilian hospital. Technically the staff of the Company Medical Unit
should be able to perform damage control surgery which does occur at hospitals such as
Selydove but not at Ocheretyne which lacks the equipment. From there if required the patient
would be evacuated to one of the MFHs for further stabilization and/or transfer to a static
hospital outside of the field of engagement. The existing plan is only forindividualmilitaryunits
use and in itself has oneseriousdrawbackencounteredinitspresentformoftenresultinginthe
transportation of serious trauma patients to a companys medical unit, when in fact rapid
transport to the MFH would better serve theinjuredchanceofsurvivability.Nordoesittakeinto
accountthelackofcapacitywithintheMoD.

The system does not take into consideration of the preexisting resources available including
resources from within the MoD infrastructure, northeabilityofthesystemtocareforthepatient
along the chain. Soldiers lack the basic training in medical care, the initial medic is too often
somebody assigned the task and again with little or no prehospital emergency training or
equipment. The patients are placed in the first ambulance that is found to be available
regardless of the quality of equipment or training of the crew. They are then often rushed at
dangerous speeds to the closest civilian hospital that is reenforced with military doctors with
minimal or antiquated equipment, to then be transferred again and finally arrived at the
designated MFH/civilian hospital to receive invasive surgical care. The strong point currently in
this system are the staff at the 66th, 65th and the reenforced hospitals manned by the teams
from the 66th, 65th, 59th and 61st at Severodonetsk, Selydove, Volnovakha and Mariupol
hospitals, plus some individualunitswithqualityambulancesandvolunteerstaffedambulances.
But they all lack either some or all: modern equipment, additional training, solid preplanning
and a system of command and control that is flexible and responsive to the shifting
requirementsintheATO.

MoDWhiteBook2014

42


MedicalATOFall/Autumn2015andWinter2016

The National Guard, Border Guards and security service (SBU) evacuation system is similar
and dovetails into the existing MoD system attheBattalionAidStationlevelorMFHlevel,They
sometimes manage their own Aid Station but usually never with surgical capacities. They
usuallyhavetheirowntransports.AllsurgeriesoftheirforcesareperformedatMoDorincivilian
hospitals. Once stabilized the patients are transferred into the MoIA system of hospitals.There
is no direct unifiedcommandbetweentheagencies.TheSBUisneitherundertheMoDorMoIA
butissubordinatetothepresidentialoffice.

Recent work by the Reforms Office to improve the evacuation chain


includingtheadditionofa9lineandcommunicationcontrolcenter isa
step in the right direction but is currently being held up, given little
support by senior staff and the lack offundingforthetoolsrequiredto
complete the proposed changes to the evacuation system. The
addition of evacuation training, medical operations and clear
operational protocols is a clear priority and given the conflict is now
enteringitsthirdyear,clearlynotapriorityofthecommandstructure.

The complexity of moving a patient from a front line civilian hospital


can be seen in the document to the left, which we obscured, but lists
no less than six people to be contacted when evacuating a patient from a frontline hospital to
one of the MFHs in the rear. It is further complicated at the MFH where longnegotiationsare
requiredtojustifytheevacuationofapatientfromtheMFHtoastaticfacility.

OSCEintheATO
Organization and Cooperation for Security
in Europe (OSCE): the Special Monitoring
Mission
There are medical support personnel,
contractors from third countries, that provide
emergency and routine medical care to the
OSCE teams while on mission. These teams
often have international paramedics on board
or available in the area of the ATO. OSCE
maintains direct comms with senior staff on
both side of the contact line but as of yethave
not sustained a majorinjury.Howeithersideof
the conflict would reacttothesituationremains
a rhetorical debate at best. Evacuation of
OSCE personnel on the occupied territories
conceivably would require transport into Russia. Interestingly the privately owned Ukrainian
Helicopters, using leased Ukrainian government helicopters, evacuated eight captive OSCE

43


MedicalATOFall/Autumn2015andWinter2016
observers on their release from Russian Forces on June 29, 2014, reportedly from contested
Donetsk.

OSCE serve as observers to this current war and conflict with a mandate stemming back to
March 2014 which states to deploy a special OSCE monitoring mission of international
observers to Ukraine. And that the details are: That the aim of the said mission will be to
contribute, throughout the country and in cooperation with the concerned OSCE executive
structures and relevant actors of the international community (such as the United Nations and
the Council of Europe), to reducing tensions and fostering peace, stability and security and to
monitoringandsupportingtheimplementationofallOSCE principlesandcommitments(OSCE,
2014).

The OSCE mission is purely monitoring and observation during conflict no engagement,
defensive or other activities are to take place. The OSCE was plagued early on in the crisis
which continues today for having Russian observers of questionable background and no
securitymeasuresinplace,potentiallycompromisingthemission.

Per the Ukrainian soldiers, separatists take good care not to shell OSCE. In some locations
where the enemy positions are nearby, Ukrainian soldiers can hear separatists radio traffic.
Once when OSCE was at their location it was being shelled and Ukrainian soldiers heard
separatists yelling on their radio to stop shelling becauseofthepresenceofOSCE.Assoonas
OSCE left, shelling resumes. Also per the soldiers, OSCE never comes to forward positions at
nightwhichisusuallythetimeofactiveshellings.

44


MedicalATOFall/Autumn2015andWinter2016

Section3Equipment

Duringitsprimeinthe1960s,theplantinKharkivrepairedmorethan60tanksand55enginespermonth,
butworkonthesitegroundtoahaltafterthefalloftheSovietUnion.
PhotoCredit
:
DailyMail

AbilityoftheUS&internationalcommunitytosupportUkraine
dependsuponthecommitmentofitsleaderstoputtheirpeopleandcountryfirst.
AssistantSecretaryNulandtestifiesonUkrainebeforeSenateForeignRelationsCommittee
March15,2016.

Logistics

The overall impression is that the supply chain for food, water, clothing and medicine has
improved in the ATO. The only constant complaint weve heard is that the system is
cumbersome, the approval chain is long andwhenan emergencyarisesitisthevolunteersthat
are turned to first. Some of this is currently addressed through the reforms programs and the
computerized system currently under construction. However, there are still many areas that
function, arguably, only with the system of volunteers and activists that continue to push for
changes in a still dysfunctional military system. Problems persist with the purchase and
distribution of hardware such as armored vehicles, ambulances, night vision equipment and
hightech items such as computers, software, secure communications, drones and there are
reportsoffueloflowqualitywhichinturnaffectstheperformanceofvehicles

VolunteerEffort
It must not be forgotten that without the efforts of the volunteers, activist organizations, friends
and the families of the soldiers, that the army was only able to survive in the early days of the
fightingandtothisdaytheystillremainasignificantforce,withtheirverymassivecontributionto

45


MedicalATOFall/Autumn2015andWinter2016
the military effort. We personally witness the delivery of these supplies and in some cases
watched as the wives and girlfriends of the fighting forces actually provided the cooking and
maintenanceatfrontlinequartersintheATO.

The effort of volunteers and activists has been staggering and there are ongoing attempts to
merge their capacity within the existing military structure. Many individuals actually joined the
military to facilitate the change from within but this avenue has largely failed among those
volunteers andactivist:theyfoundtheywerequicklyreassignedto dutiesthatlimittheirabilityto
participate and muzzled with threats of retribution and evenprosecutionforpostingproblemsin
social media. The volunteer groups that continue to help do it outside the grasps of the senior
military structure or continue their efforts without criticism for fear of losing access to military
bases and locations in the ATO. Other groups are extremely powerful and have broad support
from within the political and military structures and althoughtheyfindtheireffortsslowedbythe
existingsystemtheycontinuetoprevail,notbecauseofthesystem,butinspiteof.

There is a site that lists all the vented major providers of aid to the military and additional
support groupsforIDPsandmissingpersons.Unfortunately,atthistimeitisonlyUkrainianand
does not have an English version. However, some of the groups listed do have multilingual
websites. We have posted some examples below of a few of sites including somewithEnglish
pages.

http://4army.com.ua/
Websitelistingvariousvolunteers/groupshelpingarmyandrefugees(NoEnglish)

HelptheArmyofUkrain
e(UkrArmy)

Recent delivery of medical supplies to the


61st, 65th, and
66th MFH, and for the medical units of the 17th tank, 81st
Airborne, and 57th infantry brigades, for the total amount of
about500,000UAH.

46


MedicalATOFall/Autumn2015andWinter2016
Major Volunteer Medic Organizations in the ATO providing medical and/or ambulance
support.
Viterets Volunteer Group Medical Rapid Response Team "Breeze" Sector B, currently
Marinka.
PirogovSectorCbutatonetimeinSectorB
ASAPMostlySectorC
HospitallersMostlyworkinginSectorBandM
() Private Medical Brigade Rapid Response Appearstobenolongerfunctioning
asagroup
MedicalCorpsMostlySectorB
UkropDentalSectorC

Volunteer Medics are some of the most recognized and decorated


medics in the ATO. Several female medics were selected as
representatives for UNWomenincludingOksanaRomaniv,(topleft)a
military physician, group commander with Mykola Pirogov First
Voluntary Mobile Hospital and
"Zoya" (her call sign),a paramedicand
sanitary instructor withthemedical unit"Hospitallers".
(Thereare many
more men and women currently using standards such as TCCC that
are not recognizedbytheUkrainianMinistry ofHealth.Theintroduction
and the immediate implementation of internationally recognized TCCC
and ITLS standards are of the utmost importance for the protection of
thesemedicsandtheirpatients).

PhotoCredit:MoDFB

Helicopters
FlightMedicReceiveAwards
Tetiana Potupalova, Mi8 helicopter medic who's
made 92 flights and has provided medical care to
more than 600 wounded and sick received award
from the President Order "For courage" of the III
degree.

Sergeant Galina Khmelivska, paramedic rescue


airborne group,receivedtheOrderofPrincess,and
has carried out over 100 sorties and saved the lives
ofmorethan350warfighters.

It is wonderful news that these two flight medics have been presented with awards by none
other than the PresidentofUkraine,PetroPoroshenko.Butwhatisdifficulttounderstandiswhy

47


MedicalATOFall/Autumn2015andWinter2016
these heroes and the outstanding examples of what Ukrainecando,arenotpresentedwith the
tools they desperately required to do their jobs? It is one thing to argue that the MoD doesnot
have the funds or equipment but its is anotherwhentheequipmentisavailableand notpushed
out immediately to those that will use the equipment that should have been made available at
the start of the conflict. Modern aeromedicalevacuationhelicoptersareavailableandownedby
thegovernmentandMinistryofDefencebutarenotactivelyusedintheATO.

UkrainianHelicopters
ThecontinuingsagaofUkrainianHelicoptersremainsamurkymystery.Thecompanyboastson
its website of 28 universal Mi8MTV1 helicopters, including 6 unique helicoptertransformers
(helicopters that can be converted forvariousdifferenttasks)andare leasedfromtheUkrainian
government. Sources that have enquired to the MoD about the status and ownership of these
Mi8medical,rescueandlogisticalhelicoptershavemetastonewallofsilence.

Ukrainian Helicopters maintains offices in Kyiv, continues to provide helicopter services to UN


World Food Programme and UN Peacekeeping Missions, a working website and their press
center release in June 2015 a report on their participation at an airshow conference in Kenya
where they demonstrated their clearly superior skills and advancedcapacitiesinairrescueand
evacuation.

The history of Ukrainian Helicopter is mired in controversy.Inan articlepublishedbyDSNews.


in 2007 they write that in 2003 the newlyformedUkrainianHelicoptersbrokeredadeal withthe
Ministry of Defence for sixteen Mi8 helicopters for a fouryear lease, in2007theyrenewedthe
lease for additional four years. In 2008 then Minister of Defence, Anatoly Gritsenko contested
the contact and asked the courts to declare the contract null and void. He also subsequently
dismissed the Commander of theLandForces,ValeriiFrolov,whoapprovedtheprolongationof
the lease. The Military Service Law Enforcement was instructedtostartaninquiryandinitiatea
criminal casefor negligencebymilitaryofficials.The courtslaterrefusedtooverturnthecontract
and the officeofthenPresident
ViktorYushchenkosteppedinandaskedtheMoDtonotpursue
the issue. Valerii Frolov was to go on and become a Lt General and the Chief Inspector of the
Main Inspection Office of the MoD. The contact lease in 2007 was 300,000 UAH per month or
about60,000USDat2007ratesforall16helicopters.

OncethewarwithRussiabroke outtherewereadditionalattemptstoregaincontrolofUkrainian
Helicopters growing inventory of governmentowne
d helicopters. The fleet had now reached a
total of twentyeight, four of them leased from the Ministry of Interior, eight from the state
enterprise "Ukrainian Aviation Transport Company" KhoryvAVIA ( ) and sixteen
from the MoD. KhoryvAVIA was actually established in 1999 to help the MoI raise funds for
operations. It too was controversial when in 2011 the State Financial Office of Ukraine
submitted to the prosecutor's office a complaint that theyfailedtotransfer almost3millionUAH
tothestateofficesfortheleaseofsixhelicopters.

48


MedicalATOFall/Autumn2015andWinter2016
With the outbreak of hostilities andtheimmediaterequirementofadditionalequipmentattempts
were again made to recover these airborne assets. In an article published on August 28, 2014
by No Corruption, the prosecutor's office opened proceeding against Ukrainian Helicopters for
the return of state assets. But at that time Ukrainian Interior Minister Arsen Avakov stated that
the Ministry of Interior had no need for their helicopters. The MoD did demand their return but
according to the company, because the country has not declared martial law, and conducted
only an antiterrorist operation, the Ministry of Defence has no legal grounds to request the
return of their helicopters. In addition, the company estimates that these actions intheevent of
abreachofcontractwiththeUNmaycausepenaltybytheUNintheamountof$40million.

In
July 21, 2014 in an article by
Tetiana Chornovol in Ukrainian Pravda she goes on to blame
Chairman of the Board, Volodymyr Tkachenko and partial owner of Ukrainian Helicopters (his
wife owns the remaining shares) of blocking
the transfer back to the state for monetary
gains
. (Theactualrequestforthereturnofthe
helicopters came in March 2014 from then
Commander of Land Forces of the Armed
Forces
of Ukraine, Lt. General Pushnyakov
(who was later released for alleged
controversial actions during the Battle of
Ilovaisk and the Donetsk Airport).
Tetiana
Chornovol went on to write that Force
majeure under Ukrainianlawgives everyright
for the immediate return of these assets to the State
.
In her article she also posts a copy of a
letter from Volodymyr Lytvyn, member of the Verkhovna Rada and representative of the
CommitteeonNationalSecurityandDefenceinwhichheadvisesPrimeMinisterYatsenyukthat
these helicopters were not required by the MoD or MoIA and she makes the accusation that
Volodymyr Tkachenko of Ukrainian Helicopters used his influence to convince MP Volodymyr
Lytvyntotakethisstance.

On September30,2014UACorrespondentpublishedareportthatfourofthe helicopterleased
by Ukrainian Helicopter including one pictured to the left, a medical helicopter which meets
international standards for medical evacuation, were released to the Interior Ministry for use in
theATO.Avideoofthishelicoptercanbeviewedinthearticle.

It was also during this time a representative of Ukraine Helicopter advised one of our research
team that they had movedtwohelicopterstoZaporizhia tobeusedfortheevacuationofInterior
Ministry personnel.Wewerealsoinformedthatithadevacuatedinjuredseveraltimeswhowere
transferred from Mariupol Hospital through the airport and then by their helicopter to
Dnipropetrovsk.Thiswouldbethefirsttimetoourknowledgethat amedicalhelicopterofsucha
high standard was used in the ATO. On September 14, 2014 another article and published in
Antikor on September 14, 2014, it appears that the MoD now has no needs for this advanced
medical evacuation helicopter. One of the last articles published on August 28, 2014 in 112.ua

49


MedicalATOFall/Autumn2015andWinter2016
advised that the Interior Ministry would continue to negotiate with UkrainianHelicoptersuntilall
their helicopters were returned. Unfortunately, we have no further reports of this or any of the
other helicopters and it does not appear to be an active resource readily available to regular
armed forces or assigned to be used in the regular evacuation chain. Within the Ministry of
Internal Affairs, under the HSNS is the department of Management of Aviation and Aviation
Search and Rescue which apparently manages air resources. At this time it is unknown ifany
ofthesehelicoptersarewithinthecontrolofthisagency.

UkraineBuysMoreHelicopters
A year later in October 2015, Defence 24 published an article by Polish military expert, Julius
Sabak on Ukrainian Military Helicopters Modernization And Development Plans where he
wrote about the Mi8MSBW, amodernizedvariantoftheMi8producedbytheUkrainianMotor
Sich Company. That four were delivered to the Ukrainian MoD in 2014 and another six to be
procured in 2015. The National Guard (MoI) had receivedthreeandplacedordersformore.An
example below of this Mi8 Attack Helicopter can be seen evacuating a patient from the 65th
MFH in Bakhmut on Feb.4th2015.MrSabakwouldalsocriticizethecurrentuseofmodernized
Mi24 helicopters has not been effective and that the situation will probably remain
unchangeduntilproperoperationalguidelinesaredeveloped.

Today it seems that the brewing scandal over the use (or misuse) has slipped out of the
forefront as other scandals and the fighting in the ATO has diverted attention away from this
issue and as public figures have gone onto media to advise that the situation in the ATO is
undercontrolandallequipmentnecessaryformedicaloperationsisinplace.

The helicopters that the MoD provides to flight medics in Ukraine do not meet international
aeromedical evacuation
standards nor have the safety features, medical equipment and radios
necessary to conduct safe evacuations and treatment of the wounded warfighters out of the
ATO. What new medical equipment
that is found on the helicopters has not been the result of
MoD concern but the concern of volunteers to better upgrade them in an attempt to meet
aeromedical critical care or even emergency Search and Rescue (SAR/Medevac) evacuation
standards.

What we have seen in the aeromedical evacuation chain is the slow loading/unloading of
patients upstairs through an awkward side door on helicopters that are also used for fighting,
troop movement and logistical supply, not helicopters that canquicklyand safelymovepatients
through the rear hatch onto fastened beds and surrounded by secure modern medical
equipment where patients are strappedinfortheirsafety.Wehaveseenandconfirmedthrough
many others, patients placed on floors where the medics have to step over the patients in
overload, nonmedical helicopters and where equipment that should be securely attached,
insteadisplacedonthefloorwhereinflightitcanflyandstrikebothpatientsandcrew.

50


MedicalATOFall/Autumn2015andWinter2016
The difference is said plainly inpictures,bothhelicoptersareinUkrainebutnonmedical
helicopters are primarily used, if not exclusively used, in evacuation and transport of
criticalandnoncriticalpatientsfromtheATOtoDnipropetrovskandKharkiv.

Patientsunsecuredonfloornexttofueltank

Securedbedswithequipmentsecurelyattached

Sideloadingintoanattackhelicopter.

Rearloadingintoamedicalevacuationhelicopter

HospitalsoftheATO
We have madeanefforttovisitallofthemand canhonestlystate thateveryhospitalintheATO
has been impacted by theongoinghostilitiesthatbegan
after theMaidanprotestsandasthey expandedtoother
regional centers with their clashes betweenantimaidan
forces and then severely escalatedafter theinvasionby
Russianforces.

The underlining and disturbing impression of all the


civilian hospitals has been an almost total lack of
support of the infrastructure, staff, maintenance, pay of
staff,continuingeducationandgeneralsupportgoingon
for decades and nowevenaftertheoutbreakoffighting.
The exception to this, Mechnikov Hospital, its Director
Sergii Ryzhenko and staff are an example of a hospital
meeting international standards, civic support and then
stepping up to meet the needs of the ATO. An excellent example of what hospital care should
look like in Ukraine. The degree of neglect from the governmental institutions is consistent but

51


MedicalATOFall/Autumn2015andWinter2016
the effort of local support varies with some of these smaller regional facilities and their
administratorsperformingadmirablygiventhelackofstatesupport.

If any changes were seen in the equipment at ATO hospitals, it is not usually the MoH or the
MoD but volunteers, NGOs and international partners who once the hostilities began, have
poured millions of dollars of support and time into the collapsing monuments of the soviet and
postsoviet influence on health care in Ukraine. One good example is the Recovery and
Peacebuilding Program a regional project of the United Nations Development Program
(
UNDP
), supported by the Government of Japan and recently described in the Resilience and
rebuilding tales from a wartorn Ukraine hospital
by Natalia Liubchenkova on the district
hospitalinMykolaivka,locatedintheSlovianskmunicipalitynearthecurrentborderoftheATO.

Our perspective is not an isolated one. The rampant neglect is mirrored in the recent
assessment and opinion piece released in 2015:

UkrainesHealthSystem:TimeforChangebyMrQimiao
Fan
, World Bank Country Director for Belarus, Moldova
and Ukraine as he states that the problem lies in
inefficient allocation and use of resources, decades of
neglected investments and rampant corruption in the
sector.

In anotherreportfrom WorldHealthOrganizationreleased
in 2010 in their Ukraine Health Care System Review they
reported that The deterioration of fixed assets at state
and community medical facilities is very serious and continues to worsen: in 2000, 50% of
equipment was worn out and obsolete in 2007, this proportion had grown to 6070%. The
majorityof equipmenthasbeeninusefor20to25years,exceedingitstechnologicallifespanby
23times.

This is not to say there are no reforms in the MoH. Newly selected Minister Olexander
Kvitashvili as a health care reformist and the introduction of Health Strategic Advisory Group
are welcomed and fresh changes to a system that is considered to be extremely corrupt,
ineffective and ignoring the changing healthcare needs of Ukraine. The proposed National
Health Reform Strategy for 20152020 is an important document which outlines strategies to
bring reform to Ukraine dilapidated and crumbling system. But even within the document the
ability to address Emergency Service will require time as the backbone of the healthservices
mustbeaddressedfirst.

On Dec. 30, 2015, the MoD and MoHheldapressconferenceonthedevelopmentofproposed


cooperation between the two agencies and civilian services in the ATO. Butfornow,inmostof
the hospitals in the ATO this situation remained unchanged, yet they not only continue to
support the daily needsofthelocalpopulationbutthe9,000peoplekilled andmorethan20,000
injured in the conflict in Ukraine since April 2014. Thus, we find it deeply concerning knowing

52


MedicalATOFall/Autumn2015andWinter2016
that close to 100% of those injured warfighters transit through and are cared for by the staffs
working in substandard conditions of these MoD reinforced civilian hospital and the claimsby
topmilitarymedicalstaffthattheyaremeetingthemedicalneedsoftheirsoldiersintheATO.

The same can be said for the military hospitals which have suffered from years of neglect,
systemic corruption and even thelegalizedseizureofassetsasseenwiththequestionablesale
ofamilitaryhospitalinDnipropetrovsktoaRussianBank,ownedbytheRussiangovernment.

A general lack of concerncontinuestobeseenin thelackofcooperationbetweentheMoD and


MoH to improve the working quality of civilian hospitalsnowsupplemented withmedicalstaffed
from MoD. The military and civilian staff are forced to work around a lack of response to
systemic problems and what should be seemingly minor problems with simple solutions, such
as the access to narcotics and blood products by military doctors. This impacts the quality of
care they are attempting to provide to the injured warfighters in the ATO. We would expect to
see representatives from the MoD working closely with theMoHtoquicklyresolvetheseissues
and furthermore, as strong working advocates asking for international support to improve the
infrastructure within those hospitals where the staff and now the military staff havestruggledto
handle the 10s of thousands of casualties both civilian and military that arrive at these
hospitals.

This exemplified in astatementwhenaseniormilitarymedicalofficialwasasked, whenmeeting


with a group of volunteers why additional requests are not made for equipment from
international partners I willnotgobeggingforequipment.Suchstatementsare notacceptable,
even while volunteerorganizationssendoutalmostdailypleadsforcontinuingsupporttosupply
and support the military. Nor is it acceptable that when the international communitydoescome
in, they are slowed by unproductive meeting, unfulfilled statements and a barrage of excuses
that slows the equipment and programs to build new, modern sustainablesystemsandtraining
programs that meet international standards.
Programs thatsoldiers, thevolunteers,activistsand
the citizens of Ukraine have asked their
government and the international community to
provide.

CivilianHospitalsimpactedbytheATO

The chart to the left is the current system of


governance through the Ministry of Health and the
distribution of funds withinthehealthcaresystemof
Ukraine and basically based on the Shemasko
model with very rigid public finance management
procedures.

53


MedicalATOFall/Autumn2015andWinter2016
Below you will find a list of the hospitals in the ATO including the regional centers in occupied
Donetsk and Luhansk. It is not a complete list as many smaller clinicsandsecondaryhospitals
such as OB/GYN and Pediatrics maynotbelisted,norarethesmallerhospitalsintheoccupied
territories.

Mechnikova,DnipropetrovskCivilianHospitalIV
Artemivs'kHospitalIII(servingastheMFHforthe65th)
ShchastyaHospitalII
KurakhoveCivilianHospitalII
DymytrovHospitalII
SelydoveCentralCityHospitalII
VolnovakhaCivilianHospitalII
KrasnoarmiiskCentralDistrictHospitalII
MariupolEmergencyCareHospitalIII
KostyantynivkaHospitalII
ChasivYarCityHospital#3II
LysychanskHospitalLevelII
NovoaidarHospitalII
SvatovoHospitalLevelII(servingastheMFHforthe59th)
Starobil's'kHospitalII
RailroadUnionHospitalII(servingastheMFHforthe66th)
SeverodonetskMultiSpecialityHospitalLevelIII(proposedbaseofthe59thMFH)
Bilovods'kCentralDistrictHospitalLevelII
Debal'tseve(captured)02/18/15
DonetskRegionalTraumaHospital(Occupied)
LuganskStateRegionalHospital(Occupied)
PopasnaCentralDistrictHospitalII
MarinkaCivilianHospitalII
Dzerzhynsk(Toretsk)HospitalII
VolodarskeCivilianHospitalII(servingastheMFHforthe61th)
AvdiivkaCivilianHospitalI+
KuibysheveHospital(onceservedas61stMFH)
IzyumCentralCityHospital,LevelII(onceservedas59thMFH)
KrasnogorivkaCivilianHospitalII
SlovianskCentralCityHospital
StanytsiaLuganskaDistrictTerritorialMedicalUnion
OcheretyneHospitalII
DnipropetrovskBurnandPlasticSurgeryCentre

MilitaryHospitals
KyivMainMilitaryHospital
KharkivMilitaryHospitalIII
LvivMilitaryClinicalHospitalIII

54


MedicalATOFall/Autumn2015andWinter2016

VinnytsiaMilitaryHospital
OdesaMilitaryHospital
DnipropetrovskMilitaryHospital
ZaporizhzhiaMilitaryHospital
Khmel'nyts'kyiMilitaryHospital
IrpinMilitaryHospital

The Border Guards and MoIA have their own systems ofhospitals that takeintheirmembers
when exiting the MoD or civilian ATO system ofmedicalcare.The MoIAmaintainstwentysix
medical facilities for the National Guard and the Border Guards have three.Weve notvisited
anybutitisourunderstandingthattheyare comparativelyinbetterconditionthanmostcivilian
orMoDfacilities.

IgotyoursixAvdiivkaFOB
There is a continuing opinion in the ATO among military and volunteers, even among those
recently honored, that the people on the frontlines, or away from the public eye, are forgotten
and only remembered throughthe effortsofactivistsandvolunteers.Tousetheoldmilitarypilot
adage I got your six, it is the volunteers that the rank and file rely on to protecttheirinterests
and not the general staff. It is felt that equipment is not distributed by priority but through
cronyism or selfinterest or not at all and at the expense of those that deserve prompt action,
thoseexposedlocationsonthefrontlines.

The lack of modern equipment at frontline locations is obvious as documented cases are too
often posted onsocialmediaoractuallyseenbyobserversthatcanreachfrontline positions.As
a result, weve repeatedly heard and the perception is, that there is a lack of concern for the
safety of frontline troops by the powers that be in Kyiv and thatcertainpartieswithintheMoD
and government are enriching themselves at the expense of exposed troops. Comments like
this are seriously detrimental to troop morale and
contribute to the real public perception of exceeding
poor conditions on the front lines. The following
exemplifies whos got your six and why this
perceptionexists.

The contact line in the ATO is a series of roadblocks


or referred to locally as block posts at what was
once the mainentrancefromDonetsktotheindustrial
town of Avdiivka. The block post sits on the outskirts
of the city in a small, now abandoned industrial /
warehouse site where the forces of the 58th have
what is known in US military parlance as a Forward Operating Base or FOB
with a fortified
Entry Control Point, or ECP
. The actual complex of buildings has partially shifted between
the opposing force, which at one time were almost completely overwhelmed by the Russian
forces. If this FOB falls then the fighting would probably move west into the town of Avdiivka.

55


MedicalATOFall/Autumn2015andWinter2016
Down the road to the east and less than 1000 meters is Highway E50, a recently modernized
freeway, now partially destroyed, but controlled and used as the cover for elements of the
Russianforces.

AvdiivkaFOBinIndustrialPark.RussianForcesholdanelevatedpositiononHighwayE50atYasynuvata2Station

A recent event occurred at this FOB in February 2016. Here with the assistance of volunteers,
the 58th eliminated a deadly threat to their FOB. Forces from the 58th mechanized infantry
battalion, 16th mechanized infantry battalion at the FOB on the contact line were subject to
repeated harassing fire from occupied territories bordering Highway E50 on the outskirts of
Avdiivka. Enemy fighters took up positions within the battered highway and subjected the 58th
to sniper, automatic grenade launcher and occasionally 120mm mortar attacks from their
obscuredpositionsandoccasionallytheyalsodeployed tanks.TheUkrainianscurrentlyhaveno
artillery or tank support as of early March,2016.(ItisrumoredthatRussianForcesactuallyuse
the Ukrainian FOB to train their forces, rotating different groups through their position in an
attempttoweardownthestatic58thanddestroythemoralandeventuallytheposition).

Often all the 58th could manage was indirect fire at the enemys position. With the help of two
volunteer organizationstheunitreceivedanightscopefromComeBackAliveanddronevideo
of the enemys location from ArmySOS. The 58th were subsequently able to take out the
enemy firing points. The incident was brought to light by several media videos highlighting the
recorded destruction oftheenemypositionbutinadvertentlyexposed aUkrainianTechnicalas
a frontline vehicle. A Technical, the upgraded conversion of a regular vehicle to a
combat
vehicle
usuallyseenamongrebelgroupsinAfrica,notregulararmy.

The fact that the volunteers still in many cases can react faster than the MoD to the needs of
many of the frontline fighting units that battered and under equipped ambulances with poorly
trained crews are stationed at front line positions and a Technical can be seen as a primary
means of protection and travel is not a flattering reflection on the agility or flexibility of the
existing military systems. In a country that produces excellent vehicles such as the Z
and the VARTA and with the introduction of the US
HMMWV
thereshould benoexcusetosee

56


MedicalATOFall/Autumn2015andWinter2016
a third world technical and a battered, unreliable soft skin ambulance on a hot, exposed
frontlineposition.

Ukraines Channel 5s video on the successful elimination of an enemy firing position on the
border of Avdiivka using donated volunteer equipment and the recent fighting onanothervideo
fromComeBackAlivecanbefoundintheArticlesMentionattheendofthereport.

Technical:
improvisedfightingvehicle
inAvdiivka

"Varta"ismanufacturedbytheLLC"UkrainianArmoredVehicles"

DronefootagefromArmySOS

NightscopefromComeBackAlive

58thsoftshellambulanceinAvdiivkaChellew

MTLBstationedinKherson
Builtby:KharkivMorozovMachineBuilding(KMMB)

57


MedicalATOFall/Autumn2015andWinter2016
TheEMEDS
________________________________________________

Expeditionary Medical Support (EMEDS) Mobile


FieldHospital
USA Provides $7.6 Million Dollar Military Field Hospital
to Ukraine on August 18, 2015 in Zhytomyr, Ukraine.
Training for the units was conducted inZhytomyrbyUS
military specialist with doctors from Ukrainian military
medical staff. On deployment the unit is staffed with a
Mobile Field Surgical Team (MFST) of 2030 for
placement in a front line location to triage and perform
emergency resuscitation surgery of injured warfighters
or civilian casualties before their transfer to an MFH or
higherlevelofcare.

After the final day of training in Zhytomyr and presentation ofthehospitaltotheUkrainianMoD


medical department, the facility was packaged in its shipping containers and placed in storage
at the 95th Airbornes base in Zhytomyr for what many assumed to be an immediate
deployment to the ATO. It sat in Zhytomyr, 140/Km west of Kyiv, unused for the next three
months.

Some of the doctors eager to work with theEMEDScomplainedaboutitslack ofdeployment to


the ATO. The complaints resultinafewstoriesinthemediaincludingoneintheVoxNewstitled
MoD medical Staff complain about the bureaucracy and slow deployment of EMEDS to ATO,
on Oct 27, 2015, and the direct conflict with the commanders, specifically Viktor Ivchuk the
Airborne MedicalChief,whoisnow reportedlyinchargeofthe EMEDS.A reportwassent tothe
MoD through the chain of command alleging mismanagement by two of the doctors trained to
usetheEMEDS.ReportedlyVictor Ivchukreceivedacopyofthisreport.Shortlythereafterthose
that had sent the complaint were removed from the EMEDS project and transferred to other
assignments.

TrainingofUkrainiandoctorsbyUSMilitaryspecialistinZhytomyr,August18,2015Chellew

It appeared that because of the internal andpublicoutcry,theEMEDSlocationmovedandnow


technically deployed to the ATO. It can now be found in Sloviansk on the territory of 95th
airborne brigade HQ at the Slavkurort Resort, and sitting there for the last four months.

58


MedicalATOFall/Autumn2015andWinter2016
Currently a portion is deployed at this location and performs some primary care and small
surgery(e.g.wounddrains).Itremainsatthislocationtothisdate.

Its current location places it 111/KmwestfromPisky,oneof


the most active areas of the ATO or53/Kmwestofthe66th
MFH in Krasnoarmiisk and 45/Km west of the 65th MFH in
Bakhmut. At one time there was also talk of placing the
facility in Kostiantynivka, still not ideally suited foritstypeof
deploymentbutconsiderablyclosertothefrontlines.

Atitspresentlocationitisstaffedby78medics(afew
others are on vacation). They feel that they are of littleuse,
as usually there is no work to do: "We come to the hospital in the morning, sit there and read
books, post on Facebook and socialize among the staff as there is nothing else to do". Per a
third party, the surgeon complains of not having any major operations for six months and
worries about losing his skills. Some of the newly assigned staff have never been trained with
thefacilityandarenotallowedtopracticeonanyoftheequipment.

There are also reports that the equipment was never properly registered within the internal
tracking system and now some equipmenthasbeendamagedorremovedmakingidentification
of the problem an embarrassment to those involved and impossible to utilize given these facts
of mismanagement would be exposed to public criticism and a potential investigation if the
equipmentismissingordamaged.

The facility atitscurrentlocationisnowattachedtothecityutilitiesso theyno longerrequirethe


use of the generators and have stopped consuming diesel fuel.OnthenightofMarch14th,the
story of the missing EMEDS, the alleged missing equipment and its general mismanagement
was posted in social mediaonFacebook byBogdan Kovalev,amemberoftheSecurityCouncil
andsocialactivist.

CurrentStaffResponsiblefortheEMEDS
ViktorIvchukAirborneMedicalChief.
VitaliyCherevatovDeputyMedicalChief.
OlgaKulykovskaMedicalStationHeadandresponsibleforreceivingEMEDS.
VitaliySpitsynHeadoftheEMEDS

PeripheralHemorrhageControl:UkrainianTourniquets
Given the price of the American tourniquet, CAT and its perceivedeaseofconstruction,there
has been a rushtomanufacturealocaltourniquet.Nonehavebeensubjecttotheintensestudy
that was seen with the various American versions. However given the questionable quality of

59


MedicalATOFall/Autumn2015andWinter2016
these knockoffs, a few volunteers have taken it upon themselves to run some of these
Ukrainian models through a limited test protocol of tightness, strength, ease of use, circulatory
function with a Doppler and a pain scale. Below are two more, one on the left certifiedbythe
manufacturer, that have failed this basic testing regime conducted by
Ivan Kondratenko, a
TCCCinstructorfromDnipropetrovsk.

SPASTourniquet()CombatSpetsnaz()

A new tender is coming for 50,000 tourniquets for the army. Volunteer groups associated with
tourniquet development and some members of the armed forces are not very pleased with the
current method the MoD will use to acquirethenextbatchandplantosendaletterwithalistof
problems and suggestions which will outlinetheirconcerns.Somefeelthattheconditionsofthe
tender are written so thatonecompany,AvPharma,fitstherequirementsofthetender.Sofar
there has not been a lot of enthusiasm for these tourniquets, given what appears to be a high
rateoffailureandlittleornotesting.

On March 15, 2016 the Reforms Office announced the cancellation of the latest tender and a
review of the procedures to assure that the quality of the tourniquet meets a higher standard
thancurrentlyexists.

AmbulancesofUkraine
Currently, there are several types of soft skin ambulancesusedbytheUkrainianArmedForces
andofthemtwowereoncecommonamongthecivilservices,theUAZandGAZ.
U
AZCombi

orcommonlyreferredtoatheTabletka(littlepill)
GAZGroup
,AmbulanceTypeB
Mercedes
UnimogU1300LAmbulance

The most common ambulance of these three found in the civil sector is the
GAZ Group
,
Ambulance Type B. But over the last few years ambulances conversion and manufactures in
Ukraine have prevailed and modern versions are now commonly seen in such cities such as

60


MedicalATOFall/Autumn2015andWinter2016
Kyiv, Odesa, Lviv, Dnipropetrovsk and in Donetsk. The ambulances are adapted from vans of
such European auto manufacturers such as the Peugeot Boxer, Renault Master, Ford Transit
and Mercedes Sprinter. The older UAZ which at one time was the most common type foundin
Ukraine and the Soviet Union is still seen in rural locations, but now rarely seen in service in
majorcitiesandthenasonlyaClassAvehicle.

At the beginning of hostilities the military relied largely on the early version of the UAZ Combi
Tabletka which was manufactured as early as the 1960s and some GAZ ambulances and
someunitsevenwereassignedtheMercedesUnimogU1300LAmbulance.

UAZ2016Combi

GAZ

UnimogU1300L

ButitwastheCombithatwasprevalentintheATOformilitaryunitsandunfortunately,ifseenat
all, they lacked any emergency medicalequipmentorwerestaffedwithcrewswithlittletraining.
Most early transports were done in whatever vehicle was
available and transported totheclosesthospital.Asattentionwas
brought to the lack of ambulances, calls went outtothelocaland
international community, a small flood of ambulance began to
arrive in Ukraine. But because of customs regulations they were
all stripped down to the basic components. Those ambulances
received cover a broad section of design and quality. If using the
European standard, CEN 1789:2007, which represented the
current European standard for the design of ambulances, they are: patient transport
ambulances (Types
A1 A2
), emergency ambulances (Type
B
), mobile intensivecareunit (Type
C
). As they arrived in the ATO they were put in service to answer a broad selection besides
patienttransportandcare,suchaspersonaltravel,logisticaltransportandstorage.

As mentioned earlier importing the unitsinto countrywasdifficultandtheyarriveddevoidofany


equipment such as onboard oxygen and suction, basically an empty shell with a wide arrayof
gurney designed forabroadspectrumof ambulancesthatwerenotinterchangeablefromunitto
unit. It was further complicated by existing laws that taxed donated vehicles even though they
were destined for use with the armed forces of Ukraine. This law has recently been changed
noweasingthedifficultyandcostsofmovingvehiclesfrominternationaldonorsintoUkraine.

Theimpressionatthetimefor internationalsupporterswastherewerenolocalmanufacturersof
ambulances and this was the only way to receive equipment relatively quickly in the ATO.

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MedicalATOFall/Autumn2015andWinter2016
However Ukraine does have several ambulance conversion companies that produce high
quality A, B and Cambulancesthatmeetlocal
StateStandard7032:2009whichisbasedon
European standard, such as the models from VDYunikommers and AVTOSPETSPROM, LLC
among others, and several that can produce uparmored or armored version such as
MTLB,
built by the Stateowned
Kharkiv Morozov Machine Building (KMMB)
, or Practika which
producebotharmoredandsoftskinortheKrAZbuiltbythe
KremenchukAutomobilePlant
.

ReadySupplyofModernAmbulances

Abovelocallymanufacturedambulances

ArmoredmedicalvehiclesmanufacturedinUkraine

Recently the
RegionalCenter ofHealth CareandDisaster Medicine"in Kramatorskplacedanorder
for
34type BvehiclesfromAVTOSPETSPROM"LLCand25morefromVDYunikommersandaconvoyof
the ambulances was seen travelingto the city.But their use in conjunction with MoDforces will belimited
due to the poor interagency cooperation between the MoH, MoD,
DSNS andMoIA andgeneral lack of a
responsiveinteragencydisasterplanintheDonbasregion.

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MedicalATOFall/Autumn2015andWinter2016

Fleetofambulancesenrouteto
Kramatorsk.
PhotoCredit:
RomanDonik

At the onset of the fighting volunteers did not question the needs of thewarfighters, theyacted
and pursued any avenue which might provide the result, regardless of the request. This often
was theinternationalcommunitywhowereinquiringandwillingtoassistwithambulances.Once
arrived they were distributed to those they felt were the most in need of the assistance and
equipment. One volunteer managed to move ten ambulances in country and distributed them
directly to military units, other groups distributed ambulances to volunteer groups that support
the military or directly to military units or even in some cases toindividuals.Buttheunforeseen
results are dozen of types with various unfulfilled needs and supplies not readily available in
some circumstances in Ukraine and no standardized training fordriversormedicalstaffnorthe
logistical/maintenancerequiredtokeeptheambulancesstockedandinareadystateofrepair.

Another major issue at the time was the lack of a declaration of war or martial law which
prohibits authorities from stepping in and nationalizing assets for better distribution. This was
also further compromised by not only lack of prewar support for the armed forces but also for
theStateEmergencyServiceofUkraine(DSNS).

DSNS disaster service in Ukraine after suffering, as many other state services over the last
twenty years, saw further denigration after it merged back with the MoD on the 24th of
December 2012. On April 24th, 2014 the service was transferred to the MoIA. DSNS is
described as the central organ of the executive power,directed andcoordinatedbytheCabinet

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MedicalATOFall/Autumn2015andWinter2016
of Ministers through the Ministry of Internal Affairs. International support to update poor
technical equipment and outdated organizational structure is an area of address and help is
coming such as a capacity building project of emergency service in Ukraine commissioned
by
theGermanFederalMinistryforEconomicCooperationandDevelopment(BMZ).

But even as ambulances are assigned to a specific military unit and then registered on their
books the ambulance is then nontransferable, not even available to be used unless deployed
with the entire unit. It is further complicated due to the lack of training and the perception of
somethatanambulanceismerelyavehicleformovingpeopleandanycaretheyrequireshould
be done on arrival at a hospital.Recentlythe128thBrigadeaskedvolunteersforanambulance
which they are now soon to receive. The 128th is about to be deployed to the ATO to replace
the 93rd on the frontline near the Donetsk Airportandtheirmedicsconsistoftwo
pharmacists
and one dentist with little prehospital training andnoexperienceinambulance transport.Thisis
not only a problem with the128thbutaggravatedwiththecurrentdemobilizationandtransferof
most of the forces in the ATO taking with them all the people that might have received some
trainingandtheequipmentnowregisteredtothoseunits.

RoadsinDisrepair
LandEvacuationRoutes

Road conditions in many locations arelessthanidealandinsomelocationsareahazard tothe


health and safety of those that traverse these routes throughout Ukraine. For themedicsinthe
ATO the results are delayed response, extended transports, flat tires, damaged vehicles,
accidentsandveryuncomfortableanddangerousconditionsforwoundedwarriorsevacuatedby
highway. ASAP Rescue in a recent post in Facebook asking for donations and later further
publicized in the articleVolunteermedical"Hottabych"needshelpambulanceintheATOzone
urgently needs repairs goes on to say that conditions of the evacuation routes take a serious
tollontheirfleetevacuatingwoundedoutofAvdiivka.

On Tuesday, October 20, there was signed a tripartite Memorandum on implementation in


Ukraine of an international Construction Sector Transparency Initiative (CoST) to increase
transparency in the construction industry. The initiative was designed to address the rampant
corruptionandthelackofrepairthroughoutUkraineshighwayinfrastructure.

Not only is identification and priority repairs of the utmost importance in the ATO but for those
roadsconnecting militarybasestostrategiclocations intheEastsuchastheroadfromMykolaiv
to Dnipropetrovsk as shown inthelinkbelow.A programdevelopedinconjunctionwithNational
Security and Defense Council of Ukraine
and the MoD to identify these roads and institute a
repair program will not only benefit the military and the medical evacuationsystembutimprove
relationships with those that stillliveinthearea,provideadditionaljobsandinfusefundsintoan
areasufferingfromhighunemployment.

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MedicalATOFall/Autumn2015andWinter2016

RoadfromMykolaivtoDnipropetrovsk
Video

CitizensandsoldiersrepairandcleanvillagestreetinZorya
Photo:Chellew

BlackMarket/DarkMarket:anEnvironmentforCorruption
Since the introduction of Tactical Medicine to Ukraine there has also been a corresponding
growth in tactical medical equipment for sale on local internet sites. It is questionable as to
where/how this material was actually procured. Much of it is identical tothematerialdistributed
by volunteer organizations and the Ministry of Defence. There is littledonebythe authoritiesto
stemanyquestionablesales.
MostoftheinformationwasfoundonOLXhttp://olx.ua/apopularsitesimilartoEBay.
NomedicalitemsfoundonAvito.rewww.besplatka.ua
Severalitemsfromwww.ukrboard.com.ua

IFAK&TacticalMedicalGearForSale
IFAK

ThisIFAKidenticaltoUkrversionUSAMilitaryversion?PatriotDefenceIFAK?

The PD IFAK has yellow and blue ribbon usually provided only by PD, a yellow and blue card
with PD symbols and casualty card of the type provided by PD, plus thermal blanket only
providedwiththeirkit.

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MedicalATOFall/Autumn2015andWinter2016

CombatAppliedTourniquet(CAT)

CombatGauze

OtherItems

SamSplintDecompressionNeedleCricKit

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MedicalATOFall/Autumn2015andWinter2016

Section4Reform

Corruptionreferstothemisuseorabuseofpublicassetsbypublicservantseitherbythemselvesorin
combinationwithotherpublicservantsorprivateindividualswhetherforpersonal,familial,
partnershiporpartisangain.Thepublicassetsmostoftenaremoney,butmayalsoberealestate,
personalpropertyorsimplyinformation.Examplesincludebribery,kickbacks,theftofstateassets,
conflictofinterestandotherschemes.Theredo,however,existothermalfunctionsrelatedto
governmentsuchas,forexample,themonopolizationofpower,butjustbecausesomephenomenonisa
malfunctionrelatedtogovernmentdoesnotmakeitcorruption.
ByBohdanVitvitsky,
FormerFederalProsecutorandAssistantU.S.Attorney,U.S.DepartmentofJusticeNewJersey,USA.
RemarkspresentedatSymposium

Ukraine:EscapingFromItsPostSovietLegacy(Kyiv,April2426,2015)
.

DontlookatUkraineasthelandofyourparents.
Lookatitasthelandofyourchildren.Andthenyouwillseechanges
SviatoslavVakarchuk

TheFailureofMilitaryandCivilLaw
In August 2014, Ukraine started to restore themilitaryprosecutor'soffice,whichwaseliminated
in 2012 by then President
Viktor Yanukovych. All military trails or prosecutions would be
handled by the civilian courts and come under the Office of the General Prosecutor which is
overseen by the controversial
Viktor Shokin. The prosecutor office was described in remarks
made on September 24, 2015 by US Ambassador to Ukraine, Geoffrey Pyatt at the Odesa
Financial Forum as
That obstacle is the failure of the institution of the Prosecutor General of
Ukraine to successfully fight internal corruption. Rather than supporting Ukraines reforms and
working to root out corruption, corrupt actors within the Prosecutor Generals office are making
thingsworsebyopenlyandaggressivelyunderminingreform
.
Military or civil law is not an area within our expertise but given its potential impact on any
successful military program, if the laws and the prosecutors are not a source to deal with the
rampant corruption and misuse or misappropriation of equipment, the medics and the
warfighters on the front lines will lack another avenue of potential support and then eventually
the system will, like so much of the military, be slowly siphoned again for personal gains. The
well documented, systematic dismemberment of the Ukrainian military, their bases and
equipment, their food and lodging, fuels and supplies as means for stuffing the pockets of
unscrupulouscommandersgoesonevenassoldierssufferdeathandinjuryonthefrontlines.

Throughout our travels we have visited many military bases,wherewehavesleptincold,leaky


facilities, showered in bathrooms that resemble those portrayed in old movies with scenes of
dire, rodent infested soviet prisons,eatenthemeagerservingsof foodand witnesstherundown
dilapidated conditions throughout these poorly secured bases often surrounded by crumbling
walls. We have also seen over time some improvementssuchastheReformofFood Supplies

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MedicalATOFall/Autumn2015andWinter2016
System for Armed Forces of Ukraine Serviceman through the testing of food services in
experimental canteens and purchasing of supplies throughtheProZorrosystem.
Butreformers
areslowedorevenimpededbytheinvestigativeandprosecutorialauthoritiesinUkraine.

The deterioration of the Ukraine military structure began during the last years of the Soviet
Union in the early 1980s and accelerated into 1990. After the Independence of Ukraine the
situation failed to improve and a report released in 1998 afteraUkrainianparliamentaryinquiry
concluded that between 1992 and 1998, Ukraine lost $32 billion in military assets, in part
through theft, discount arms sales and lack of oversight. Ukrainian military bases became
nothing less than a ghetto administered and managed by military slumlords as they
systematically profiteered and looted the militaryindustrial system for their own personal
enrichment.

Sadly the result too often,ifapartyisexposed,theyaretoorarelypenalizedandinmanycases


continue to maintain their position and even are promoted to a higher rank, often allegedly by
bribing a senior officer. We can only hope the tide is changing given the firing of
Lieutenant General Volodymyr Khyzhyi
( ), Deputy Head of
General Staff. Recently implicated in failing to maintain organization of the
ammunition storage in Svatovo which resulted in fire anddeaths,thechaoticNATO
training with Ukrainian Special Forces in Khmelnytskyi, and the deplorable
conditions for the 53rd brigade. He was released from service onFeb18th,2016becomingthe
first general to be fired from the Ukrainian Armed Forces for his systemic unfulfillment of
contract requirements. But on Feb 23, he filed appeals to Vinnytsia court to reinstate him in
office. To do this hechangedhislegal placeofresidencefromKyivtoVinnytsiaallegedlytofind
morefavorablejudicialconditions.

His career is riddled with controversy. He was once referred to as the merchant in uniform.
There wereearlierscandalswiththegeneralin2008,whenhewasHeadofMainAdministration
of Logistics and advocated that the military maintained too much
redundant equipment. Later the same base he inventoried was
involved in theillegalsalesofweapons.IntheSummerof2012,the
SBU opened an investigation which could potentially implicate
Khyzhyi in corrupt fuel purchases, food of poor quality and inflated
costs. But instead he was given the option to resign to limit the
scandalaninvestigationmightcreate.

Khyzhyi resigned but was reinstated in 2013, by then


Minister of
Defense of Ukraine, Pavlo Lebedev a Russian who received
Ukrainian citizenship in 2012. Pavlo Lebedev during his short
tenure initiated a largescale sale of MoD property. He too was a controversial figure known to
have accumulated questionable wealth and was seen at one time sporting a Swiss brand
CORUM watch in the Rada worthabout130,000USD.HefledofficeaftertheflightofPresident

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MedicalATOFall/Autumn2015andWinter2016
Yanukovych, for Russia and was present at the Kremlin during the ceremony for the
"acceptance"ofCrimeatoRussia.

In March of 2016 Pavlo Lebedev and his predecessor, Mykhailo Yezhel who is wanted for the
sale of military equipment to Russia, werefinallysubjecttowarrantsfortheirarrestbytheChief
Military Prosecutor Anatolii Matios. Dmytro Salamatin, who served as Minister of Defence
between Lebedev and Yezhel, another Russian citizen and confidant of then President Viktor
Yanukovich, was again accusedofquestionablebehavior.Salamatinatonetime alsoservedas
General Director of the State
"
Ukroboronprom
" which oversees the Ukrainian military industrial
complex. He too has fled the country with areported11milliondollarssecuredinaSwissBank
andallegationsthathehasconnectiontotheRussianSecurityService.

Although some have fled and others resigned the properinvestigationandprosecutionofthese


and many other cases is more than a travesty of justice. Meanwhile, thewebofdeceit remains
in place given that the justice system fails to prosecute, arrest and address the rampant
corruption that allegedly exists at all levels. It is likely innovations or changes will have little
chance of longterm success if new programs are blocked, bled or incompetent administrators
remain.

There must be immediate support for the Deputy Prosecutor


Davit Sakvarelidze whos reform
and corruption staff are harassedandmarginalizedbytheactionof thePGsoffice.Theirefforts
must be recognized and supported both internally and internationally, along with the efforts of
the National AntiCorruption Bureau.
Otherwise the system will remain unchanged if ineffective
judicial admini
strators remain in place like Prosecutor General Viktor Shokin and subordinates
suchasKonstiantynKulyk,anATOmilitaryprosecutorofquestionableabilityandjudgement.

CriminalElements
Criminal elements that existed before the outbreak of hostilities are now reported flourishing in
the ATO. Unsavory public officials withconnectionsonbothsidesoftheconflict,thatwereonce
connected by a short drive, have found the new barrier between the occupiedandgovernment
control territories a lucrative market that supplies the booming illicit markets in the occupied
territories. These same black marketeers are in many cases free to transit throughout their
regions and even across the contact line, and are now connected and intertwined to the
separatists constituting, as former SBU
LieutenantGeneral Alexander Skipalsky says a real
threat f
rom foreign intelligence services
. They are exposing not only the military and military
industrial system, but the warfighters to another threat of violence and betrayal from within the
civil authorities in the governmentcontrolled territory. It is a real threat with escalating
confrontations between soldiers and local police and little support for the warfighters from a
weak judicial system to investigate allegations of impropriety of corrupt local police, officials or
elementsofthearmedforcesengagedintheseillicitactivities.

Ukraine's Deputy Prosecutor General and Chief Military Prosecutor Anatolii Matios has made
severalcontroversialappointments,includingKonstiantynKulykasthe MilitaryProsecutorofthe

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MedicalATOFall/Autumn2015andWinter2016
ATO
.
Kulyk has been a
ccused of questionable behavior such as protection schemes and his
mysterious wealth. Both his mother and girlfriend own expensive cars. The girlfriend has Land
Cruiser for 1.21 mln UAH (she with a registered official income for the year of 1687 UAH) and
his mother bought a vehicle for 459,000 UAH. He is the owner of two Kyiv apartment, both
gifts, one from his mother in 2011 and in 2014 from a Givi Maksheev. Both people have
committed allegedly questionable deals with Ukrainian railways andinvolvedinaseriesoflegal
problems. His mother "owns" a newly formed company which was supplying coal to Ukrainian
railroads in 2014, acquired during the times when Kulyk was working as prosecutor on
transportationissuesintheKyivRegionalProsecutionOffice.HealsohasconnectionstoEugen
Zhylin, head of titushkas and terrorist organization Oplot in Kharkiv. The National
AntiCorruption Bureau started an investigation against him on corruption. To this date he
continues to workastheATOprosecutor,althoughstaffhaverarelyseenhimattheofficeinthe
ATO.

The fear of social activists and reformers is that the system is so endemic andprotectedbyan
unresponsive judicial and political system. It remains largely intact and even within the military
system in the ATO, where now smuggling is becoming an increasingly lucrative business, that
once again, after the current uproar has subsided it will all quickly slip back into the murky
quagmire of black marketeering, protectionism, nepotism, cronyism and blatant corruption. A
modern progressive military, responsive to its citizens and a system of military and medical
training cannot exist in such conditions and these currently proposed rehabilitations have little
chance of longterm improvement without the proper investigation, prosecution, therecoveryof
assets and removal of those responsible for such conditions. This cannot be done without the
completereorganizationand
serioustransformationsofthejudiciaryandlawenforcement.

In2015,Ukraineranked130outof168onTransparencyInternationalCorruptionIndexscoring27outofapossible100.

MedicalLegalReform

Outside of the University and college systems and the Ukrainian Military Medical Academy
(UMMA)
there are currently only two services legally entitled to teach prehospital medicine
including CLS/TCCC in Ukraine, the Ukrainian Red Cross and the
Ukrainian Resuscitation

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MedicalATOFall/Autumn2015andWinter2016
Council. And even these programs are restricted to what they can teach given the existing
antiquate laws. Nor are there regulations to govern those currently performing skills advocated
within the TCCC algorithm. It should be mentioned here that the introduction of an emergency
ordinance based on existing TCCC standards to protect both the caregivers and patients is of
immediate,urgentconcern.

There is a growing movement to adapt to NATO standards in the military medical sphere. We
applaud these endeavors and we are strong advocates oftheseinstitutionalreforms. But atthe
current pace it will be years before these programs are fully realized and in the meantimethey
offer little in the wayforthosepracticingorattemptingtopracticetheseskills onthefrontlinesof
Ukraine. Nor do the attempts by some within the MoD, some volunteer organizations or
institutional organizations to marginalize the hundreds if not thousands of volunteers,
warfighters and frontline medics who will help in moving this process forward at a pace where
we will seeresultsinamoretimelymannerandanoutcomethatwillbemorethananattemptto
placatethosecriticalofthecurrentsystems.

On March 3rd, 2016


Olga Bogomolets, MD, the President of Ukraines
Counselor on Humanitarian Issues hosted a conference organized by
Health Care Committee of the Supreme Council inviting all participants
involved or potentially involved in prehospital and TCCC training to
discuss changes to the existing law and incorporate these skills into
universities, colleges, military, rescue and police services. "Practice of
paramedical care in Ukraine, prospects of its development and legal
implementation". Dr Bogomolets showed strong support of theideathat
all these trainings should be managed by the state, through existing
institutions such as colleges, universities and military academies. She was also extremely
critical of the representatives of the MoIA and the MoD for rosy descriptions of training and
supplies, when reports continue coming from front line troops of no training and inadequate
supplies
.
There is an initiative on changes to legislation with regard to TCCC, in coordination with the
MoH led by Denys Surkov, Head of Coordination Council of the Ukrainian Resuscitation
Council.

MilitaryReforms
In 2015 the Ukrainian MoD published its tenth edition and latest White Book evaluating the
Ukrainian armed forces in the year 2014. An annual publication prepared by the Ministry of
Defence and the General Staff of the Armed Forces of Ukraine. In the final section titled
Conclusions the staff lists the main priorities of the optimization and reorganization of the
ArmedForcesin2015:

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MedicalATOFall/Autumn2015andWinter2016

Transition tothenewfunctionalstructureoftheArmedForcesofUkraine,optimizationof
control of troops (forces), forming Special Operations Forces, in particular Special
OperationsForcesCommand
Transition tothenewstandardsofcombatreadinessandtrainingoftheArmedForcesof
Ukraine in accordance with modern military standards, developing and supporting the
abilitytorepulsearmedaggression
Introduction of the extraterritorial mixed manning of the Armed Forces of Ukraine,
namely by military personnel under thecontractandconscripts,achievinganewlevelof
personnelsupportoftroops(forces)andformingtheeffectivepersonnelreserve
Increasing the volume of repair works and modernization of material development and
adoptionofhightechweaponsandmilitaryequipment,increasingthecomponentsofthe
newestandmodernizedsamples
Improving logistics and equipping of the Armed Forces of Ukraine, creating a new
systemofcomprehensivesupplies
Providing the implementation of social, economic and legal guarantees for servicemen,
their families andpersonneloftheArmedForcesofUkraine,includingtheintroductionof
effectivemechanismsofhousingbuildingformilitarypersonnel
Detecting violationsandcorruptioninthefieldof financialandeconomicactivity,bringing
the perpetrators to justice and taking measures that make impossible violations and
corruption actions in the management area of the Ministry of Defence of Ukraine and
preventingtheminfuture.

The report briefly referred to the Medical Support and goes on to conclude that Due to the
taken measures it became possible to solve the main problems of medical support of troops,
military units and detachments participating in the antiterrorist operation. In the section:
Implementation of Humanitarian Policy intheArmed Forcesthepublicationgoesontoprovide
statistics such as During the year military medical institutions provided 163.400 people with
inpatient treatment. The number of outpatient consultations was 1,230,000 cases. There is
little said on military medical training, equipment, NATO standards, TCCC, aeromedical
evacuation equipment, soft skin or armoured ambulances except for a small reference to
medical training with foreign militaries. Nor is there enough mentions of theeffortsbyvolunteer
organizations on their support and equipping both hospitals and warfighters and volunteer
medics on the front lines and the positive impact that contributed to their care and wounded in
theevacuationchain.

In the final section Conclusions the document goes on to describe the main priorities of the
optimizationandreorganization oftheArmedForcesin 2015.Nothingwasmentionedinregards
to reforms in military medicine for the medical staff and soldiers or military medical training
facilities and bases. Wehopetoseeagreaterinclusionofmilitarymedicinein thereleaseofthe
MoDWhiteBookfor2015.

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MedicalATOFall/Autumn2015andWinter2016

GovernmentalReformProjects

Reform projects started at the highest level and are now seen within all the government
structures in the diagram below. The first and foremostreformprogramistheNationalReforms
Council which addresses reforms throughout the government, followedbythe
NationalSecurity
and Defence Reform looking at reforms throughout the defence structures and industries and
thentheReformsOfficewithin.theMoD.

NationalReformsCouncil
President of Ukraine, Petro Poroshenkois HeadofNationalReformsCouncil.Itwascreatedto
ensure political consensus during the reformation process. It consists of representatives of all
stakeholders and is a platform for reaching consensus and making decisions. The primary
objectives of the National Reform Council include setting reforms priorities, coordination of
reformation actions, monitoring of reforms implementation and reaching their final goals. The
decisions of National Reform Council are adopted by consensus of all participants, ensuring
consistency of positions in the reformation process. It should be noted that Aivaras
Abromaviius The Minister of Economic Development and Trade of Ukraine member of the
Executive Committee of the National Reforms Council, recently resigned in frustration as
ministerwhichinturngeneratedaninternationalscandal.

Illustrationfrom:
NationalReformsCouncil

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MedicalATOFall/Autumn2015andWinter2016

Within the National Reforms Council is the


National Security and Defence Reform
which is
headed by
current Secretary of the National Security and Defence Council of Ukraine,
Oleksandr Turchynov. Among the projects is
the
Development and Adoption of the
MilitaryMedical Doctrine, a joint endeavor between the MoD and the MoH looking at
proposed reforms in military medicine in Ukraine with the expectation they will bring military
medicine closer in line with NATO Standards.
The draftwasdevelopedbytheMODofUkraine,
and submitted to the Mi
nistry of Justice for expertise on 07/28/2015 220/1320. It was last
submittedtothePresidentforreviewonDecember30,2015.
Another project is
The development of concept of the reform of military education
,
including military training departments of civilian institutions. Organization of cooperation with
NATO military educational institutions. According to the Defence Reforms website this project
standsat80%completeasofDec30,2015.
Within the MoD is the
MoD Reforms Office
which was once headed by then MoD Deputy
Minister Yurii Gusev who also resigned for undisclosed reason asstatedinanarticle published
in NewsMe on Jan 26, 2016. The projects, the teams within the Reforms Office are currently
workingonare:

The"InstitutionalReformProcurement"
ReformsProject"ElectronicProcurement"
The draft reform of management of public enterprises belonging to the Ministry of
DefenseofUkraine
The pilot project "Automation of Accounting and Logistics in the Field of Property ofthe
ArmedForcesofUkraine"
Theconceptof"ReformNormsandStandardsandProprietarySoftwareProcurement"
Theconceptof"ReformofFoodSuppliesSystemfortheArmedForcesofUkraine"
Theconceptof"ReformonHousingandRealEstateManagementintheArmedForces"
Key provisions of the draft Law of Ukraine "On StatePrivate Partnership in National
SecurityandDefenseofUkraine"
Automation of accounting system of the medical property of the Armed Forces of
Ukraine
MilitaryMedicineReformProgram"EHEALTH"
OptimizationofMedicalEvacuationSupportoftheArmedForcesintheATOzone.

AdditionalinformationontheseprojectsisavailableontheMoDwebsite.

The three projects of interest with respect to military medicine in Ukraine are: EHealth
automatization of logistics/ electronic accountability for medical storages and the evacuation
project. Out of the three, the one that has moved very little istheEvacuationProjectwherethe
initiative among several is toapproveaNATOstandard9Line(STANAG2087).Ithascurrently
stalled and is not likely to resume in the nearest year although with the current introduction of
evacuation training conducted by elements of the US military this might change. They have

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MedicalATOFall/Autumn2015andWinter2016
approved the "Unified Guidelines of Medical Evacuation but is basically a rehash of the old
standards, ideas and concepts andisnotbasedonNATOstandards.Withinthisproposalisthe
development of a separate medical radio channel but again stalled given there is no money
budgeted for equipment and controllers at a command center for medics andtransports.There
is also a lack of ground vehicles for evacuation and funding topurchase proposedambulances
and armored MTLB. The purchase of additional equipment is also complicated by the
regulation which prevents moving equipment between units so that even if a unit is to receive
new equipment they are unable to pass it on to relieving units nor move or provide service to
othersnotassociatedwiththeirgroup.

Automatization of logistics/ electronic accountability for medical storages are all growing out of
the highly touted EProcurement Reform Project which has met some success on purchases
and a reduction of costs by placing supplies out for tender:
The system of underthreshold
procurement Pro Zorro marked its first anniversary, it has already saved at least UAH 500
million for the state budget. The systems creators have another occasion to celebrate: on
February 19, 2015 the Law On state procurement came into force. Thus starting from April 1
all centrallevel state agencies will conduct procurementbasedonProZorroprinciples.Starting
from August 1 they will be expanded on all holders of budget money. Eprocurement will be
used to purchase goods and services in the amount of over UAH 200 thousand and UAH 1.5
millionrespectively.ItisexpectedthatUAH5billionwillbesavedin2016.

There are a few accusations that the tenders are currently undergoing designs that will only
provide a single source as the sole fit for the tender. This was currently raised with the tender
for combat tourniquets and accusations that only AV Pharmawillbeselectedeventhoughtheir
newly designed tourniquet has been subject to repeated failures in some of the existing CLS
training programs in Ukraine. In March 2016 the tender was canceled to review the standards
afterintensepressurefromvolunteergroups.

Another reform moving forward with atestprojectannouncedonApril25,2015,inaMoDpress


release, EHealth a
Medical Information System which will improve quality of medical aid in
medical establishments of the Ministry of Defense of Ukraine and increase their efficiency
thanks to new European information technology solutions implemented in Estonia under the
auspices of Helmes.
The medical information system will include Electronic Health Record,
diagnostics results and other information on each patient. This system will increasequalityand
operational efficiency of medical aid provision to servicemen as well as it will create the
comprehensive health care policy within the Ministry of Defense
. We would also recommend
that
to improve trauma care and as an adjunct in the future, a Trauma Registry should be
incorporated asanotherstepintheestablishmentoffunctioningtraumacaresystemsinUkraine
andwithintheMoD.

Unfortunately, much of all of this isnowinaquestionablestagegiventherecentresignationsof


Deputy Minister of Defence Yurii Husiev who led the reforms movement from within the MoD
and the search for his impending replacement. it is rumored that Yurii Husievs First Deputy

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MedicalATOFall/Autumn2015andWinter2016
Pashynskyi is a potential replacement. It is hopedthatthenewleaderofthe reformsmovement
does not come from the preexisting status quo of old soviet thinking seen within the current
military industrial system. New dynamic and strong leadership that can push for changes in
rapid sequence is theforcemultiplierthatisnecessaryagainstastronglyentrenchedstatusquo
of institutional inefficiency. An effective leader and the proposed addition of the Reforms
Committee within the Reforms Office are without a doubt the necessary steps to continue
forward. The Reforms Committee is to be comprised of civilians with solid business
backgrounds, combat experience Ukraine military representatives, plus international
representatives from NATO. The potential for change is high, if they receive proper support
fromtheotherministriesandmostimportantlyfromtheexecutivebranchofUkraine.

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Section5HealthandWelfare
Treatyourmenasyouwouldyourownbelovedsons.Andtheywillfollowyou
intothedeepestvalley.
SunTzu
,
TheArtofWar

PostTraumaticStressDisorder(PTSD)
TheInvisibleConsequencesofWar

Overview
Over 250,000 soldiers took part in the
AntiTerrorist Operation in the East of
Ukraine in the years 2014

2016, according
to the information provided by Ukrainian
authorities. This was the first armed conflict
on the territory of theStatesincetheSecond
World War, and the first armed conflict in
which so many Ukrainian militants were
involved since the Soviet campaign in
Afghanistan (1979

1989). In Spring 2014, in


addition to the regular armed forces, a significant number of volunteer battalions formed in
Ukraine, and only by 2015 were they legally incorporated with the regular units of the Armed
Forces of Ukraine, the Ministry of Interior and the National Guard of Ukraine. Those included
people from all parts of the country, of different age, social status, beliefs and military
experience, who have all undergone different training. Due to this fact, no uniform measures,
such as psychological preparation, psychological support during service, or combat and
postcombat assistance were on any level taken in the past years in the military and police
units.

The traumatic experience of military conflict has deep consequences,bothpersonalandsocial.


It may result in PostTraumatic Stress Disorder and other related disabilities that negatively
affect the mental health of current and former soldiers, and often lead to economic
marginalization and poverty, substance abuse, violent behavior (including domestic violence).
Suicide is one of the most serious consequences of psychological trauma. According to official
statistics, 171 soldiers in the Armed Forces of Ukraine (as of October2,2015),and26soldiers
in the National Guard of Ukraine (as of March 22, 2016)committedsuicideduringservice.This
data is only the tip of the iceberg, as there is no valid statistic on suicide rates among former
combatants.

A properly designed program of psychological assistance and social reintegration can mitigate
the postwar traumatic experience, prevent the emergence of PTSD symptoms,andreducethe
risk of psychological disabilityandrelatedsocialconsequences. Theissuesofsoldiersreturnto
civil life, recovery from shock and trauma, PTSDandpostconflictsocialdynamicsarecurrently
on the forefront of global psychological research. As a country in a state of ongoing war on its

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territory, Ukraine can make a significant contribution to the theoretical knowledge and practice
ofpreventionofPTSDandrelatedpsychologicaldisabilities.

In order to improve the mechanisms of psychological assistance to combatants in different


branchesofservice,werecommendthefollowing:

Introduce a licensing mechanism for psychiatrists and psychologists who work with
militants.
Create a special university course aimed at enhancing the professional capacity of
practicingpsychologists.
Implement peertopeer approach in psychological assistance (see p. below for
explanation).
Enhance dialogue between the government and civic organizations in order to find the
bestsolutionsforcooperation.
Reviewandreformthemechanismofpsychologicaltestingformilitants.
Organize crosstraining for managers and trainers within civic organizations that work
withreturningsoldiersinUkrainetogetherwithcolleaguesfromallovertheworld.
Supporteducationalprogramsforeducatinglocalspecialists.
Improvethemilitarypsychologyeducationcoursesinuniversities.
Implementobligatorypsychologicalquarantine(followup)forreturningmilitants.
Assist in funding civil society in developing programs aimed atpsychologicalassistance
tosoldiersandformersoldiers.

PostTraumaticStressDisorderasaPsychologicalandSocialIssue

Post TraumaticStressDisorder(
PTSD
)
isamentaldisorderthatcandevelopafteraperson
is exposed to a traumatic event, such as sexual assault, warfare, traffic collisions, or other
threats on a person's life. Symptoms may include disturbing thoughts, feelings, or dreams
related to the events, mental or physical distress to traumarelated cues, attempts to avoid
traumarelated cues, alterations in how a person thinks and feels, and increased arousal.
ThosewithPTSDareatahigherriskofsuicide.

In a recent research On the attitude to rehabilitationamongthe ATOveteransconductedbya


Public Initiative Psychological Crisis Service and supported by the International Renaissance
Foundation, 431 soldiers were interviewed, 304 of them demobilized and 127 receiving
treatment at hospitals and health care facilities. According to this study, soldiers haveadmitted
noticingfollowingsymptomsoftraumaintheirbehaviourinthetwoweeks,priortothetest:

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PsychologicalPreparationforCombat.

From the beginning of the armed conflict, the Ministry of Defence has not given appropriate
attention to psychological training of personnel during the training, preparation and combat
coordination. As aresult,reserveofficersofhumanitariandirection werebeingrecruitedtothe
positions of deputy commanders, responsible for work withpersonnel.Journalists,historians,
publishers, librarians, methodists became Officers of Human resources Andrii Kozinchuk,
military psychologist, SeniorinspectoronsocialcasesoftheDepartmentofSpecialOperation
ofthePolice.
By the start of the conflict no psychological training was being
conducted prior to deployment. The overall physical preparation
would take from one to 45 days, depending on the branch of
service.

According to Andrii Kozinchuk,


the term of training for mobilized
personnel prior to deployment to the ATO zone in the Armed
Forces of Ukraine is 45 days. The first 2 weeks are dedicatedto
general training, 2 weeks for specialized training
(artillery, tanks,
snipers, engineers, every military specialty), and final 2 weeks
for combat coordination in various units. No psychological

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training is conducted as of now, as there is simply no time allocated for it. In certain units the
training timewasevenshorter.Forexample,thevolunteerbattalion,whereIserved(battalionof
specialpurposepatrolpolice Kyivshchyna)thetrainingtimewas5days.Itconsistedofa1day
shooting from a Makarov pistol and a Kalashnikov, 1 day of physical training and 2lectureson
rules of firearms and criminal detention. Other police units could be deployed to the frontline
withnopreparationatall.

In 2015 Tetiana Rychkova (a volunteer now working in the Ministry of Defence) started the
reformation process of the personnel psychological training system for the Armed Forces of
Ukraine. Together with her team Tetiana initiated recruitment of psychologists to the training
campsandworksonimplementingasystemofpsychologicaleducationformobilizedsoldiers.

According to Tetiana Rychkova, starting with the 4th wave of mobilization, a psychological
selection was introduced at military commissions. Both
volunteer psychologists and representatives of Educational
Psychological Service have been involved in this work.
Coordination
is
conducted
by
the
Ukrainian
ScientificMethodological Center of Practical Psychologyand
Social Work. The preparation of mobilized soldiers is now
conducted at training centers and at shooting ranges
.
Previously it would happen at military bases. In order to
prevent development of combat psychological trauma and
PTSD,psychologicallessonswereaddedtothegeneraltrainingcourse.

Psychologicalsupportisconductedinfollowingdirections:
1. Professional and psychological diagnosis, consisting of primary screening, indepth
selectionandcombatcrewcoordination.

Professional and psychological selection is implemented in regional military commissariats


through outsourcing to groups that conduct professional andpsychologicalselection.Intraining
centres (shooting ranges) it is performed by human resource units, and on military bases by
relevantselectioncommissions.

2. Psychological training for


specialassignedtasks isconductedwithallpersonnel,bothas
general training, for the preparation for a relevant specialty and as targeted training, for the
executionofaconcretecombatmission.

This type of personnel training is part of the system of combat training oftroops(forces)andis
implemented by commanders (chiefs), psychological instruction officers in military training
centers(shootingranges)andofficersinchargeofmoralandpsychologicalsupport.

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3.
Psychologicalcounselling,duringserviceandtasksforthepurposeoftroops.
monitoringindexesofsocialandpsychologicalwellbeing,
psychologicalpreventionofmilitarydisciplineviolation,suicideandwartrauma,
psychologicaleducationandcounselingofpersonnel,
psychologicalassistance,includingprimarypsychologicalcareatthefrontline,
psychological rehabilitation in outsourcing institutions that provide psychological care
andrehabilitationtobrigadesandin
sparesort
typehealthcarefacilities.

The document regulating psychological training of militants in the Armed Forces of Ukraine is
called
Military standard of Psychological Training (General Provisions). According to this
document, the main method is physical training in conditions that simulate combat. The
description is very basic, stating only that one should use norms specified in the Standard of
preparation. IST4. Individual psychological training. However, it contains little to no
informationabouttheapplicablemethodologyofpsychologicaltraining.

Similar changes were adopted in units subordinate to the Ministry of Interior. According to Mr.
Kozinchuk,
obligatory training for Human resource professionals within the National Police of
Ukraine has been started from the 4th wave of mobilization. Duringsuchtrainingfutureofficers
(doctors only) were taught norms of completing documentation requirements, directives, laws,
military regulations and orders were introduced to them. They were, however, not trained for
directworkwithpersonnel.

Account of personal experience. Psychological testing prior to signing acontracttojoin


theNationalGuardofUkraine

Olena Sontseslava, 26, until 2013 resided in Lviv, workingwith


stained glass. In 2014 she joined the revolutionary Maidan
movement and was part of the first volunteer paramedic group
in the ATO zone (together with Armen Nikogosyan and Ilya
Lysenko). Autumn same year she developed a medical
entrepot near Debaltseve village. She managed the work at
that position until the end of January 2015, when she was
convinced by brothers in arms to legally join the
Kulchytsky
battalion. She was
officially mobilized on February 24, 2015.
Now Olena is deciding on whether she should sign a new
contractwiththeNationalGuard.

Military HospitalCommission(MHC)isanobligatoryprocedure foreverybody,whoplanstosign


a contract for a duration longer than 6 months and up to 5 years in the National Guard of
Ukraine, the Armed Forces or the National Police of Ukraine. In order to understand, whether
one is eligible for military service, candidates undergo psychological testing at the Centre of
Psychiatrichelp.Thetestingisstandardizedandunified.

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The procedure contains 4 differentteststhatare administeredwith thehelpofacomputer.After


that, in case a candidateissuspectedtohavepsychologicalissues,thetestngisfollowedbyan
interview with a psychiatrist. Computerized tests are of two types: either a multiple choice or a
yesornoquestions.Eachtestconsistsof80to160questions.Thetestsarethefollowing:
1. Identificationandassessmentofneuroticstates
2. Leonhardcharacteraccentuation.
3. Multivariateindividualresearchtest
4. Ravenstest.
All the tests are unified, they aresupposed tosuit bothmenandwomen,allagegroups,people
withdifferentcombatexperience.

According to Maria Berlinska, social activist who fights for equal rights for women in the
Ukrainian Army, it is common for the bureaucracy processes to be suited only to men in the
army. When passing the tests Olena experienced that they contain questions of sexual nature
thatareaddressedspecificallytomen,andareimpossibleforawomantoanswer.

During the testing process there are no requirements concerning the physical wellbeing ofthe
participants. Candidates receive no guidelines prior to the test and are not asked about their
health on the day of the test. According toOlena:
ThenightbeforethetestIvesleptonlythree
hours and was yet allowed to attend. Nobody asked me how I felt. I drowsed off three times,
while passing the test and can confidently say that I dont remember answering at least one
question from the list. The [psychological commission] also was not aware that I had already
servedfortwoandahalfyears.TheythoughtIwasonlyabouttosignthefirstcontract.

According to Olena, most answers are limited to yes and no, even though the questions
would logically require specification. Somequestionsarepoorlyformulated:inherpointofview,
limiting the answer to only yes or no drove her into a corner and made her afraid people
would get her wrong. It made her think over the questions, be scared of mistakes, lie in her
answers.

In addition, all the information, provided by candidates during psychological testing is not kept
confidential and is added to ones personal case. As a consequence, soldiers are most often
afraidtofailthetestsandroutinelylieintheiranswers.

According to Olena, all her colleagues were worried about the questions. They lied in the
answers. Among her colleagues one had failed the test. When working with soldiers at military
bases upon arrival during the past 3monthstogetherwithhercolleagues,Olenanotedthatone
of the most commonquestioneveryonewasaskingwas:Howtopassthepsychologicaltesting
andnotfail?.

While the first part of psychological selection is unified at first, the process then becomes fully
subjective. When a candidate enters the cabinet of a psychiatrist, his future depends on the

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personal opinion of the expert. Yet, no license, other than a university diploma is required in
order to practice as a psychiatrist in Ukraine: psychiatric workers undergo no specific training
thatwouldpreparethemtoworkwithmilitarypersonnel.

Olena was assigned a further examination by a psychiatrist. Below is her description of the
traumaticexperienceoftheinterview:

The individual conversation with the psychiatrist was very tense. He started off by
mockingmylastname(
SontseslavafromUkrainian isGlorytotheSun)askingifIama
pagan. I could notanswer,asthemanwasconstantlyinterrupting.Hewasaskingallthe
questions very quickly.Theywereunexpected. HetriedtoconvincemeIhaveanswered
no to questions I clearly remember answering yes to (hetoldmeitwasimpossiblein
an abusive mocking manner). I tried to stand for myself but was being convinced I was
wrong. I felt pressure on myself in some questions very important for me. Reading my
characteristics out loud to me he inserted phrases, never mentioned in it. Such as
suicidal thoughts, voices I hear, schizophrenia. I denied it all, ofcourse.Iexplainedthat
in some questions I had a limit of only two variants and that it didnt let me expand my
answer. He stood his ground. Suddenly he told me I was free to go and in an hour
another doctor will be waiting for me. I refused to go out of the room. I demanded an
adequatepersonalconversation,askedtobeheard.Hesentmeoff.

Waiting for another doctor (it was a woman of about 60 years old) I smoked cigarette
after cigarette, had some coffee trying to calm myself down, but innerly preparing for
furtherpressure.Togetherwiththe womanwe wentbacktothepsychiatrist.Theveryfirst
thing he said was that to hisopinion,Iwasunsuitabletosignthecontract.HearingthatI
again was flooded with emotions, as I understood how hard it would be to prove him
wrong. I warned them Ill leave in case theygooninterruptingme.Andthenthiswoman
had to calm him down. She began asking very calm, neutral questions about me. It
helped her achieve some contact with me. Before we left the man again said he thinks
Imunsuitable.

I felt abused. As I understood, the next doctor we went to was the head doctor in the
clinic. He was the one to finally decide if I was suitable or not. Most likely he was
concerned that it took so much time to work with me (I spent the time from 10:00 to
16:00 in the hospital). He asked some calm questions and the woman helped me
answer, as I was alreadyverydepressedatthatpoint.Itriedmybesttostayemotionally
neutral.HedidntspotanyreasontodeclineandwrotethatImhealthy.

The process of psychological selection in the Armed Forces of Ukraine is further described by
Head of the Main psychological support department for human resources of the Armed Forces
Ukraine,
Sergii Hryliuk, who, together with Tatyana Rychkova, works on reforming the process
of psychological training and support within the military. According to Sergii Hryliuk, during last
year the Armed Forces have improved the system of selection of bound to military service in

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regional military commissariats and training centres
(shooting ranges). 485 outsource groups of professional
psychological selection were created, staffed with
representatives of nongovernmental and volunteer
organizations, along with over 600 human resource
officers. As a result of their work, only in 2015, 8398
candidates were denied to join the military due to their
personalqualitiesandpsychologicalstate.

In addition, in order to improve the quality of professional


psychological selection activities, seven pilot projects
were organized in seven regional military commissariats of Ukraine (Odessa, Lviv,
Dnipropetrovsk, Zaporizhya, Kharkiv, Kirovograd, Chernihiv), which lasted from April to
September 2015. As a result of this project it was decided to introduce 4 new positions in
human resource and public relations groups in all regionalmilitarycommissariatsofUkraine,to
include 2 civil psychologists and 2 secretaries. Starting from September 2015, 440 positionsof
psychologistswereadditionallycreatedinallregionalmilitarycommissariats.

After the pilot project on improvement of psychological preparation


at training grounds in
Mykolayiv and Zhytomyr regions from May to September 2015 it was decided to add 22
positionsofofficerinstructorsinpsychologicaltrainingatthemilitarytrainingcentres.

The pilot project was conducted together with volunteer psychologists of civil organizationslike
Ukrainian Association of Experts in Overcoming Traumatic Events, Officers league,
Ukrainian Psychodrama Association and the G.S. Kostyuk Psychology Institute of the
Ukrainian Academy of Pedagogic Sciences. The topic of psychological
preparation within the
overallmilitarytrainingsystemwasthoroughlyoverhauled.

Psychologicalsupportduringcombat

Evolving from a massive volunteer movement, a wide range of NonGovernmental


Organizations, aimed at providing psychosocial adaptive support to militants emerged in 2015.
Various psychological groups provided firstaid psychological assistance to the troops on the
frontlines, supported wounded soldiers in hospitals and in military units all over Ukraine.
Volunteer groups are unofficially working with the troops on the frontlines, maintaining direct
contact with soldiers and commanders.And
while theircommittedanddedicatedworkdeserves
full respect, it cannot be overlookedthatmostofthevolunteerslackappropriatetrainingtowork
with military trauma and
are simply not qualified enough to provide psychological support, and
atthesametimeareveryhardtocontrol.

Andrii Kozinchuk, military psychologist, notes that every unitofmorethan51 personisrequired


to have a psychologist or a human resource officer, according to regulations. It is notrequired,
however, that these people have psychological education, but they are expected to be

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MedicalATOFall/Autumn2015andWinter2016
responsible for the moral and psychological state, cohesion, leisure and conflict prevention in
the unit. These officials are not obligated to be sufficiently competent in working with the
personnel. It is common toemployonthesepositionsofficerswhoarenot competentenoughto
workwithtechnicalequipmentandhavenocommandingtalent.

The audit of morale and psychological state in the unit is performed by external commissions,
that evaluate the morale of theunitthroughdocumentanalysis,butnotbyindividualtestsofthe
personnel.

According to Mr. Kozinchuk, from the moment the military unit undergoes first combat clashes
and experiences first deaths, all work of the human resource officer (in other words,
psychologist) is narrowed to planning moral psychological support,
conducting internal
investigations on losses and injuries, preparation of numerous reportsandstatements.Insome
units these people would organize concerts and keep contact with volunteers. We have met
people who refused to work with personnel and invented different work for themselves. For
example, one was looking for a printer on the frontline. Despite their qualification, potentially
prepared military psychologists, who could be possibly managing personnel work, were
retrained and overtook the role of platoon and company commanders, due to the lack of
support.Thecountrywaswastingtalentsandrelyingonvolunteerpsychologists.

Since the beginning of the ATO external groups of psychological support, including
volunteerpsychologists, were operating at military bases of units, taking part in the operation.
From February till September 2015 outsource groups of officers psychologists, officers of
informational sphere and sergeants were working with the troops. These groups were under
command of sectors chiefs in the ATO zone. Currently, activities of psychological support are
performed by officers psychologists within the units and by volunteer psychologists (per
agreement).

Theactivityisorganizedatthreelevels:
1. Directly at the front line, conducted by commanders and officers on providing acute
psychological aid, monitoring of psychosocial morale of the unit,
control over the
emotional and volitional state of servicemen, supervising the fair distribution of
responsibilities,providingappropriateconditionsforassignedmissions.
2. At the second line of defence psychologists work with soldiers, who show signs of
combatpsychologicaltraumaandrequirelessthan12hourstorecover.
3. 3day psychological recreation activities are being conducted at Centres of
Psychological Help and Rehabilitation, that areopenat militarybasesonthethirdlineof
defence. Afterwards, soldiers who stillrequire medicalpsychologicalassistancearesent
to the military hospitals for examination and to psychiatric hospital departments for
treatment.

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In January 2015 highly mobile groups of internal communication at military bases (units) ofthe
Armed Forces of Ukraine started to operate within the troops. Their main task is to instruct
commanders, officers of human resources and chiefs of staff in practical forms of how to treat
the servicemen, how to provide information and training to the fighters, how to provide
psychological education to personnel. These groups provide psychological consultations,
prepare recommendations to commanders concerning the organization of military service and
conductindividualworkwithsoldiers.

Currently,theworkofmilitarypsychologistsreliesonthefollowinglegalfoundation:
Order of the Ministry of Defense of Ukraine 702 from 09.12.2015"OnApproval ofthe
Principle of psychological rehabilitation of the servicemen of the Armed Forces of
Ukraine, who took part in antiterrorist operations during the recovery of combat
readinessofmilitaryunits(subdivisions)
Order of the Chief of General Staff Chief of the Armed Forces of Ukraine 317from
04.12.2014 " OnApprovalofthePrincipleofPsychologicalServiceoftheArmedForces
ofUkraine."

As of today, the preparation of additional regulatory provisions is absent from the agenda,
accordingtoSerhiiHryliuk.

Is there a trust problem towards


psychologists?
In the Soviet Union psychiatry was
used as aninstrumenttopunishthe
people whodisagreedwiththestate
ideology. It was used to protect the
society from wrong, disturbing
images of people with different life
viewsandexperience.

Nowadays, psychiatry in Ukraine


still largely operates in accordance
withtheprescriptions,createdinthe
Soviet times. A great number of
people that work within the system
are still the same. Due to the bureaucracy intheArmy,psychologiststhatareassistingsoldiers
in accordance with the regulatory provisions are supposed to pass the information on to the
commanders,whichdestroysthetrustandanonymityofwork.

An alternative peertopeer approach has proved itself in many countries and under various
circumstances. It is based on training people with relevant traumatic experience to help
eachother overcome consequences. However,thismethodrequiresalotmoreeffortinorderto

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MedicalATOFall/Autumn2015andWinter2016
be implemented. It may become a reality provided there is cooperation between civic and
governmentalinitiatives.

Theroleofthechaplainsonthefrontline
Since the events of the Revolution of 2013

2014 chaplains have played a vital role in


supportingactivistsandsoldiers.

Militarychaplain

OleksandrDobrovolskyDmytroPovorotnyi

As it is not yet common among Ukrainians to seek help from a psychologist, it was easier for
chaplains to gain trust of their units. In 2015 a volunteer group of 400 chaplains hadjoinedthe
troops in the ATO zone. Prior to that, a significant number of clerics went in the army
independently. Igor, who is a chaplain with a Marine unit, notes: They (chaplains) are
volunteers, receive no documents and salary. At thesametime,permissionfrom theMinistryof
Defence is required in order to join the units on the frontlines.Duetothisfactourrotationsare
only two weeks long. After that youmayspendfromtwoweeksuptoacouplemonthsathome.
Prior to my rotation I have undergone a special paramedic training by the International
Association of Chaplains (if I remember it clearly). It includes some psychology as well. I may
say, that soldiers were coming to me quite often. When a person is a believer, he will be
searching for himself even at war.Andhecomesto achaplainforadvice.Butitdependsonthe
chaplain,whetherhewillbetrustedbysoldiers.

Makariy Diadus, unofficial chaplain of the Kulchytsky battalion: Most


chaplains are volunteers. The Armed Forces of Ukraine give them
some sort of certificate through the Synodal Management of Military
Clergy. A fewhavejoinedthearmyassimplesoldiers,likeme,inorder
to go to the front line with the guys. Nowadays according to the
legislation, it is allowed to formalize a chaplain in thebattalion, butitis
not remunerated. Thats why we nowhaveachaplainforthebrigade.I
haventmethimyet,though.

In my personal practice I have met a lot of chaplains along the front line.Theyarealwaysvery
enthusiastic about the visits of psychologists. They are searching for information everywhere,
tryingtounderstandthetoolstohelpthesoldiers.Theyhavehighauthoritywithsoldiersandare

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MedicalATOFall/Autumn2015andWinter2016
usually trusted a lot. At the same time, most of them are less protectedbylaw.Theyalsocant
bewieldingaweapon,accordingtotheirstatute.

Returning

The first wave of demobilization took place from the 18th of March to the 1st of May 2015 and
involved over 35,300 servicemen, who were the first to be deployed to the zone of ATO in
spring 2014. The first three waves of demobilization together have involved approximately
100,000 veterans. In March 2016 President Poroshenko has signed a Decree on
demobilization of the most populous 4th mobilization wave. It ends on the 30th of May 2015.
Afterthat,therewillbe
50,500
more

veteransinUkraine.

There is no difference in the process of returning for soldiers, regardless iftheyareplanningto


renew their contract, for those, who wait for the next rotation and for those planning to be
demobilized. The whole unit is withdrawn from the front line, most commonly, directly to the
military base in their hometown. There they return theirweapons,signsomeformalpapersand
return homeonthesameday.Afterwards,stillunderthecontrolof theircommanders,they have
to return to the base every now and then for some formal tasks but are now allowed to stayat
home. There is no obligatory psychological consultation, testingorsupport.Somecommanders
will ask volunteer groups to give lectures and psychological counselling to their units upon
arrivalandmanagethisprocess.Mostcommonly,however,nothingisbeingdone.

When you return home, even if its a shortterm vacation, if its a short time, in the first few
days,thefirstmoments,yourepsychologicallystillinthemilitary,inthewarzone. But yourbody

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and soul are already at home. And problems appear, first of all, with the mutual understanding
among relatives and close ones, friends.
alias Prokuror, soldier at a Marine unit near
Mariupol,says.

In order to smoothen the


reintegration of a soldier to
the society, we suggest
implementing a quarantine
period upon arrival. In this
time the unit would continue
to live together onthemilitary
base while psychologists and
social workers would provide
them appropriate tools to
return back home. It would
allow to strengthen the sense
of community within the unit,
by teaching them distance cooperation and support instruments in the civil world. It would also
ease the record of returning soldiers and let psychologists work with their families in the base.
The duration should depend on further plans of each single soldier (renewal of contract,
demobilization) and may take up to 1,5 months. This will make it easier to finish all the
bureaucratic procedures with less stress for the returning individual and mayalsobeusedasa
time for quality experience exchange between veterans and newcomers. This technique is
widespreadworldwide.

HereiswhattherepresentativesoftheMinistryofDefencesayaboutthereturningprocess:
When the troops are withdrawn from the region of service to training centres, traininggrounds
andmilitarybases,aprocessofmedicalandpsychologicalfollowupisorganized.Itincludes:
Obligatorymedicalexaminationofallservicemen
Obligatory (a week in advance) individual assistance to every soldier planning to be
demobilized. A written report of the conversation with the unit commander,
officerpsychologistandamedicalworkerisprepared.

At military bases (units) regular medical examinations within the general system of
medical supportofservicemen intheArmedForcesof Ukraineandindividualconversationswith
psychologists (in order to reveal theneedinthepsychological,physicalandsocialrehabilitation
ofsoldiers)areconducted.

The general system of individual instruction of personnel of the unit is approved by the
commander and determines the frequency and accountability
in the conduct of interviews with
subordinate personnel. In this system officer psychologist conducts conversations with the
whole military battalion (monthly), with military personnel assigned to the "group of increased

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psychological attention" each week, if necessary every day. Schedules and results of
interviewswithsubordinatepersonnelareenteredintheworkbookofthepsychologist.

A hotline
(044)4544451) has been set up by the Main
Department of human resources in the Armed Forces of
Ukraine, in order to provide consultations on
psychologicalandsocialissuestomilitants.

To manage the work on psychological rehabilitation of


affected participants of military actions in terms of the
antiterrorist operation military commissariats each
month prepare a report on demobilized servicemen who
require psychological rehabilitation to regional
administrations, and quarterly to the Ministry of Social
Policy of Ukraine, through the Main Department of
Personnel of the Armed Forces of Ukraine and the
Department of Social and Humanitarian Policy of the
MinistryofDefenceofUkraine.

Many mobilized soldiers come from distant villages, where no volunteer or governmental
support is available. It happens often that bothvolunteerandgovernmentalinitiativeslosetrack
of such people very soon. It is almost impossible to diagnose PTSDorspotanyconsequences
of war under suchcircumstances.Thebestwaytoapproachtheseveteransisaqualifiedmedia
approach. At the moment Ukrainian media is overloaded with various information on the topic,
however, they are largely unqualified. We need to develop an information strategy to deliver
information to the greatest number of veterans. Media cooperation in terms of employment is
another option
linking national TV companies to train veterans for work at their facilities. This
couldopenopportunitiesbothforveteransandtheirfutureemployers.

As a result of lack of followup many veterans turn to alcohol and drugs,whenreturninghome.


A drug problem has started in late 2014, when, due to the lack ofmedicalsuppliesonthefront
line, volunteers had to deliver strong addictive painkillers to the farthest positions. Control was
lacking, and some soldiers were stealing painkillers from the medical units and it led to a
massive drug addiction problem. Additionally, Eastern Ukraine with its massive industrial base,
coal mines and agriculture industries has never experienced a high level of social/educational
development for men, therefore, antisocial behaviors such as alcohol and drug abuse were
high within the fluctuating employment levels in the metropolitan areas. Long before the war,
drug abuse was one of the biggest problems in the region. Militaryactionshaveonlyeasedthe
accesstodrugs.

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Alcohol was easily available as well. Special attention was brought to the alcohol addiction
problemsinthetimesofceasefire,whenvolunteersoldiers,willing tofightfortheircountry,were
forced to keep the positions peacefully, spending their time in routine needs of the unit. These
problemshavetobeconfrontedthroughpsychosocialworkaswell.

Evaluationsystem

Despite all the efforts of the new people in the government, the system still functions following
Soviet regulations. The success evaluation of psychosocial assistance is measured in beds.
One bed equals one person. So the effectiveness is the quantity, but not the quality of
assistanceorwellbeing.

During service and combat, the evaluation of the moral and psychological state of the unit and
every individual soldier has twopoints:satisfactoryandunsatisfactory.Theresponsibilityforthe
psychological satisfaction of the unit is placed on the commander of a unit. The Officer of
HumanResourcesbearsnoresponsibilitywithrespecttothemorale.

Afterdemobilization,theresponsibilityforfollowingupon veteranswellbeingispassedfromthe
Ministries of Defence or Internal AffairstotheMinistriesofHealthandSocialPolicy.TheArmed
Forces maintain no further tracking and, therefore, are unable to evaluate the longterm
consequencesoftheirpsychologicalapproach.

Smaller volunteer civilian groups would be expectedtobemorelikelytokeeplongtermcontact


with their clients and have direct responsibility for the results of their programs(providedthey
receiveregularfinancialsupport).

If good old buddies meet, sure, yes, everything is good as they are sitting there together. But
then they leave and one is left alone with his problems. So whats the solution?Thesolutionis
toteachapersontocopewithonespsychologicalneeds.aliasIndiana,AZOVregiment.

Suiciderates

According to the public information provided by the Ministry of Defence in October 2015, there
were 171 registered cases of suicide commitment among soldiers of the Armed Forces of
Ukraine in the years 2014

2015. The National Guard of Ukraine reported 26 cases in

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20142016 (as of March the 22, 2016). These are only cases among the enlisted soldiers. We
expect these numbers to be low giventherealityoftheexistingsystems.Onereasonitislowis
that in order to keep the social status and legal guarantees for the family of aperson,whohas
committedsuicideduringservice,itiscommontorecordthecauseofdeathasdifferentfromthe
actualevent.Neitherdothesenumberscontaindataamongsuiciderateofveterans.

On April the 7th 2016 we received an answer to arequestforaccesstopublicinformationfrom


the Ministry of Defence.Itsaysthataccordingto
the
GeneralDirectorateofMilitaryPoliceofthe
Armed Forces of Ukraine303casesofdeathsamongservicemenwereaccountedintheArmed
Forces as noncombat losses in the offduty time. 71 of them died due to accidents. The
definitionsusedintheresponseareuncertainandthedatadiffersgreatlyfromtheone,received
inOctober.Thisagainprovestheneedforadetailedstatisticalanalysis.

We have requestedtheupdatedpublicinformationonsuicideratesfromtheMinistryofDefence
and Ministry of Internal Affairs. When this data is provided, we will be able to compare the
results and launch a thorough study. We
couldnt access anystatisticaldataonthesuicideand
divorce rates among veterans of the ATO. According totheStateStatisticalServiceofUkraine,
no record is being kept. However, these social consequences of war trauma need to be
evaluatedandtakenintoaccount.

Governmentinitiatives

It is not within the competence of the General Staff of the Armed Forces of Ukraine to ensure
implementation of psychosocial rehabilitation of servicemen, who have been demobilized from
the Armed Forces of Ukraine.
Sergii Hryliuk
, Head of the Main psychological support
department on work with the personnel of the Armed Forces Ukraine. Psychological
rehabilitation of demobilized militants, their family members and families of dead servicemenis
within the competence of the Ministry of Social Policy of Ukraine. It is the main manager of
funds of the budget program 2505150 Activities on psychological rehabilitation of affected
participants of the antiterrorist operation (Cabinet of Ministers of Ukraine Decree from
31.03.2015 221
On the use of funds provided by the state budgetfortheimplementationof
measures for psychological rehabilitation of the affected members of the antiterrorist
operation)

Governmental initiative is now being developed. At the moment, a guaranteed legal benefit for
veterans is a free twoweekrest inasparesorttypefacility.However,ifstillatservice,asoldier
can only use if this benefit is within the time ofhisyearlytwoweekvacation.Noadditional time
for rehabilitation is provided. According to the official data, the clinical base is eleven
rehabilitation hospitals1,888beds,andregionalhospitalsforwarinvalids7,248 beds,seven
physiotherapy hospitals, and more than 12 thousand beds of the Private Joint Stock Company
of therapeutic institutions of the Ukrainian Trade Union Ukrprofozdorovnytsa
(www.ukrzdrav.com),inadditiontodepartmentalandspafacilities.

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On the 17th of March2016IrynaSysoyenko,a
NationalDeputyofthe
VerkhovnaRada
,drafted
a bill On prevention of disability and rehabilitation systeminUkraine.Itwillsoonbepresented
to the parliament. In an interview to Ukrainska Pravda Sysoyenko said that: The law On
prevention of disability and rehabilitation system in Ukraine will create a coherent system of
rehabilitation in Ukraine and regulate the principles of its funding from the state budget. ATO
veterans will get access to full rehabilitation in specialized departments of medical institutions,
rehabilitationcentersandsparesorts.

Rehabilitation of soldiers is conducted at all health care and


sparesort
type facilities of the
MinistryofDefenceofUkraine.

Evaluation of level of satisfaction with services,providedbystatebodiesandstructures,among


the ATO participants (According to the research by the Public Initiative Crisis Psychological
Service).

Stateagency

Number of those, who


werecontacted%

Badly

Satisfactorily

Good

Perfect

Department of Labor and social


protectionofpopulation

54

12,6

34,7

43,2

9,5

ATO Veterans help centre at


RegionalStateAdministration

22

4,2

21,1

47,4

27,4

Regionalmilitarycommissariat

32,7

16,3

50,4

26,2

7,1

EmploymentCentre

15,1

12,3

33,8

46,2

7,7

Sparesorttypehealthcarefacility

26

1,9

23,8

51,4

22,9

Psychologist,psychotherapist

32

6,5

18,1

48,6

26,8

Memorandums on cooperation were signed by six civil and volunteer organizations in order to
provide psychological assistance to servicemen. According to these memorandums, from 280
upto400volunteerpsychologistsmaybeadditionallyemployed.

Apart from that Veterans Hospitals, the following


institutions are currently providing psychological
rehabilitation:

1. UkrainianStateMedicalSocialCentreforWar
Veterans(Kyivregion,
PereyaslavKhmelnytskyiarea,VillageTsybli1)
2. Kirovogradregionalhospitalofwarveterans
(Kirovograd,Str.Korolenko,58)

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3. HospitalofwarveteransinKremenchuk(Poltavaregion,Kremenchukcity,Str.
Zhovtneva,23/1)
4. Mykolayivregionalhospitalofwarveterans(Mykolayivcity,Str.Kyivska,1)

As for 02.02.2015 4
sparesort
type facilities have won the bid to provide services of
psychologicalrehabilitation.
1. State Enterprise Clinical health resort Bereziv mineral waters (Kharkiv region,
Derhachivarea,Berezivskevillage)
2. State Enterprise Southhealth resortService, Orizont
sparesort (Odessa region,
BilgorodDnistrovskyiarea,VillageofcitytypeSergiivka)
3. Mensk
sparesort
Ostrech(Chernihivregion,Menskarea,cityMena,tractOstrech)
4. LLCFeofaniaresort(Kyiv,AcademicBohomoletsst.)

LegalBenefits

There are 22 legal benefits, guaranteed by the Ukrainian legislation, according to the laws
On
the status of war veterans, guarantees of their social protection, On improving financial
situation of combatants and war invalids, "On social and legal protection of servicemen and
theirfamilies"andotherregulatorydocuments.

Few of these documents take into consideration the psychological and medical aspects of
returning.

Everyveteranisprovidedwithfreehealthresorttreatmentorreimbursementofcostsof
independentspatreatments.Therulesregardingthegrantingofcompensationvouchers,the

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amount and order of reimbursement of the cost of independent treatment is determined by the
CabinetofMinistersofUkraine.

The veterans also have legal rights for preferred access


to institutions of social protection, as
well as maintenance services, and to social protection at home.Incaseoffailuretoreachsuch
care institutions Social Welfare reimburses the costs associated with caring for this veteran of
thewar,inthemannerandextentestablishedbythelegislation

Veterans have a right for noncompetitive access to institutions of higher education and
preferentialrighttojointhevocationalschoolsandcoursestoobtainrelevantprofessions.

In the beginning of the conflict (2014) there existed a bigproblemwithdocumentation. Soldiers


wereoftenimproperlylistedinthedocuments, whichwascausedbythepoor organizationinthe
Armed Forces and the Ministry of Internal Affairs. The situation changed greatly in 2015, but
some of the first soldiers are still facing problems of proving their participation in the war. The
bureaucracy machine in Ukraine is still working following the Soviet rules. It takes a lot of time
andeffortforasoldiertoreceivethebenefitsthatareguaranteedbylaw.

LocalNonGovernmentalinitiatives

It is great luck for Ukraine, that in the state of an ongoing war alternative systems of
psychosocial adaptation for returning soldiers are being developed. As the experience ofmany
countries has shown, the cooperation between NGOs and the government can be very
beneficial.

Following the massive volunteer movement of 2014, a great variety of civil organizations,
covering the psychosocial adaptation issues emerged. With the experience of Maidan and a
yearofwarwehadtowelcomethefirstwaveofdemobilizationinspring2015.

With all respect to the volunteers dedication, it is obvious, that they all lack experience,
education and knowledge. We need assistance in raising professional staff in Ukraine to work
withcombatveterans.

CIVIL ORGANIZATION Public Organization Ukrainian Center of assistance to victims of


terrorismintheEastofUkraineFORPOST

BasedinDnipropetrovsk,consultingalloverUkraine
phone:+38(096)8397617
mail:
forpost.dnepr@gmail.com
www.facebook.com/groups/1576615529262824/

A Dnipropetrovskbased civil organization. Specializing in posttraumatic treatment of former


hostages and prisoners ofwar.Providingexclusive therapytovictimsandtheirfamilymembers.

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Participant of Human rights First program, collecting evidence of human rights violations in
Eastern Ukraine. Consultancy centres operating in four regions : Dnipropetrovsk, Donetsk,
Kharkiv,Kyiv.

Services:
Psychologicalassistance
PsychologicalandsocialpatronageofATOparticipantsandtheirfamilymembers
Crisiscounseling
Individualpsychotherapyandsupportgroups
Psychological assistance in legal and advocacy support of prisoners of war, former
hostages,otheraffected
Primaryandsecondarylegalassistance
Longtermlegalpatronage
Businessassistance
RecreationalprogramsforVeteransfamilies.

NonGovernmentalOrganizationFreePeopleEmploymentCentre(FPEC)

BasedinKyiv,consultingalloverUkraine
phone:+380(67)2966643
mail:
czsl.staff@gmail.com
www.facebook.com/czvl.staff
www.czvl.org.ua

FPEC is one of the few local organizations helping IDPs, veterans and volunteers tofindwork.
The organization is working under improvement of organizational capacity to provide more
support to IDPs and veterans in this direction. The organization works closelywithanumberof
main headhunting agencies, the public and private organizations working in the employment
sector.

AworthyjobfortheATOveteransprojectstartedinJanuary2015
Objectives of the project providing support in employment through career guidance and giving
information about coaching to use the tools for effective job search for the veterans and the
volunteerswithdisabilitiesattheirplacesofresidence.

Providing the ATO veterans and volunteers with possibilities for acquiring new skills
througheducationaleventsandtrainings
ProvidingcomplexlegalsupportforthedisabledATOveteransandvolunteers

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Advocacy of labour rights lobbying the rights and interests of the ATO veterans and
volunteersforHR
Expanding the network of loyal employers for strong partnership in employing disabled
ATOveteransandvolunteers
EstablishingtheprojectvolunteersnetworkaroundUkraine
Increasing the social involvement to the social adaptation and integration of disabled
veteransandvolunteers.

CivilOrganizationUkrainianPublicUnionPOBRATYMY

BasedinKyiv,operatingalloverUkraine
phone:+38(
098)6620228
mail:
pobratymy.training@gmail.com
www.facebook.com/pobratymy.training

The work of the PO UPUPobratymyisaimedathelpingreturningsoldiersadapttosociallife,


deal with the psychological consequences of war, preventing and mitigating psychological
disability(suchasPostTraumaticStressDisorder(PTSD),AcuteStressReactionandothers).

Pobratymy isa CivicOrganizationofveteransandvolunteers,unitedbytheissuesof returning


soldiers,dealingwarshock,traumaandPTSD.
They provide psychological assistance using the equaltoequal approach (
only people with
relevant experience can be group cotrainers (such as veterantoveteran). The organization
wascreatedin2015asaresponsetotheeventsofthepastyearsandisrapidlydeveloping.

Methodics:
Bodynamics International. Cooperating with Ditte Marcher and counseled by
colleaguesfromDenmark,USA,Israel,Bosnia.

Mainactivities:
TrainingonHealingMilitaryShock,TraumaandPTSDforformerservicemen.
One group session is 4 course meetings in6monthsforeverygroup(25soldierseach).
Providing instruments notonlytoworkwithone'spersonaltraumaticexperiencebuthelp
brothersinarms.
Lecturesaboutreturningformilitantsonthefrontlines
Lectures and seminars for volunteers, soldiers family members, social workers of
differentdisciplines
Workwithreturningsoldiersinthemilitaryunits
ProgramofsocialadaptationfordemobilizedsoldiersSectorV.

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SectorV

A pilot project of a social adaptation centre for veterans of the military actions in Eastern
Ukraine in the years 2014

2016. Target audience: 60 Veterans. Duration: 45 days. Innovative


for Ukraine system of veteran to veteran approach. This rehabilitation approach is aimed at
securing the basi needs of a soldier upon demobilization in order to help him adapt to a new
social status of a veteran. The programisbasedon theprinciplesofrehabilitationregardingthe
Employment Housing Benefits priority of a returning soldier. They have created a unique
learning schedule, emphasizing these three factors. It contains social, educational and
psychological blocks. During a 1,5month program veterans work with over thirty highqualified
trainers, who have previously beenpreparedbyour organization.Theprogramgivesapowerful
educational background, considering all the obligatory skills for those, who want to create a
project, enterprise or seek for employment upon demobilization. Soldiers receive structured
skills in project management, finance, law, IT, entrepreneurship, English, business Ukrainian,
etc. They cover the psychologicalsideof theissuebyteachingaveteranspecificinstrumentsin
selfrehabilitation. Taking into consideration the whole family (partners, parentsandchildren)of
the participant, the project works on improving the communication and understanding within a
family. 6 times in terms of the project the entirefamilyofaveteranisinvitedtothecentre.They
develop special courses for women and children, provide family trainings and consultations.
They create a professional network of veterans and entrepreneurs in terms of their projects.
Finally, veterans are taught how to implement and fund a personal project under current
circumstances,howtotransformtheirpreviousmilitaryexperienceintothecivilreality.
1. Veteran to veteran approach. (Trainers are veterans, who have undergone the 4
monthlongpreparationcourse,alongsidewiththe2weektrainingpriortotheproject)
2. A complex 6 weeks system of adaptation, combining both social and psychological
needs.
3. The project gives the participants the instrument to provide psychological assistance to
theircomrades.
4. Strongeducationalpart.
5. Familyintheproject.Includingchildrenandelderly.
6. Furtheremploymentofparticipants.

WoundedWarriorUkraine
NameofOrganization:HealingWarScars,Inc.

BasedinKyiv,operatingalloverUkraine
mail:
roman@woundedwarriorukraine.org
www.woundedwarriorukraine.org

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Project Wounded Warrior Ukraine aims to provide psychosocial support to war veterans and
civilians affected by armed conflict in Eastern Ukraine. The principal objective is to help
waraffected individuals veterans, prisoners of war, and members of their families, as wellas
internally displaced people, and other civilian population, living in or near areas of hostilities
mitigate the effects of traumatic stress and resume their normal social, personal, and
professionallives.

Methods: cognitive behavioral and bodyoriented psychotherapyinvolvingpeertopeermode of


operation: when emotional and psychosocial support is provided by people who suffered the
sametraumaticexperience.

The first complete fourlevel cycle of trainings in peertopeer psychosocial support to


veterans with PostTraumaticStressSyndromesymptomshadtrained19cotrainers.By
June 2016, 20 new cotrainers are expected to finish the second complete cycle of
trainings and join the team in creating active peer support groups all over Ukraine and
engagingnewparticipantsinourtrainings

ComprehensivePostTraumaticStressSymptomsPublicHealthAwareness

A campaign to educate waraffected veterans and civilians in Ukraine about ways to


workthroughshocktraumaandpreventitsmanyconsequences.

They also plan to initiate the mental health care system reform in Ukraine. With the helpofthe
partner, the Medical Group of the Reanimation Package ofReforms,WoundedWarriorUkraine
has recently formed a working group dedicated to the issues of psychosocial support for
veteransandtheformationofanewsystemofmentalhealthcareinUkraine.

PsychologicalCrisisService

BasedinKyiv,operatingalloverUkraine
phone:
+38(096)7300100
mail:
uaoste@gmail.com
www.facebook.com/psychological.crisis.service.ukraine

Public Association Ukrainian Association of experts on overcoming the


consequences of traumatic events.
500volunteerpsychologistsalloverthecountry,amember
of
EuropeanSocietyforTraumaticStressStudies(ESTSS).

Individual and group work with internally displaced people from Crimea and Eastern
Ukraine.Adultsandchildren.

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Support and counselling of family members of dead. Format: Family circle. Individual
andfamilyconsultations.
Psychologicalsupportof
woundedsoldiersinmilitaryhospitalsandrehabilitationcentres
participantsofmilitaryactionsincludingworkinmobileteams
militantsfamilymembers.
Psychological rehabilitation for participants of protest movements, including hostages
andthose,whosufferedtorture.
Methodological recommendations for victims of traumatic events of all categories, and
those who work with them (volunteers, social workers, psychologists in educational
facilitiesandsocialservices,etc.)
Special training for experts in crisis intervention and first psychological aid (together
withmilitaryeducationalfacilities,StateEmergencyService)

HerosCompanion
CanadianUkrainiannotforprofitproject.

KalynaKardash,Founder&Director(English,Ukrainian)
phone:+38(098)6492900
mail:
info@heroscompanion.org

The projectaimstopairqualitytrainedservicedogswithveterans
of the Ukrainian Armed Forces and volunteer battalions who continue to struggle with
PostTraumatic Stress Disorder and other invisible and visible injuries inflicted by time spent in
combat operations. The project also runs a therapy dog program for soldiers and veterans
currently recovering from physical and psychological injuries. Heros Companionisthefirstand
onlysuchprojectinUkraine.

In a society that does not yet understand the potent nature of PTSD and in which a strong
stigma is often associated with those seeking psychological and/or psychiatric help, it is not
uncommon for veterans to turn to alcohol, drugs, and heavy medications in an attempt to
silence the newfound demons in their minds. Heros Companion is a response to an urgent
need to address these growing problems in a safe, healthy, and sustainable manner. The
project grew out of a recognition of the distinct bond that could regularly be observed between
soldiersandtheircaninecompanionsonthefront.

Three service dogs in training, all of which are provided to the veteran at no cost to
them.
Running a therapydogprograminKyiv,incooperationwithanumberofmedicalcentres
andrehabilitationprograms.

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MedicalATOFall/Autumn2015andWinter2016

Creating a mobile dog team to work in distant locations, including training bases and
closetofrontlocations.

Careforthecaregivers.
It is very important, that people involved in the rehabilitation are not suffering themselves
BjarneBerner,
the
ChairmanforSocialServicesofVeteransupport(Denmark).
Events of the past years had a significant influence on a lot of people. Every 16th family has a
member who is serving in the conflict. Volunteer movement was first of all driven by people
whose loved ones were deployed. As opposite to the volunteer movements around the globe,
when people dedicate a couple hours of free timetoothers,Ukrainianmovementcanhardly be
called volunteer any longer. It is common for people to give up their usual ways of life, regular
jobs, sometimes even families, in order to have more time for what they see important.
However, such desperate attitude to workmayleadtoharmfulconsequences.It isimportantfor
the Ukrainian civil society now to advance from the crisis volunteer attitude to creating strong,
long lasting sustainable social enterprises. They should still be nonprofit, but by changing the
attitude we would change the quality of providedservices.Ukrainenowhasachancetobringa
difference into the development of social sciences worldwide, but we require support and
education.

It is the responsibility of every group, working with highlighted questions to provide strong
supervisiontoitsemployees,inordertomakesurethattheycanhandlethepressure.

Suggestions
The past years have tested the strength of Ukrainian civil society. Volunteer movements (both
military and civil) are a phenomenon of the modern history of our country. But the biggest
strength we are lucky to witness is the strength of unity. Despite the bureaucratic obstacles,
corruption and desuetude of state institutions, only the cooperation of civil and governmental
initiatives can bring fruitful results. NonGovernmental Organizations have practical experience
in addressing the issues under the pressure of the crisis. The government has greatresources
and influential tools to reach a wider audience. We need to develop a system, where these
teamscanworktogether,givingeachotherasmanypossibilities,aspossible.

Anexampleofsuchcooperationcanbeseen,forexample,inDenmark.
The structure [of psychological support] in Denmark is not very old. Weve realized after the
Balkanwars,thatourveteransneedassistance.Beforethenormalwayofsolvingproblemswas
committing suicide or drinking. Then drugs became more fashionable. After weve realizedthat
veterans suffer the government has created Veterans Centers. They needed the help of
volunteer groups. Some are better than others. We have a social system, that lets people
receive treatment on any physical or psychological issue that has to be solved and treated by
the state. You can make the private institutionthatwillreceivethefunding fromthegovernment
or local municipalities.3,5millionEurosarespreadaroundthevoluntarymovements,1,3million

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MedicalATOFall/Autumn2015andWinter2016
a year, that can be applied for every year. ButtheagreementwiththeStateruns outattheend
ofthenextyear
BjarneBerner,the
ChairmanforSocialServicesofVeteransupport.

Creating governmental institutions, that would coordinate the work of civil organizations,
providing required resources and data, we would facilitate the work for the state. The country
should benefit from the development of NonGovernmental movements. But it requires a lot of
trust,diplomacyandsupportfrombothsides.

Analyzing experience of all countries, participating in military actions in the past 20 years we
can clearly see that the consequences of war in Ukraine will last for a long time. PTSD hasno
expiry date. Many former soldiers suffer for the rest of their lives. We need to create strong
sustainable support systems. Being forced to crisis management and fast reactions today, we
can already pursue strategic investments in the future of our projects. Making benefit out ofan
arising interest in the military we may now raise a new generation of military psychologists.
Students of military academies and courses at civil universities, as well as psychiatric faculties
do not receive structured training inhealingwarfareshock,trauma,dealingwithcrisissituations
and incidents. We need to be more precise and pernickety when talking about the quality of
educationforourfuturecolleagues.

By giving more responsibility and freedom at the lower ranks in the army we may change the
attitude to moral psychological training of the soldiers. A propersystemofevaluationshouldbe
developed,consideringtheresults,butnottheactivitiesthemselves.

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HealthThreats2016
NCDsandthewar

It is anticipated that noncommunicable diseases (NCD) will be the number one global health
threat for the next half century. Diabetes, hypertension, cardiovascular disease, chronic
respiratory diseases, cancer and obesity are key NCDs which require longterm primary health
care services, prevention measures and healthcare infrastructure. The war in Ukraine
exacerbates NCDs because prevention and/or reducing the risk factors associated with these
diseases may be completely halted inmanyaffectedareasatwar.Lowcostpreventionfocuses
on the reduction of the common modifiable risk factors (alcohol abuse, any tobacco use, poor
diet and physical inactivity). Many primary healthcare clinics throughout contested areas of
Ukraine cannot implement programs employing these methods of prevention or risk reduction.
They cannot offer these basic services to patients and consequently, health burden andhealth
securityprojectionswillbelowandtheirnegativeimpactswillbefeltfordecades.

InfectiousDiseaseandConflict

Herd immunity to many vaccinepreventable diseases are at critically low rates and have been
well under 4050% for some vaccinepreventable illnessesinUkraine(Holt,2014).Therewasa
similar pediatric healthportraitinSyriacirca2012beforeitspolioandmeaslesoutbreakconflict
is a great medium for infectious disease to grow and spread for atrisk populations. Dr. Dorit
Nazan, the WHO Country Director in Ukraine warned of a potential polio outbreak due to low
compliance with immunization and diminished stockpiles of vaccines from the unpredictable
environmentofwar.

So it was no surprise that in late 2015, policy supported by the World Health Assembly (WHA)
promoted an urgent response to the Ukrainian polio outbreak with three largescale
supplementary immunization activities and an appropriate amount of oral polio vaccine,
covering a target population of 2 million children aged less than five years, and public
declaration of the outbreak as a national public health emergency (Mayor, 2015). A policy of
prevention is cheaper than treatment with infectious childhood diseases such as polio. The
conflict highlights the risk of increased disease burden brought on by sustained conflict and
violence.

SwineFlu
Although there was an outbreak of Swine Flu in Ukraine it appears that the military unitsinthe
Eastwerenotseverelyimpacted.Therewerenoviralmedicationorvaccinesreadilyavailable.

HIV/STI/TB
Intensification of risky sexual behavior, in particular among the military on both sides of the
armed conflict, activation of sex work, high level of migration, big numbers of internally
displaced persons and challenges in organizing medical aid in the military conflict areas pose
significant risksintermsofthepotentiallybigincreaseintheincidenceofHIV/STI/TBbothinthe

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MedicalATOFall/Autumn2015andWinter2016
conflict areas and in other regions of Ukraine. There are almost no HIV/STI/TB screening
activities for those conscripted or mobilized to the army as well as contract soldiers, and the
means to prevent viral infectionsarealmostnotavailableinthearmedconflictzone.Systematic
actions are required to cover new vulnerable populations (first of all the military serving in the
conflict zone, those mobilized/demobilized) with prevention services, their provision with
condoms and access to HIV/STI testing, etc. Further information on the humanitarian situation
in the East of Ukraine as of 19 January 2016 maybefoundinthebulletinoftheUnitedNations
Office for the Coordination of Humanitarian Affairs (UNOCHA), report of the UN Refugee
AgencyandreportsoftheOSCESpecialMonitoringMission.

HepC
More details concerning the scheduled campaign were presented by Pavlo Skala, Director:
Policy and Partnership attheInternationalHIV/AIDSAllianceinUkraineduringthebriefing:We
care about the health and lives of people who defend the territorial integrity of Ukraine and for
the first time in our country we initiate an innovative project to test combatants who went
through ATO for hepatitis C. Preliminary screening among thewoundedmilitaryservants which
was recently held in the Central Military ClinicalHospitalattheinitiativeofAllianceUkrainewith
full support of the Volunteers Assault Force and the Ministry of Defense, demonstrated the
rates of positive test results much higher than the average indicators in Ukraine. But the data
obtained are not representative, so Alliance Ukraine with the supportoftheMinistryofDefense
and the Ministry of Interior starts launching a pilot initiative to carry out 5,000 screening tests
using rapid test kits, which within 1015 minutes show results on the presence or absence of
antibodies to hepatitis C virus.Itisexpectedthatthecampaignwillcoverupto 2,200personsin
militaryhospitals,upto500personsinrehabilitationcenters,1,200personsinmilitaryunits,500
persons in military registration and enlistment offices and up to 600 persons who were already
dischargedfrommilitaryservicealloverUkraine.

Among one unit that served in the ATO the medic reported two cases of hepatitis B and many
cases of hepatitisC.Hisopinionisthatbecauseofthehighflowofcasualtieshospitalswerenot
properly checking blood for transfusions. One case of a soldier who had been treated in three
different hospitals within a month,andwhencheckedinthefirst,hewasclear,whencheckedin
the third, he had hepatitis. About 80 ATO soldiers are currently receiving hepatitis treatment in
KyivBloodCentre.

Alcoholanddrugabuse

Alcohol and drug abuse have plagued the armed service evenbeforethestart
of the conflict. Consumption of alcohol is seen at all levels with open
consumption visible in the early days and restriction and detainment observed
on a more constantbasisastheprofessionalismofthearmedforcesincreased
and warnings were given to ATO vendors and stores to not sell alcohol to
anyone in uniform. Fines are now levied and confinement for public
drunkenness are becoming the norm, along with military MPs now patrolling

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areas frequented by soldiers. But additional actions are required such as improvements in the
military infrastructure, removal of the proliferation of alcohol Kiosk across from bases, the
repair of pools, new sports facilities and equipment and theaters for entertainment and wifi
internet. Additionally, there needs to be more public information programs and treatment
centers.Theavatarphotoaboveisanattempttoaddhumortoaseriousproblemthatremainsa
largely unaddressed issue within the Armed Forces. The patch depicts an Avatar with
reference to the blue people in the movie and the bluish complexion of an alcoholic and the
snailimplyingthattheabusersofalcoholslowthemovementofthearmy.

Nalbuphine
Also, of concern is the myth of pain shock and its misconception that people will die if not
treated immediately for the discomfort and pain of a traumatic injury. The myth continues to
proliferate among both soldiers and volunteers and most disconcerting from old school
medical staff. This has resulted in large quantities of the drug readily available throughout the
ATO and Ukraine and exacerbated by volunteers providing large quantities of nalbuphine, a
semisynthetic opioid used commercially as an analgesic. It is often used as animmediateand
sometimes the only first line treatment for injuries in the ATO. It is further exacerbated by the
inclusionofnalbuphineintheUkrainianIFAK.

Many of the soldiers suffering from addiction to nalbuphine were at one timeinjuredincombat.
Once hospitalized and then visited by friends or volunteers they are unfortunately supplied
additional doses of nalbuphine. We haverepeatedlywarnedinlecturesandconsultationsofthe
potential hazard of both the pain shock misconception and the ready accessofthisdrug.The
problem has largely beenignoredwithlittledataavailableorrecognitionoftheproblemfromthe
commandstaffofthearmedforces.

SurgicalRehabilitation
The fourth team of Canadian medical
professionals again travel to Ukraine to conduct
a Master Class for Ukrainian Military surgeons
and to perform reconstructive surgeries on
victimsofviolencefromVladimirPutinsinvasion
into Eastern Ukraine. The mission ran February
19 28, 2016. Thisisfollowingthreesuccessful
medical missions in November 2014, May 2015
and October 2015, all headed by Dr. Oleh
Antonyshyn, Head of the Adult Craniofacial
Program at Sunnybrook HealthSciencesCentre
and Professor of Plastic Surgery, University of
Toronto. Since we began these medical
missions, Dr. Antonyshyn and his team of

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Canadian medical volunteers have completed 183 procedures on 97 patients, and have
consulted on a total of 232 cases. Sponsored by CanadianUkrainian Foundation and the
Government of Canada and coordinated by
Krystina Lauren, Director of Humanitarian
Initiatives,Toronto,CUF.

Other programs have focused on evacuating wounded warriors to Germany


, the USA, Great
Britain, Latvia, Israel,
Lithuania
, Estonia, Italy, Austria, France, Bulgaria, Romania, Greece,
Poland,Slovakia,andHungary
.

An innovative
collaborative enterprise sponsored
by the
Peoples Project
which provides
Bioengineering Rehabilitation for Wounded in
Ukraine. At the only medical center, providing
such treatment and in conjunction with the
Kyivbased biomedicalcompany,iLaya.TheIlaya
Clinic specializes in innovative technologies of
treatment. We use the technology of regenerative
medicine based on stem cells and tissue
engineering to restore bones. The facility has a
modern cell laboratory and a team of experienced
doctors with successful experience inpatient
rehabilitation after complex trauma, regardless of
whenandhowithappened.

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ExclusionisnotaSolution

On the eve of International Women's


Day, President Petro Poroshenko met
with prominent women ATO
participants,
volunteers, medics,
teachers, artists and athletes. The
photo to theleftisofsomeofthesame
women, medics, now meeting with
MoD general staff on the same day.
Photos can be interpreted many ways,
but the look here is not one of elation.
Medals, awards and other tributes are
anexcellentroute toimprovingmoral
ifthesemedicsreceivethesupportthat
theyrequireonthebattlefield.

As mentioned many times in this and early reports, medic and soldiers rely on, too often,
volunteers for quick responsive actions to their emergency and daily requirements in not only
providing a higherlevel ofcaretothewarfighters onthefrontlinebutalsototheirdailyexistence
on the frontlines. A step in the right direction is notonlypromotionoftheirdeedsthroughsocial
media but actual promotion of rank into positions of influence so that their new ideas and
lessons learned are incorporated into a new army necessary for rapid change from withinthe
MoD and pushing out the soviet thinking, ineffective systems and endemic corruptionthatnot
onlyinfluencethewarfightersbutallcitizensthroughoutUkraine.

Issues continue to plague the system as there are wins in the development of new
institutionalize processes in reforms but the wins are lost if the commanders continue to
perpetuate a system devoid of honest and transparent
discussionwiththerankandfile.

Another failure of the system was again highlighted in a special


report from Hromadske TV. They received littlecooperationand
reported intimidation and threats as they struggled to expose
unhealthy conditions of the 53rd Brigade based on a military
firing range near Dnipropetrovsk. The situation erupted into a
major scandal on social media before the military stepped in to
rectify the situation, but only after activist andthemediapushed
the issue to theforefrontandthenfinallyinterventionbyshamed
higherauthorities.

The strength of social media and the activists that power the
medium has createdabacklashfromtheGeneralStaffclamping

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down on those they can control by threatening retribution and the prohibition of posting
information, speaking to themediaorspeakingtoactivistandeventheauthorsofthisreport.All
of which only disillusions those fighting for change, diminishing the trust of those in power and
perpetuates the belief among ordinary citizens that the mantra of apoliticianis:Ifyourepeata
lieoftenenoughitbecomesthetruthorinthecaseofUkraine,politics.
Reflexively Repressive
a story highlighted in the KyivPost on a measure to forbid civil
servants from criticizing public officials and institutions was adopted February. 11, 2016. The
policyonlybecamepubliconMarch1,2016

ArmyUAFMRadio(ArmyuaFM)
Ukraine launches first military radio station
Ukraine's first militaryradio
Army FM has been launched in test mode as an internet radio station,
according to a Ukrainian Defense Ministry repost of an Army uaFM
announcement on Facebook. This is a project of the Ukrainian Defense
Ministry in conjunction with volunteers and is funded by Spirit of
America. It is staffed with some of the same people that brought to
fruition the Central Television and Radio Studio of the Ministry of
Defense which has produced some stunning videos ofthearmedforces
ofUkraine.

FrozenConflictHealthandWelfareofUkraine

During the transitional phase ofsocialunrestfromlate2013toearly2014andnowwithareturn


to violence and hostilities throughout 20152016, Russia deploys lethal hybrid warfare with
proxy Russianbacked terrorists throughout twolargeEasternUkrainianregionsofDonetskand
Luhansk creating a hellscape of nongovernment controlled areas, and annexed the Crimean
Peninsula without any international community response. (Snyder and Sharifulin, 2014
Borowski, 2014). The repercussions of violence in these regions may affect infectious disease
risk throughout Ukraine and the region and eliminates basic systems for noncommunicable
disease (NCD), primary health care and the emergency medical evacuation chain. The other
environmental threats of weapon systems, UXO/ERW and destroyed infrastructure exacerbate

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thetenuous securityportrait.Thesefactorsofstatefragility,Russianweaponsystems,controlof
violence by nonstate actors and increased disease risk may exacerbate the already degraded
environmentalimpactandfalloutfromrecentfightingandconflict.

Definitions
A failed state is a country whosepoliticaloreconomicsystemhasbecomesoweakandlacking
in capacity that the government is no longer in control or offering any component of the social
contract. Fragile states are those countries at risk of failing and who find it increasingly difficult
to deal with external and internal economic, political, environmental, social andsecurityshocks
(Grimm,etal,2014).

Ukraine isafragilestate,atriskoffailurefromcurrentand continuedRussianbackedincursions


onto its sovereign territory. This is exacerbated by: expanding numbers of displaced peoples
(well over5millionin2014and2015(ACAPS,2015)noaccess toemergencyservicesinmany
regions a growing atrisk population without adequateaccesstoprimaryhealthcareservicesor
vaccines an ever expanding displaced geriatricpopulationwithoutaccessto NCDmedications
and finally, all other noncombatants caught in the middle of war and faced with violence and
threatsofviolencethroughoutthecountry.

Warfare in Ukraine has escalated incrementally since 2014 and the resulting mental stress on
its approximately 35 million people is likely to cause poor clinical outcomesfordecades.These
multifactorial risks, burdens and variables leave Ukrainians and internally displaced peoples
(IDPs)withamarkeddecreaseinfood,health,economicandhumansecurity.

As at late 2015 hostilities continue revealing many violations of international human rights law
and international humanitarian law and demonstrating the aggressors lacking accountability
(OHCHR, 2015). These violations are evidenced by the Organization for Security and
Cooperation in Europe (OSCE) hourly monitoring updates and multiple reports of Minsk I and
Minsk II ceasefire violations (Baer, 2015) the Minsk I and II ceasefire agreements being the
only international agreements between Europe,NorthAmericaandRussiadetailinghowtostop
warfighting activity by armed groups and militaries.The fate of Minsk II may crumble in 2016 if
worldpowersdolittletoforceRussia'shandonthematter.

FrozenConflict
A commonplace in geopolitical literature in postSoviet states is the
frozen conflict (Lynch,
2002). The term frozen conflict is a misnomer, the threat of violence is still violence. Loaded
weapons in rifles, strategically positioned larger weapons and soldiers ready to deploy on
multiple sides from a potential further escalation doesnotengenderhumanorhealthsecurityin
any setting. Despite these facts,
Frozen Conflict has become a hallmarkofRussianFederation
foreignpolicy.

By definition, active armed conflict is intermittent or has stopped, yet no peace treaty and no
political or social framework has been agreed upon by armed groups, combatants or states

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taking part in the conflict (usually with the blocking of resolutions by a third party or thirdstate)
describes frozen conflict (Kennelly, 2006). These postSoviet nonresolved conflicts can
reignite at any point, can encourage a militarization of an entire region or country and define
insecurity for these countries affected. The instability in frozen conflicts may strip a region of
health security for all inhabitants.These
frozenconflictslackclearlydefinedboundariesandare
stateless(sometimeslawless)regionslitteredthroughoutthepostSovietlandscape.

Examples of these illegitimate nonstates are easily seen in Transnistria, a hairline splinter on
the map between Ukraine and Moldova where Russian troops are stationed at multiple bases.
Otherexamplesinclude:

(a) the NagornoKarabakh region. This ethnically Armenian enclave within Azerbaijan
whereadisputebetweenAzerisandArmeniansfesters

(b) The Republic of Georgia: the AbkhazGeorgian conflict and the GeorgianOssetian
conflict, which has arisen owing to two largely unrecognized regions within the
internationally recognized Republic ofGeorgia comingoutofwarintheearly 1990s. The
conflict was further stoked by Russian invasion of Georgia in 2008 leaving the
Russianbacked Republic of South Ossetia and Republic ofAbkhaziain
defactocontrol
of the South Ossetia and AbkhaziaregionsinnorthandnorthwestGeorgia(awasteland
forhumanrightsandcivilliberties)(Jones,2008)

And finally, the 2014 Russian annexation of Crimea and the scaled invasion of the
Donbass, where Lugansk and Donetsk have proppedup regional powers creating a
hellscape of criminality, where the rule of law does not exist and basic services and
healthcareinfrastructureareintatters(OrttungandWalker,2015).

These stateless nonstates left in frozen conflict form a buffer zone with regional powers to
promote Russian foreign policy and corrupt business practices at the cost of human life and
human security (Nygren, 2007 Trenin, 2003 Donaldson, Nogee, Nadkarni, 2014). Other
examples of frozen conflict not directly linked to the former Soviet Union arguably are found in
NorthernCyprus,IsraelandPalestine,NorthernIrelandandSriLanka,amongothers.

Moscow has a toolbox of soft and hard power tactics at its disposal to exert regional influence
(i.e. bribes, energy exports, trade ties, military to military collaboration and guarantees),
however supporting separatist movements both financially and militarily remains its strongest,
yet bluntest, weapon (Mankoff, 2014). It is possible that this frozen conflict description may be
exactly the goal and the planned outcome of the 20132015 Russian militarybacked
interventionsthroughoutUkraine.

However, such recent foreign policy has reduced statestability,mitigatedstatesovereigntyand


in the process stripped human and health security for millions of Ukrainians and multiple
bordering communities. The lack of: clearly defined borders, the public admission of Russian

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MedicalATOFall/Autumn2015andWinter2016
involvement and/or the international communitysresponsebeyondeconomic sanctions, means
thatthelikelihoodofincreasedconflictandincreasedfatalitiesishigh.

UkrainesInstitutions
Ukraine is a fragile state and extractive Soviet and postSoviet governmental and business
practices over the past two decades have given way to a paninstitutional decline and deep
ministerial decay.Insum,RussianeverleftUkrainianpoliticsdespiteitsrelativesovereigntyand
independence, Russia and the elite in Ukraine willing to collaborate with Russian business
practices continued to profit from a system of taking out of the Ukrainian economy, political
infrastructure,militaryandhealthsystem,insteadofbuildingitup(Way,2005Kupatdze,2015).

Accountability was absent, corruption and nepotism rife and capacity extremely limited in
postSoviet era Ukraine (Markus, 2015). The repercussions of such lack in capacity are a
decrease in human and health security where institutions are unable to weather any shocks in
times of crisis and disaster. The humanitarian crisis that has erupted has proven how much
human lives can be lost in such a short period of inactionandnoninterventioninglobal health.
When the public sector fails, sometimes the private and humanitarian sector can pickup slack
andprovidehealthsecuritythroughoutlimitedandtemporarysolutions.

EnvironmentalDegradationandWarfightingactivity
Explosive remnants of war (ERW) and unexploded
ordnance (UXO) will be a major health and
environmental concern for the next three to four
decades in Ukraine water contamination, deaths and
other sequelae from these munitions will plague the
landscape. More globally, Ukraine faces significant
environmental challenges like the still present fallout
from the Chornobyl nuclear power plant disaster in
1986, prolonged industrial pollution and poor waste
managementalsoexacerbatedbytheconflict.

Ukraine ranks 20th in the world for greenhouse gas emissions and is among the European
countries with the highest levels of energy consumption and water usage. The coalburning
industries of eastern Ukraine, which emit high levels of sulfur dioxide, hydrocarbons, and dust,
have created severe air pollution throughout the region, somearestillinoperationairqualityis
particularly poor in the cities of Dnipropetrovsk, Kryvyi Rih, and Zaporizhzhya. Major rivers,
including the Dnipro, Dniester, Inhul, and Donets, are polluted with chemical fertilizers and
pesticides from agricultural runoff and poorly treated or untreated sewage (Britannica, 2015).
These environmental risks and hazards will hinder human and health security intheimmediate
and distant future if not addressed through transparent and accountable public health
institutions.

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MedicalATOFall/Autumn2015andWinter2016

Section6Training
Thenationwhichforgetsitsdefenderswillitselfbeforgotten.CalvinCoolidge

TrainingUpdates:TacticalCombatCasualtyCare(TCCC)past,presentandfuture
Medical training for the warfighters and
volunteers from volunteer organizations and
eventually governmental bodies has been a
challenge since the start of the fighting.
Standards remain elusive. Standards do see
monthly gains and get better and better with
more access to best practices, NATO member
state professional mentorship and exchanges
andbattleexperience.

We can look back totheearlydayswhereanall


too frequent account mirrored this one from the Battle of IIovaisk in August of 2014, the first
majordefeatforUkrainianforces.Minimalornotraining,littlepreplanning,extendedevacuation,
poorlyequippedMFHandmedicslearningastheytreat.

The medics at this aid station set in a kitchen, atonetimesurroundedandtheneventually held


prisoner by Russian forces would later, after their release spent three days attempting to
evacuate nine wounded to the only military field hospital in the ATO, the 61st in Rozivka
approximately 200/km from the battlefield. Today with four MFHs, evacuation times to a higher
level of care more often the norm of one hour, care there haveseenmanysignificantchanges.
But the situation remains difficult with no clear protocols based on modern standards, little
consistent training, substandard or no equipment at many locations, poor communications and
entrenched doctrine, corruption or just plain incompetence making a difficult situationeventhat
muchmoredemoralizing.

Said plainly, at the beginning of the conflict there were no TCCC providers inUkraine,plusthe
elimination of military departments in most higher educational institutions of Ukraine in
20092010 affected the readiness of military medical service of the Ukrainian army. Now there
are about a dozen plus volunteer organizations conducting training in TCCC and military
medicine with some also providing equipment of varied quality, consistency and resupply.
Ukrainian MoD has struggled to create a sustainable TCCC program that integrates best
practices across military for basic and advanced training regimes and there have been some
advances that areoftenovershadowedbytheworkofcivilianprovidersorareprovidedmorefor
theirpublicrelationseffectthantointegratebestpracticethroughouttheevacuationchain.

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MedicalATOFall/Autumn2015andWinter2016
CurrentDevelopmentsinUkrainianMilitaryMedicine

Col Mykhailo Badiuk oftheDepartmentofOrganizationofMedicalSupportoftheArmedForces


helped organize a conference to introduce and institutionalize TCCC/ATLS standards with
representatives of many of the medical colleges and universities here in Ukraine. "TSMU the
Heads of Military Departments from All Over Ukraine Defined the Strategy of Military Medicine
Development". You will findalinktotheconferenceintheArticlesMentionedattheendofthis
report. The conference included,
Vitaliy Krylyuk,arepresentativeoftheUkrainian Resuscitation
Council.

All Ukrainian medical professionals received theirmedicaleducationinthesecivilianinstitutions


and the militarys adjunct armed forces programs over the last twentyfive years and in the
preceding Soviet years. These are prestigious institutions,somewithlonghistoriesof hundreds
of years, sitting on beautiful parklike campuses, in needofandundergoingresurrection.Given
once again and regrettably decades of mismanagement, resulting in the closure of existing
programs or a skeleton of what they once were, with staff that often graduated from and still
using the same material introduced to them. There areexceptionssuchastheDanyloHalytsky
Lviv NationalMedicalUniversitywherepilotcoursesonemergencymedicalmanagementbased
oninternationalstandardsaretaught.

A list of Ukraine instructional institutions can be found on the International Universities and
Colleges website. Sadly some of the topratedinstitutionsarenowinoccupiedareasofUkraine
where many of the students and staff have fled to safer areas. Ukraine is not a Third World
Country but a Second World Country leftbehindthroughtheineffectivenessandthendemise
of the Soviet system, butstillmanagestoproduceaUNESCO2015literacyrateof99.8%,isan
emerging leader in the IT industry, aeronautics and boast of cities like Kharkiv with
38 higher
educational institutions.
Two of its universities made the QS World University Rankings by
Subject, Tchaikovsky National Academy of Music (Kyiv Conservatory) and Taras Shevchenko
NationalUniversityofKyiv.

MinistryofEducationWebsite

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MedicalATOFall/Autumn2015andWinter2016
As much as the various volunteer programs have done for Ukraine we advocate
institutionalizing these military medical programs in cooperation with trainers from volunteer
programsthroughdirectmilitarytomilitaryprogramsandsupportingtheexistinguniversitiesand
colleges in conjunction with the Ministry of Education (MoE), MoH and MoD, with proper local
and international oversight as the best way forward. We believe this will increase the various
programs effectiveness exponentially and prove a corresponding improvement in general
medicine and surgery as the civilian variants of modern trauma medicine are applied incivilian
institutions.

An up and coming conference and again in cooperation with Col Mykhailo Badiukrepresenting
the MoD is The introduction of the latest achievements of medical science in the
Ukrainian health care practice".
Ukraine International MedicalCongress,April1921.Apanel
discussion will be held on the evolution of TCCC/CLS in the Ukrainian military and will be an
excellent opportunity to discuss and educate the medical community of the benefits and
institutionalizationofmodernmilitarymedicaltraining.

MoD,1stMedicalTrainingCompany(Newlyformed)
Commander:OlegVolodymyrovychVozniuk.
ChiefInstrutor,VsevolodCherniakhovskyi

Based at the 169th training centre in Desna. They have


conducted a training
starting in September that went on for
four months to teach saninstructors tactical and military
medicine. However like many other elements of the
Ukrainian military they rely on the donations of equipment
from civil groups to provide medical equipment for training.
Donations from some of the largest civiliandriven training
programs are rare and instead may only donate a training.
They receive little support from the general staff for their
efforts. They are consistentlyunmentionedbythegeneralstaffindiscussionwithNATOandthe
US Military and have not been invited to participate in NATOdriven training programs such as
the ongoing military medical training at the Joint International Peacekeeping Security Center in
Ukraine (JMTC). Only recently through volunteer efforts several of their trainers participated in
advancedTCCCtraininginEstonia.

Asonetrainerrecentlysaid:"Thereismovement,butthereisnoprogress".

The First Medical Training Company, led by Col Vsevolod Stebliuk is therightdirectionforan
institutionalizedprogramwithintheMoDmilitarymedicalprogram.Howeverthereportsreceived
from those involved are not encouraging signs of institutional change but reversion to the new
status quo of portraying a program as successful when in fact it is not. Reports by volunteers

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MedicalATOFall/Autumn2015andWinter2016
and military staff involved with the training have only resulted in the removal ofthesevolunteer
instructors from the training. Upon graduation of the first group the news media were invitedto
participate where certificates were distributed to those completing the course. In reality, per
theinstructors,onlyafewwerefittoreceivecertification.

There have been two more courses with reports that conditions have only deteriorated as time
goes on with the purposeful removal of civiliantrainersfortheirhonestcritiquesoftheprogram.
Another problem with the program is that many candidates were actually soldiers with
performance problems within their own units and were specifically transferred to the training to
remove them from their unit. It should also be noted that when our team after receiving
authorization from the training company and base commander and travelled to the base to
witness the training, we were subsequently denied access at the gate byanunknownauthority
in Kyiv, who revoked our invitation and advised that we now did not have the necessary
permissions.

InstitutionalChanges
A recent evaluation conducted at the following institutions recommends thatPyrogovVinnytsia
National Medical University, IvanoFrankivsk National Medical University, Danylo HalytskyiLviv
National Medical University, Odessa National Medical University, in terms of training (legal,
technical,personnelandlogistics)arereadytobegintrainingmedicalofficersofthereserve.

At the LvivNationalMedicalUniversitythereisthepossibilityofestablishingatrainingcenterfor
postgraduate improvement and training sessions with officers reserve. Department of Disaster
Medicine and Military Medicine of Dnipropetrovsk Medical Academy, Ukrainian Medical Dental
Academy (Poltava), Bukovyna State Medical University (Chernivtsi) requiring scientific and
methodological assistance from Ukrainian Military Medical Academy, which will be provided as
soon as possible. Training future reserve officers of Medical Service of the Armed Forces of
UkrainewillbeginonthefirstofSeptember2016.

WomenTCCCInstructors

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MedicalATOFall/Autumn2015andWinter2016
Ukrainian women have been at theleadingedgeoftrainingandactivelyparticipatedintheATO
as medics using TCCC standards as their guide for battlefield injuries. However under current
law females are not allowed to serve as instructors nor as combat medics in the military.
Apparently the regulation is to be changed by the end of March 2016. This is per Oleksiy
Pokotylo, Head of the Presidential Administration Main Department of National Security and
Defence.Hewasverysupportiveoftheidea,aswellastheAirborneCommanderZabrodskyi.

IndividualUnitTraining
Training throughout the Ukrainian military services can now be seen regularly posted on social
media sites and in the Ukrainian media conducted byvariousbranchesandinmanycaseswith
the support of volunteer training organizationsorinternationalsponsors.Theyusuallyconsistof
one short day of CLS type skills, buddy aid, loading into an ambulance, sometimes on scene
treatment and veryoccasionallyhigherlevelofcare.Trainingsinmedicalcommandandcontrol,
ATLS, basic first aid, advanced airway management, helicopter critical care and search and
rescue medicine, communications, pharmacology, surgical resuscitation, Mobile Field Hospital
deployment, air evacuation, driver safety, medical transport, personal protection, hygiene,
PTSD, drug/alcohol abuse, extended care, preplanning are virtually nonexistent in thesphere
ofmilitarydrivenmedicine.

KhersonDetachedMechanizedBrigadeconductsmedicalevacuationandtreatmentexercise

A fourday first aid training in basic and CLS aid of


National Guard personnel by the first aid training
organization, Special Training Center a virtually
unknown organization outside of Ukraine but with an
excellent track record, extremely professional and
internationally certified staff. Their first aid course
curriculum is aperfectfit forthefirstaidtrainingforthe
policeservicesinUkraine.
Photo:NationalGuard

Trainingatthe66thMFH

According to Colonel IvanBohdan,themilitarydoctors


of the Western Region were studying Tactical Combat Casualty Care (TCCC) for over ayear
after which they received accreditation by the United States.AgroupofUkrainiantrainershave

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MedicalATOFall/Autumn2015andWinter2016
also beenqualifiedintheU.S.underthissystem.ThesetrainersareinKrasnoarmiiskwithstudy
guides, training mannequins and equipment. The trainers will conduct classes for military
doctors,healthworkersandcombatmedicsfollowingthestandardsofTacticalCombatCasualty
Care program at the 66th MFH. This was stated by the Chief Surgeon of the Western Region,
Medical Corps Colonel Ivan Bohdan during a working meeting with Commander of the
Operational Command East, MajorGeneral SerhiiNaiev.ThistrainingissupportedbytheU.S.
National Association of Emergency MedicalTechnicians(NAEMT)andthe WorldFederationof
Ukrainian Medical Societies in the United States, whose head Roksolana Horbova also
attendedthemeeting,peranarticlepublishedinCensor.netcitingthe
pressservice
oftheMoD.

TCCCmaterialandmedicalpublicationstranslatedintoUkrainian

CurrentlytherearesixsourcesavailableforTacticalMedicineandothercombatmedical
literatureandpublicationstranslatedintoUkrainian:
AmericanUkrainianMedicalFoundation
UkrainianResuscitationCouncil
Medsanbat
MoD,DepartmentofOrganizationofMedicalSupportoftheArmedForces
SpecialTrainingCenter(mostlyCPRandFirstAid,butsomeTCCC/CLS
PatriotDefence

There is an extremely high demand and consumption of this material and additionalsourcesof
funding should be explored to support AUMF tocontinuetotranslateandpublishmanualssuch
asthe
EmergencyWarSurgery
nowavailableforfreedownloadofftheirwebsite.

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MedicalATOFall/Autumn2015andWinter2016
MoDNewTCCCbasedManualsandAdjunctEquipment

Newly written medical manual produced by Col Mykhailo Badiuk and the Department of
Organization of Medical Support of the Armed Forces which include sections on modern
tactical medical equipment and TCCC standards, plus new military medical bag, casualtycard,
andaMISTtraumacard.SupportfortheprogramalsocamefromMedsanbat.

CivilianorganizationsprovidingTCCC/CLSTrainingand/orSupport

MedsanbatCurrentlynotprovidingTCCCorfieldhospitaltrainingbutstill
issuingreplacementequipment.
TrainingCenter44(NowUkraineEMSA).TCCC/CLS/TEMS/FirstAid
WhiteBeretsTCCC
UkrainianResuscitationCouncil(providerofACLS/BLSnowalso
NAEMTTCCC)
PatriotDefenceCLS,remotemedicandnowproposingaUTLScourse
(UkrainianTraumaLifeSupport)
DoctorsforUkraineDonatedsuppliesandsometraininginEstonia
MedPatriotUACLSandfirstaid
TacticalUkraine(MilitarytacticsandTCCC)
TacMedTrainingCenterREAGOUkraine.TEMS,TCCCHeartSaver,PHTLS
andtacticalmedicalsupplies
SpecialTrainingCenter(mostlyCPRandFirstAid,butsomeTCCC/CLS)

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MedicalATOFall/Autumn2015andWinter2016

MalteserreliefserviceinKyiv(mostlyCPRandFirstAid,butsomeTCCC/CLS)
RedCrossUkraine(mostlyCPRandFirstAid,butsomeTCCC)
FASTFirstaidandspecialtrainingFAST.BusinessFirstAidandTEMS/first
aidforpoliceservices
SumyTacticalMedicineCLS
MilitaryPatrioticClubMilitaryMedic
SaninstructorUA
TCCC
PirogovUkrainianSocialOrganization"MilitaryMedicineofUkrainetraining,
donatedsuppliesandmedicalpersonneltothefront
THelpersLviv
TCCC
UnitTCCC
UkraineLegionMilitaryandtacticalmedicaltraining
MarusinBearsMilitaryandtacticalmedicaltraining
SisterofMercyKharkiv.TrainingMedicsworkingfrontlines.
MedicalCorpsTCCCtraining,suppliesandmedicalpersonneltothefront.
VabaUkraina,Estonia.TCCC,ATLS,supplies

http://freeukraine.net/et/
MedicalCollege"Monad"pilotprogramforTCCC.Collegeforpharmacists,
nursing,techniciansandnowTCCC.
FacultyforTrainingofDoctorsfortheArmedForcesofUkraineBogomolets
NationalMedicalUniversity.

InternationalMilitarytoMilitaryEffortsinUkrainianMilitaryMedicine

UkrainianlandforcesbeginFearlessGuardianIItraining,November24,2015.

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MedicalATOFall/Autumn2015andWinter2016
Military/Medical Training by USA, Canadians, British and Lithuanian forces at the remote
training center near Yavoriv, which is now referred to as the Joint International Peacekeeping
SecurityCenterinUkraine(JMTC).

The Ukrainian Land Forces will receive infantrybased, defensivefocused training at the
individual and collective levels including medical training in combat lifesaver and casualty
evacuation counterunmanned aerial vehicle tactics training counterimprovised explosive
device training cordon and knock/search training Law of Armed Conflict and use of force
training and various common Soldier and collective tasks such as first aid, survival, land
navigation,communication,andunitoperations.

Additionally, there have been medical specific training such as the cadaver and live tissue
training for Ukrainian doctors and surgeons and conducted with supportfromtheUSEmbassy,
KyivOfficeofDefenceCooperation(ODC)andateamfromEUCOM.

Other groups that are involved in medical training through the Office of Defense Cooperations
are the Security Assistance Training Management Organization (SATMO) and the Defense
Institute for Medical Operations (DIMO) which will conduct training in the 68W medical
assistance program along with other programs such as resuscitative surgery, evacuation care,
medicalmissioncontrolandfieldcare.

InternationalMilitaryTeams
USA,U.S.Armyparatroopersfromthe173rd,2DBattalion(Airborne)503D,Infantry
(TheRock
)
USA,1stSquadron,91stCavalryRegiment,173rdAirborneBrigade.
USA,3rdBattalion,15thInfantryRegiment,2ndInfantryBrigadeCombatTeam,3rd
InfantryDivision
USA,10thSpecialForcesGroup
USA,CaliforniaNationalGuard,JointMultinationalTrainingCommand
LithuanianGrandDukeAlgirdasMechanizedInfantryBattalion
EstonianDefenceForce
UnitedKingdom
2ndCanadianMechanizedBrigadeGroup
1stCanadianBattalionofthePetawawa,Qubec
USA,30thMedicalBrigade

Ukraine's 1st Battalion 24th Mechanized Infantry completes the 55th day of training on
#OpUNIFIER.

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MedicalATOFall/Autumn2015andWinter2016

SpiritofAmerica
Spirit of America stepped in to assist, providing a NATOstandard first aid kit (IFAK) to every
graduatingsoldierparticipatinginFearlessGuardianIItraining.

SpiritofAmericadistributingTacticalMedicalSolutionsIFAKtoUkraines1stBattalion,24thMechanizedInfantry

OtherTrainingsorConferencesby
(
www.urc.org.ua)
April1921,NivkiExhibitionCenterMedicalForum
May19,Masterclassesfordoctors(IOaccess,bleedingcontrol,airwaymanagement,etc).
May2325,inKharkov.AllUkrainiancompetitionofambulancecrews.
May1315,inKyiv.TCCCtraining.
Contacts:VolodymyrIvchuk,VitaliyKrylyuk

ATLS.NGO,VabaUkraina,Tartu,EstoniaSeptOct2016.
emsa.ukraine@gmail.com

PhotoofTCCCtraininginUkrainemakesthecoveroftheApril,2016
JournalofSpecialOperationsMedicine.

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MedicalATOFall/Autumn2015andWinter2016

TCCCtrainingwiththe93rdand25thAirborneonOct.17,2014

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MedicalATOFall/Autumn2015andWinter2016
NATOTrustFund

Trust Funds
a mechanism which allows individual Allies and partner countries to provide
financial support on a voluntary basis have been set up to support the launch of substantial
newinitiativesinfivecriticalareas,including:
1. Command, control, communications and computers (C4) tosupportthemodernisation
of Ukraines structures and capabilities, both to enhance the countrys ability to provide
foritsownsecurityandtocontributetoNATOledexercisesandoperations
2. Logistics and standardization to help reform Ukraines logistic systemandincreaseits
interoperability with NATO, notably through the adoption of NATO standards for the
trackingandmanagementofnationalmilitaryequipmentandsupplies
3. Cyber defence to help Ukraine develop technical capabilities tocountercyberthreats,
providetrainingandadviceonpolicydevelopment
4. Military career transition toassistUkrainesdefence ministrywiththedevelopmentofa
sustainable and effective resettlement programfor militarypersonnelreturningtocivilian
life(thisbuildsonexistingNATOsponsoredretrainingactivities)
5. Medical rehabilitation to ensure that injured Ukrainian servicemen and women have
access to appropriate rehabilitation services and that local Ukrainian medical centres
havetheequipmentrequiredandthatstaffreceivespecializedtraining.
6. AsixthfundisproposedtoaddressUXOanddemining.

NATOLegalFrameworkCompleted
Executing Agent Agreement between the Lead Nations and NSPAentered intoforceon
29June2015.
Financial Management Agreement between NATO FC and Lead Nations entered into
forceon29June2015.
Support Cooperation Agreement (SCA) between NSPO and Ukraine entered into force
on30July2015.
Implementing Agreement (IA) between NSPO and Ukraine entered into force on 21
September 2015. This was announced by NATO Secretary General during his visit to
Ukraineon21September2015.

Finance
Enabled the budgettobe 25%coveredbutnotthefinancialthresholdof700,000EURto
bereached.
Bulgaria, Finland, Sweden, the Netherlands, Slovakia, Turkey provided financial
contributionsandpledges.
Estonia,France,HungaryandtheUnitedStatesprovidedinkindcontributions.

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MedicalATOFall/Autumn2015andWinter2016
ProjectProposal
Draft 2year Project Proposal developed by NSPA was approved by Lead Nations on
September 18, 2015 for a 2.25 MEUR estimated cost. The project was launched at the PCSC
meetingwithUkraineon05October2015.
ProjectAchievements:
Project activities initiated include: 12 servicemen supported either for medical
rehabilitationand/orprovisionofprosthesis.
5 experts visits and 8 conferences/seminars/lectures events financially supported for
development of competencies. More than 1,000 Ukrainian experts from Health and
SecuritySectors,aswellasNGOs,havebenefittedfromtheseevents.
Military Medical Services reform to include doctrine, educationandstandardssupported
through1HUNmilitarymedicaladvisor.
Physiotherapist(PT)recognizedasaprofessioninUKR.
NSPA is currently purchasing equipment for Lviv Military Hospital and Novi Sanzhary
National Guard Hospital. MedicalfacilitiesinKharkiv, Kiev,Irpin,V. LuibinandTsybliwill
be supported in 2016. NSPA is also investigating supporting the delivery of a train the
trainer course to international standards to psychological experts. Finally, the first
10person vocational rehabilitation camp is being finalized with Ministry of Social Policy
(MSP).
PublicRelationsincludedthemonitoringofpressreleasementioningtheTrustFund.
114relevantpressreleaseshavebeenidentified.

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MedicalATOFall/Autumn2015andWinter2016
MilitaryCommandStructureandManagementoftheMilitaryMedicalSystem

SupremeCommanderinChief
UkrainianPresidentPetroPoroshenko

Petro Oleksiyovych Poroshenko is the fifth and current


President of Ukraine, in office since 2014. He served as
the Minister of Foreign Affairs from 2009 to 2010, and as
the Minister of Trade and EconomicDevelopmentin2012
.
Wikipedia

MinisterofDefenceofUkraineGeneraloftheArmyStepanPoltorak

(Ukrainian: ) is Minister of Defence of Ukraine from 14 October


2014, previously the commander of the Internal Troops of Ukraine and National
GuardofUkraine.
Wikipedia

UkraineMinistryofDefence

StructureofUkraineMinistryOfDefenceWhiteBook2014

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MedicalATOFall/Autumn2015andWinter2016
DeputyMinistersofDefence

MoDDeputyMinisterLtGeneralIgorPavlovskyi(
)

SupervisorforDepartments:
Departmentofstatepurchasesandmaterialresourcessupply
MilitaryMedicalDepartment
AndriiVerba
Departmentofconstructionandsurplusfundsusage
MainhousingadministrationoftheAF

CompositionofUkrainesMilitaryMedicine

Illustrationfrom:MedicalSupportofArmedForcesofUkraine

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MedicalATOFall/Autumn2015andWinter2016
MainMilitaryMedicalDirectorate(MMMD)

Military Medical Department of the Ministry of Defense of Ukraine.


Military Medical
DepartmentoftheMinistryofDefenseofUkraineisastructuralunitoftheMinistryofDefenseof
Ukraine, which is designedforthedevelopment andimplementationofstatepolicyinthefieldof
military healthcare and military veterans, their families, war veterans and other categories of
citizens which under the law ofUkrainemaybeprovidedmedicalcarein healthcareinstitutions
of the Armed Forces of Ukraine. Military Medical Department of the Ministry of Defense of
Ukraine manages the medical support of the Armed Forces of Ukraine and accordingly, the
direct managementofsubordinatehealthinstitutionsArmed ForcesofUkraineinpeacetimeand
timesofcrisis.

GeneralAndriiVerbaHeadoftheMilitaryMedicalDepartment

Main Military Clinical Hospital (MMCH)


. The MMCH units and clinics serve as a base for
UMMA for the training of military physicians and research on the organizationofoutpatientand
hospital medical care, the improvement of the quality of medical care and medical expertise,
etc.
The Main Military Clinical Hospital provides highly specialized medical care, five Regional
Military Medical Centers provide specialized medical care and further 14 Military
Hospitals and 1MilitaryMedicalClinicalCenterforOccupationalPathologyprovide
furtherspecializedandqualifiedmedicalcare.
Anatoly P Kazmirchuk
MajorGeneral of Medical Service.
Head of the
NationalMilitaryMedicalClinicalCentre"TheMainMilitaryClinicalHospital"

Ukraine MilitaryMedical Academy (UMMA)


provides the instruction, training and
preparation for active personnel of the military medical service. UMMA focuses on the
postgraduate medical education and the selected training during 23 year magisterial
course for talented graduates. Each 5 years they have postgraduate advanced training
courseslasting16monthswitha1monthprecourseexercise.

ValeriySavytskyi,ColoneloftheMedicalService

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MedicalATOFall/Autumn2015andWinter2016
MoD, 1st Medical Training Company, Desna Training Grounds (Newly
formed).Commander:OlegVolodymyrovychVozniuk.

Al
though based at the 169th Training Centre in Desna it is proposed by
VsevolodStebliuk
theyworkdirectlyundertheMilitaryMedicalAcademy.

Bogomolets National Medical University


DeanofFacultyonTrainingtheDoctors
ForArmedForcesofUkraine
The main task of the Faculty wastoprovidetrainingandeducationofupto100experts
under core curriculums of professional direction Medicine for obtaining Specialists
degree with the purpose of their further entrance into the Armed Forces of
Ukraineandothermilitaryunitsstartingfrom1997.
OlegMykolayovychVlasenko.DoctorofMedicine,Professor,ColonelofMedicalService

Departme
nt of Organization of Medical Support of the Armed Forces Mykhailo
Badiuk

Colonel Mykhailo Badiuk (Retired)


Above in Training Section are
screenshots of the new manual developed through the Colonel's department
for the Ukrainian armed forces medical training academy which Medsanbat
assistedindevelopingwithandfortheMoD.

SpecialAdvisorMinisterofDefenceforMedicalIssues

Col.VsevolodStebliuk

Professor,MD

Research Institute of Military Medicine (RIMM)


(

)
.
The RIMM is the main executor of research on occupational medicine,
improvement of the organizational structure and management of the medical
services, medical evaluation of armament and military engineering, and other
issues. The RIMM consists of 2 boards, 7 departments and 17 laboratories.
SubordinatetotheMilitaryMedicalDepartment.
Col. Oleg Vlasenko, M.D. (

). Professor, Deputy
HeadoftheAcademyonScientificResearch.

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MedicalATOFall/Autumn2015andWinter2016

National University of Defense of Ukraine (NUDU)


Ivana Chernyakhovskohoisauniversity
of higher military education inUkraine,locatedinitscapitalcityof
Ky
iv.Subordinated
to the Ministry of Defence of Ukraine, theUniversityistrainingofficersspecializingin
thedefenseofthecountryincludingmedicine.

LieutenantGeneralVasylMaksymovychTelelym

DeputyMinisterofDefence
1stDeputyMinister.Education

MoD 1st Deputy Minister Ivan Rusnak


( ).ColGeneral
oftheReserve
.
SupervisorforDepartments:
DepartmentofMilitaryPolicyandStrategicPlanning
MobilizationDepartment
DepartmentofStateAviationRegulation
NationalUniversityofDefence
DepartmentofEducationandSciences.Militaryeducationalfacilitiesinclude:
Secondaryschools(CivilianColleges)
Military sergeant colleges,trainingBAspecialists,2.5yearsofeducation. Partof
MoD
Highereducationinstitutions(45years)partofMoD

DeputyMinisterofDefenceReforms

Yurii Husyev, Deputy Minister of Defence of Ukraine,


PhD
Economics.
Ex

Head of the MoD Reforms Office within the MoD.


Resigned once before but his resignation was not accepted until his
second attempt. Although he said that he had met his goals, it is largely
believed by many of his staff that he grew increasinglyfrustratedwiththe
statusquo.Sofarhispositionhasbeenleftopen.

DeputyHeadoftheMedicalEvacuationDepartmentofMilitaryMedicalDepartment.

ColonelYuriMalanitchev

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SummaryandKeyRecommendations
The following summary and key recommendations supercede the ATO Summer 2015 report
and address the most prescient issues faced by not only the battlefield warrior, but also the
systems throughout the MoD and ancillary institutions that support warfighting, defence and
basic state sovereignty. Based on the data reviewed this period, and based on recent
institutional shocks across key medical and defense agencies in Ukraine, novel and pragmatic
approaches will be required from partner and key stakeholder nation states to encourage
reform, NATO processes and standardsalignmentandtobetterservethewarfighterandcitizen
ofUkraine.

In short, the acute and emergency needs remain medical best practices and standards,
systemic training, sustainable accesstoadvancedmedicalequipment,oversightandmonitoring
of all medical projects and a systems level approach to all logistical and clinicalcomponentsof
the evacuation chain. In the chronic and longtermsystemsapproachesthataddress command
and control / mission control across the MoD will be required that encourage a more internally
transparent decisionmaking process, open procurement, accountable resource allocation and
bestbusinessandclinicalpractices.

KeyRecommendationsandNovelApproaches:

1. NATOInteroperability:
a. NATOSystems,InstitutionalandClinicalStandardizationPromotion
i.
Professionalclinicalandmedicalcommandexchanges
ii.
Mentorshiponbasicmedicalandlogisticalprocesses
iii.
Establishment of a Ukrainian Asymmetric Warfare Research Group,
operational and Red Teamdepartment: designedtomirror theprogramin
the NATO/US current procedures and to anticipate and prevent calamity
fromhybridwarfaretactics.

b. NATOandNATOPartnerProjectsandCollaboration.

i.
Continued support and crosstraining and interagency collaboration of
developing Role 1 & 2 Capabilities (i.e. DCS, TCCC, ATLS, critical care
and air evacuation) across all branches of service and echelons (i.e.
encourage ALL enlisted personnel and commissioned officers across
medical specialities to professional exchanges and advanced training in
andoutsideofUkraine).
c. Research
i.
This conflict is different: TCCC ideology, equipment and algorithms must
be tested against general and hybrid warfare. The need for a TCCC

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MedicalATOFall/Autumn2015andWinter2016
review board based on NATO andUSMilitaryinUkraineis needed1 .Due
to the nature of current Russia and Russianbacked insurgent activity,
evidenced based clinical decisionmakingrequiresabroadresearchbase
from Ukraine and for all practitioners of TCCC, DCS and battlefield
medicine. Blood and blood product support must also be considered
alongwithboneandtissueregenerationprogramsinUkraine.

2. MilitarytoMilitaryCollaborationandMilitaryandCivilianLiaison.
a. Comprehensive Monitoring and Evaluation of all medical assets sent in country
(military and civilian) through defined metrics all programs and training staffon
impact and assessments for future work, mitigation of skills fade, allocation of
resourceandequipment.
b. The establishment of a permanent office in Ukraine (Kyiv / Dnipropetrovsk) of a
medical representative from ODC/EUCOM to liaison and coordinate medical
trainings and distribution of medical equipment in Ukraine and encourage
accountability,transparencyandsustainabilityofofferedmedicalassets.
c. Continued support for and a continued expansion of the Rough and Ready
programtothenextlevelwiththeadditionofciviliantrainers/plannersfromNATO
countries to assist in the evolution of civilian training and prehospital care in
Ukraine. Consideration of a stable and 12month deployment of multiple
iterations of the Rough and Ready program with static medical and operational
training units in Yaroviv and within the established military andcivilianacademic
institutions.

3. PsychologicalandRehabilitativeSupport
.
a. Reviewandreformthepsychiatrictestingsystemforthemilitary.
b. Introduce a licensing mechanism for psychiatrist and psychologists who work
withmilitants.
c. Crosstraining for managers and trainers of civil organizations working with
returningsoldiersinUkrainetogetherwithcolleaguesfromallovertheworld.
d. Moderate the dialogue and enhance cooperation between nongovernmental
organizationstocreateacomplexsystemofpsychosocialsupport.
e. Prosthesisandphysicalrehabilitationsupportandcoordination.
f. Support the NATO lead course to enhance professional capacity for practising
rehabilitationandphysiotherapists.
g. Launcharesearchonpsychologicalstateofbothactivedutyandveterans.
h. Improve the collection of statistical data in order to study the causes of
psychologicalconsequencesofparticipationinthecurrentconflict.
1

MinistryofHealthandtheCabinetofHigherEducationapprovedtheadditionofanewcourseof
emergencymedicineincludingcomponentsofTacticalMedicine(TCCC):
http://www.medsanbat.info/domedichnadopomogavekstremalnihsituatsiyahnavchalnaprogramadlyastu
dentivmedikiv/

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MedicalATOFall/Autumn2015andWinter2016
i.

Physiological program development including PTSD prevention for both active


dutyandveterans.
j. ImprovethemilitarypsychologyeducationcoursesinUniversities.
k. Implementobligatorypsychologicalquarantineforreturningwarfighters.
l. Assistanceinfundingofdevelopingcivilprograms.

4. RotaryandFixedWingMedicalEvacuationSupport
:
a. NATO and NATO aligned country support for the further development,
advancement and standardization of fixed wing and rotary winged medical
evacuation.
b. Appraise data of evacuation chain management from the air evacuation (rotary
and fixed wing) to evacuation times, numbers transported, medical acuity and
severityandoutcomes.
c. The consideration of offering assets and training for medical evacuation may be
acute and the requirement of critical care training, air evacuation support,
communications,airdenialandothercapabilitiesmaybeconsidered.

5. GroundEvacuationandPrePlanningSupport.
a. The evacuation chain on the ground requires continued support. In not only
transport from the front lines but Critical Care transport which is often done by
volunteers and when done by MoD assets the equipment is often old or
nonexistent or must be borrowed from an existing MFH cache depleting a
lifesaving resource. Medical treatmentduringevacuationfromthefrontlineis too
often solved with speed and with no evacuation preplanning done prior to an
emergency.
b. TCCC:prepackagingandpreparationandpreventionofmorbidityandmortality:
i.
The lack of preplanning has questionably resulted in the deaths and
injuryofmanycivilianvolunteerandmilitarymedics.

6. Medical Standardization Promotion


: the crosslinking, promotion and facilitation of
international recognized medical certificate and licensurecoursefordoctors,nursesand
physicianextenders.Thisshouldincludeandisnotlimitedto:
a. AdvancedCardiacLifeSupport(ACLS)
b. AdvancedTraumaLifeSupport(ATLS)
i.
InternationalTraumaLifeSupport(ITLS)
c. ExtendedFocusedAssessmentwithSonographyinTrauma(eFAST)
i.
Withaccesstohandheldandbattlefieldtesteddevices
d. DamageControlSurgery(DCS)training,mentorshipandscenarios
e. AdvancedMentalHealthCourseforwarfightersandbattlefieldexposure
f. Introduction and promotion of WHOrelated medical practice standards, US
American Medical Association and UK based NICE guidelines for surgery,
internalmedicineandanesthesia(toexpeloldSovieteramedicalpractice).

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MedicalATOFall/Autumn2015andWinter2016
i.

Ukraine is a European country and its future will beahybridofEuropean


andotheradvancedresourcesrichcountrymedicalpractices.

7. MobileHospitalSupport.
a. Comprehensive training such as the Live Tissue (LTT)andCadavertrainingthat
recently occurred in Lviv is an excellent example of a program that should be
incorporatedinthecurriculumofmilitarymedicineforMFHpersonal.
b. Institutionalize:

i.
the process for volunteers and international partners requiring the
introduction of
methods to streamline the processwiththeacceptanceby
Ukraine MoD and using
concrete metrics of success to identify and
improve the level of training and develop internal programs that are
sustainable.
c. Modern equipment and training including portable CT scanners, portable
ultrasound, ventilators, CArm Xray, IStat, intraosseous device (IO),
StO2,
lactate analyzer, blood transfusion equipment including transfusion disease
testing devices
, lightweight computers with patienttrackingsoftware,criticalcare
ambulances,communicationhardwareandsecurity.

8. Legal Reform
: the promotion of legal reform to approve and enhance the medical
licensure processformedicalpractitionersfromthemilitary andciviliansectorstosecure
interoperabilityinwartimeandinpeace.
a. Sanitar 68W and
Emergency Medical Technician (EMT) level training withlegal
certification to be standardized across the military and civilian sector. The
guarantee of military trained and certified medical practitioners must be
transferabletothecivilianworld
b. Synchronization with MoD, MoH and MoIA operational requirements and legal
reformwiththelegalframeworkofEU,ECandNATOandjurisdiction
c. ContinuedsupportwithMedicalDoctrineenforcement
d. Legal Reform medical standard / paramedics / military to civilians / civilian to
military and military standards to civilian (reciprocity andtransitionofcertification
andlicensure)
e. Establishment of a joint office between the Special Prosecutor Office and the
Military Prosecutor Office to investigate the activities of the sale of military
propertiessuchasin20092010andformerMinistersofDefence.

9. TraumaRegistryandElectronicMedicalRecords
a. Liaison and encouragement in TCCCled Electronic Medical Record (EMRs)
suchastheEHealthprogramfromUSMil/USState/NATOtoMoD/MoH.
b. TCCCled software for patient care in the form of EMRs that are used in MoD
and theMoHoperationalareasandtheadditionofaprogramtomonitortrendsin

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MedicalATOFall/Autumn2015andWinter2016
the field and in the hospitals with the view to establish a trauma registry in
Ukraine.
c. Civilian crossover and interoperability. Off the shelf US or European software
systems are in use across branches ofserviceand canbeofferedinamilitaryto
military effort that fits the Ukrainian experience and requirements and available
resources.Thereneedstobeamobileoptionforlivetracking.

10. Finance and Funding


: allocation of specific resource and funding to secure the gains
made thus far and advance further TCCC and battlefield best practices are required.
Specifically:
a. Translations, Computer Assisted Translation (CAT) Software, training materials
(mannequins, tourniquets, training pressure / Israeli bandages, evacuation care
materials (SKEDCO, TALON, rescue rope and adjunct equipment, etc)
ultrasound, intraosseous device (IO),
StO2 and lactate analyzer, blood
transfusion equipment including transfusion disease testing devices
and
airway/tension pneumothorax equipment remains to be a major underserved
area.
b. Focused funding to specific units, organizations and MoD, the Ukraine Military
Medical Academy, military hospitals, National University of Defense of Ukraine,
civilian medical colleges and universities, MoH and MoIA departments with
concrete metrics of success and waypoints for further funding these are to
include reporting and evaluations of people trained, the units trained and many
othercorecapacitymetricswithanypartnershipprojects.
c. Ensuring and encouraging transparency of all funding, training and equipment
and institutions to EU and NATO standards propose an online clearing house
withclearlydescribedmoneyinandassetspurchased
d. Funding to establish armed forces induction centers with modern facilities fully
equipped with highly trained medical staff where every new recruit is given a
complete exam including psychological and ophthalmology exam and in the
cases required, the issuing of free eyewear (see above national database and
EMRs).

11. ContinuedsupportoftheReformsCouncil
,andnowthe
ReformsCommittee
.
a. Project management: capacity to this body of planning, organizing, motivating
and controlling resources to achieve their specific goals and meet specific
success criteria to push UkraineMoDoutofitssovieteraprocessandineffective
organization. The problem solving and decisionmaking process is very linear
and is completely dependent upon oneindividual atthetop tomakealldecisions
fromstrategicplanningtothepurchaseofbasicsoftmaterials.
b. This has to be managed with monitors and maintenanceofinternationalprojects
with civilian oversight to confirm if equipment and training are utilized effectively
by a qualified individual. Such as thesituationwiththeEMEDSwhereaqualified
individual with a medical background ascertains that the deployment, use and

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MedicalATOFall/Autumn2015andWinter2016
continuing trainingisperformedusing
concrete metricsofsuccessandwaypoints
for further assistance with the intent to maximize the effect of modern medical
equipment/trainingforparticipatesintheATO.

12. PrehospitalMedicineandParamedicine
a. Must be institutionalized within the MoD, MoIA, Border Guards, MoHandcivilian
structures like the Ukrainian Red Cross, Ukraine Resuscitation Council and
volunteer organizations. This can only be properly completed with the direct
support of the MoH, colleges, universities, teaching and training institutions and
immediate legislation to legalize a process already practiced without formal
guidelinestoprotectthepatientsandhealthcareproviders.
b. From a broader SYSTEMS perspective an approach that is consistentwithEMS
planningtoincludethefollowing8elements:
SystemOrganization,Management,andMedicalDirection
ManpowerandTraining
Communications
ResponseandTransport
HospitalsandCriticalCareCenters(Ietrauma,STEMI,Stroke)
Datacollection,evaluationandQuality
PublicInformationandEducation
DisasterMedicalResponse
The BIG list can be veryoverwhelming, thislistisnotexhaustive.Soaprioritized
list with concrete activities is easier to start and identify solutions. To be donein
conjunction with the MoD and MoH to join these actions together. All completed
with a philosophical EMS systems planning component, prioritizing the list, and
thenstarttodevelopmeasurableobjectivestobeginachievement.

13. MedicalSupportEquipment
:
a. Medevac upgrades in both rotarywing and ground transport with corresponding
trainingforbothflightandgroundevacuationcrews.
b. Advanced medical communications suite (land, air and sea) multiple units. The
communication throughout the ATO has improved but the simple cell/mobile
phones remain a key communication tool and a major barrier to security and
medicalsupportoperation.
c. CT scanner (portable), C arm radiology capability, portable ventilators, portable
ultrasound
, intraosseous device (IO),
StO2, lactate analyzer, blood transfusion
equipment including transfusion disease testing devices, IStat,
pulse oximetry,
EndTidal Co2 detectorsandwholeblood capacitydesignedtomeetstrict AABB,
ANRC, and FDA requirements for storage and transferofwhole bloodandblood
components (platelets, plasma, red blood cells) at forward locations such as
EMEDS and frontline hospitals and field transfusion kits at FOB and forward aid
stations.

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MedicalATOFall/Autumn2015andWinter2016
d. Additional nonlethal assistance has already come from NATO and other NATO
aligned countries and has been met with great success. For the sake of this
report no commission or description of any nonlethal assets are reviewed,
however, all support offered to date that has been deployed, has offered major
advancement for defence capability. Consideration of additional nonlethal
assistanceshouldinclude:
i.
AirdenialcapabilityforMFHandmedicaloperations:
1. Morecounterbatteryradarsystems
2. Moreunmannedaerialvehicles(UAVs)andtraining
3. MoreelectroniccountermeasuresforuseagainstopposingUAVs
ii.
Antitankweaponsystems
iii.
ContinuedUXO/EODtraining,supportandmentorship

14. MissionControl/CommandandControl
a. Balance of command and control in unified Armed Forces in field and air
operationsincooperationwithciviliandisasterauthorities.
b. Encourage reverse command for midlevel commanders to seize, retain and
exploit the initiative to be at a constant relative advantage against a persistent,
wellarmedanddeterminedenemyandhybridtactics
c. Empowerment across medical command and battle groups to subordinates in
exploitingtheinitiativetomaximizeadvantage(encouragedecisionmaking)
d. Renewal, continued support for and a continued expansion of the Rough and
Ready program to the next level with the addition of civilian trainers/planners
from NATO countries to assist in the evolution of prehospital care and disaster
managementinUkraine.

Conclusions
Based on recent experience in the ATO / contact line regions and through the data reviewed,
the battlefield medical standards in Ukraine for warfighters has increased in standard,
availability and supply line considerably since mid 2014 and throughout 2015. Much has been
done, however, much more remains to be done andbattlefieldmedicalcareinUkraineisstill in
its infancy. Prevention is the best medicine and state institutional capacity, accountability and
transparency will lead to best outcomes and this isgreatlyneededatalllevelsofpracticeinthe
MoD.

The need for continued internal pressureoncentralinstitutionssuchastheMinistryofDefence,


Ministry of Health, Ministry of Internal Affairs and thejudiciarysystemtocontinuetransitioninto
modern capacity, transparent institutions and clinical standards are required. With this,
volunteers and volunteer philanthropic institutions, along with relatively recently started local
NGOs need to step up and lendtheirexpertisetorebuildtheseinstitutionsandforegotheir own
developmentofparallelandduplicate systemsandallowforthesestateinstitutionstoeventually
manage and lead. Indeed, key leadership for battlefield health and medical practice will reside

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MedicalATOFall/Autumn2015andWinter2016
only within a state agency, not private or humanitarian organizations without a publicmandate.
It should be noted that state medical institutions in the ATO have proven their ability to adapt
and be resilient in the face ofshocksandadversityatabattlefieldlevel,butlacksuchresilience
at a command level the pace in Kyiv continues to be slow, cumbersome and at times largely
ineffective and is often only moved by the pressure exerted by volunteers, activists, reformers,
andexposingsocialmedia.

With this above mentioned advancements in state institutions and their capacity, the fragile
state of Ukraine will become more stable on the stability spectrum only through allowing these
state institutions to lead, to organize and coordinate and to practice evidencebasedpolicyand
practice in time of crisis. This can be enhanced through the support, guidance and material
support offered through NATO and NATOmemberstates.Ukraine MilitaryDoctrine isbasedon
the duration of threat from Russia and demands full compatibility of the Armed Forces with
NATO standards, there is a clear mandatetomoveforwardandbringtheUkrainearmedforces
medical system up to international standards. This report focuses on healthcare and battlefield
medical support, but there are many other streams such as state capacity, rule of law,
democracy promotion, civic action and judicial reform that will also increase stability for the
European nation state of Ukraine. Transparency of state institutions and a policy of prevention
mayleadUkraineintoamoreindependentandstablenationalstate.

137


MedicalATOFall/Autumn2015andWinter2016

GraduationfromtheMilitaryAcademyinKharkiv.PhotoCredit
:MoD

138


MedicalATOFall/Autumn2015andWinter2016
ArticlesMentioned

Section1EvacuationChaininSectorB

MinksIITelegraph
http://www.telegraph.co.uk/news/worldnews/europe/ukraine/11408266/MinskagreementonUkrainecrisist
extinfull.html

Russianforces

https://goo.gl/Y2URi8

UN:CasualtiesinUkraine
http://data.un.org/Data.aspx?d=POP&f=tableCode%3A240
CurrentFightingintheATO
ATOspokesperson:NationalGuardmedicsprovidedaidtoalmostninethousandservicemenandcivilians
inATOareainlessthanayear.Nov11,2015
https://twitter.com/uacrisis/status/664394490946433024

375Ukrainiansoldierskilledand1,500wounded
www.newsweek.com/ceasefiresyriaturnsputinseyeukraineonceagain431465

Keyrailroadjunction

http://www.bueker.net/trainspotting/map.php?file=maps/ukraine/ukraine.gif

RinatAkhmetov

https://en.wikipedia.org/wiki/Rinat_Akhmetov

AvdiivkaContactLine
NolanPetersonsarticleintheDailySignal
IsThisRealLife?
http://dailysignal.com/2016/03/18/isthisreallifeinsidetheukrainewarsgrayzone/

NewYorkTimespieceonAvdiivkaCokePlant
AUkraineFactoryThatCantClose,andWorkersWhoWont
Quit
byAndrewRoth.
http://www.nytimes.com/2015/03/26/world/europe/aukrainefactorythatcantcloseandworkerswhowontq
uit.html?_r=0

InformationResistance:DestructionbyterroristsoutskirtsAvdeevka.
http://sprotyv.info/ru/news/kiev/unichtozhennayaterroristamiokrainaavdeevkistanovitsyapohozheynaprip
yatfoto?_utl_t=fb

CareinTheZero
Interviews

EvacuationfromAvdiivka
Interviews

AvdiivkaEvacuationGaps
Interviews

MedicsofAvdiivka
ASAPRescue

http://www.hottabych.org.ua/eng

139


MedicalATOFall/Autumn2015andWinter2016
MilitaryvehiclefromFeb5thblastandfirewithtwoWIA.PhotoCredit
:TSN
http://tsn.ua/ato/nadonbasinaminipidirvavsyauralizviyskovimiatoyepostrazhdali586630.html?g=articl
e&m=385239904

VolunteerMilitaryAmbulances
ThelegalityofvolunteeroperationssupportingtheATO:
http://gazeta.zn.ua/socium/zernaiplevelyonelegalnomvvolonterstve_.html

MilitaryAmbulance
Photos:MoDNewUkraineMTLBinKherson

http://goo.gl/PlQTQ1

EvacuationChainfrom
Avdiivka
OZN,boundingfragmentationantipersonnelmine
http://www.nolandmines.com/Mines/OZM72_bounding_AP_mine.pdf

OcheretyneHospital
Interviews

66thMFHin
Krasnoarmiisk
TheEvacuationChainfrom
Avdiivka
OfficeofDefenceCooperation
(ODC)
http://ukraine.usembassy.gov/odc.html

EUCOM
http://www.eucom.mil/

Centerfortrainingmilitarydoctorscensor.ne
t
http://en.censor.net.ua/n363666
Photosfromthetraumaandoperatingroomofthe66thMFHbasedatRailroadHospitalinKrasnoarmiisk
https://www.facebook.com/photo.php?fbid=899117960202563&set=pcb.899122400202119&type=3&theater
https://www.facebook.com/photo.php?fbid=899116943535998&set=pcb.899122400202119&type=3&permP
age=1

CenterfortrainingmedicalofficersunderNATOstandardsstartsoperatinginKrasnoarmiisk,Defense
Ministry12/04/15
http://en.censor.net.ua/news/363666/center_for_training_medical_officers_under_nato_standards_starts_op
erating_in_krasnoarmiisk_defense

YanaZinkevychFB
https://www.facebook.com/photo.php?fbid=1623338874553374&set=pcb.1623338891220039&type=3&thea
ter

Trainevacuationofthewoundedfrom66thMFHtoDnipropetrovsk
http://vchasnoua.com/donbass/32944vpervyeizkrasnoarmejskavdnepropetrovskpoezdombylievakuirov
anyranenyevoennosluzhashchie

InterCityTrainEvacuation
http://vchasnoua.com/donbass/32944vpervyeizkrasnoarmejskavdnepropetrovskpoezdombylievakuirov
anyranenyevoennosluzhashchie

140


MedicalATOFall/Autumn2015andWinter2016
HighspeedtrainsfromKrasnoarmiisk
http://vokzal.org.ua/en/railwaystations/zheleznodorozhnyjvokzalkrasnoarmejsk2

Trainstationlocation
https://goo.gl/maps/exrNipHZM9k

MechnikovHospital,Dnipropetrovsk,NATOLevelIVHospital,TraumaCenter
MassiveturnoutforMechnikovHospital,Dnipropetrovsk,LevelIVtraumacentersblooddrive
https://www.facebook.com/photo.php?fbid=1754731978096269&set=pcb.1754732494762884&type=3&thea
ter

DnipropetrovskMilitaryHospital
DnipropetrovskMilitaryHospital
VsevolodStebliuk

https://www.facebook.com/vsevolod.stebliuk?sk=wall

ThemajorityshareholderoftheVTBBankistheRussianGovernment,whichowns60.9percentofthe
votingsharesor85.3percentoftheBankssharecapital.
http://www.vtb.com/group/

AnatoliyHrytsenko
https://www.facebook.com/profile.php?id=100003313481489&sk=timeline

KyivMohylaAcademy
http://www.ukma.edu.ua/eng/

AnatoliyHrytsenko

https://www.facebook.com/profile.php?id=100003313481489&sk=timeline

TheFinalStep
DistributionofinjuredwarfighterfromDnipropetrovskandKharkiv

Airtransport,DniproAirport.
https://www.facebook.com/photo.php?fbid=775061255971257&set=pcb.775061362637913&type=3&theater

DespitetheceasefirewoundedcontinuetoarrivetoDnipropetrovsk.Oct12,2015
http://www.segodnya.ua/regions/dnepr/vdnepropetrovskevertoletamidostavili12ranenyhboycov655160.
html

Medevac
http://www.mercyflight.org/content/pages/medevac

MainMilitaryClinicalHospital
HospitalnaStreet,Kyiv

NATOSystemofPrimaryHealthCareinKievMilitaryMedicalCenter
http://www.dtic.mil/dtic/tr/fulltext/u2/p010935.pdf

MainMilitaryHospital,Kyiv
http://www.gvkg.kiev.ua/

KyivFortress
https://en.wikipedia.org/wiki/Kiev_Fortress

KyivMilitaryHospitalMuseum
http://www.ukraine.com/museums/kievfortress/

Section2TheATO
CACDS

http://cacds.org.ua/en/comments/505

141


MedicalATOFall/Autumn2015andWinter2016

SectorBMedicReports

PhotosofthemilitarydoctorsworkingatKurakhoveHospitalnearthefrontlinesinDonetsk:
https://www.facebook.com/photo.php?fbid=925143887562798&set=pcb.925147147562472&type=3&theater

SectorA59thMobileFieldHospital

March1st,2016.NearNovotoshkivske

http://www.pravda.com.ua/news/2016/03/1/7100772/

LiveMapUA
http://liveuamap.com/en/time/03.03.2016

SeverodonetskMultiSpecialityHospital.
Wikimap:
http://wikimapia.org/14717735/uk/%D0%9A%D0%BE%D1%80%D0%BF%D1%83%D1%81%E2%84%963
#/photo/2926473

DTEKLuganskaThermalPowerPlant
http://www.dtek.com/en/ouroperations/electricpowergeneration/vostokenergo

MassiveexplosionatUkrammodumpw/inj&dead.UkrsaysterroristactOct29,2015
https://twitter.com/EuromaidanPR/status/659893375768858624

Feb29th,2016Anunarmoured
HMMWV
vehiclewashitbyshellfragments.NataliiaMeshcheriakova
https://www.facebook.com/photo.php?fbid=947773585314411&set=pcb.947775821980854&type=3&theater

Video.Onscenetreatmentofanexplosiveinjuryfromthe28thBrigadenearShchastya.Nov.2015.
https://youtu.be/yo1Mpof8xCc

SeverodonetskMultiSpecialityHospital

UkraineMedicalandHealthReportSummer2015ATOUpdate.
https://www.scribd.com/doc/285198051/UkraineMedicalATOSummer2015

SectorC65thMobileFieldHospital

Atleast14civilianskilledinrenewedfightingineasternUkraine.
Photo
http://mashable.com/2015/01/30/rocketskillciviliansinukraine/#FknRV_OvJEq4

Ukraine:Russiabackedrebelsoverrunanothertownineast.
DailyMail
.
29January2015,ByASSOCIATED
PRESS
http://www.dailymail.co.uk/wires/ap/article2931701/UkraineRussiabackedrebelsoverruntowneast.htm

SectorC,VolunteerMilitaryMedics

MayorskabattleUkrainiansoldierKIAandvolunteerwhotriedtosavehim,receivedshrapnelwounds.
http://uapress.info/uk/news/show/116264

142


MedicalATOFall/Autumn2015andWinter2016

SistersofMercy

http://4army.com.ua/volunteer/sestramiloserdiya/

MedicalCorps

http://medcorp.org.ua/ukr/index.html

Volunteerscameundermortarattack
http://news.liga.net/news/politics/8765032mashina_volonterov_popala_pod_minometnyy_obstrel_pod_may
orskom.htm
DetailsofMortarattackonvolunteers
http://kh.depo.ua/ukr/kh/stalividomipodrobitsiobstriluharkivskihvolonteriv31012016132800

SectorMMariupoland61stMFH
Mariupol

https://en.wikipedia.org/wiki/Mariupol
IlyichIronandSteelWorks

https://ilyichsteel.metinvestholding.com/en
AssaultonMariupol

https://en.wikipedia.org/wiki/Offensive_on_Mariupol_(January_2015)
NationalGuard

http://ngu.gov.ua/en

PJSCAzovstalIronandSteelWorks

http://azovstal.metinvestholding.com/en

NGOSpravedlyvist.
http://spravedlyvistato.org.ua/

BattleofIlovaiskFieldCareandEvacuationfromtheIlovaiskKettle
,August2014
http://www.interpretermag.com/thebattleofilovaiskaturningpointinrussiaswaronukraine/

CNNVideo

http://edition.cnn.com/videos/world/2014/09/02/pkgmagnayukraineilovaiskcaptured.cnn

MedicalCommandandControlMissionControl

On24December,2012theMinistryofEmergenciesofUkrainewastransformedintoStateEmergency
Service

andplacedunderjurisdictionoftheMinistryofDefenceofUkraine.On25April2014theservicewas
transferredtotheMinistryofInternalAffairsofUkraine
.
http://www.mns.gov.ua/

MoD
https://en.wikipedia.org/wiki/Ministry_of_Defence_(Ukraine)

Illustration:UkraineMoD2014WhiteBook
http://www.mil.gov.ua/content/files/whitebook/WB_2014_eng.pdf

UkraineMoD2013WhiteBook
http://www.mil.gov.ua/content/files/whitebook/WB_2013_eng.pdf

OSCEintheATO
http://www.osce.org/ukraine

143


MedicalATOFall/Autumn2015andWinter2016

HeadofOSCEObservationMissionAmbassadorErtugrulApakanthankedAirlines"UkrainianHelicopters"
forhelpingtosavetheobservers.
http://ukrcopter.com/ua/news/20140709vertoletaviakompaniiperevezosvobozhdennihnablyudatelejobs
e#sthash.SrOWKN7r.dpuf

Section3Equipment
PhotoCredit
DailyMail,
photographerPavloItkin
www.dailymail.co.uk/news/article2572149/StunningimageshugeabandonedtankgraveyardUkrainemac
hinescomeretirementtensionsRussiacontinueescalate.html#ixzz43U00ky3U

AssistantSecretaryNulandtestifieson#UkrainebeforeSenateForeignRelationsCommittee
https://twitter.com/hashtag/Ukraine?src=hash

UkrainemeetswithJapaneseembassyrepstodiscusscooperationonmilitarymed.
http://www.mil.gov.ua/en/news/2015/08/05/japaneseukrainianmilitarymedicalcooperationdiscu

Logistics
Interviews

VolunteerEffort

Websitelistingvariousvolunteers/groupshelpingarmyandrefugees

http://4army.com.ua/

HelptheArmyofUkrain
e(UkrArmy)
https://www.facebook.com/helpukrarmy/photos/pcb.1131421416869619/1131420833536344/?type=3&theat
er

MedicGroups
ViteretsVolunteerGroup
MedicalRapidResponseTeam"Breeze"
SectorB,currentlyMarinka.
https://www.facebook.com/Rescue.breeze/info/?tab=page_info

Pirogov
SectorCbutatonetimeinSectorB.
http://medbat.org.ua/?lang=en

ASAP
MostlySectorC.
http://www.hottabych.org.ua/eng

Hospitallers
MostlyworkinginSectorBandM.
https://www.facebook.com/hospitallers?pnref=story

()PrivateMedicalBrigadeRapidRespons
eAppearstonolongerfunctioningasagroup
https://www.facebook.com/groups/779681182081521/

MedicalCorps
MostlySectorB

http://medcorp.org.ua/ukr/index.html

UkropDental
SectorC

https://www.facebook.com/groups/728109477287265
/

PhotoCredit:MoDFB
https://www.facebook.com/theministryofdefence.ua/photos/pcb.1052546884807816/1052546668141171/?ty
pe=3&theater

144


MedicalATOFall/Autumn2015andWinter2016
Footnotefromlastassessment.ThisphotowasusedtoshowthelevelofPPEnowseenintheATO.Sadlyit
wasrecentlyrevealedthatthewarfightershown,22y/oPeterPolytsyakofthe80thAirbornewascaptured
attheDonetskAirportandlaterdiedundertortureincaptivity.
https://www.facebook.com/photo.php?fbid=952624411457854&set=a.682943935092571.1073741826.1000
01309124796&type=3&theate

Helicopters

UkrainianHelicopter
http://ukrcopter.com/en

UkrainianHelicopters
presscenterrelease
http://ukrcopter.com/en/news/20150506ykrainskievertoletiprezentovaliskajtransformervafrike

FlightMedicReceiveAwards
http://www.president.gov.ua/news/naperedodni8bereznyaprezidentnagorodivvidatnihzhinokv36821

112.ua
http://ua.112.ua/polityka/nacgvardiyaekspluatuyevzoniato4vertolotizranisheperedanihvorenduavako
v107780.html

DSNews

http://www.dsnews.ua/politics/art34629

StateFinancialOfficeofUkraine
http://www.dkrs.gov.ua/kru/uk/publish/article/87473jsessionid=BC3D45204B4DB009027D7F9859245171

NoCorruption
http://www.dkrs.gov.ua/kru/uk/publish/article/87473jsessionid=BC3D45204B4DB009027D7F9859245171

UkrainianPravda
http://blogs.pravda.com.ua/authors/chornovol/53ccd42fd6c2f/

UACorrespondent
http://ua.korrespondent.net/ukraine/3412415natshvardiiaotrymalamodernizovanivertoloty

Antikor
http://antikor.com.ua/articles/13636kompanija_ukrainskie_vertolety_trebuet_u_minoborony_prinjatj_arendo
vannye_vertolety

UkrainianMilitaryHelicoptersModernizationAndDevelopmentPlans
http://www.defence24.com/269678,ukrainianmilitaryhelicoptersmodernizationanddevelopmentplans

ManagementofAviationandAviationSearchandRescue
http://www.mns.gov.ua/content/upravlinnyaavia.html

Sideloadingintoanattackhelicopter
http://mashable.com/2015/02/05/medicsonukrainefrontlines/#KEt9T6SwjuqS

HospitalsoftheATO

145


MedicalATOFall/Autumn2015andWinter2016
HospitalofATOMap(permissiononly)
https://www.google.com/maps/d/edit?mid=z0igp8EihJ08.ksgnuRmI5318&usp=sharing

MechnikovHospital

https://www.facebook.com/MechnikovaBoln/?pnref=lhc

SergiiRyzhenko

https://www.facebook.com/rsa010963?fref=ts

UnitedNations
DevelopmentProgram
http://www.euronews.com/tag/unitednations/

GovernmentofJapan

http://www.ua.embjapan.go.jp/itprtop_en/00_000173.html

ResilienceandrebuildingtalesfromawartornUkrainehospital
byNataliaLiubchenkova
http://www.euronews.com/2016/03/14/resilienceandrebuildingtalesfromawartornukrainehospital/

DnipropetrovskMilitaryHospital
http://hospital.dp.ua/

Civilmilitarycoordinationheadquartersofcareadopted82decisionsonissuesofmedicineinATO
http://www.mil.gov.ua/news/2015/12/30/zachasrobotivijskovoczivilnogokoordinaczijnogoshtabumedichn
oidopomogiprijnyato82rishennyashhodoproblemnihpitanmedzabezpechennya/

UkrainesHealthSystem:TimeforChangebyQimiaoFan
http://www.worldbank.org/en/news/opinion/2015/04/06/ukraineshealthsystemtimeforchange

UkraineHealthCareSystemReview
http://www.euro.who.int/__data/assets/pdf_file/0010/140599/e94973.pdf

Illustration:UkraineHealthCareSystem
http://www.euro.who.int/__data/assets/pdf_file/0010/140599/e94973.pdf

MoHNationalHealthReformStrategyfor20152020
http://healthsag.org.ua/wpcontent/uploads/2015/03/Strategiya_Engl_for_inet.pdf

Dr.N.A.Semashko,TheCommissarofHealth
www.marxists.org/archive/semashko/semashko.htm

Igotyoursix

http://www.urbandictionary.com/define.php?term=I%20got%20your%20six

AvdiivkaFOB

PhotoCredit:VladDemchenko
https://www.facebook.com/photo.php?fbid=10209102715744509&set=pcb.10209102848147819&type=3&th
eater

GoogleMapFOBAvdiivka
https://www.google.com.ua/maps/place/Yasynovs'kyi+Ln,+64%D0%91,+Avdiivka,+Donetsk+Oblast,+86060/
@48.1183623,37.7914989,520m/data=!3m2!1e3!4b1!4m2!3m1!1s0x40e08415eea9bd45:0xbc4dbb35deecc
dcf?hl=en

ComeBackAlive,

http://savelife.in.ua/

146


MedicalATOFall/Autumn2015andWinter2016

ArmySOS

http://armysos.com.ua/en/

ArmySOSDroneShot:

https://www.youtube.com/watch?v=pFCSD_ukNtg&feature=youtu.be
https://www.facebook.com/photo.php?fbid=586512631500727&set=gm.1764269543801644&type=3&theate
r

Channel5videoofAvdiivka

https://youtu.be/9NAG3tAEHD4

ArecentvideoofthefightingandmedicalcarefromComeBackAlivecanbefoundat:
https://www.facebook.com/backandalive/videos/608435739313867/

NightscopefromComeBackAlive

http://savelife.in.ua/

KharkivMorozovMachineBuilding(KMMB
)

http://morozovkmdb.com/eng/index.php

TheEMEDS

MoDmedicalStaffcomplainaboutthebureaucracyandslowdeploymentofEMEDStoATO,Oct27,2015
http://ukrainian.voanews.com/content/ushospitalforukraine/3023718.html?nocache=1

FinaltrainingonUSsuppliedEMEDSMFHcompletedinOctober,2015
http://www.mil.gov.ua/news/2015/10/21/zavershalnijetapsertifikacziiprohoditosobovijskladmobilnogogos
pitalyuvdvzsukraini/

VitaliyCherevatov,actinghospitalchiefatthetime
Eng:
http://www.mil.gov.ua/en/news/2015/10/21/mobilehospitalofukrainianairbornetroopsundergoescertificati
on/
samearticle,Ukr:
http://www.mil.gov.ua/news/2015/10/21/zavershalnijetapsertifikacziiprohoditosobovijskladmobilnogogos
pitalyuvdvzsukraini/

SlavkurortResort,GoogleMap

https://goo.gl/maps/dEr36hiCGUu

Kostiantynivka
,GoogleMap
https://goo.gl/maps/kvcJfhubwTq

BogdanKovalev,amemberoftheSecurityCouncilandsocialactivist.
https://www.facebook.com/cobritob

ViktorIvchuk,medicalchiefoftheairborne.IssaidhegraduatedfromVinnytsiacollegewithadiplomaofa
nurselevel.Jul5,2014ReceivedBohdanKhmelnytskyiIIIawardforbraveryandheroismduringthe
operationsforSlovianskandotherplaces
http://www.mil.gov.ua/news/2014/07/05/prezidentukrainipidpisavukazpronagorodzhennyavoinivzavizvo
lennyaslovyanska/

ViktorIvchuk:Sept12,2014receivedDoctoroftheYearawardbeingamedicalchiefof95th,LtColof
medicalservice

147


MedicalATOFall/Autumn2015andWinter2016
http://www.mil.gov.ua/news/2014/09/13/uzhitomirivkonkursividznachilivijskovosluzhbovcziv95okremoia
eromobilnoibrigadi/

ViktorIvchuk:Apr14,2015ActingchiefofmilmedserviceinAirborneCommand
http://www.mil.gov.ua/news/2015/04/14/medikiobgovorilinadannyameddopomogivatopidrozdilamivdv/

OfficiallyreceivedbyAndriiVerba,headofMilMedDepartmentandYaroslavLaguta,headofZhytomyr
regionstateadministration
.
http://www.ukrmilitary.com/2015/08/emeds.html
http://www.forumdaily.com/amerikanskievoennyeprivezliukraintsamgospitalvideo/

MoDpublicationsaboutEMEDS
:
http://www.mil.gov.ua/searchresults?query=emeds

PeripheralHemorrhageControl:UkrainianTourniquets

SPASTourniquet()

http://mpr.biz.ua/p132057022krovoostanavlivayuschijzhgutturniket.html

CombatSpetsnaz()
https://www.facebook.com/photo.php?fbid=1672009419739443&set=pcb.1672011796405872&type=3&thea
ter

AvPharma
http://avpharma.com.ua/kompan%D1%96ya

ReformsOfficeannouncescancellationtothelatesttourniquettender
https://www.facebook.com/reformsmod.ukr/photos/a.881564058579530.1073741828.879626822106587/97
4298629306072/?type=3&theater

AmbulancesofUkraine

U
AZCombi

http://www.uaz.ru/en/cars/commercial/combi

GAZGroup,AmbulanceTypeB

http://azgaz.ru/

Mercedes
UnimogU1300LAmbulance
https://www.mercedesbenz.com/en/

VDYunikommers

http://www.vidiuc.com.ua/services/ambulances

AVTOSPETSPROMLLC

http://ukrmedprom.info/?p=185&lang=ru

KharkivMorozovMachineBuilding
(KMMB)

Practika
whichproducebotharmoredandsoftskin

KrAZ
KremenchukAutomobilePlant.

State own Ukroboronprom


enterprises on engineering, production, and sale of defense products for
domesticandforeignmarket

http://www.ukroboronprom.com.ua/en/

148


MedicalATOFall/Autumn2015andWinter2016
PhotoCredit
:RomanDonik
https://www.facebook.com/photo.php?fbid=1092417477456879&set=a.658903810808250.1073741834.100
000659128651&type=3&theater

VOLUNTEERSWEREABLETOFREECUSTOMSCLEARANCECARS(ambulances)FROMABROAD
FORATO
http://www.5.ua/video/VolonteryzmohlybezkoshtovnorozmytnytyavtomobilizzakordonudliaATO10521
0.html

UKRAINIANHOSPITALSRECEIVEFOURAMBULANCESFROMCANADA
http://www.homin.ca/news.php/news/15709/group/5

GermanFederalMinistryforEconomicCooperationandDevelopment(BMZ)
https://www.giz.de/en/worldwide/36591.htm

RoadsinDisrepairLandEvacuationRoutes

Volunteermedical"Hottabych"needshelpambulanceintheATOzoneurgentlyneedsrepairs
http://vchasnoua.com/donbass/34686volontermedikkhottabychnuzhdaetsyavpomoshchireanimobilyuv
zoneatosrochnoneobkhodimremont

Memorandum
onimplementationinUkraineofaninternationalConstructionSectorTransparencyInitiative
(CoST)
http://www.kmu.gov.ua/control/en/publish/article?art_id=248567484&cat_id=244314975

NationalSecurityandDefenseCouncilofUkraine

http://www.rnbo.gov.ua/en/

RoadfromMykolaivtoDnipropetrovsk
https://www.facebook.com/vasyl.kalachyk/videos/vb.100009287409466/1555169694802596/?type=2&theat
er

BlackMarket/DarkMarket:anEnvironmentforCorruption

OLX
http://olx.ua/
apopularsitesimilartoEBay.

NomedicalitemsfoundonAvito.re
www.besplatka.ua

Severalitemsfrom
www.ukrboard.com.ua

HeadoftheMedicalDepartmentoftheMinistryofDefence

MeetingbetweenGeneralVerbaandvolunteerreps.
https://www.facebook.com/Petro.Vyshyvanets/posts/1661982997417280?pnref=story

MeetingbetweenvolunteermedicsandtheMoDMilitaryMedicalDepartmentdirectorGeneralVerbaNov
23,2015

149


MedicalATOFall/Autumn2015andWinter2016
https://www.facebook.com/photo.php?fbid=1661982057417374&set=pcb.1661982997417280&type=3&thea
ter

Section4Reforms

TheFailureofMilitaryandCivilianLaw

BohdanVitvitsky,FormerFederalProsecutorandAssistantU.S.Attorney,U.S.DepartmentofJusticeNew
Jersey,USA.RemarkspresentedatSymposiumUkraine:EscapingFromItsPostSovietLegacy(Kyiv,
April2426,2015).
http://voxukraine.org/2015/06/05/corruptioninukrainewhatneedstobeunderstoodandwhatneedstobe
done/

ReformofFoodSuppliesSystemforArmedForcesofUkraineServiceman
http://www.mil.gov.ua/en/content/files/reforms/en_food2.pdf

MILITARYSTRATEGYOFUKRAINE.InorderforUkrainetocreateavictoriousarmy,itneedsmodern
professionalapproaches.Butprofessionalismandsovietfeudalismcannotcohabit.
http://en.censor.net.ua/resonance/367277/military_strategy_of_ukraine
ZoltanBaranyDemocraticBreakdownandtheDeclineoftheRussianMilitary,Originallypublished:
January1,2007
UkrainecashinginonillegalarmssalesDaveGilson
http://www.pbs.org/frontlineworld/stories/sierraleone/context.html
http://www.csmonitor.com/2002/0212/p09s02woeu.html

Newdefenseminister,
PavloLebedev
tostartthesaleofpropertyandland
http://censor.net.ua/news/228688/novyyi_ministr_oborony_planiruet_nachat_rasprodaju_imuschestva_i_ze
mel

PavloLebedevGenshtab
http://genshtab.info/%D0%9B%D0%B5%D0%B1%D0%B5%D0%B4%D0%B5%D0%B2,_%D0%9F%D0%B
0%D0%B2%D0%B5%D0%BB_%D0%92%D0%B0%D0%BB%D0%B5%D0%BD%D1%82%D0%B8%D0%B
D%D0%BE%D0%B2%D0%B8%D1%87

State own Ukroboronprom


enterprises on engineering, production, and sale of defense products for
domesticandforeignmarket

http://www.ukroboronprom.com.ua/en/

TwoformerUkrainiandefenseministersannouncedwantedchiefmilitaryprosecutor
http://en.interfax.com.ua/news/general/330472.html

AnatoliiMatios
http://matios.info/en/aboutme/biography/

ChiefmilitaryprosecutorinATOsuspectedofillegalincome
http://tsn.ua/video/videonovini/viyskovogoprokurorazoniatokostyantinakulikapidozryuyutukorupciyi.ht
ml

150


MedicalATOFall/Autumn2015andWinter2016
DeputyProsecutorDavitSakvarelidze
http://www.kyivpost.com/article/content/ukrainepolitics/sakvarelidzeacompletemessasshokinblockspro
secutorialreform410678.html
NationalAntiCorruptionBureau

http://nabu.gov.ua/en
TransparencyInternationalCorruptionIndex

http://www.transparency.org/country/#UKR
SerioustransformationsofthejudiciaryandlawenforcementSergiiAleksashenko
http://www.brookings.edu/blogs/upfront/posts/2016/02/12ukrainestallingreforms

MedicalLegalReform

MilitaryReformMoDConclusions
MoDWhiteBook2014
http://www.mil.gov.ua/content/files/whitebook/WB_2014_eng.pdf

NationalReformsCouncil

http://reforms.in.ua/en

FORMERUKRAINIANDEFENSEMINISTERSALAMATIN
KEPTINASWISSBANKMORETHAN$11MILLION
http://ru.tsn.ua/groshi/eksministroboronyukrainysalamatinhranilvshveycarskombankebolshe11million
ovdollarov409751.html
CLANOFTHEMILITARYPROSECUTOR'SOFFICEAnatoliiMatios
http://prokurorskapravda.today/article/klanvvoennojprokuratureimladistarvstrojkmatiosustal/
ATO
PROSECUTOR
CAUGHTPURCHASINGCARSWORTHMORETHANAMILLIONHRYVNIA
http://ru.tsn.ua/politika/sozhitelnicuprokuroraatoulichilivpriobreteniiavtostoimostyuboleemillionagriven
568239.html
ChiefmilitaryprosecutorinATOownsluxuryapartments
http://24tv.ua/yak_golovnomiy_viyskoviy_prokuror_zoni_ato_nazhivayetsya_rozkishnimi_kvartirami_n66037
4
ExSBU
LieutenantGeneralAlexanderSkipalskyinaninterviewwith
RuslanIvan
ovinUA1:arealthreat
f
romforeignintelligenceservices
http://ua1.com.ua/publications/putinzalishivnamtrichotirimisyacigeneralsbuskipalskiy18463.html

"Ayudar"ownedbySvetlanaKulyk,motherofchiefprosecutorinATO
http://nashigroshi.org/2014/12/02/vuhillyazaliznytsina100miljonivzbyrajetsyapostachatyprokladkamene
dzheraekspratsivnykaukrzaliznychpostachu/

ChiefmilitaryprosecutorinATOownsthreeluxuryapartments
https://ordua.com/2015/12/14/nadzirayazazakonnostyuvatoprokurorkulikkupiltrielitnyiekvartiryi/
AneweditionoftheMilitaryDoctrineofUkraine.NationalSecurityCouncilandDefenceofUkraine,Sept1,
2015
http://www.president.gov.ua/documents/555201519443

151


MedicalATOFall/Autumn2015andWinter2016
Thedevelopmentofconceptofthereformofmilitaryeducation
http://reforms.in.ua/en/reform/indicator/10043
ReformsCouncilisrevisingtheevacuationprotocolstoreduceevacuationtimestomeettheGoldenHour.
https://www.facebook.com/reformsmod.ukr/photos/a.881564058579530.1073741828.879626822106587/91
5447451857857/?type=3&theater
NationalSecurityandDefenceReform
http://reforms.in.ua/en/reforms/nationalsecurityanddefencereform
TheGuardian.AivarasAbromaviiusresignsasTheMinisterofEconomicDevelopmentandTradeof
Ukraine.
http://www.theguardian.com/world/2016/feb/04/economicministerresignationukrainecrisisaivarasabroma
vicius

DevelopmentandAdoptionoftheMilitaryMedicalDoctrine
http://reforms.in.ua/en/reform/indicator/1003
1
CabinetapprovedtheMilitarymedicaldoctrinePublished:December30,2015
http://bogomolets.com/ua/news/1623kabinetministrivzatverdivvijskovomedichnudoktrinu

Reformofmilitaryeducation.
http://reforms.in.ua/en/reform/indicator/10043

ReformsOffice

http://www.mil.gov.ua/ofisreform

MoDDeputyMinisterYuriiGusevresigns
http://newsme.com.ua/en/ukraine/politic/3277736/
MajorreformsbroughttotheMoD
http://www.mil.gov.ua/en/reformsoffice/
ChiefofGeneralStaffChiefoftheArmedForcesofUkraineArmyGeneralofUkraineViktorMuzhenkohas
nowpubliclyadvocatedseriousreforminmilitaryeducation
.
http://www.mil.gov.ua/en/news/2016/02/26/educationalprocessinmilitaryschoolsrequiresdrasticchanges
basingonatoexperience%E2%80%93ministerofdefence/

EHealth
http://www.mil.gov.ua/en/news/2015/04/15/ehealth%E2%80%9Dformedicalestablishmentsofministryof
defense/

Helmes
http://www.helmes.ee/

EProcurementReformsProject
http://www.mil.gov.ua/content/files/reforms/en_ereforms.pdf

ReformsforNormsandStandardsforProcurement
http://www.mil.gov.ua/content/files/reforms/en_food.pdf

UkrainianCrisisMediaCentre,Digestofreforms,February1319,2016.

http://prozorro.org/

UkraineRedCross
http://www.ifrc.org/en/whatwedo/wherewework/europe/ukrainianredcrosssociety/

UkrainianResuscitationCouncil
http://www.urc.org.ua/

152


MedicalATOFall/Autumn2015andWinter2016
WorldJEmergSurg.2006,Historyanddevelopmentoftraumaregistry:lessonsfromdevelopedto
developingcountries.BenedictCNwomeh,
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1635421/

UKRAINE20152016:THEREFORMCHALLENGE
http://www.razumkov.org.ua/upload/Pidsumky_2016_FNL_A4.pdf

Section5HealthandWelfare

PostTraumaticStressDisorderTheInvisibleConsequenceofWar
Militarychaplain
OleksandrDobrovolsky
www.volynnews.com
DmytroPovorotnyi
www.life.pravda.com.ua/person/2016/02/10/207938
/

SynodalManagementofMilitaryClergy
(
www.suvd.com.ua
)

PrivateJointStockCompanyoftherapeuticinstitutionsoftheUkrainianTradeUnionUkrprofozdorovnytsa
(
www.ukrzdrav.com
)

Interviewfor
www.pravda.com.ua

Sysoyenkosaidthat:ThelawOnpreventionofdisabilityand
rehabilitationsysteminUkraine

UkrainianCenterofassistancetovictimsofterrorismintheEastofUkraineFORPOST
Basedin
Dnipropetrovsk,consultingalloverUkraine.Phone:+38(096)8397617
Email:
forpost.dnepr@gmail.com

www.facebook.com/groups/1576615529262824/

NonGovernmentalOrganizationFreePeopleEmploymentCentre(FPEC).BasedinKyiv,consultingall
overUkraine.Phone:+380(67)2966643.Email:
czsl.staff@gmail.com

www.facebook.com/czvl.staff
www.czvl.org.ua

CivilOrganizationUkrainianPublicUnionPOBRATYMY.BasedinKyiv,operatingalloverUkraine.
Phone:+38(
098)6620228Email:
pobratymy.training@gmail.com
www.facebook.com/pobratymy.training

WoundedWarriorUkraineNameofOrganization:HealingWarScars,Inc.BasedinKyiv,operatingallover
Ukraine.Email:
roman@woundedwarriorukraine.org
www.woundedwarriorukraine.org

PsychologicalCrisisService.
BasedinKyiv,operatingalloverUkraine.
Phone:
+38(096)7300100
Email:
uaoste@gmail.com

www.facebook.com/psychological.crisis.service.ukraine

HerosCompanion
CanadianUkrainiannotforprofitproject.KalynaKardash,Founder&Director(English,Ukrainian)phone:
+38(098)6492900.Email:
info@heroscompanion.org
www.facebook.com/HerosCompanion862377377193122

www.heroscompanion.org

153


MedicalATOFall/Autumn2015andWinter2016
InfectiousDiseaseandtheConflict
ThesecondAnnualSeniorLeadershipWorkshop"Preventionofsociallydangerousdiseases(HIV/AIDS,
tuberculosis)intheArmedForcesofUkraine",Dec34,2015
http://aidsinstitute.org/en/news/118services14.html

HepCratesUkrmil
http://www.moz.gov.ua/ua/portal/pre_20151013_c.html
http://www.aidsalliance.org.ua/ru/news/pdf/13.10.2015/ReleaseHCVATOen.pdf

AlcoholandDrugAbuse

Nalbuphine
http://reference.medscape.com/drug/nalbuphine343329

SurgicalRehabilitation
AthirdteamofCanadianmedicalprofessionalswilltraveltoUkraineThemissionwillrunOctober23
November1,2015.
http://www.cufoundation.ca/news/124canadianmedicalteamreturningtoukraine

CanadaUkraineFoundationbeginsthethirdroundofreconstructivesurgeryinUkraine
https://www.facebook.com/cufoundation/posts/905860472827666

PhotoCredit
:UkrainianCanadianFoundation

Internationalsurgicalsupport
http://www.mil.gov.ua/en/news/2015/10/01/internationalcommunityprovidescomprehensiveandefficientm
edicalsupporttoukraine/

Germany
https://rickrozoff.wordpress.com/2014/09/02/germanytreatsukrainiantroopsinbundeswehrhospitals/

Lithuania
http://mfa.gov.ua/en/newsfeeds/foreignofficesnews/44815posolukrajinivlitovsykijrespublicivolodimirja
cenkivsykijvidvidavvijsykovijreabilitacijnijcentrimenijbasanavichyusaumdruskininkaj

ThePeoplesProject
http://www.peoplesproject.com/en/biotech/

iLaya
http://bones.ilaya.ua/?utm_source=ilaya&utm_medium=referral&utm_campaign=referral&utm_expid=11087
50731.g9P1dXaaSFGFBWCGQelolA.0

ExclusionisnotaSolution

PresidentPetroPoroshenko
awardsmedalstowomenonInternationalWomensDay
http://www.president.gov.ua/en/news/naperedodni8bereznyaprezidentnagorodivvidatnihzhinokv36821

Storyontheconditionsofthe53rd
.
http://www.hromadske.tv/politics/beznadiiniitil/

154


MedicalATOFall/Autumn2015andWinter2016
Ukrainestrugglestorecruitsoldiersforwarineast
http://uk.reuters.com/article/idUKKCN0VD21Q?ref=browsi
80thseparateairbornebrigadeJuniorSergeantIgorZinych,KIA,awardedHeroofUkraine
http://www.mil.gov.ua/news/2015/10/15/gerojukrainimedikkiborgigorzinichbuvspravzhnimgeroemmedi
komvidbogaspogadibojovihpobratimiv/

Ifyourepeatalieoftenenoughitbecomesthetruth(politics)

http://banksy.co.uk/out.asp

ReflectivelyRepressive
http://www.kyivpost.com/article/opinion/oped/reflexivelyrepressive409332.html

ArmyRadio
ArmyRadioFBpage

https://www.facebook.com/armyuaFM/?fref=ts
TelevisionandRadioStudiofundedbySpiritofAmerica.UNIAN:
http://www.unian.info/society/1280064ukrainelaunchesfirstmilitaryradiostation.html
MilitaryTVUTubepage

https://www.youtube.com/user/ctrsTVua/featured
The "Raid" doc film about the 95th AirMobileattack deep into enemy territory in the earlydays ofthe war.
http://ukraineunderattack.org/en/movieraid
WithEnglishsubtitles.

FundedbySpiritofAmerica
https://fundraise.spiritofamerica.org/campaign/2016savelivesstopsufferingandprotectfreedominukrain
e/c70461

FrozenConflictHealthandWelfareofUkraine

OfficeoftheUnitedNationsHighCommissionerforHumanRightsReportonthehumanrightssituationin
Ukraine16Augustto15November2015.
http://www.ohchr.org/Documents/Countries/UA/12thOHCHRreportUkraine.pdf
UNOCHA:HumanitarianSnapshotasof07October2015
https://www.humanitarianresponse.info/en/operations/ukraine/infographic/humanitariansnapshot07october
2015
HidinginPlainSight
http://www.atlanticcouncil.org/images/publications/Hiding_in_Plain_Sight/HPS_English.pdf
Illustration:TransparencyInternationalCorruptionIndex
http://www.transparency.org/country/#UKR
Photo:UNICEFUXO.Unexplodedordnance,Nikishine,EasternUkraine
https://www.flickr.com/photos/unicefua/16801154538

Section6Training

155


MedicalATOFall/Autumn2015andWinter2016
TacticalCombatCasualtyCare(TCCC)Past,presentandfuture
TacticalCombatCasualtyCare
https://www.facebook.com/TCCCTacticalCombatCasualtyCare%D0%A2%D0%B0%D0%BA%D1%82%
D0%B8%D1%87%D0%BD%D0%B0%D0%BC%D0%B5%D0%B4%D0%B8%D1%86%D0%B8%D0%BD%
D0%B0851349311624676/timeline

CurrentDevelopmentsinUkraineMilitaryMedicine
MinistryofEducationandSciences
http://www.mon.gov.ua/

F
romFrench
tiersmonde
,formulated1952byFrencheconomichistorianAlfredSauvy(18981990)on
modelofthe
thirdestate
(French:
tierstat
)ofRevolutionaryFrancehis
firstworld
(TheWest)and
second
world
(theSovietbloc)

www.dictionary.com/browse/thirdworld

Publishedinthe
L'Observateur
onAugust14,
1952

http://www.hommemoderne.org/societe/demo/sauvy/3mondes.html

UNESCO2015literacyrate
http://www.uis.unesco.org/DataCentre/Pages/countryprofile.aspx?regioncode=40530&code=UKR

MILITARYMEDICALDOCTRINEOFUKRAINE
OlegShekera
http://healthysociety.com.ua/index.php?option=com_content&view=article&id=919:militarymedicaldoctrine
ofukraine&catid=34:20110227210808&Itemid=53
ArticleonthestateofmilitarymedicineinUkraineHead
MilitaryMedicalAcademy,ValeriiSavitsky.
http://www.politikhall.com/issue/597

ControversycontinuestoswirlaroundMoDmilitarymedical12/25/15
https://www.facebook.com/valentyna.varava/posts/1187641447930316

InstitutionalChanges

InTSMUtheHeadsofMilitaryDepartmentsfromAllOverUkraineDefinedtheStrategyofMilitaryMedicine
Development
http://www.tdmu.edu.ua/en/2016/02/01/intsmutheheadsofmilitarydepartmentsfromalloverukrainedefi
nedthestrategyofmilitarymedicinedevelopment/

UkrainianResuscitationCouncil

http://www.urc.org.ua/

UkraineInternationalMedicalCongress

http://medforum.in.ua/en/node/707

VsevolodCherniakhovskyi
,ChiefInstrutor
https://www.facebook.com/vsevolod.cherniakhovskyi

MilitaryMedicalAcademy
https://www.facebook.com/photo.php?fbid=831336193650894&set=pcb.1640177232906652&type=3&theat
er

DepartmentofUkrainianArmedForcesMilitaryMedicalAcademy
http://medakademiya.com.ua/k_org_metod_zabez

156


MedicalATOFall/Autumn2015andWinter2016

EstoniaTraining
https://www.facebook.com/photo.php?fbid=1039876189402603&set=pcb.1039897509400471&type=3&thea
ter

MilitarymedicinetobetaughtatmedicalcollegesinLvivandKyiv
https://www.facebook.com/photo.php?fbid=987640097944769&set=a.886100444765402.1073741833.1000
00963649764&type=3&theater

"TheArmedForcesofUkrainetointroducedNATOStandardmedicalevacuation"DeputyMinisterof
DefenseofUkraine,YuriiGusev
h
ttp://www.mil.gov.ua/news/2016/01/14/uzbrojnihsilahukrainivprovadzhenostandartnatoshhodomedich
noievakuacziizastupnikministraoboroniukrainiyurijgusev/

ParamedicstobeintroducedintotheUkraineambulancesystemwhichiscurrentlystaffedbyMDs.Nov.9,
2015.
http://moygrad.kiev.ua/2015/11/09/kkievlyanambudetvyezzhatskorayapomoshbezspecialistovsmi/

ArecentevaluationofMoDmedicaltrainingcentersconductedatthefollowinginstitutionsrecommends
https://www.facebook.com/photo.php?fbid=1236640336363298&set=pcb.1236641016363230&type=3&thea
ter

InstitutionalChanges
http://www.mil.gov.ua/news/2016/02/29/rezervvijskovomedichnoisluzhbizbrojnihsilukrainigotuvatimutu
medichnihuniversitetah/

This toowasmirrored byPresidentPoroshenko who alsospoke thesamedayattheUniversityofDefense


ofUkraineInFeb2016.
http://www.mil.gov.ua/en/news/2016/02/26/educationalprocessinmilitaryschoolsrequiresdrasticchanges
basingonatoexperience%E2%80%93ministerofdefence/

WomenandTCCC
Photos:Chellew,WomenTCCCInstructors

MilitaryTraining
ThemedicaleducationdepartmentofMoDinconjunctionwithMedsanbatreleasenewtrainingmanualfor
SanInstructorwithinclusionofprinciplesofTCCCandwesternmilitarymedicalequipment.Nov1,32015
https://www.facebook.com/medsanbat/photos/pcb.1659069464340720/1659069361007397/?type=3&theate
r

81stAirbornepracticetriage,treatmentandevacuationskills.Feb8th2016
https://www.facebook.com/GeneralStaff.ua/photos/pcb.552176881618240/552175111618417/?type=3&thea
ter
ThefirsttrainingoftheArmedForcesMedicalcompanyofUkraineFBpage
https://www.facebook.com/groups/MedrotaVSU/?multi_permalinks=1674068966184145&notif_t=group_high
lights

157


MedicalATOFall/Autumn2015andWinter2016

NationalGuardfourdaymedtraining
http://www.mil.gov.ua/news/2016/02/24/vijskovimedikinapoligonahvdoskonalyuyutpraktichnialgoritmipor
yatunkuporanenih/

U.S.NationalAssociationofEmergencyMedicalTechnicians(NAEMT)
http://www.naemt.org/

WorldFederationofUkrainianMedicalSocieties
http://www.umana.org/about.php?func=committees

Censor.net

http://en.censor.net.ua/n363666

KhersonDetachedMechanizedBrigademedtraining
http://ngu.gov.ua/ua/news/gvardiycivviyskovoyichastyny2260vchylynadavatymedychnudopomoguumy
rnyychas

"Retoolinganarmyfromscratch,"asitfightsawar.
Intheearlydaysoftheconflict,hesays,"therewasalot
ofblood."
http://www.cbsnews.com/news/usukrainearmyretooltroopstrainingrussiabackedrebels/

CivilianTraining
LettertoMedsanbataboutthenecessityandimportanceofcontinuingTCCCeducationOct9,2015
https://www.facebook.com/medsanbat/posts/1654024048178595
UkrainianAssociationparamedicsandinstructors
https://www.facebook.com/groups/517354995106934/533951023447331/?notif_t=group_activity

UkrainianCouncilofResuscitationTCCCvideo
https://www.facebook.com/TCCCinUkraine/videos/1635833916691021/?fref=nf

ParamedicAssociationstartedwithvolunteertrainersfromvariousactiveTCCCtraininggroups
https://www.facebook.com/groups/517354995106934/531271843715249/?notif_t=group_activity

SumyTacticalMedicine
https://www.facebook.com/groups/490844707736291/524211691066259/?notif_t=group_activity

TACEVAC
http://www.urc.org.ua/images/01_02_2016/Koncepciya_TACEVAC.pdf

Medsanbat

CurrentlynotprovidingTCCCandfieldhospitaltrainingbutstillissuingreplacementequipment
andsupportingMilitaryefforts.

TrainingCenter44
(NowUkraineEMSA).TCCC/CLS/TEMS/FirstAid

WhiteBerets
TCCC

UkrainianResuscitationCouncil
(providerofACLS/BLSnowalsoNAEMTTCCC)

PatriotDefence
CLS,remotemedicandnowproposingaUTLScourse(UkrainianTraumaLifeSupport)

DoctorsforUkraine
DonatedsuppliesandsometraininginEstonia

158


MedicalATOFall/Autumn2015andWinter2016

MedPatriotUA
CLSandfirstaid

TacticalUkraine
(MilitarytacticsandTCCC)

TacMed

TrainingCenterREAGOUkraine.TEMS,TCCCHeartSaver,PHTLSandtacticalmedicalsupplies

SpecialTrainingCenter
(mostlyCPRandFirstAid,butsomeTCCC/CLS)

MalteserreliefserviceinKyiv
(mostlyCPRandFirstAid,butsomeTCCC/CLS)

RedCrossUkraine

(mostlyCPRandFirstAid,butsomeTCCC)
FASTFirstaidandspecialtrainingFAST.BusinessFirstAidandTEMS/firstaidforpoliceservices.

https://www.facebook.com/firstaidod/?pnref=story

SumyTacticalMedicineCLS
https://www.facebook.com/groups/490844707736291/530333727120722/?notif_t=group_activity

MilitaryPatrioticClub
MilitaryMedic

SaninstructorUA

TCCC

PirogovUkrainianSocialOrganization"MilitaryMedicineofUkraine

training,donatedsuppliesand
medicalpersonneltothefront

THelpers
Lviv
TCCC

Unit

TCCC

UkraineLegion
Militaryandtacticalmedicaltraining

MarusinBears

Militaryandtacticalmedicaltraining

SisterofMercy
Kharkiv.TrainingMedicsworkingfrontlines.

MedicalCorps
TCCCtraining,suppliesandmedicalpersonneltothefront.

MedicalCollege"Monad"pilotprogramforTCCC.Collegeforpharmacist,nursing,techniciansandnow
TCCC
http://www.monada.lviv.ua/

FacebookPage

FacultyforTrainingofDoctorsfortheArmedForcesofUkraine
BogomoletsNationalMedicalUniversity.

TCCCmaterialandmedicalpublicationstranslatedintoUkrainian

AmericanUkrainianMedicalFoundation
http://aumf.net/

159


MedicalATOFall/Autumn2015andWinter2016
UkrainianResuscitationCouncil
http://www.urc.org.ua/

Medsanbat
http://www.medsanbat.info/materials/page/2/

Departme
ntofOrganizationofMedicalSupportoftheArmedForces
PublishedbooksusingTCCCstandardsbytheMoD.
TacticalmedicinemilitarytrainingICT3Standard.
3:..:,
2015.148p.ISBN9668126513

Professionaltrainingofcompany(battery)sanitaryinstructor(1stedition):
()(1)..:,2015.416p.
ISBN9789667166342

SpecialTrainingCenter.
MostlyCPRandFirstAid,butsomeTCCC/CLS
http://1aid.com.ua/bazovyykursokazaniepervoyneotlozhnoypomoshchi

VabaUkraina,Estonia.TCCC,ATLS,supplies

http://freeukraine.net/et/

PatriotDefence

http://patriotdefence.org/en/

InternationalCollegesandUniversities
http://www.4icu.org/ua/

UkrainieMinistryofEducation
http://www.mon.gov.ua/

DanyloHalytskyiLvivNationalMedicalUniversity
http://www.meduniv.lviv.ua/index.php?lang=en

KharkivInfo
http://www.kharkovinfo.com/universities.html

KharkivAerospaceUniversity
http://www.khai.edu/efc/general/index.html

TwoUkrainianUniversitiesAreInQSWorldUniversityRankingsBySubject
http://itsukraine.com/education/twoukrainianuniversitiesareinqsworlduniversityrankingsbysubject/

QSWorldUniversityRankingsbySubject

http://www.topuniversities.com/subjectrankings/2016

InternationalMilitarytoMilitaryTraining
JointMultinationalTrainingCommandsupportUkrainemissionuntil2020
http://www.army.mil/article/163067/Joint_Multinational_Training_Command_support_Ukraine_mission_until_
2020/

InRivneendedtrainingcoursewiththeparticipationofUkrainianunitsoftheArmedForcesandBritish
militaryinstructors.
http://www.mil.gov.ua/en/news/2016/02/02/ukinstructorsconductedtrainingcourseforukrainianmilitary/

160


MedicalATOFall/Autumn2015andWinter2016
TheDefenceSecretaryhastodayannouncedtheUKwillgiftaround500,000worthoffirstaidkitstothe
UkraineArmedForces(UAF).
https://www.gov.uk/government/news/defencesecretaryannouncesmoresupporttoukrainearmedforces

OfficeofDefenceCooperation(ODC)
http://ukraine.usembassy.gov/odc.htm
l
EUCOM.EuropeanCommand
http://www.eucom.mil/

(
SATMO
)
SecurityAssistanceTrainingManagementOrganization
http://www.usasac.army.mil/usasatmo.aspx

DefenseInstituteforMedicalOperations
(
DIMO
)
http://www.dimo.af.mil/

TwittertagforUkrTraining
#OpUNIFIER

SpiritofAmericaBlog
https://spiritofamerica.net/recentblogposts/1826firstaidkitdistributioninukraineroundii.html

USArmy,
13thPublicAffairsDetachment

kcarmichael@dvidshub.net
http://www.army.mil/article/159088

USAgivesUkraineUSD23/mlllioninmedicalequipmentandmilitarycommunications
http://uatoday.tv/news/usgivesukraineusd23mlninmedicalequipmentandmilitarycommunications572
965.html

SWATtrainingfromUSAforeliteInteriorMinistryspecialforcesunitKORD
http://uatoday.tv/society/watchukrainesnewustrainedswatforceteamsinaction515350.html

173rdprovidingTCCCtrainingandequipmenttotheUkrAirborne
https://twitter.com/173rdAbnBde/status/676725842224013312

SpiritofAmericaprovidingmedicalequipmenttoUkrAirborne
https://twitter.com/SpiritAmerica/status/676856375453052928

NATOTrustFund
http://www.nato.int/nato_static_fl2014/assets/pdf/pdf_2015_12/20151130_1512factsheetnatoukrainesupp
ortr_en.pdf

CompositionofUkraineMilitaryMedicine

GeneralAndriiVerbaHeadoftheMilitaryMedicalDepartment
https://www.facebook.com/Ukrainian.mil.med

MainMilitaryClinicalHospital(MMCH).
AnatolyPKazmirchukMajorGeneralofMedicalService.
Headof
theNationalMilitaryMedicalClinicalCentre

http://www.gvkg.kiev.ua/

CompositionofUkraineMilitaryMedicine
http://www.dtic.mil/dtic/tr/fulltext/u2/p010930.pdf

MoDWhiteBook2014
http://www.mil.gov.ua/content/files/whitebook/WB_2014_eng.pdf

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MedicalATOFall/Autumn2015andWinter2016

MoDWhiteBook2013
http://www.mil.gov.ua/content/files/whitebook/WB_2013_eng.pdf

PetroPoroshenko
http://en.wikipedia.org/wiki/Petro_Poroshenko

StepanPoltorak
https://en.wikipedia.org/wiki/Stepan_Poltorak

MoDDeputyMinisterLtGeneralIgorPavlovskyi
(
)
http://www.mil.gov.ua/ministry/kerivnicztvo/kerivnicztvoministerstvaoboroniukraini/generalmajorpavlovskij
igorvalentinovich.html

MoDMedicalAcedemy
http://medakademiya.com.ua/

UkraineMilitaryMedicalAcademy(UMMA
)
ValeriySavytskyi,ColoneloftheMedicalService
http://medakademiya.com.ua

MilitaryMedicalAcademy
https://www.facebook.com/photo.php?fbid=831336193650894&set=pcb.1640177232906652&type=3&theat
er

BogomoletsNationalMedicalUniversity

http://www.nmu.edu.ua/eng/e8.php

OlegMykolayovychVlasenko.DoctorofMedicine,Professor,ColonelofMedicalService
http://www.nmu.edu.ua/eng/e8.php

MoD1stDeputyMinisterIvanRusnak()
http://www.mil.gov.ua/ministry/kerivnicztvo/kerivnicztvoministerstvaoboroniukraini/rusnakivanstepanovich
.html

Departmentofeducationandsciences
dvon@mil.gov.ua
http://www.mil.gov.ua/ministry/strukturaaparatuministerstva/departamentvijskovoiosvititanauki.html

Secondaryschools
http://www.mil.gov.ua/diyalnist/vijskovaosvitanatauka/vijskoviliczeitaliczeizposilenoyu/
(notethatonlythetwofirst,marked*areMoDtherestareMinistryofEducationandScience)

Militarysergeantcolleges,trainingBAspecialists,2.5yearsofeducation.PartofMoD
http://www.mil.gov.ua/diyalnist/vijskovaosvitanatauka/vvnztavnpvnzpidgotovkumolodshogospeczialista
naposadiserzhantskogoskladu.html

Highereducationinstitutions(45years)partofMoD
http://www.mil.gov.ua/diyalnist/vijskovaosvitanatauka/vvnztavnpvnzprohodzhennyavijskovoisluzhbiza
kontraktom.html

MoDMinisterofDefenceHusievresigns.
http://en.censor.net.ua/news/370189/cabinet_accepts_resignation_of_deputy_defense_minister_husiev

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MedicalATOFall/Autumn2015andWinter2016

ivilmilitarycoordinationheadquartersformedicalcaretake82decisionsforUkrainianmilitarymedicine
http://www.mil.gov.ua/en/news/2015/12/30/sivilmilitarycoordinationheadquartersformedicalcaretake82
decisionsforukrainianmilitarymedicine/

http://ukraine.ppl.ebrd.com/materials/docs/pa_kd_3.pdf

http://www.mil.gov.ua/en/news/2015/10/27/firstdeputyministerofdefenceofukraineholdstalkswithnato
adviserformilitaryeducationreform/

GraduationfromtheMilitaryAcademyinKharkiv.
https://www.facebook.com/GeneralStaff.ua/photos/pcb.559377370898191/559376720898256/?type=3&thea
ter

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MedicalATOFall/Autumn2015andWinter2016
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Acknowledgements
Oursympathytothefriendsandfamiliesofthefallen.

The authors would like to pay special thanks to all the unsung volunteers who work tirelessly
behind the scenes, the warfighters, ATO medical staff and the civilian hospital workers that
continue to perform in less than ideal conditions. To the many people that have supported the
MedicalATOprojectourdeepestgratitudeandsincerethanks.

Disclaimers
Theauthorsofthisreporthavenoconflictsofinterest.Mr.Chellewservedasmedicalconsultant
forMedsanbatandDr.QuinnasitsMedicalDirector.
IvonaKostynaisthe
ViceChairmanatPOBRATYMYandSectorV.
OlgaRomaniukworkedasatranslatorwith
MedsanbatandPatriotDefence.
ThereporteddataarebasedonmultipleATOvisits,
conversationswithactiveandinactivearmedforcespersonnel,trainingorganizations,
volunteers,activists,representativesofUkrainesinternationalpartners,NATOandUSmilitary
representativeandreportsfromcolleaguesinthefield.Theauthorscommentsandopinionsare
entirelyoftheirownanddonotreflecttheviewsofMedsanbat,UkrainianWorldCongress,any
donororpartnerorganization,theUSgovernment,NATO,anyofitsaffiliationsordepartments
oranyassociatedpolicywithinanygovernmentofanykind.Theauthorsopinionsareentirely
theirownanddonotreflectofficialorunofficialpolicyoropinionofanyorganizationsorthatof
itsguarantors.

167


MedicalATOFall/Autumn2015andWinter2016

Authors

John Quinn, MD,


PhD Candidate, Prague Center for Global
Health, First Faculty of Medicine, Charles University in Prague,
an emergency room physician, served as lead assessor for the
2014 Ukrainian World Congress (UWC) Medical Assessment
Report has served as Medical Director for Medsanbat until
September2015andhasservedasmedicaladvisortoelements
of NATO for conferences, medical doctrine review and systems
appraisalsupport.

Patrick Chellew, a paramedic, US citizen, is a resident of


Ukraine, coauthor to the 2014 Ukrainian World Congress
(UWC) Medical Assessment Report has served as Project
Director for Medsanbat and served as medical advisor to local
elements and elements of NATO for conferences, document
review and update medical support. Previously participated in
the
2004 Ukraine Rough and Ready disaster exercise with the
California National Guard and elements of Ukraine disaster
responseorganizations.

Ivona Kostyna,
Ukrainian citizen, Vice Chairman at

POBRATYMY a civil organization, working with returning


soldiers in Ukraine on a peertopeer approach. Founder of the
Sector V project a program of psychosocial adaptation for
veterans and their families. In 2014 organizator of the
CharitableArtfestivalUKROP.

OlgaRomaniuk
Born in Lviv, Ukraine. Holds a Master in Philology and
Translation Studies. Maidan activist.Assistedinternationalmedia
with research and translations. Participated in the introduction of
modern military medicine to Ukraine as translatorand interpreter
for international instructors which developed into the research of
the effects and the impacts on the existing military medical
infrastructureinUkraine.

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MedicalATOFall/Autumn2015andWinter2016

ListofAbbreviations
ATOAntiterroristOperation
FOBForwardOperatingBase
ECPEntryControlPoint
GCAGovernmentControlledAreas
IOIntraosseousaccess
IVintravenous
NGCANonGovernmentControlledAreas
M2MMilitarytoMilitaryCollaboration
MoDMinistryofDefence
MoIAMinistryofInternalAffairs
SBUSecurityServiceofUkraine
MoHMinistryofHealth
TXATranexamicAcid

SelectedDefinitions

An
oblast (Ukrainian: ), in English referred to asaregion,referstooneofUkraine's24
primaryadministrativeunits.

DefinitionsofJuniorMedicalPersonnel

Sanitar medical worker that fulfills supplementary functions. Does not require medical
educationbutmayneedspecialtrainingdependingonthework.
Duties: Sanitary and hygienic service including disinfection of rooms cleaning medical
instruments patient care, transportation, changing their clothes and bed sheets, informing
nursesanddoctorsaboutchangesinpatientstatushelpingmedicalpersonnelwithprocedures.

MidlevelMedicalPersonnel

Saninstructor junior sergeant personnel of medical service in military units. In wartime he


organizes medical supply of his unit using so called combat sanitars, who are either added or
assigned from the soldiers. Saninstructor is obliged to know the combat task of his unit,
location of the battalion or regiment clinic, provide medical recon he himself provides primary
medical aid. Together with sanitars he has to organize self and buddy aid, search and
evacuation of the injured from the battlefield. Heidentifiesandprovidesfirstaidtosicksoldiers,
controls hygiene of the personnel, teaches the rules of selfaid and buddy aid, supplies
personnel with first aid tools. Saninstructor reports to the commander of the company and
battalion clinic about the medical situation, number of wounded and necessary aid. His

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MedicalATOFall/Autumn2015andWinter2016
equipment consists of a combat medic bag that has equipment for first aid and an evacuation
strap.

Feldsher specialist with postsecondary medical education who is authorized to diagnose,


provide independent care or direct the patient to a doctor and prescribe. Onambulancesbeing
a part of a feldsher brigade, feldsher is a responsible provider of all work being a part of a
doctor brigade they work under the command of a doctor. In the absence of a doctor may do:
CPR, automatic defibrillation, intubation, cric, obstetric aid, puncture of external jugular vein,
prescribingmeds.
Clinical responsibilities may be considered midway between those of physicians and those of
nurses. In International Standard Classification of Occupations, 2008 is in the category of
paramedicalpractitioners.

Medsestra doctors assistant in treatment and prophylactics, performs the orders of a doctor
or feldsher. Gives orders to junior medical personnel (sanitary). Depending on their work, may
work as administrators or take care of patients according to the prescriptions, start IVs and
infusions, assists with the manipulations that only doctors are authorized to do, assists during
operations,preparingsurgicaltools,suturesanddressingsetc.

Nursing
2yearsnursingprogramADN(AssociateDegreeinNursing)
4yearsBachelorprogramBSN(BachelorofScienceinNursing)
2yearsBachelorprogram(forstudentsalreadyhavingADNdegree)BSN
2yearsMasterprogramMSN(MasterofScienceinNursing)

Seniorpersonnel
:Doctor(
likar),surgeonsandspecialists

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MedicalATOFall/Autumn2015andWinter2016

GeneralVerbaHeadofUkraineMilitaryMedicine
.
The following was an interview conducted by
Galina Titis ( ) in August of 2015
and printed in the Pravda Ukraine with General VerbaonmilitaryIFAKs,TCCC,volunteersand
the state of military medicine inUkraine.TheorigonalarticleisinUkrainianandcanbefounda
t
http://life.pravda.com.ua/person/2015/08/14/198596/
. All photos from the article have been
addedtothistranslatedcopy.

HeadofMedicalDepartmentofMoD:Onlyhalfofthemilitaryhasfirstaidkits

GalynaTytysh14082015
Andrii Verba is the one in MoD responsible for the whole medical
sphere in the ATO and more than that since Feb 2015 he heads
MilitaryMedicalDepartmentoftheMoD.
Before this medical service Colonel Verba operated in a MFH. A
simple Google search gives a number of Vinnytsia websites
publications talking about complicated surgeries in field performed by Verba in the ATO and
about thousand others the hospital has done under his command. Today Andrii Verba has a
much broader field of work and reporters have lots of questions to him. Verba arranges a
meeting in Kyiv Military Hospital Club. He looks comfortable here. In the first minutes of the
conversationhemakesanashtrayfromanapkinandsmokesacigarette.
The head of the Medical Department doesnt look like an official: emotional quick moves when
he gets interested in the conversation, frank answers to phone calls as iftherewasnoreporter
next to him. Look how it is organized he is passionately talking about the structure of the
medical careintheATOandtheplanstochangeitandstartsdrawinginthereportersnotebook
and even accidentally drops the voice recorder. At other times he answers slowly, carefully
choosing his words. Sometimes there is a smile on his face that is difficult to understand: is it
ironic, or mocking, or masking while Verba is thinking about his answer and checking the
reporter. It was only the after interviewthatthereporteraskedhimAreyoureadytoresign?to
whichVerbareactedimmediatelyandabsolutelysincerely:Eventomorrow!
So who has persuaded you to take this position insuchcase?askedthejournalist.ButVerba
didnotanswer,justsmiledmysteriouslyagain.

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MedicalATOFall/Autumn2015andWinter2016

WE ARE READYTOGETVOLUNTEERSINVOLVEDASTEACHERS SIGNACONTRACT,


GETAMILITARYRANKANDGOAHEAD
GT A year ago our army had no tactical medicine training. Today we know many
volunteer organizations doing TCCCtraining
(knowninUkrainesimplyastacticalmedicine
author).
What is done on the state level to ensure first medical aid is provided on the
battlefield?Meforexample,Iseeonlyvolunteersefforts.
AV This question should be dividedintofoursections.Thefirstsectionis
doctorstraining.The
second section is
feldshers training. The third key section is
saninstructor training. And the
fourth section is
shootersanitar training. Right away I want to say that this year we restored
positions of shootersanitars and saninstructors which were reduced few yearsago.Nowback
to the sections. There are no questions concerning the first section: they are trained in higher
educational facilities and since the fourth wave of mobilization a course was organized in
Ukrainian military medical academy to retrain officers. This is a course at one of the training
grounds, for the mobilized doctors. They took place in fourth, fifth and sixth waves of
mobilization. There were more than 300 doctors in the first classes (4th wave of mobilization).
This is the first time in the history of independent Ukraine that we have so many mobilized
doctors! At that time it was hard to see the big picture, see how it should be done. Some
mistakesweremade.
GT
Whatmistakes?
AV We tried to give them full combat training, full team building training. However, we didnt
take into account that they should have gone for some time to our hospitals to understand
where they were going. Second, there are some fundamental aspects of medical care,
especially in field military therapy, surgery, anesthesiology. So we corrected this from the fifth
course. In a short intensive period they are taking combat training and 4045% of training is
done by certainspheresinourmilitaryhospital.Concerningthesecondblock
feldshers
.They
are trained in medical colleges. The military does not train feldshers. What can be done about
it? MOH supported us and we will make a state order for 2016 concerning feldshers. Aperson
in college studies in a socalled special group. They are a mobilization reserve. Then we take
them to our training grounds, take them through 1.52 months of combat training, give them
military ranks and assign them to units. This will bedonebothinpeacefulandinwartimes.The
third block is
saninstructors
. And thats where we have most problems. What is a
saninstructor? He is not a medical professional. It canbeapersonwithbasicschooleducation
or vocational secondary education whichdoesnothavetobemedical.Thispersonlearnssome
st
first selfaid skills, predoctor care. We have approved that Sept 1
we are opening a
training
medical company on one of our training grounds that will trainsuchprofessionals.Durationof
thecourseisabout2.5months.

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MedicalATOFall/Autumn2015andWinter2016

GT
Andwhowillbedoingthetraining?
AV These are teachers and students of our Ukrainian academy. 23 officers have taken
international training and have internationalcertificatesonTCCCand otherspheres.Also,there
are volunteer groups working on our training grounds (the schedule is approvedbytheheadof
General Staff). These groups are covering this problem on tactical medicine training for our
warfighterscompletelyto90%.Thiswillbethefirststatetrainingforsuchprofessionals.
GT
Various volunteer groupsusedifferent approaches.Howdoyoudecidewhoisgoing
totrain?
AVYou areabsolutelyright.Thisis like religion:ithaslotsofschools.Bytheway,Iorganizeda
short meeting on this question on Tuesday, thats why we have approved standards for such
training,thatcorrespondtothestandardsof.
GT
Medsanbat website provides translated US TCCC standard and the Ukrainian
standard. They are different. If the American standard says that your first action is to
return fire and take cover and not moving anywhere until the shelling is over, the
Ukrainian standards 2015 say: return fire and move to the casualty(paragraph8).Idont
quite understand, if somebody teaches to shoot back and run for the casualty it is an
importantmistakebecauseyoucangetshotatthatmoment.
AVAmistakeiswhenyoudontprovidethecareneeded.
GT
Thisisabouttheorder.Anditisdifferent.
AVMyansweris:anystandardsarenotaxioms.
GT
Buttheyshouldhavealogicalexplanation?
st
AV In the beginning we mentioned the Medical company that is to be opened Sept 1
. I am
sure that during the first course a significant portion of those standards willbereviewed.Ithink
that by the end of the year we will have more unified, more pragmatic standards. We will use
personnel of our military academyforthistrainingcompany.Themainvisioniswearelooking
for staff and we want to appoint as teachers the
officers of medical service who have many
years of combat experience. So I think we have good quality standards and we will discuss
them and develop a unified standard. Concerning the statement that some other states have
something great. NATO medicine is NATO medicine. But every NATO member state has its
own medicine. And in some countries it differs substantially from the others. But the system of
predoctor care is similar in the basic ideas. So these standards do not differ much. I think in
trainingprocesswewillunifythesestandards.

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MedicalATOFall/Autumn2015andWinter2016

GT
I will explain why Iamtalkingso muchaboutthis standard. Iamabitconcernedthat
this standard was developed notsolongago.So,havingeighteenmonthsofwar,having
volunteer organizations we still get a standard that is going to be improved. Now
according to this standard people are teaching to crawl to the casualty, while another
standardtellstoshootbackandnotcrawl.Theseareradicallydifferentactions.
AV There are different types of war. These standards were writtenbasedontheexperienceof
the previous wars, so standards will be changed tomeetthedemandsofmodernwar.Because
the modern war is absolutely different from what wars used to be before. We know American
TCCC but we dont know its logistical aspect. In our system one shootersanitar has to gather
casualties in one place and treat them. He is onefortenpeople,hecantprovideaidandshoot
at the same time. So for now you crawl to the casualty. For now. And later we will see. I see
what you mean. To many representatives of ourvolunteerorganizationsactivelyinvolvedinthe
process I have suggested, suggest and am ready to suggest: you are welcome,
we are ready
to take volunteers as teachers inthetrainingmedicalcompany.
Wearereadytogivethem
suchpositions.
GT
So if somebody from Reago or Patriot Defense comes and says that they want to
teachinthistrainingcompany,youwilltaketheminsteadofofficers?
AV
Yes, sign a contract, get a military rank and go ahead. An official teacher, official military
rank.Iamtotallyforit.
GT
Whatisthesalary?
AV
Ithink,officersgetaboutfourthousandUAH.

Photo

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MedicalATOFall/Autumn2015andWinter2016

IF A MAJOR VESSEL IS INJURED, SELFAID IS ILLUSORY. BUDDY AID IS OFTHEMAIN


IMPORTANCE
GT Another question about the medical academy. These new standards they have
written do not talk about tourniquets that are used inNATOarmy,theyadvisetousered
rubber tourniquets. And they show pictures of their application. So when all our
volunteers are bringing CAT tourniquets, it provides for rubber tourniquets. This is
seriously falling behind. How come a 2015 standard can provideforrubbertourniquets?
How?
AV
I will explain. It is very simple. This year we have bought more than 30 thousand
tourniquets. Everything else is rubber tourniquet. We are not the US, not Israel, not Great
Britain, France or Germany. We are a state involved in a war. And we are a state with limited
funds. Lets talk basedonrealconditions.Ifthereisanopportunitytoprovidethem,andprovide
them immediately a decision should be made. So saying now that we should completely
supply all spheres according to international standards do you understand how much it will
costandifthestatehasfinancialresourcetodoso?Medicineisthemostexpensiveofall.

Rubbertourniquetapplication(picturefromthe
newstandards

ICT3).

(Captionforphotoabove)

(CaptionforPhotobelow)
AtthesametimemodernTCCCcoursesareteachingtourniquetselfapplicationinthedarkwith
onehand.Imaginedoingitwiththerubbertourniquet?

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MedicalATOFall/Autumn2015andWinter2016

VideotutorialonCATapplication
GT
Didyouestimatethebudget,howmuchitwillcost?
AVI knowMoDbudgetinmysphereverywell,article2220.AndIknowverywellhowmuchwe
requestfor2016and2017.
GT
Volunteers think that the best thing MoD has done was buying the chemical
hemostatic device QuickClot. Regarding tourniquets why was it decided to take
Ukrainiananalogtheperformanceofwhichislittleknown?
AV It was described in regulations as a mechanical device for bleeding control. There were
companies at the tender with offers for 160 and 400 UAH. We required thattherewerestudies
of its use in the ATO and we received more than 80 references fromtheATO.Next,theexpert
commission carefully studied tourniquets and we have protocols and signatures of the experts.
We have gone through this procedure twice. And for the tender, we bought more than 30
thousand tourniquets manufactured in Ukraine. And we have feedback, we have assessments
ofourexpertcommission.
GT
HavetheybeentriedintheATO?
AVYes,theyhavebeengiventothefrontlines.
GT
DidthewarfightersagreetotheUkrainiantourniquet?
AV There are confirmations. The first type of aid is self and buddy aid. It is important thatyou
understand, that
when a major vessel is injured, selfaid isillusory.Buddyaidisthemost
important role. It is desirable that a warfighter have a buddy who can provide aid or a
shootersanitar (shootermedic). There are some designs from volunteers of a special uniform
with builtin tourniquets both on higher and lower extremities. I think thatastheeconomicstate
ofthecountryimproveswewillconsiderthatspecialforceswillhavesuchuniform.

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GT
I am rather concerned about the resolutions of the Ukrainian institutes which say
that this is good and quality product You know how such resolutions are bought?
(bribe)
AVNothingisbought.
GT
I think it would be right to give it to some international research institute that could
testit.
AVTorelievesocialtensions?Doyouthinkthereissocialtensioninthisregard?
GT
There certainly is tension among many volunteers. Because it isaboutatourniquet.
If it is low quality a soldier wont be able to stop the bleeding and will die from
exsanguination.
AV Do you know what the requirement is for a chemical device for bleeding control? 5%. The
mainneedistopackthewoundandsecurethebandage,timelyandproperly.
GT
Iamtalkingabouttourniquets
AV There can be venous bleeding and only wound packing is used in such case. Tourniquet
application will only deteriorate casualtys conditions. So the need for a chemical device for
bleeding control on the frontline specifically is only5%.Wefoundthatithastobekaolinbased,
definitely. We will now buy more, we were given a resource to buy moreandweneedupto 30
thousand chemical devices for bleeding control.There is a device registered in Ukraine, it has
beenclinicallytested
GT
Ittakesalongtimeforittostopbleeding,67minutes
AV Has been tested, it is kaolinbased. So when we start a tender procedure to buy kaolin
again, anexpertcommissionwillbemakingthedecision.IfitdecidesthatQuickClotisbetterwe
will buy QuickClot. If a decision is made that Ukrainian device meets the requirements, we will
buy the Ukrainian device. In the end, I think thecountywillproducethecomponentsforfirstaid
kits(IFAKs)andothermedicaldevices.

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Photo

GT
Lets talk about the IFAK. It does not include a chest seal, nasopharyngeal airway
(NPA).Thesearenecessarycomponents.

AV Concerning NPA. Ifyougatherallvolunteershere youwill getabsolutelyoppositefeedback


about the need for such device. I personally not as the head of the Department but as a
military field surgeon I havent heard of a single suggestion from the people on the frontline
wheretheywouldneedanNPA.
I think that this is a skill that a saninstructorshouldknow.AndthereareNPAs, severalones in
his bag. Regarding the chest seal: together with volunteers we havemadeadecision:wehave
individual bandage kits
,
and plenty of them in storage. Do you know what that kit is? And that
thisindividualbandagekitwasmadeforthisfunctionandwillbeusedforit.

ProposedcontentsofindividualmedicalaidkitofUkrainianArmedForcesmilitary.

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GT
SountilwerunoutofIBKs,wewillnotbuychestseals?
AV It is not the best state approach in my opinion to have IBK, and it is designed as an
occlusivedevice,andnottouseitforthispurpose.
GT
Theyareoldfrom7080ies.
AV We are talking aboutthepackitself,not aboutthecontents.Bytheway,ifwetalkaboutthe
contents, and if you do a chemical analysis of the bandage, it is 100% Indian cotton. Just
compare visually the quality of that bandage and of modern bandages they are totally
different! And why do weneedthisgauze bandage?Forsecuring.Notforosmosis,no,wehave
anotherdeviceforthis.

TODAYONLY50%INTHEATOHAVEIFAKS(Fall2015)

GT Again back to IFAKs. I have seen many notices including on the MoD website that
everybodywillbesuppliedwithindividualaidkits. Butnoteverybodyis.RecentlyItalked
to a volunteer whoconfirmedthatfor example17th
tankbrigadedoesnthaveIFAKs.How
isitpossible?

AV They dont. In early 2015 army was at 150 thousand. The Department gets requests from
the bottom. The request formulated by the Armed Forces was 93200 IFAKs inthebeginning of
the year. With the army of 150 thousand. With 3035 thousand in the ATO at the time. 93
thousand for 150 thousandwas75%ordered.Weunderstoodverywellthat3045thousandwill
go to the ATO, and what will happen to the rest? It will go to emergencyreserve.Everythingis
good, everything is ok. And then interesting things begin. The contents of IFAK have been
designed. I am a surgeon. There was tender procedure and companies which took part in the
tender and were expecting towintheprocedureweresayingtotheDepartmentthatMoDhasto
pay 7% tax. The budget code of Ukraine says that all medical products are taxed 7%. And the
Article 32 of thefinal provisionscontradictsit.Sowhatshouldwedo?Theydemand7%andthe
Department of Finance approved it without 7%, following Article 32 final provisions. If we pay
7% it means additionalmillions,andifwedonttheotherpartywontsellus theirproducts.What
shouldwedo?Fortwomonthsithasbeenarealhell,ahugepackageofdocuments.And finally
the decision of the Cabinet of Ministers cancelled this 7%. But only for the list given for the
IFAKs. For two months weve been working in hell. Two companies won the tender: one
company two sets of 10,000 the other seven sets. Two months later and wehavethequestion
solved by the 31st of July. And then literally in two weeks the second company, the one that
won seven positions says: pay us in advance, we dont have money. But you have joined the
procedure, you have won! No, give us 50% in advance so that we start making pouches. And
legally we cant do it because it is not an IFAK, it is a pouch, it is not a medical product.
Payment in advance can be done for medical products. So we understand that it means No.
For long time weve been trying to persuade themtoterminate thiscontract, otherwisethispain
intheasswouldstillcontinue.

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Now there are only two positions, only 20 thousand. The procedure is over and in the next
threefour weeks we were trying to figure out the type of cloth. Because the cloth was brought
from abroad andwecouldntcheckitsqualityaccording toallStateStandards. Althoughwehad
a sample and the cloth was really good, but this is just a visual impression, and we needed a
document. And we went through this hell too. Today therearemorethan30 thousandIFAKsin
theATO.

GT
Andhowmanyarerequired?

AV Do you know how many soldiers are there in the ATO? Today theneedsaresatisfiedonly
by 50%. And by August 20th we will have a contract signed for the second batch, which is
th
70200. There is an idea that about the 27
of August we will have pouches and contents
broughtandmovefromthatpoint.Wearegivingthemlittlebylittletoeverysector.Butthereare
slightlydifferentfacts,thatstrue.

GT
Canyougivemethisdatasowecouldseeiftheyhavebeensold?

AVWhowouldsellthem?

GT
Blackmarketprofiteers.

AV How could they do it, at which stage? They can be sold only by the warfighter or by the
supply officer who received them. But I dont think they will do it because there are receipts,
numbers. We are talking about the state IFAKs. According to the order of the General Staff
Head, an IFAK has an inventory number. If Verba received an IFAK, leaving the battlefield he
has to turn in his weapons and IFAK. Why? Torefillitscontents.IfVerbadidntturnin hisIFAK
afterleavingtheATO,heshouldberesponsibleforthisinadministrativeorsomeotherway.

GT
So,mostlikelyifIFAKsarebeingsold,theyarefromvolunteers?

AV Have you seen an IFAK? It is written on it, it has a patch that is verydifficulttoremoveI
triedtodoitandIcouldnot.Thematerialisverygood.

GT
The IFAKs you are talking about will have all contents as you say, or will they lack
something?

AVYouknowthatmanyoftheNATOcountrieshavesimilarcontentsorsmaller.Significantly.

GT
Ifwetakeintoaccounttheregulargauzeandbrilliantgreenantiseptic,itissmaller.

AV We dont count the brilliant green antiseptic. Some groups have the same three
components. My dream was to have one IFAK for all security and armed forces. We are not
talking about special operations forces they need other contents, they have other needs.But

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the Armed Forces, the National Guard, Ministry of Interior, Border Guards, all of them should
have the same types. And my dream was to have a state order, Ukrainian manufacturing,
powerful, making, packing and shipping it by itself. The law has one cancelled position, it ison
state orders for medical products. This week we had a meeting with all of these forcesto have
one IFAK type for the security and armed forces. The law 0203 approves it, this is theorderof
the General Staff Head, and for the special period, for the wartime, the General Staff Head is
thetopmilitary.ThisisanexpensiveIFAKforsecurityandarmedforces.

GTHowmuchdoesitcost?

AV
Over a thousand UAH (40 USD). It is expensive. Thats why I think we haveaprettygood
IFAK.Butsomepositionsshouldbereduced.

GTForexample?

AVOnlyaftertheresolutionofanexpertcommission.ButoverallthisIFAKisgood.

GTButifyoucomparethem,theyaredifferentfromNATOIFAKs.

AVComparedtowhichstate?

GTAtypicalNATOmilitaryIFAK.
AV Ukraine has gone further thantheU.S.havegonein200years.Wehavedonethesamein
fiveyears.SoUkraineshouldhaveitsownIFAK.Ukraineisacountrywithactiveactiontoday

Medsanbat
.
IFAKcontents

GT
What makes you think that our scientists can do what American instructors have
been doing for years? QuickClot and Celox were not created in six months, such
productstakealongtimetocreate.

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MedicalATOFall/Autumn2015andWinter2016
AV Being in my position I get a lot of information about scientific researches, not something
makeshift, but designs of our science and research institutes which by the way understand
nanotechnology but to legalize it and organize productionwewouldhavetodoatripofMoses.
In my opinion, we should have created a committee, bureau, association which would work on
it, and would involve all nanotechnologies, all state institutions and may be nongovernmental
structures, people with initiative would go to this committee, and a fast review would be
completed,fastclinicaltrialandthenmanufacturing.Andyou willsee thatourpotentialandIQis
notlowerthantheirs.

GT
I am not talking about potential. If scientists say that ifearlierallonerequiredwasa
phone and a rope to conduct a research, nowadays complex tools are used anditcosts
lots of money. And to create QuickClotandCeloxequipmentworthhugesumsofmoney
is used. We are trying to do it with no tools, we dont havesuchequipmentbecauseour
scientificspherechronicallylacksfunding.

AVIwilltellyoumysubjectiveopinion,ifwedonttry

GT
We have to invest. But on the other hand, we have a war and we are talking about
things that save a life. This is not just a belt, a skirt,wearetalkingaboutseriousthings,
about things that stop bleeding. If it takes 67 minutes for our haemostatic device to
work,whydoweneedit?

AV In such case we will continue buying QuickClot or analogs. But the Ukrainian production
has to start now. Because we need to have emergency reserves. Every need is counted for
110%. Starting from the army of 150 thousand andorderfor93thousandwhichis75%.Butwe
counted everything as 110%fortheATO.Today'sarmyis250thousandroughlyspeaking.Soif
we take it for the whole army there should be 250,000 IFAKs in warehouses. So the order is
formed in the General Staff and in 2016 we will have increased funding for such things. This
year wehaveaspecialbudgetfundof230million.I madeadecisionthat money shouldnotstay
in the central administration. 75% was given to hospitals andthefirstlinkofchain,becausethe
order should be decided by a person, and only25%wasleftforthecentraladministration.35%
is93thousandpouchesand8.3millionforhardware.Yes,hardwaretoo.
First, we had a vision: buy one CTscan,itwascriticallyneeded foroneofourcentralhospitals.
But I made a decisionthat8.3hadtobedistributedforwartoo.Andwhatisneededatwar?Itis
anesthesiarespiratory machines to support the second line hospitals (Dnipropetrovsk and
Kharkiv). When we had the situation in Debaltseve, Artemivsk (MFH) lacked anesthesia
machines I made an order and we tookthemfromourhospitalsandsupportedthem.Andnot
to have to take them from other hospitals, 8.3 million is purchasing anesthesiarespiratory
machinesforsecondlinehospitals.
Next. Monitoring is needed in mobile hospitals and in our reinforcement groups working on
hospitals premises. And this is Xray machine for Dnipropetrovsk hospital. Thatswhywedidit
thisway.

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MedicalATOFall/Autumn2015andWinter2016
But the need for such diagnostic machines is extremely high. I hope thenextyearwewillhave
higherfundingtocoverit.

GT
Americanswantedtodonateusahospitalandthereweremanyproblemsaboutit

th
AV We already have it. Canadian hospital was given to 59
MFH according to my decision.
th
Because the 59
doesnt have any tents. In 2006 they received a French hospital which was
th
about 20 years old at the time, and from 2006 to 2014, the 59
MFH was set up morethan10
times because it was participating in all trainings. And in the ATO it was set up out in the field
four times. And one of them was very fast because the situation was very bad. So the tents
were given to them.AndnowwehaveaprojectwhichIwilldevotemylife. Intheirclassification,
it is level two hospital, in our classification it is not the second level, it is basically a medical
station.

GT
Whatdoesleveltwohospitalmean?

AVTheyhavetheirownclassification.

GT
Whatislevelone?

AV Level one hospital is one small tent. Level two is a more serious centre, with some
equipment, personnel of doctors. How is it done now? The patient should be stabilized. Thisis
done by a shootersanitar. Heevacuatesthecasualtyfromunder fireandprovidesprimarycare
applies a tourniquet and brings casualties to the socalled nests,acasualty collectionpoint,
protected from fire. Then a saninstructor takes care of the patients. Then there is a medical
company which evacuates and stabilizes the casualty until theygettoafieldhospitalora static
hospital. It has medical professionals who provide higher care. To have everything working
properly there must be armored vehicles on the frontlines (Saxons and
MTLBs
), good
communication, trained personnel and medical vehicles. If all these logistical components are
availablewehavenoproblemswithevacuation.

The weakest link so far is medical transport


. Today with 100% vehicles required we only
have 85%. And 40% of those are given to us by volunteers. These are ambulances of various
classes from A to C. We dont need C class here, we need fast fourwheel drive A class
vehicles. We cant completely cover this gap, we need about 150200 medical vehicles here.
But we also have to create service centers to replace details such as filters. And our state
doesnt have production of medical vehicles organized.
UAZs
,
Sabols
,
Gazels
are all Russian
vehicles. And we are calling up plants in Lviv, Kremenchuk and tell themtowork,producenew
vehicles.

We have some serious achievements regarding mobile wound care stations, mobile dental
stations and mobile Xray stations. Also, we need shower disinfecting stations. All of them are
based on
GAZ66
vehicles. So we know that we have Ukrainian manufacturer
KRAZ
. And we

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MedicalATOFall/Autumn2015andWinter2016
worked out medical and technical requirements for mobile wound care stations and Xray
stations. And as this manufacturer is Ukrainian, we have the questionofmaintenancecovered.
But evacuation vehicles remain the biggest problem for us. Regarding the mobile hospital. We
have three of them in the ATO (
drawing in reporters notebook).
Here isthehospitalsystemon
thefrontline.

GT
ThewayyoudrawitMFHsarefurtherthanregularhospitals?

AV That is true. They are 50100 km away from the frontline. But we will movethem,theyare
mobile. Local hospitals are used to provide care faster because they are closer to frontlines. A
medical company consists of 120 people. Basically, it is a minihospital capable of surgical
interventions. But the thing is that they are not allowed to use narcotics. Andweuseamedical
company, its professionals to reinforce local hospitals. But very soon we are going to end this.
We want to replace it with the system available in the hospital the US donated to us. This is a
very important thing. Itisgoingtobeavehicle withdoctors.Itcomes,opensatentandprovides
care.Andyoucanmovedependingontheoperativesituation.

I WANTTOHAVEAPROGRAM ofAFMEDICALSERVICEDEVELOPMENTFOR 5YEARS


READYBYMIDOCTOBER

GT
When you took this position, you had clear understanding what you wanted, what
yourgoalswere.Whatdidyouwant?

AV (laughs) I lived a normal good life of a region chief surgeon. But I was completely
unsatisfied withwhatwashappeningintheATO notwithwhatwashappeninginhospitals,but
in the ATO itself. But Iam ahospitalofficer.Ihavegonethroughallthesestages,Ihaveserved
in the military for 5 years, I know it all. But I was not satisfied with this mess.Mydreamwasto
start and do organizational changes in the ATO. I imagined that this was averyhighposition.I
will put everything into order fast and they will let me go. Then I started bringing in more
likeminded people and we completely changed ATO medical service system.
We removed
those guys with no education and no training. I started to rely onhospitalofficers.Especiallyin
sectorsBandC.
And the way to join medical service was different. No officer could join it until he came to the
military medical educational department and renew his knowledge. He had to calculate a
number of casualties, need for medications and medical devices, medical vehicles, define
evacuation routes. I want to have a program of Armed Forces medicalservicedevelopmentfor
five years ready by mid October. We had some ideas on the program but we did not see the
military doctrine. It is to be approved soon and we know the keypoints. Theprogramhastobe
practicalandclearaboutwhichspheresaredeveloped.

GT
I dont understand, how it can bethatalot ofworkisdonebyvolunteersbutdespite
thefacttheyarenotactivelyinvolvedinworkingwithyou.

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MedicalATOFall/Autumn2015andWinter2016
AV Some volunteers are doing very good work in evacuation. But to make them even more
effective we need them toenterthe generalevacuationnetworkbecausetheATO medicalchief
needs to understand what resources and where they have. But some people want to be their
ownkings.Weneedanorganizedsystem.Everythingshouldbeinageneralnetwork.

GT
Dowehavesuchnetworknow?

AVYes,currentlywehaveaprojectonsupplyingitwithGPSnavigators.

GT
Yes, this is being done by the team of developers headed by Eugene Maxymenko. I
wonder,whendidthisnetworkstartworking?

AVSinceAprilMay.

GT
And again about getting volunteers involved. I still dont understand why you dont
involveforeigninstructorsfromNATOtodotacticalmedicinetraining.

AV No questions. Here you have the training grounds, here another one. You are welcome.
Everything shouldbedoneofficially, tohave somebodyresponsibleforit.Wegiveyouatraining
ground and you workonthisquestion.Andanothergroup willworkonthe othertrainingground.
Because if you listen tosomevolunteers,everythirdUkrainianhastakensuchcourses.Butitis
nottrue.

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TheEnd

186