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Five Myths About Medical Care, Training and Equipment for Ukrainian Soldiers in the Anti-Terrorist Operation (ATO)

By Dr.Ulana Suprun
Original article:

Myth 1. We need to buy EKG machines and ambulances for Ukrainian soldiers on the front lines.

Truth: What's needed at the front are tourniquets, bandages and lessons in basic hygiene to prevent non-battle related illness.

There are scores of hospitals and polyclinics within 30 km of the front lines where routine procedures like EKGs can be performed. The front lines require training and equipment that save the lives of the injured by treating massive hemorrhages, maintaining airways, treating tension pneumothorax and assuring adequate circulation, then transport to a facility where a higher level of care can be provided to the wounded. EKGs are not included as a necessary procedure in these protocols and are not performed on the battlefield.

Moreover, shiny white civilian ambulances with bright red crosses are wonderful targets for the terrorists' artillery and snipers. They should be used as transport vehicles from local or field hospitals to major centers like Kharkiv, Dnipropetrovsk, Kyiv, etc. Evacuation vehicles deployed to the front should be armored, properly supplied with trained personnel and equipment to provide medical care to the wounded

Myth 2: Any aid is good aid.

Truth: Focused aid is effective aid. For example, empty tents without medical equipment inside do not fulfill the criteria of a “mobile hospital.” That money would be better spent on improving the capacity of local hospitals in the ATO through training of medical personnel in trauma care and providing basic equipment that could save hundreds of lives, both civilian and military.

An objective assessment of the real needs for medical equipment and supplies by a third party, such as an independent NGO, should guide the choices made by government and international agencies when providing any material aid to the security sector, specifically to the Ukrainian Ministry of Defense.

Myth 3: All foreign instructors are qualified to teach medical courses.

Truth:  In the USA, Canada, and Europe, only those who have certified instructor status for courses such as Advanced Life Support, Advanced Trauma Life Support, Advanced Cardiac Life Support and are Registered Paramedics or Medical Doctors, are allowed to teach trauma courses.

Instructors should also have experience in having taught multiple courses and access to appropriate training equipment. Class sizes should be small for advanced level courses, no more than 5-6 students per instructor. Each course should include both written and practical exams. And the course description, course materials, teaching objectives and course schedule should be made available to registered students in advance of the course, so that they can familiarize themselves with the materials. Any promise of certificates or equipment to be distributed at the end of the course must be followed through upon by the course organizers.

Myth 4: Anyone who has taken a Tactical Combat Casualty Care or Combat Lifesaver Course can be an instructor and teach others.

Truth:  To qualify as an instructor for either TCCC or CLS, one must take the course itself, then take and pass an instructor level course. At that time the "junior instructor" would greatly benefit from mentoring by a more experienced instructor.

The TCCC or CLS course must be taught with a student to instructor ratio of no more than 20:1, and the instructor must provide the students with training materials such as tourniquets and bandages, as well as manikins and other equipment for hands-on practice of the skills. 

Evaluation of knowledge and skills by way of practical exams and successful completion of specific simulated scenarios, where students provide care to injured, should be mandatory.

Myth 5:  All TCCC courses are the same.

Truth: The Tactical Combat Casualty Care (TCCC) course introduces evidence-based, life-saving techniques and strategies for providing the best trauma care on the battlefield.

The TCCC-AC (TCCC for All Combatants) course also known as Combat Lifesaver (Self Aid, Buddy Aid) in the US Army, is designed for non-medical military personnel and includes first responder skills appropriate for soldiers, sailors, airmen and marines.

They are taught Care Under Fire, stopping life-threatening hemorrhage, airway management, treating tension pneumothorax, controlling bleeding and tactical evacuation. 

The TCCC-MP (TCCC for Medical Personnel) course is designed for combat EMS/military personnel, including medics, corpsmen, and pararescue personnel deployed in support of combat operations. 

It is an extended course, teaching the same skills and protocols as above, but includes chest tube insertion, treating burns, obtaining intravenous access, fluid resuscitation, protocols for administering Tranexamic acid (TXA), blood and analgesia, and splinting of injured extremities. 

Finally, a very important component of tactical medicine lies in the first word, i.e. “tactical.”  The TCCC protocols for Care Under Fire include:

1. Return fire and take cover.
2. Direct or expect casualty to remain engaged as a combatant if appropriate.
3. Direct casualty to move to cover and apply self-aid if able.
4. Try to keep the casualty from sustaining additional wounds.
5. Casualties should be extricated from burning vehicles or buildings to places of relative safety. Do what is necessary to stop the burning process.
6. Airway management is generally best deferred until the Tactical Field Care phase.
7. Stop life-threatening external hemorrhage if tactically feasible

Only after a number of tactical decisions and actions are taken, can care be provided to the casualty, and only to stop life-threatening hemorrhage and to stop an active burning process.

Thus, to teach a TCCC course, one must not only have the "medical" portion of the training covered by the instructors, but the "tactical" portion as well.  That is why most instructors are ex-military or have a large amount of experience in conflict zones. 

Karl Popper wrote, that “we can learn through criticism of our mistakes and errors, especially through criticism by others, and eventually also through self-criticism.” If we hope to survive and save lives, we must open ourselves to constructive criticism, acknowledge our mistakes, own our failures and base our approach to medicine not on myths, but on evidence.