Medical ATO Report: Ukraine

Rapid Communique: 100 Meters

Winter 2016-2017
Patrick Chellew
Disaster Medicine Specialist
Program Lead
Medical ATO Report Series
Kyiv/Ukraine

Olia Romaniuk
Medical ATO Report Series
Project Researcher / Linguist
Kyiv/Ukraine

John M. Quinn MD, MPH, Paramedic

Medical ATO Report Series Medical
Advisor
Ph.D. Candidate and Researcher
Prague Center for Global Health
Institute of Hygiene and Epidemiology
First Faculty of Medicine
Charles University, Praha, Czech Republic

Executive Summary
This extremely short rapid field assessment will serve as an immediate identification of gaps in
the medical evacuation chain experienced this winter with severe upticks in violence in the war
in Ukraine. At the time of this publication, Ukraine continues to see steep upticks in violence
with another reported shelling of Avdiivka with civilian casualties as of February 16th, 2017. The
daily skirmishing along the line of control1 is vicious and lethal: The Ukrainian Armys mortality
rate for the duration of the conflict is higher than that experienced by the United States Armys
during the Iraq War.2

Based on field data collected from December 2016 to February 2017, there are multiple gaps
that prevent patient care and lead to increased morbidity and mortality of Ukrainian warfighters
and all civilians caught in the middle of conflict. This reports aim and primary objective is to
share a snapshot of the incidence and prevalence of warfighting associated trauma and illness,
highlight gaps in the evacuation chain, and discuss what can be done to mitigate these gaps;
and finally to serve as a very short Medical Lessons Learned knowledge sharing in Hybrid
Warfare. The underlying methodology of the Medical ATO Report Series can be found in

1
Also referred to as ATO (anti-terrorist operation), ATO Zone, Line of Contact (LoC) and Line of Control (LoC)
2
A Real War Going On: Mixed News From the Front Lines in Ukraine
http://dailysignal.com/2016/02/05/a-real-war-going-on-mixed-news-from-the-front-lines-in-ukraine/
previous reports. We find that through medical and health support in Ukraine, NATO and NATO
partner states can enhance their strategic commitments for the region. Lastly, Command,
Control, Communications, Computers, Intelligence, Surveillance and Reconnaissance (C4ISR)3,
4
, remains a core process to reform in Ukraine MoD military doctrine. The approval of the
Strategic Defense Bulletin (SDB) by President Petro Poroshenko on May 20, 20165 has
supported these best practices and international standards and continues to evolve as seen in
the past 18-24 months and will hopefully push and advance with more evidenced-based
reforms.

Ukraine MoD and other support agencies have developed rapidly in both capacity and
capability, however, medical command and control remains elusive, as well as tactical decisions
at the level of battalion and brigade as top-down management freezes6 the ability for those on
the front to react in real time to real time events and the shifting changes seen on the front.
Therefore these gaps that exist create for the medical teams increased morbidity and mortality
from preventable battlefield trauma and illness. The risk to health and health security
deterioration is great in both government and non-government controlled areas. These
government controlled areas currently at war, uncontrolled government areas and ungoverned
spaces threaten the basic sovereignty and rule of law for Ukraine. This risk and threats make
Ukraine a fragile state and supporting healthcare and health security infrastructure can mitigate
this fragility and can encourage rule of law and basic democratic institutions.

Please find at the end of this report a detailed list with thorough historical context related to this
war as well as to the theme and underlying methodology for the Medical ATO Report Series,
this rapid assessment is one supplement as part of this extensive series. Due to brevity, there
are both link-references to websites and video in support of these findings, as well as historical
references and academic articles in the form of footnotes and in the end of this short report.
This is only a rapid assessment and seeks to identify very fixable gaps in the medical
evacuation chain and prevent death and morbidity on the battlefield and neighboring regions.
This report is a brief snapshot and offers very practical solutions.

Very Brief Review: Winter Upticks

In December 2016, 19 Ukrainian soldiers were killed in the Donbas conflict zone. In January
137 Ukrainian soldiers were killed or wounded in the war in eastern Ukraine in January, with 20
KIA and 117 WIA. Journalist and military analyst Yury Butusov estimated that in 2017 Russian
forces lost about 70 fighters.7 As of Feb 24, 2017, 31 Ukrainian soldiers were killed, 229

3
Command, Control, Communications, Computers, Intelligence, Surveillance and Reconnaissance (C4ISR)
http://www.lockheedmartin.com/us/what-we-do/aerospace-defense/c4isr.html
4
Ukraine MoD military doctrine https://defense-reforms.in.ua/news/ukrainska-armiya-otrimaye-novu-it-infrastrukturu
5
Strategic Defense Bulletin (SDB)
http://www.president.gov.ua/en/news/prezident-zatverdiv-strategichnij-oboronnij-byuleten-ukrayin-37309
6
Tzvi Arieli, Instructor military tactics Ukraine. Front line forces are better, faster and more adequately perceive incoming
information, where unfortunately traditional Ukrainian response requires top down permission to act.
http://www.dsnews.ua/politics/tsvi-arieli-pochemu-nevozmozhno-pobedit-na-donbase-bez-uvazheniya-20022017220000
7
2017 Russian forces lost about 70 fighters
https://www.unian.ua/war/1777897-protivnik-vibitiy-z-dvoh-pozitsiy-jurnalist-rozkriv-vtrati-l-dnr-u-2017-rotsi.html
wounded since the beginning of year.8 As of February 20, 2017, the Ministry of Foreign Affairs
of Ukraine reports that war against the Ukrainian people has resulted in over 9,800 Ukrainian
people killed, about 23,000 wounded and almost 1.8 million internally displaced persons.9
President Poroshenko announced on Feb 22, 2017, that 2608 Ukrainian soldiers were killed in
this war.10 The background to events of Russian invasion and current warfighting activity is
extensive and will not be entirely covered in this rapid report assessment, more details and
context can be found in the links and references section at the end of this report.

Updated Notes on Chemical, Biological, Radiological and Nuclear (CBRN)

The Medical ATO Report Series has commented previously about the threat of CBRN and
warfighting activities in the ATO Zone. The use of white phosphorus has been documented
several times in the past 18-24 months.11 The use of biological weapons has not been founded
or evidenced to the date of this publication. The use of depleted uranium rounds and munitions
may be an additional step in the evolution of warfare; currently there is no evidence of this and it
remains a potential threat and challenge.

Additional info from The Toxic Remnants of War Network12

8
Please see LiveUAMAP: https://twitter.com/Liveuamap/status/835412153788170243 up to the hour updates on warfighting and
upticks in violence.
9
MFA: War against the Ukrainian people: over 9 800 Ukrainian people were killed, about 23 000 wounded and almost 1.8 million of
internally displaced persons:
http://mfa.gov.ua/en/press-center/news/54926-zajava-mzs-ukrajini-shhodo-tretih-rokovin-zbrojnoji-agresiji-rosijsykoji-federaciji-proti-
ukrajini
10
President Poroshenko announced on Feb 22, 2017 that 2608 Ukrainian soldiers KIA
https://twitter.com/radiosvoboda/status/834421489952759808
11
http://europe.newsweek.com/ukraines-defence-forces-accuse-separatists-using-white-phosphorus-327537
12
The Toxic Remnants of War Network
http://www.trwn.org/new-data-on-ukraine-conflicts-environmental-risks-supports-calls-for-comprehensive-assessment/
Furthermore, in the heavily industrialized region such as Rubizhne is a massive industrial
engineering center in the Luhansk oblast. Combined with the cities of Lysychansk and
Severodonetsk, the three cities form one of the most important chemical centers in the country
13
of Eastern Ukraine and given their proximity of about 30 Km from the contact line, the threat
of an accidental release or spill as the result of collateral damage or a direct attack is a real and
present danger; and the threat of radiological and/or tactical nuclear weapons remains possible
and training and treatment efforts are lacking for prevention and preparedness to this threat.
Defence against Chemical, Biological, Radiological, and Nuclear (CBRN) Agents is a core
health security challenge and one that requires renewed efforts in data collection and support
for basic civilian and medical disaster response infrastructure.

Medical countermeasures against CBRN agents and training related to rapid identification
should be highlighted with projects and programming. Over the past decade, the United States
and key international partners have addressed these dangers through a variety of programs and
strategies aimed at developing and enhancing countries' capacity to rapidly detect, assess,
report, and respond to acute biological threats.14 Methods and technology regarding the
protection against, diagnosing effects, detection, decontamination, destruction, disposal and
containment of CBRN agents remains a core requirement for Ukraine Ministry of Defense (MoD)
15
; Ministry of Health (MoH)16; Ministry of Interior (MoI)17 which oversees the National Guard,
State Emergency Services, National Police, State Border Services; medical institutions such as
Mechnikov Hospital and academic institutions such as Ternopil Medical Institute18, Shupyk
National Medical Academy of Postgraduate Education Department of Disaster Medicine19 and
the Ukrainian Resuscitation Council20, and civil responders such as the Ukraine Red Cross and
their elite Rapid Reaction Brigade21; all of which above require further collaboration with
international efforts and coordination.

Risk management and recovery strategies for CBRN and other health security threats and
challenges require renewed efforts by partners and the Ukraine MoD and MoH. One supporting
health security project that disaster services benefit from is the interaction with the Joint External
Evaluation (JEE)22. This voluntary, collaborative process assesses a countrys capacity under

13
http://www.ukraine.com/luhansk-oblast/rubizhne/
14
Moudy, R. M., Ingerson-Mahar, M., Kanter, J., Grant, A. M., Fisher, D. R., & Jones, F. R. (2014). Bridging the Health Security
Divide: Department of Defense Support for the Global Health Security Agenda. Biosecurity and bioterrorism: biodefense strategy,
practice, and science, 12(5), 247-253.
15
MoD http://www.mil.gov.ua/en/
16
MoH h ttp://www.moz.gov.ua/ua/portal/
17
MoI http://www.mvs.gov.ua/en/
18
Ternopil Medical Institute http://emmt.tdmu.edu.ua/english
19
Shupyk National Medical Academy of Postgraduate Education http://nmapo.edu.ua/index.php/en/
20
Ukrainian Resuscitation Council h ttp://www.urc.org.ua/
21
Ukraine Red Cross http://redcross.org.ua/
22
Please reference Global Health Security Agenda: Assessment in Ukraine:
https://www.ghsagenda.org/docs/default-source/jee-reports/ukraine-jee-report.pdf
the International Health Regulations (200523,24) (IHR) to prevent, detect, and rapidly respond to
25 26 27
public health threats whether occurring naturally or due to deliberate or accidental events. , ,

Assessment Sites and Links in the Medical Evacuation Chain

Please find a list of visited sites by the Medical ATO Report Series with listed gaps in the
medical evacuation chain, lessons learned and potential fixes for Winter (December 2016-
February 2017). A summary of the key recommendations and core systems and processes to
be addressed are found in the conclusions section of this assessment. Please also note that this
assessment is only the latest and in addition to the multiple other reports and their key findings
and recommendations from the previous reporting and should not be viewed in a vacuum or as
an isolated data set.

Battle of Avdiivka. January 29 - Feb 5th, 2017

Promka, Avdiivka, Ukraine

After much of the eastern Donbass region was

occupied by Russian forces and their separatist
proxies in the Spring of 2014, government forces
retook control of Avdiivka on July 21st, 2014.
Avdiivka, an industrial town and best known for
the Metinvest Avdiivka Coke Plant and was now
on Ukrainian government-controlled territory in
Eastern Ukraine, but precariously, along the
contact line, about 6km to the north/west of
Donetsk.

Since warfighting and hostilities began, the town has been subject to periodic attacks, mostly
shelling after government forces took control from the separatists and these attacks continued
sporadically till March of 201628. The 72nd Brigade established a Forward Operating Base
(FOB) near the eastern approach to town known as the Promka or Industrial Zone. The
location is within the area stipulated in the Minsk II (please also see sections below reference to

23
World Health Organization. (2016). WHO statement on the first meeting of the International Health Regulations (2005)(IHR 2005)
Emergency Committee on Zika virus and observed increase in neurological disorders and neonatal malformations. Saudi medical
journal, 37(3), 332-333.
24
World Health Organization. (2008). International Health Regulations (2005). World Health Organization.
25
Please also see: https://www.ghsagenda.org/assessments
26
Shearer, M. P. Health Security.
27
Region, E. M. (2015). Assessment of essential public health functions in countries of the Eastern Mediterranean Region.
28
Medical ATO Report Fall/Autumn 2015 and Winter 2016 on the evacuation chain in Avdiivka at the start of the March 2016
escalations: https://www.scribd.com/doc/309297065/Ukraine-Medical-ATO-Fall-Autumn-2015-and-Winter-2016
Minsk II) agreement as part of the government-controlled zone of the Donbass29. However, it
gives the Ukrainian armed forces a tactical advantage over the key highway, H-20, contacting
Donetsk with Horlivka and also limits the Russian forces ability to harass and shell the town with
mortar fire. Over the 2016 / 2017 winter months, there has been an ever-increasing escalation
of lethal attacks by Russian forces on this Forward Operating Base (FOB) and neighboring
areas.

Based on qualitative data gathering from Ukrainian personnel on the ground, Russian forces
regularly rotated fighters through their position at the
Yasynuvata Road Police Post for live fire training on
Ukrainian position in the Promka. Furthermore, it has
been reported that over the last 12 month period, there
have been many attempts to breach the Ukrainian
positions along the Avdiivka city border. The latest and
most serious example, on the 29th of January, 2017,
when an escalation began at 5 AM, in Promka and
continued for almost a week before returning to below
normal or normal levels of fighting (normal
described as 40-90 number of reported violations per
day of various intensity).30 31 By January 30th, fighting
broke out along the line from Mariupol in the South to Lugansk in the North, with Avdiivka taking
the brunt of the hostilities and Svitlodarsk Bulge suffering a significant portion of the casualties
including one medic killed in action (KIA) and several others injured (please see the section
below related to Svitlodarsk Bulge).

Over a two week period of shelling in the Donbas 327 homes were damaged or destroyed. First Vice-Speaker of the
Verkhovna Rada, Irina Gerashchenko32

29
Please also referrence Minsk II text at:
http://www.europarl.europa.eu/RegData/etudes/BRIE/2016/573951/EPRS_BRI(2016)573951_EN.pdf and
https://www.ft.com/content/21b8f98e-b2a5-11e4-b234-00144feab7de for full content and context
30
MoD ATO Reports can be found here: http://www.mil.gov.ua/en/
31
OSCE ceasefire violation graph of previous 5 weeks prior to Feb. 24, 2017
https://twitter.com/OSCE_SMM/status/835044830535352320/photo/1
32
First Vice-Speaker of the Verkhovna Rada, Irina Gerashchenko on damaged structures
http://korrespondent.net/ukraine/3816424-na-donbasse-za-dve-nedely-razrusheno-bolee-300-domov
 Ukraine Crisis Media Center Interactive map for January 30, 201733

After less than a week of fighting and according to a report published on Feb 3, 2017, in the
Wall Street Journal, 13 Ukrainian soldiers were killed and over 70 wounded.34 This included
Natalia Khoruzha, RN/medic, 54th Brigade, KIA when her clearly marked tabletka ambulance
was hit by an anti-tank missile in Svitlodarsk
Bulge and another civilian medic KIA in Avdiivka
during the shelling of the city.35 A total of five
other medical personnel or passengers were
wounded in these two incidents with one medic
dying Feb 21st from his wounds36. Other media
outlets pegged the casualty count for the
Avdiivka offensive as 110 Ukrainian soldiers
were killed or wounded during the week with 18
KIA and 92 wounded in action (WIA).37 A major
issue with the medical lessons learned process remains accurate mortality and morbidity data of
warfighters and civilians alike, and trauma data related to their injuries and care rendered to a

33
Ukraine Crisis Media Center Interactive map for January 30, 2017 http://uacrisis.org/ato-interactive-map
34
Wall Street Journal, 13 Ukrainian soldiers were killed and over 70 wounded
https://www.wsj.com/articles/renewed-fighting-in-eastern-ukraine-presents-challenge-for-trumps-plans-with-russia-1486152949
35
Civilian medic KIA in Avdiivka https://www.facebook.com/permalink.php?story_fbid=1237732046264393&id=100000828276750
36
Mykola Chechotkin: Dmytro Tryteykin, wounded on Feb02 in Avdiivka, died in Dnipro hospital today
https://www.facebook.com/MykolaChechotkin/posts/765018606986842?pnref=story
37
Julian Rpcke, Journalist. Political editor @BILD https://twitter.com/JulianRoepcke/status/828208568457371648/photo/1
medical standard. The Mechnikova Hospital has attempted to address this issue with limited
success, as has the Ministry of Defense in Ukraine (MoD) with very little progress made with the
release of a new Computerized Patient Data Management Systems (CPDM).

The Avdiivka Escalation - January 29th, 2017

A medic on duty in January 29th, 2017 described the situation in Avdiivka as a blur of wounded
and dead that seem would never end as the
shelling not only struck the forward positions
but now rained down even in the central district
of the city. A spokesperson for the Russian
separatists, Eduard Basurin, stated eighteen
fighters have been killed and 26 wounded since
fighting intensified.38 The Organization for
Security Cooperation in Europes (OSCE)
Special Monitoring Mission to Ukraine (SMM)
recorded 38 civilian victims, including eight fatal
cases. On Jan 31st the SMM noted a
significant increase in ceasefire violations
recorded in Donetsk region, including over 10,330 explosions, compared with around 2,500 in
the previous reporting period. The number of explosions was the highest yet recorded by the
SMM. Over 9,250 of them were recorded in the area of Avdiivka and Yasynuvata39.

Weapon systems40 deployed included drone aircraft, R-330ZH Zhitel jamming station41 for
electronic warfare; psychological operations (psych ops) such as harassing messages on
individuals cell phones; per the East Stratcom Task Force, pro-Kremlin media disinformation
campaigns spiked with anti-Ukrainian aggressive
rhetoric on Russian TV42 43; BM-21 GRAD multiple
launch rocket system (MLRS); multiple artillery batteries
(122mm and 152mm); T-72B3 and T-64 tanks; mortar
systems (82mm and 120mm); automatic grenade
launcher (AGS-17), RPG-30 and the RPG-26 Aglen, a
disposable anti-tank rocket launcher; along with snipers,
anti-aircraft, heavy machine guns and automatic

38
Spokesperson for the Russian separatists, Eduard Basurin
http://edition.cnn.com/2017/02/03/world/ukraine-fighting-intensifies/index.html
39
For the full report, please reference 1st February 2017 OSCE SMM: http://www.osce.org/ukraine-smm/296961
40
Database and Video Overview of the Russian Weaponry in the Donbas
https://informnapalm.org/en/database-russian-weaponry-donbas/
41
For more details, please reference:
http://www.armyrecognition.com/russia_russian_missile_system_vehicle_uk/r-330zh_zhitel_jamming_cellular_satellite_communicati
on_station_technical_data_sheet_pictures_video.html and https://informnapalm.org/en/r-330zh-jammer-battle-debaltseve/
42
East Stratcom Task Force was set up by EU High Representative Federica Mogherini in 2015, in response to a request from all
28 EU Heads of Government to address Russias ongoing disinformation campaigns
https://euvsdisinfo.eu/kremlin-tv-versus-ukraine-open-calls-for-violence/
43
East Stratcom Task Force Disinformation Review Issue No 58 - 16 February https://goo.gl/ecdeCw
weapons (for full analysis of weapon systems deployed in this war and their effects on mortality
and morbidity, please visit previous Medical ATO Report Series supplements). There have also
been infrequent reports of incendiary weapons and an unconfirmed report that a Buk
anti-aircraft missile was used to shoot down a drone. On Feb. 21, local media reported a
Russian CBRN vehicle entered Ukraine for an unknown reason along with a 15 Russian
"humanitarian" aid trucks.44

During the fighting, about 14,000 Avdiivka residents were cut off from electricity, heating and
water. Utilities were restored for most residents by Feb. 6th, 201745. Of note this appears to be
the first time that the government displayed a concerted effort to deal with a potential
humanitarian crisis, mustering multiple agencies and non-governmental organizations (NGO) to
confront the results of the hostilities on the civilian population in Avdiivka.46 A state of
emergency was declared in Avdiivka by the Donetsk Governor Pavlo Zhebrivskiy47 and
agencies responded such as the United Nations High Commissioner for Refugees (UNHCR),
the U.N. Refugee Agency, who delivered 40 metric tons of humanitarian assistance to the town
of Avdiivka by Thursday, Feb. 2.48 However, to our knowledge an interagency after action report
to access the Lessons Learned (LL) was never generated by the managing authorities. The LL
process per NATO military medical centers of excellence process can greatly enhance
international support, save lives and target focused aid and partners can gain in tactics and
trauma data.

44
Russian CBRN vehicle
http://zn.ua/UKRAINE/v-sostave-60-go-gumkonvoya-iz-rossii-dvizhetsya-mashina-rhb-zaschity-239840_.html
45
Please also reference: https://www.ft.com/content/d1f20e84-ec56-11e6-ba01-119a44939bb6
46
Governor Zhebrivskyi on situation in Avdiivka
http://en.censor.net.ua/news/425712/people_get_hot_meals_and_tea_average_temperature_in_apartments_15_degrees_no_panic
_in_town_governor
47
State of emergency was declared in Avdiivka. http://en.censor.net.ua/n426329
48
Please refernce the Febraury 7th, 2017 UNHCR report:
http://www.unhcr.org/news/press/2017/2/5894a88c4/unhcr-sends-aid-2500-residents-avdiivka.html
 Avdiivka Hospital

Ukraine Military Medical Avdiivka Stabilization Center- Avdiivka Central Hospital

supported by the 66th Mobile Field Hospital (MFH)
There are three major points of contact in the Avdiivka area. The Promka (Prom Zone), Kruta
Balka and the Butovka Mine. The primary evacuation location for wounded off the line is the
Avdiivka Central Hospital, located at Komunalna 16, in Avdiivka. Based on core metrics and
assessment methodology49, the hospital can be considered to be a NATO Role II/Level II facility
with limited surgical capabilities and without a neurosurgeon. Comment as to damage control
surgery (DCS) and damage control resuscitation (DCR) will be made when possible and
relevant.

The military medical team from the 66th MFH of doctors, surgeon (one surgeon served in
Afghanistan with ISAF), an anesthesiologist and local staff have a small, narrow room as a
two-bed receiving area, with no portable x-ray, no access to portable ultrasound in keeping with
Advanced Trauma Life Support (ATLS) standards or any access to CT / MRI. Surgery is
performed at an operating theater located in the same building but on the second floor. Labs are
provided in house and usually during business hours only, but now labs including blood typing
and crossmatching are available 24/7. They have access to blood products which the staff uses
in their trauma care, a combination of RBC and plasma in a 1:2 ratio.50

Like many of the other hospitals in Eastern Ukraine, it is a relic of what was once a large
multi-story facility and now a shadow of this within a system, long neglected and in dire need of
modernization and basic governmental support. Indeed, the health infrastructure decline and
deficit seen here in a Ministry of Health (MoH) facility is terrible for basic health services, let
alone the acute need for an integrated trauma system. Health security for the 38 - 43 million

49
Please reference NATO Doctrine: http://www.shape.nato.int/resources/site6362/medica-secure/publications/ajp-4.10(a).pdf and
Cubano, M. A., Lenhart, M. K., Army, U. S., & Office of the Surgeon General. (2014). Emergency war surgery. Government Printing
Office. Chapter 2, pages 17-28 (also available):
http://www.cs.amedd.army.mil/FileDownloadpublic.aspx?docid=1a73495d-1176-4638-9011-9e7f3c6017d8
50
Updated information directly related to Avdiivka Central Hospital to be released in the near future on the Medical ATO Map.
https://drive.google.com/open?id=1yeApG4JzHbHW0yVmQAqYWqRzmPM&usp=sharing
people living in Ukraine is tied to the Ministry of Health, and in this facility, it is almost
non-existent.

The hospital is currently, re-enforced with military medical staff deployed from Lviv Military
Medical Hospitals 66th MFH and various volunteers and NGOs. The military medical personnel
refers to the section of the facility manned by their staff as the Stabilization Center. It now has
24/7 security provided by elements of the armed forces.

The 72nd Brigade is the primary unit protecting the

area spread out along the contact from Avdiivka
down to Marinka with elements of 81st Separate
Airborne Brigade supporting their operations. Both
units have a Battalion Aid Station with the 81st Aid
Station located in Kramatorsk and the 72nd Aid
Station located in nearby Ocheretyne. There is also
an aid station / transfer point / staging location at
the Nines (photo left), two heavily damaged
nine-story buildings on the edge of town near
Promka. The 66th Mobile Field Hospital provides
medical support, reinforcing the Avdiivka Civilian Hospital and is based in Pokrovsk at the
Railroad Hospital about 63/Km drive along badly maintained roads. The 66th provides
stabilization surgery in Pokrovsk before evacuation usually by air to Dnipro Airport and
Mechnikova Hospital51 or the Dnipro Military Hospital for non-critical patients.

Mechnikova Hospital and Trauma Center in Dnipro. Dnipro Airport Tarmac

Evacuation from Avdiivka is by ground only, no air assets. This is despite military rotary winged
aircraft helicopters used to bring VIPs such as National Security Defence Council (NSDC)
Secretary Oleksandr Turchynov to Avdiivka.52 Both ASAP Rescue53 and Hospitallers54 provide

51
Mechnikova Hospital Facebook Page: h ttps://www.facebook.com/pg/MechnikovaBoln/about/?ref=page_internal
52
Turchynov flying into Avdiivka (photos) https://photo.unian.net/ukr/themes/70498
53
ASAP Rescue https://www.facebook.com/lisenko.ilia.hottabych
54
Hospitallers https://www.facebook.com/hospitallers/
volunteer ambulance service along with asset from the 66th MFH, Pirogov First Volunteer
Mobile Hospital surgical bus and local civilian emergency providers55. Although volunteers are
well stocked, standards adhering to equipment re-supply and interoperability from these groups
are inconsistent. There is also a recent addition of a Hematologist, Dr. Rostyslav Zauralskyi
( ), a civilian and volunteer heading a project Bloodmobile to transport
blood and blood products from Kharkiv Blood Center56 about a 4 hour drive to Avdiivka. He
advocates a combination of RBC and plasma in a 1:2 ratio as opposed to the current
recommendation of fresh whole blood (FWB) or plasma, RBCs and platelets in 1:1:1 ratio57
(please also see comments below in reference to blood and blood products for damage control
resuscitation (DCR) and damage control surgery (DCS) echelons of care and the new Tactical
Combat Casualty Care (TCCC) Treatment Standards58 and details from the Committee on
TCCC (Co-TCCC)59).

Expeditionary Medical Support (EMEDS) Mobile Field Hospital

The USA Provides $7.6 Million Dollar Military

Field Hospital (MFH) to Ukraine on August
18, 2015 in Zhytomyr, Ukraine. Training for
the units was conducted in Zhytomyr by US
military specialist with doctors from Ukrainian
military medical staff. On deployment the unit
is usually staffed with a Mobile Field Surgical
Team (MFST) of 20-30 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 higher level of care.60
Currently as of February 12th, 2017 the US
supplied EMEDS is reported to be in Chasiv
Yar about 43 KM from Svitlodarsk and 75 Km from Avdiivka. More details related to EMEDS can
also be found other Medical ATO Reports.

55
Pirogov First Volunteer Mobile Hospital http://medbat.org.ua/?lang=en
56
Kharkiv Regional Blood Center http://bloodservice.org.ua/
57
Bloodmobile http://www.peoplesproject.com/en/bloodmobile/
58
Please see:
http://www.naemt.org/docs/default-source/education-documents/tccc/072016-updates/tccc-guidelines-for-medical-personnel-160603
.docx?sfvrsn=2
59
Please see: http://www.c-tecc.org/guidelines
60
EMEDS arrives Ukraine
http://www.mil.gov.ua/en/news/2015/08/19/united-states-pass-ukrainian-airborne-forces-$7-6-million-dollar-field-hospital/
The Avdiivka Contact Line: Promka (Prom Zone or Industrial Area), Butovka Mine
(Spartak) and Kruta Balka (Filtration Plant).

Promka - The Industrial Zone

Promka. What was once a major route
into Avdiivka from the villages of
Yakovlivka and Yasynuvata and the
East is now a rubble-filled war zone of
damaged buildings, a pockmarked
landscape from the incessant shelling
that stretches down a low ridge to
Highway 20 and to what is known as
the Yasynuvata Road Police Post and
ground zero for the Russian forces
attempting to breach the defensive line
of Eastern Avdiivka. Ukraines Promka
FOB is located in a series of industrial
buildings located around number 60
Yasynovskyi Ln. Most of the nearby
small cottages that once dotted the
ridge to the south of the complex are
damaged and destroyed and now
provide shelter and cover to both
Ukrainian and Russian forces (Blue
area as seen in the picture to the left, are areas approximately controlled by Ukrainian Forces
and the Red areas, controlled by Russian Forces). The lower photo is the view of Yasynovskyi
Ln from the Russian held side and going west towards Avdiivka.

Evacuations by foot from the

trenches are either to the industrial
building or a rally point located in an
abandoned home southwest of the
complex near the gravel pit. The
urgent requirement for tactical
evacuation efforts in the
standardized form with the use of a
Skedco or similar devices is acute.
From here the patient is loaded into
the 81st Saxon or other transport
vehicles for the 15 min ride to
Avdiivka Hospital or to the Aid
Station at the Nines.
Satellite Imagery of the Promka (Yasynovskyi Ln, 60,) taken January 20, 2017. For a larger image:
https://medium.com/@DFRLab/weekend-of-fighting-in-eastern-ukraine-3696042720f1#.qsn9x2int

During frequent periods of shelling, evacuation crews are

held at a staging area until deployed by the field commander,
sometimes waiting as long as several hours with known
wounded casualties receiving little or minimal care usually
restricted to a tourniquet, bandage and an intramuscular (IM)
dose of butorphanol. Ambulances are considered a
high-value target by Russian and Russian-backed proxy
mortar units and other weapon systems teams deployed
across the line. Evacuation ambulances have been and
continue to be targeted by sniper fire and shelling.

Aerial photos exposed a network resembling an ant hive

which stretches all along the frontlines.61 In the photo above
of the Southern exposure of Promka, you can see the
trenches extend down the slope for what appears to be
hundreds of meters. The reality on the ground is a surreal
network of connecting and isolated trenches, bunkers,
exposed landscape, bombed out and littered terrain of
damaged and destroyed structures, shattered and burnt
vegetation, ground sculpture by explosive impact leaving pot marked craters dotting the land.
Dirt filled ammo boxes add height to the mud filled and frozen trenches. This hellscape
infrastructure is similar to those described in World War I trench warfare.

61
DFR Labs: Weekend of Fighting in Eastern Ukraine
https://medium.com/@DFRLab/weekend-of-fighting-in-eastern-ukraine-3696042720f1#.qsn9x2in
Evacuation off the line is often by a four person hand carry, utilizing a soft litter carry in many
cases. Patients are moved to the industrial complex or rally point where they may be treated at
a small aid station or loaded into an ambulance for transportation (if there is no shelling) to the
Avdiivka military Stabilization Center for a higher level of care. Exposure to cold weather and
the elements is of major concern and is currently not being addressed with spot training and
printed presentations. Treatment at the front line Aid Station is inconsistent as many frontline
medics have little in the way of tactical medicine training in line with international standards
(such as Tactical Combat Casualty Care (TCCC) and Prolonged Field Care (PFC) or any
battlefield medicine equipment. This gap in both capacity and capability remains elusive in
Ukraine MoD units despite recent efforts and multiple improvements seen since the last visit in
March of 2016, but largely in a reaction to and not the result of solid pre-planning, preparation or
appropriate training.

Hospitallers Medic in Avdiivka on Feb 2, 2015, with the DUK 5th Battalion

Treatment largely consists of tourniquets, bandaging and covering patients with blankets for the
15 minute trip to the hospital. Some crews will place an IV catheter but the use of tranexamic
acid (TXA) in keeping with ATLS and TCCC standards is currently rare at this location. If TXA is
administered, it is done at the hospital level, possibly many hours post injury and past the
treatment window and best practice. The logic often offered for this is described as the patient
will be there in 15 minutes. This treatment window may not be reached or met for all patients.
 Vehicles used for evacuation now consist of a Ukrainian
MT-LB62 (seen in the photo to the left), Tabletka vans,
ambulances and a British Saxon assigned to the 81st
who were deployed to backup the 72nd. The Saxon and
the MT-LB are an improvement over the soft skin
evacuation vehicles but the Saxon too has an Achilles
heel with its inflated tires no match for the shards of flying
razor-sharp shrapnel or littered throughout access points
and roads. More track vehicles are one option to mitigate
this omnipresent problem for evacuation off the line and in recent battle zone areas.

Another major issue is general vehicle repair with no available parts for the Saxon in Ukraine; so
repair results in the cannibalization of other vehicles and a dwindling fleet. (Of note the Marines
36th Separate Brigade in the Mariupol Sector reportedly has one of the better vehicle repair
facilities with much assistance from NGO, donors and volunteer mechanics.63 One of the Burtek
B4731 HMMWV ambulances was recently seen there undergoing maintenance.) There is also
an issue with light discipline in the Saxon and the inability for the medics to utilize tactical lights
at night which if used, impede the drivers ability to see out the window along the darken roads.
Night vision is currently not available for drivers, or tactical driving and basic ambulance
operations. Because of its size, there are off-road locations that the vehicle is unable to
traverse. There have been no confirmed reports of the US supplied Burtek B4731 HMMWV
ambulances64 on the contact line in Avdiivka or Svitlodarsk.

Five of Burtek vehicles were provided by the US Department Of

Defense (DoD) and facilitated by the Office of Defense
Cooperation (ODC) based in Kyiv. An additional 35 of these
potentially integral evacuation chain enhancers are planned.
Identifying which units received these, more training associated
with how to maximize their battlefield and tactical capabilities
and feeding back to ODC and DoD through a lessons learned
process as to their benefits may help describe their use and support for future projects and
equipment. Expediting the delivery of such equipment with appropriate training / translations
(including repair manuals) and feeding back details as to the operational use and added value,
as well as any shortcomings, may help indirectly saving life and capturing data on gaps that can
be identified and remedied.

62
Ukrainian medical servicemen stand on an Armoured Personnel Carrier after carrying wounded soldiers to the hospital in Avdiivka
on January 30 (Correction to article: patients were actually transported to the Nines exchange point as seen in the photo)
http://www.telegraph.co.uk/news/2017/01/31/ten-killed-dozens-injured-surge-violence-east-ukraine/
63
Series of photos post to Facebook of the 36th Repair facility in Mariupol but as with much of the other equipment arriving, no
professionally translated manuals
https://www.facebook.com/photo.php?fbid=1797589327189149&set=a.1450507481897337.1073741831.100008142969253&type=3
&theater
64
Ukrainian Army receives the first batch of M1152 HMMWV Ambulance from USA , Aug 27, 2016
http://defence-blog.com/army/ukrainian-army-receives-the-first-batch-of-m1152-hmmwv-ambulance-from-usa.html
Medical equipment varies from unit to unit assessed and appraised for this report and much of it
is often donated from various volunteer organization and sometimes only delivered to a
favorite crew or other non-transparent mechanism. There are multiple anecdotal accounts of
volunteer organizations providing equipment to units in Avdiivka, by-passing the 72nds
logistical medical supply station and without a defined priority of the type of equipment and who
may benefit from it most. Donations of unwanted or useless medical supplies persist. This has
been a major issue across the ATO Zone as there are no de facto clearing house or leadership
from MoD/Disaster services allocating and accounting for medical equipment sent in country.
Many of the medics arrived here with little if any equipment but now many have modern medical
packs supplied by volunteer organizations but none of this weighs in on the balances sheets.

The omni-present tabletka and the crew of the Saxon posing with others at the Nines

Several of the better trained medics in this area are from the recent US Military 68W program in
Yavoriv.65 Unfortunately, the MoH has not seen fit to recognize the program as a legitimate and
limiting the skills the medics are able to perform including pain management and life saving
airway interventions. The 68W program is a great platform and mechanism to springboard and
dovetail multiple medical trainings platforms from both the military and civilian sectors. MoH
Ukraine should promote, enforce, encourage and completely support this life saving and major
capacity building program. Overall the field medical teams are a mix of untrained assigned
medics, plus feldshers66, sanitars, nurses, doctors and other allied medical personnel from
civilian volunteer organizations and the military medical system, all with a wide range of
experience and training but often with little in the precepts of standardized prehospital and
evacuation care.

The Zhgut, the Soviet era red rubber tourniquet although readily available is now largely
obsolete at this location, at least among the medics as donations of the Combat Applied
Tourniquet (CAT), Soft-T and the Ukrainian cloned versions of these, are widely available for
many of the medics. The use of these cloned and copied tourniquets have no data as to their
efficacy, ease of use or overall survivability. Please see previous Medical ATO Reports for

65
Medic Training Yavoriv https://www.dvidshub.net/image/2737668/medic-training
66
For a complete list and breakdown of terminology and physician extender roles in Ukraine MoD and Ministry of Health (MoH),
please see previous Medical ATO Reports (available in links at the end of this report)
deeper analysis and discussion of peripheral and central hemorrhage and the use of
tourniquets.

Peripheral access can be extremely difficult in major trauma and central rapid access
mandatory. There are now FAST-1 IOs67 (intraosseous access) arriving from international
donors, most notably from European Frontier68, but so far most are in possession of the
volunteer ambulance crews, crews used largely for interfacility transport and that do not usually
transport off the line in this location. The urgent need for not only FAST-1 IOs to be readily
available for line medics, but also the required translations and training of these medical teams
and for hospital personnel to appreciate their use, strengths and basic operations remain acute
.

Based on the Individual or Improved First Aid Kit (IFAK) model employed by TCCC standards,
and phases of care, airway is of special note. Nasal airways are rare and crews would like to
see more of them. In addition, there are very few decompression needles observed in medical
kits and tension pneumothorax remains a significant threat to airway on the battlefield. The
number one request from experienced medics operating throughout the ATO Zone remains
training and professionally translated material to assist in training of others. Training on basics
and advanced echelons of care is completely inadequate and due to rotations, injury and
deaths, the MoD lacks a coherent and sustainable program to address the skills fade and core
military medical principles to provide TCCC, PFC, DCS and DCR to injured warfighters.

None of the military field evacuation ambulances are

equipped with heart monitors (ECG) and a recent event
highlights the need for immediate distribution of this
device along with protocols to assist in determination of
death in the field. One recent victim of a shelling killed
while attempting to evacuate KIA was loaded into a
vehicle of deceased victims only to have someone note
later - signs of life. It is potentially likely that given the
then current temperature range of -7 to -17 degrees
Celsius, the victim, along with his traumatic injury,
suffered from hypothermia and was in this state of near
suspension, the patients blood flows slowly, his heart rarely beating, that the responders only
noted the waxy flesh of his limbs, stiff as old putty, his pulse nonexistent, pupils unresponsive
to light and may have assumed death69. It should be noted that portable ultrasound will also aid
in this function and provide basic and easy-use for pneumothorax, thoracic and abdominal
trauma diagnostics and basic cardiology, along with peripheral and central IV access and

67
Fast 1 IO http://www.pyng.com/fast1/
68
Europe Frontier Facebook page
https://www.facebook.com/europefrontier/photos/a.490807881070495.1073741828.477486782402605/756554564495824/?type=3&
theater
69
Frozen Alive https://www.outsideonline.com/2152131/freezing-death
consideration for REBOA70,71 and other advanced prehospital medical capabilities and
interventions.

Some integrated systems on the market provide ultrasound capability, end tidal carbon dioxide
detection (end-tidal CO2), pulse oximetry, continuous core temperature measurements, blood
pressure, and standard 3 and 12 lead ECG capability and other telemedicine options. In
keeping with PFC standards of care, such advanced medical equipment is easily deployable
and should be standardized across the ATO Zone. The added value of such advanced systems
and appropriate training and translated material accompanied with it, are a medical force
multiplier.

Some feedback from international donors state that based on the dearth of medical resources
and decreased interest from the Ukraine MoD, such advanced systems should not be pursued.
This is completely regressive, shortsighted and condescending for the many dead and maimed
from this war. This report should illustrate not only the need for such equipment and its life
saving capability, but also the potential data in PFC and TCCC that can be captured, sent
onwards to NATO Lessons Learned (LL) Centers of Military Medical Excellence (MilMED COE)
and other NATO and NATO partner nations.

Hospital staff when asked about the average temperature of admitted patients, advise that this
info was not regularly or systematically captured but the patients all arrive cold. Nor at this time
there is no guide for medics to determine death in the field, address exposure and
environmental cold injuries or capture trauma data as very few if any casualties cards are
available or used, and if so, this data is not shared or sent to any central authority. These gaps
can be easily addressed with concerted reforms and leadership from the MoD Military Medical
Academy and do NOT require any special piece of equipment or multimillion dollar investment.
Field medics and the support personnel need proper protocol-based guidance, education, and
training and system reviews to increase their capacity and decrease preventable deaths in the
field.

Currently, we have no access to post-mortem reports for this period but will be looking into the
information at a later date as data collection related to morbidity and mortality with this conflict
remains elusive and sometimes obstructed by the very agency tasked with their analysis.

70
Biffl, W. L., Fox, C. J., & Moore, E. E. (2015). The role of REBOA in the control of exsanguinating torso hemorrhage. journal of
trauma and acute care surgery, 78(5), 1054-1058.
71
Sadek, S., Lockey, D. J., Lendrum, R. A., Perkins, Z., Price, J., & Davies, G. E. (2016). Resuscitative endovascular balloon
occlusion of the aorta (REBOA) in the prehospital setting: an additional resuscitation option for uncontrolled catastrophic
haemorrhage. Resuscitation, 107, 135-138.
 Avdiivka

100 Meters
In the recent battle there are now several reported
cases of soldiers killed or injured attempting to rescue
victims off the line of fire. The network of trenches that
offer some protection are not never ending, nor at
times, interconnected as they stretch along the contact
line. There are times you must surface and traverse
open terrain, exposed to enemy fire.

At one such location, judged to be about 100 meters of

exposed terrain, soldiers often choose to take off the
heavy vest and protection gear to enable them to
sprint across the frozen land quicker than if impeded by personal protective equipment (PPE).
Once on the front line and if either a medical emergency or a traumatic injury by fragmentation
or small arms gunfire, the casualty may require evacuation with the use of an Emergency
Evacuation Soft Litter, often carried by up to four soldiers.

Given their injury, patients are sometimes combative, some may be suffering from acute
psychotic episode or other undifferentiated altered mentation (possible due to due to
hypothermia, hypoglycemia or elevated blood sugar, or due to the abuse of illicit drugs or
alcohol). The ability to move patients secured, safely, effectively and quickly with a minimum
use of personnel and at times over hundreds of meters of trench and open field in sub-zero
temperatures requires quick, labor-saving devices such as a Skedco72, padded with either a
insulation mat or thermal blanket or North American Rescue (NAR) Hypothermia Prevention and
Management Kit (HPMK)73 on an adaptable Talon Stretcher74 or standard NATO compatible
evacuation platform.

The distribution of haul lines across the exposed areas will also eliminate the risk of exposing
litter bearers to sniper fire and minimize the risk to the patient as they are hauled across
exposed area. Further lessons learned from these frontline medics must be shared with other
units widely across Ukraine MoD and partner nations. Often after hours exposed to freezing
temperatures and arrival to the ambulance evacuation zone, patients are met by vehicles with
poor or no heating systems and grossly inadequate emergency medical materials. This delays
lifesaving interventions and certainly delays the re-warming process and action for what is
hopefully, an unimpeded 15 minute trip to the Role II hospital.

Skedco training top left, Skedco center top, Patient packaged in an HPMK on a Talon stretcher top right.
Avdiivka medics covering patient with blankets lower left and the HPMK kit, bottom right.

72
Skedco http://skedco.com/product/sked-basic-rescue-system-od-green/
73
HPMK h ttps://www.narescue.com/nar-hypothermia-prevention-and-management-kit-hpmk
74
Talon Stretcher https://www.narescue.com/talon-ii-model-90c-collapsible-handle-litter
Butovka Mine (Next to abandon SAM missile base not in photo but 1/Km to the south)

Butovka Mine has vulnerable geography. Owing to flat

farmland terrain, lack of natural barriers and proximity to
the Russian-fortified Donetsk Airport and the
surrounding urban areas on its eastern and northern
flanks, the mine is very exposed and difficult to defend.
Transport time from the mine is about 10 minutes to the
Avdiivka Central Hospital. The medics maintain an aid
station at the site with much of the care provided by the
Hospitallers; however this is less than Role I based on
the lack of equipment, re-supply and medical training
conducted there. The location has repeatedly been the
focus of sustained artillery and mortar barrages in the
past.
 On January 30, 2017, tanks gathered at the nearby village of
Spartak, then charged through the demarcation line at the Butovka
mining complex and Pisky, shelling the area to an extent not seen
since the Battle of Donetsk Airport.75 This FOB has and will
continue to be a prime location as are many other FOBs across the
ATO for prolonged care standards and training, however, MoD
needs to elevate standards, and re-supply and incorporate
disparate factions (see Table below)76. As with the Donetsk Airport
stationary armor or any vehicle is subject to sustained barrages.
The position is staffed with members of both the 72nd Brigade, 8th
company who call themselves the
Stalkers; 25th mechanized
infantry battalion Kievan Rus,
54th Battalion; and Pravyi Sektor,
Fighters of the Ukrainian Volunteer Corps (referred to as
DUK). They garrison in the mine or shelters in the SAM base
for protection from the relentless shelling with 152-mm artillery
and 120-mm mortars.

75
Tanks Breach the line
https://www.unian.net/war/1751686-shahta-butovka-opyitnoe-i-peski-popali-pod-samyiy-moschnyiy-tankovyiy-obstrel-so-vremen-boe
v-za-dap.html
76
PFC http://www.specialoperationsmedicine.org/
Kruta Balka Flank and the Donetsk Filtration Plant

On the North-Eastern flank of Avdiivka sits the

village of Kruta Balka and the strategically
important filtration plant that supplies water to over
400,000 residents of the Donetsk Oblast and
contains large stores of chlorine in a warehouse.77,
78 79
, Currently the plant sits in territory controlled by
Russian forces80 81 but the plant operation is
repeatedly disrupted by shelling and if severely
damage, place the Donetsk region on the brink of
a man-made disaster per Ukrainian officials
through the spread of infectious diseases.82

The soldiers in the area do not receive the same

support from volunteers as does the Promka and
Butovka Mine and is known as the forgotten flank by the soldiers position there. It experiences
many of the same problems as the other locations including the prevention and treatment of
frostbite and environmental exposure, plus the potential of a Chlorine gas leak and Chlorine
Toxicity83. Both in the field and at hospitals and aid stations there are no Standard Operating
Procedures or Protocols (SOPs) on hypothermia, exposure, frostbite or in the event of a spill or
detonation at the plant, chlorine toxicity.

77
On Feb 24, 2017, a report, unconfirmed at the release of this report from @GirkinGirkin twitter account that the warehouse was
damaged and chlorine gas is leaking/ staff evacuating https://twitter.com/GirkinGirkin/status/835031486734696448
78
Chemical disaster fear in Eastern Ukraine prompts UN expert to raise alarm - See more at:
http://www.ohchr.org/EN/NewsEvents/Pages/DisplayNews.aspx?NewsID=21344&LangID=E#sthash.PnV6Lkb7.dpuf
79
Water Filtration Plants and Risks of a Chlorine Mass-Casualty Event in Donetsk
https://www.bellingcat.com/resources/case-studies/2017/03/10/water-filtration-plants-risks-chlorine-mass-casualty-event-donetsk/
80
Disruption at the Donetsk Filtration Station and photo credit
https://medium.com/@DFRLab/a-digital-forensics-survey-of-the-last-week-in-the-donbas-1f7ca3f0a1f#.higo7nf75
81
Weekend of Fighting in Eastern Ukraine and photo credit
https://medium.com/@DFRLab/weekend-of-fighting-in-eastern-ukraine-3696042720f1#.d7zjs649z
82
The Donetsk region is on the brink of a man-made disaster Ukrainian officials
http://euromaidanpress.com/2016/03/15/donetsk-region-brink-man-made-disaster-ukrainian-officials/#arvlbdata
83
Chlorine Toxicity, Medscape: https://goo.gl/oV5Q75
One fairly quick and practical solution would be to translate poster size internationally
recognized standards for display at hospital and first aid facilities and reinforced with MoD
Ukraine Military Medical Academy acceptance and Ministry of Health (MoH) promotion of the
below two tables (Table 2 and Table 3):

Wilderness Medical Society Practice Guidelines for the Prevention and Treatment of Frostbite84

In addition to basic exposure protocols and treatment guidelines, the sharing of temperature
data, both general and specific medical lessons learned across NATO and NATO partner
nations, time/length of cold exposure and successful vs/ unsuccessful resuscitation efforts
(warmed IV fluids, bladder lavage and other active re-warming efforts, etc) would also be key in
sharing best practices and realizing best patient outcomes. These efforts have been attempted
in the past yet no systematic approach with practical outcomes and verifiable data have been
produced by the Ukraine MoD or Ministry of Health (MoH) related to these very prescient
factors.

84
Wilderness Medical Society http://www.wemjournal.org/article/S1080-6032%2811%2900077-9/fulltext
The Battle of Svitlodarsk Bulge - December 18-22, 2016

Serious fighting flared in the Svitlodarsk Bulge south of government-controlled Svitlodarsk and
north of the Russian-controlled Debaltseve. Some of the heaviest fighting took place near a
small body of water southeast of Svitlodarskthe Hryazevskyi pond.85 Ukrainian forces of the
25th Mechanized Battalion and 54th Independent
Mechanized Brigade suffered nearly fifty casualties from the
fighting in the Svitlodarsk Bulge, including nine soldiers who
died. The Chief Intelligence Directorate of the Ministry of
Defense of Ukraine says 18 militants were killed and 38
were wounded during the battle for Svitlodarsk, Donetsk
region, on December 19-25, 2016.86 A ceasefire deal went
into effect on December 24, but fighting continues in the
Svitlodarsk Bulge with a significant uptick during the Battle
of Avdiivka in late January 2017.

Fierce fighting allegedly commenced in the early morning hours of December 18th as Ukrainian
forces pushed to move Russian force out of the Grey Zone from positions that harassed
Ukrainian positions defending the strategic Vuhlehirska Power Station, a coal-fueled thermal
power station located in Svitlodarsk, Ukraine. Russian forces reportedly unleashed three rounds

85
Separating Fact and Fiction in the Svitlodarsk Bulge
https://medium.com/@DFRLab/separating-fact-and-fiction-in-the-svitlodarsk-bulge-bbb725334694#.auipva57s

86
18 militants were killed and 38 were wounded during the battle for Svitlodarsk
http://ukranews.com/en/news/468854-defense-ministry-intelligence-18-militants-killed-38-wounded-outside-svitlodarsk-donetsk-regio
n-december-19-25
of shelling on Ukrainian positions, with each lasting three to six hours. The Ukrainian forces
sustained heavy casualties during the initial stages of the fighting.

Squadron of five Russian self-propelled howitzers, placed in violation of the Minsk agreements, shooting in the direction of
Svitlodarsk, Dec. 21st, 201787

Medics established an impromptu casualty

collection point located in Luhanske village, on
the Kharkiv-Rostov road near Svitlodarsk. Per
one witness the spot was chosen given its equal
distance from three Ukrainian positions taking
fire. The road is also the direct route to Bakhmut
about 30 minutes drive on difficult roads where
elements of the 65th MFH are located at
Artemivsk Central District Hospital. Here the
patients received stabilization and helicopters are
deployed to transfer the wounded, generally to
Kharkiv Military Hospital88.

Helicopter transport is done only from Bakhmut.

However, better patient outcomes and reduction in lost
time may be accomplished by using a closer point to
Luhanske. A gap identified is that the medical
evacuation control system is not flexible and is reactive
to current tactical considerations, not predictive or
anticipatory to potential needs; these gaps lead to
preventable death and morbidity related to trauma.
Minor injury patients were transported by ground about

87
https://medium.com/@DFRLab/a-digital-forensics-survey-of-the-last-week-in-the-donbas-1f7ca3f0a1f#.giobp3bxs
88
For a detailed breakdown of this facility under new military medical management, please see previous Medical ATO Reports
20 Km from Svitlodarsk to where the 25th Battalion Aid Station is located in Klynove.

The collection location was on the main square of the village - next to the bus stop, post office,
village administration and store. Nearby this location and about a 12-minute drive is the
Svitlodarsk Hospital. The Hospital was once used by Ukrainian Forces, most notably during the
Battle of Debaltseve in January 2015 where it was once targeted by GRAD and one of their
nurses was killed and several other people injured. It is currently not re-enforced by the
Ukrainian military and was not used that day to our knowledge.

The local hospital could have been utilized as a forward surgical post for damage control
surgery (DCS), a concept of abbreviated laparotomy, designed to prioritize short-term
physiological recovery over anatomical reconstruction in the seriously injured and compromised
patient and damage control resuscitation (DCR). This focuses on initial hypotensive
resuscitation and early use of blood products to prevent the lethal triad of acidosis,
89 90 91
coagulopathy, and hypothermia. ,

Instead patients were received at the

collection point and moved either outside
on the ground or into the arriving
vehicles from Bakhmut. Most of the
ambulances that arrived over the next
several hours were from volunteer
organizations such as ASAP Rescue or
Sisters of Mercy92 and various volunteers
with vehicles put in use for evacuation.
Patients arriving during lulls in the
intense shelling from the front lines on
the Bulge were arriving in Tabletka and
any vehicle available and treated initially
with tourniquets and bandages. For additional photos of the collection point please see the
Photo Annex.

In Svitlodarsk, Dec 18th, 2016, bare military "tabletka" arriving from the front with patients were
met by well-stocked volunteer units arriving from the Bakhmut area but none according to
witnesses were truly prepared for the 7 KIA and 17 WIA received over the next several hours.

89
Lamb, C. M., MacGoey, P., Navarro, A. P., & Brooks, A. J. (2014). Damage control surgery in the era of damage control
resuscitation. British journal of anaesthesia, 113(2), 242-249.
90
Kaafarani, H. M. A., & Velmahos, G. C. (2014). Damage control resuscitation in trauma. Scandinavian Journal of Surgery, 103(2),
81-88.
91
Nielsen, J.S. & Watson, J. Curr Trauma Rep (2016) 2: 165. doi:10.1007/s40719-016-0049-8 Damage Control Resuscitation and
Surgery in a Forward Combat Setting
92
https://www.facebook.com/Sistermerci/?hc_location=ufi
The Battle of Svitlodarsk Bulge raised evacuation concerns originally described in Medical ATO
Reports 2014-2015 and again voiced in December 2016 over social and the general media
inquiring as to "why the volunteers continue to be the backbone of the medical evacuation effort
when there is equipment from the USA and local military equipment and personnel that does not
seem to be able to find its way to the front lines"93. The ensuing "discussion" that erupted began
on the FB page of Dmitriy Grigorievich who along with a reporter, Sergey Ermakov from Kharkiv
were present and witnessed the event at the collection point.94 A video of the collection point
and Dmitriy criticizing the government and the MoD is posted on YOUTube.95

Shortly thereafter the Ukraine military countered with a press briefing where the military
spokesman, Serhii Khalik, Deputy Head of Office of Organizing and Planning of the Military
Medical Dept advised that the Ministry of Defence say has no problem with medical
transportation in a combat zone, but thanked volunteers for their help.96

He went on to state when asked where are the vehicles he said they are there "but I am not
allowed to tell you where the medical vehicles are".97 The military command apparently
conducted an investigation into the medical surge during the Battle of Svitlodarsk Bulge and
according to General Verba, head of the Military Medical Department, in an interview in the MoD

93
Where is the Equipment:? Volunteer appealed to the President and Minister of Defence
http://news.liga.net/video/politics/14268972-gde_tekhnika_volonter_obratilsya_k_prezidentu_i_ministru_oborony.htm
94
Sergey Ermakov Facebook post
https://www.facebook.com/photo.php?fbid=361902007509948&set=pcb.361910977509051&type=3&theater
95
Dmitriy Grigorievich scene video https://youtu.be/BoOlhVvt5HM
96
https://health.unian.ua/country/1693467-problemi-z-medichnim-transportom-u-zoni-boyovih-diy-vidsutni-minoboroni.html
97
TSN Report: Medics described the condition of medical transports in the ATO https://youtu.be/kVPq2P8n2Ao
publication Army of Ukraine" everything went to plan, everything was completed in a timely
and professional manner and to NATO standards.98

General Verba later went on to add that equipment is on

the way including the controversial Bogdan Ambulance,
a modified Toyota as seen in the photo on the left. It is
ironic that the article is highlighted with a photo of two
MT-LB tracked evacuation vehicles that are not deployed
to the most serious hotspots in the ATO. Later in another
article published in a local Vinnitsa publication, General
Verba went on to state that people should not donate money and equipment to these medical
NGOs given the military medical system has everything it
requires.99 His remarks were countered by Petro
Vyshyvanets, a member of the Reforms Committee MoD
and the Armed Forces, Medical Group, Volunteer at the
Ministry of Defense of Ukraine and a director with at
Medicine of the National Home Front100, a local NGO
supplying medical equipment to medics on the front. Mr.
Vyshyvanets criticized the General for his perceived
ignorance of the lack of pre-hospital supplies and
equipment on the front lines. The narrative is clearly blurred and only accountable, transparent
and reproducible data will bring to light what needs to be done to save life, we hope this report
shares some of this data for review and consideration.

It does appear that considerations surrounding interventions and evacuation are not
predetermined for the most effective response but instead are purely reactive and rely heavily
on civilian volunteer resources that in some case self-dispatch and are not all directly in
communications with military command and control resources putting themselves at risk and
additionally, not giving medical command the ability to ascertain if necessary resources are
deployed to an event. Furthermore, some of these medical volunteers have no medical
background or clinical training of any kind.

Nor does it appear that the MoD is effectively patched into the disaster and emergency services
who were not deployed to for what was a serious multi-casualty event, nor does it appear that
core elements were included in a post-incident evaluation such as the Ministry of Interior (MoI)
which oversees the National Guard, State Emergency Services, and National Police or disaster
specialist from Shupyk National Medical Academy of Postgraduate Education. Said very simply
and clearly, there are absolutely no definitive medical evacuation command and control

98
General Verba, head of the Military Medical Department, in an interview in the MoD publication Army of Ukraine"
http://na.mil.gov.ua/43573-hto-ne-hoche-bachyty-zmin-u-vijskovij-medytsyni-toj-yih-ne-pobachyt
99
General Verba lashes out at NGOs
https://vn.20minut.ua/Podii/general-andriy-verba-ne-virte-tim-hto-zbirae-koshti-na-liki-dlya-poran-10582087.html
100
Medicine of the Home Front https://www.facebook.com/MedicineoftheNationalHomeFront/?pnref=lhc
structure, bodies or elements overseeing all needs, requirements and crisis serving the ATO
Zone in any organized fashion.

Named bodies and points of contact (PoCs) are nothing more than place holders with little to no
impact on the logistical movement of equipment to and the evacuation of ill and injured
warfighters in Ukraine. This remains a major gap not yet appropriately addressed by Ukraine
MoD or disaster agencies. Consequently, major crisis and post-event debriefing are
non-existent and involving all players to address concerns or lessons learned from this or other
events, nor were the findings from the investigation of the Battle of Svitlodarsk Bulge
multi-casualty event publically released along with lesson learned to avoid repeated mistakes
and help build a robust medical response structure.

Common reasons organizations fail to learn from

and even repeat errors and mistakes

Failure of leadership.

Failure of communications.

Failure to plan.

Lack of ethics.

Resource conflicts.

The complex, chaotic and negative effects of an incident should provide sufficient inducement
to learn and translate the lessons into behavioral change, but for some profound reason that is
not the case101. One such methodology to accomplish this is the Red Team / Alternate Analysis
102 103 104 105
Protocol , , , and should be incorporated into the military academic institutions, military
medical doctrine, strategic command structures and decision-making in Ukraine. The current
linear decision making process observed in command structures, although changing over time,
may not provide best practices for the active warfighter or resilience to the hybrid warfare
deployed by Russia in the ATO Zone.

It is hoped that retired Army Gen. John Abizaid and Mr James Cahill, MHA who are now both
advising the Ukrainian MoD can quickly move forward with the General Staff on command
enablers and incorporate recent lessons into planning, curriculum, and training for future

101
Lessons Learned In Disaster Response - FEMA
https://www.usfa.fema.gov/downloads/pdf/publications/operational_lessons_learned_in_disaster_response.pdf
102
Please reference: Zenko, M. (2015). Red Team: How to succeed by thinking like the enemy. Basic Books.
103
Brown, J. (2014). Strategy for intelligence, surveillance, and reconnaissance (No. AU-AFRI-2014-1). AIR UNIV MAXWELL AFB
AL AIR FORCE RESEARCH INST.
104
Abbass, H. A. (2015). The Art of Red Teaming. In Computational Red Teaming (pp. 1-45). Springer International Publishing.
105
Dickson, P., Minkov, A., & Hrychuk, H. (2015). Measuring Success: A Canadian Perspective of Red Teaming Operations in
Afghanistan. DRDC-RDDC-2015-P07.
commanders and the preparation of new officers with After Action Review106 and Lessons
Learned Process107. The systems approach to the medical evacuation chain gaps must not only
be addressed in the immediate and grassroots levels as mostly discussed in this report and
assessment, but must also be made sustainable with support, pressure and renewed strength to
all those decision-makers and thought leaders in high office.

Death in the Field, December 18, 2016, Svitlodarsk Bulge

106
US Army After Action Review
http://www.armystudyguide.com/content/powerpoint/Training_the_force_presentations/after-action-review-aar-2.shtml
107
The lessons learned process (LLP) is a deliberate and systematic process for collecting and analyzing field data and
disseminating, integrating, and archiving observations, insights, and lessons collected from Army operations and training events
www.apd.army.mil/pdffiles/r11_33.pdf
 Equipment Recommendations for NGO and Humanitarian Aid for the
Avdiivka Central Hospital,
Battalion Aid Stations,
Front Line and Evacuation Medics based on assessment team gap findings
(Should not be considered a definitive list)

Avdiivka Central Hospital - EMEDS for the 66th MFH at Avdiivka, if not, then as a start:
Translated instructions for equipment and training material
Digital Ear Thermometer
Digital Rectal and Oral Thermometers
I-Stat
StO2 Tissue Oxygenation Monitor
Portable Ultrasound
Portable Digital X-Ray
Patient Rewarming Device
Blood Warmers
Talon II Model 90C Collapsible Handle Litter
Eldon Blood Typing Kits
Single Blood-Pack Unit, 450 mL
Hepatitis C blood test kits
Rapid HIV test
Urine Dip Sticks
Hand-held testing device for quantitative measurements of lactate in whole blood
Pulse oximetry
Capnometry
FAST 1 IO
BIG IO
Blood Transfusion Kit
NAR Hypothermia Prevention and Management Kit (HPMK)
Secure Comms
NATO Standard Patient Care Report
Written Standing Protocols including but not limited to ACLS, ATLS, etc

Battalion Aid Stations

Translated instructions for equipment and training material
Digital Ear Thermometer
Digital Rectal and Oral Thermometers
I-Stat
Talon II Model 90C Collapsible Handle Litter
Portable Ultrasound
Portable Digital X-Ray
StO2 Tissue Oxygenation Monitor
 Patient Rewarming Device
Blood Warmers
Eldon Blood Typing Kits
Single Blood-Pack Unit, 450 mL
Hepatitis C blood test kits
Rapid HIV test
Urine Dip Sticks
Glucometer
Pulse oximetry
FAST 1 IO
BIG IO
Blood Transfusion Kit
NAR Hypothermia Prevention and Management Kit (HPMK)
Secure Comms
NATO Standard Patient Care Report
Written Standing Protocols including but not limited to ACLS, ATLS, etc

Front Line and Evac Medics

Translated instructions for equipment and training material
Progressive and comprehensive Standing Orders
3-lead Cardiac Monitor - ambulance crews and evacuation rally points
Skedco Extrication Device
(6) M113 Armored Personnel Carrier (APC) Ambulance or Ukroboronprom
MT-LB for (3) Avdiivka, (3) Svitlodarsk
Deployment of the Burtek B4731 HMMWV Ambulance
NAR Hypothermia Prevention and Management Kit (HPMK)
10,000 meters of static rescue rope in 100 meter lengths
Talon II Model 90C Collapsible Handle Litter
StO2 Tissue Oxygenation Monitor
Pulse Oximetry
Hearing Protection
Ballistic Glasses
Nasal Airway
Decompression Needles
Analgesics and antipsychotic including opiates, ketamine, diazepam, midazolam
and haloperidol.
IO Devices
Secure Comms
Casualty Cards
Medical Command and Control System
Blood Far Forward, the walking blood bank: Vampire Protocol

Blood Far Forward was initiated by the Norwegian

Naval Special Operation Commando in 2010 and
collaborators and participants today includes the
Department of Immunology and Transfusion
Medicine Haukeland University Hospital, The
Norwegian Armed Forces Medical Services,
Norwegian Special Operation Command,
Norwegian Army Special Operation Commando
and US Army Institute of Surgical Research. The
evidence for this process is still being produced but
is well understood to support through TCCC and in
other battlefield medicine sectors. Indeed,
evidence is clear as to the battlefield effectiveness
and positive aspects to the walking blood bank and
blood products to be considered and administered
within the TCCC phases of care and within the
108 109
more advanced Prolonged Field Care (PFC). , ,
110,111,112,113

Described very simply and plainly, the aim of blood

far forward is to improve battlefield survival by
developing a safe method for prehospital whole
blood transfusions. The model is based on buddy
transfusion and field blood bank. US Forces in
WWII established what could be termed Field
Blood Banks, where whole blood was collected from immediately available donors and used on
site immediately (Buddy Transfusion), or banked, or delivered as far forward as possible for
pre-hospital resuscitation.114

108
Hejl, C. G., Martinaud, C., Macarez, R., Sill, J., Le Golvan, A., Dulou, R., ... & De Rudnicki, S. (2015). The implementation of a
multinational walking blood bank in a combat zone: the experience of a health service team deployed to a medical treatment facility
in Afghanistan. journal of trauma and acute care surgery, 78(5), 949-954.
109
Strandenes, G., Austlid, I., Apelseth, T. O., Hervig, T. A., Sommerfelt-Pettersen, J., Herzig, M. C., ... & Kristoffersen, E. K.
(2015). Coagulation function of stored whole blood is preserved for 14 days in austere conditions: a ROTEM feasibility study during
a Norwegian anti-piracy mission and comparison to equal ratio reconstituted blood. Journal of Trauma and Acute Care Surgery,
78(6), S31-S38.
110
Strandenes, G., De Pasquale, M., Cap, A. P., Hervig, T. A., Kristoffersen, E. K., Hickey, M., ... & Williams, S. (2014). Emergency
hock, 41, 76-83.
whole-blood use in the field: a simplified protocol for collection and transfusion. S
111
Beckett, M. A., Callum, J., da Luz, L. T., Schmid, J., Funk, C., Glassberg, C. E., & Tien, C. H. (2015). Fresh whole blood
transfusion capability for Special Operations Forces. Canadian Journal of Surgery, 58(3 Suppl 3), S153.
112
Chass, M., McIntyre, L., English, S. W., Tinmouth, A., Knoll, G., Wolfe, D., ... & Fergusson, D. A. (2016). Effect of blood donor
characteristics on transfusion outcomes: a systematic review and meta-analysis. Transfusion medicine reviews, 30(2), 69-80.
113
Gonzales, R., Taylor, A. L., Atkinson, A. J., Malloy, W. W., Macdonald, V. W., & Cap, A. P. (2016). US Army blood program:
2025 and beyond. Transfusion, 56(S1), S85-S93.
114
Strandenes, G., Cap, A. P., Cacic, D., Lunde, T. H. F., Eliassen, H. S., Hervig, T., & Spinella, P. C. (2013). Blood Far
Forwarda whole blood research and training program for austere environments. Transfusion, 53(S1), 124S-130S.
Ukrainian combat medics need proper protocol-based guidance, education, and training if
whole blood collection and transfusion are to be successfully performed far forward and where
evacuation to military treatment
facilities is often delayed.115 We have
already seen two known successful
occurrences where emergency blood
transfusions were initiated during the
Battle of Lugansk Airport in 2014 and
the Battle of Debaltseve in 2015, but
without the standards, policies,
screening, testing and tracking
capacities in place to protect the
patient, donor and the health care
providers.

Chinook TMM-FBTK Field Blood Transfusion Kit116

There should be special note of the applicability and seemingly limitless medical and tactical
Lessons Learned (LL) capability for the Ukraine hybrid war experience and blood transfusion far
afield. Data remains elusive, local and regional capability remains strained, Ukraine MoH and
MoD restriction to the basics and blocking of efforts are fierce, but the process is known and is
applicable to this conflict.117 Great benefit will be gained globally when this process and set of
clinical standards are encouraged by Ukraine MoD and there is a two-way sharing of Lessons
Learned with blood and blood products within the
DCS and DCR paradigm. The capacity exists in the
ATO Zone, however systems in Ukraine that can
support it are neglected.

The Ukraine Armed Forces have mobile capacity to

harvest, move and store blood products as seen in an
article published on Kharkiv Regional Blood Service
Center website by the head of Ukraine Armed Forces
Blood Centre, Chief Transfusiologist of the MoD Anatolii Zamkovyi on the current state and
challenges of military transfusiology.118 The question is why has it not and what can be done
immediately now to deploy such systems that would support not only the clinical needs, but also
feed data back into the system and interdisciplinarily to enhance it?

115
PFC https://prolongedfieldcare.files.wordpress.com/2014/11/emergency-wb-protocol.pdf
116
Chinook TMM-FBTK Field Blood Transfusion Kit
http://www.chinookmed.com/cgi-bin/item/01370/s-iv_io/-Field-Blood-Transfusion-Kit-(TMM-FBTK)
117
Dr. Larisa Vakhnenko, O.Shalimov Surgery and Transplantology National Institute: Current MoH legislation needs to be
addressed: Order of Ministry of Health 164 from 05.07.1999g. "Whole blood -. It is the raw material for the manufacture of blood
components. Whole blood can be used only in extreme conditions
https://lb.ua/society/2014/12/03/288079_pochemu_ukraine_seloxa.html
118
Kharkiv Blood Center http://bloodservice.org.ua/wp-content/uploads/2015/10/Dopovid%60-240915-L%60viv.pdf
 Ideal Resuscitation Fluid119

119
http://rdcr.org/wp-content/uploads/2017/02/D-RDCR-PRINCIPLES-MODULE-4-edited.compressed.pdf
Steps forward: What does the future hold?
Predicting the future of warfare, and its evolution in Ukraine and neighbouring regions is
impossible. However, if the past is prologue and we can review the past 24 to 36 months and
the escalation of violence, warfighting activity, weapons systems deployed and scaled
escalation, an overall Russian strategy across the region, the future looks bleak, violent, hybrid
and lethal. But the root cause delaying progress at these regional healthcare facilities and poor
management must be addressed. The Minsk agreement which holds its signatories to promises
that they cannot keep leaving these facilities, sometimes referred to as so-called separatist120
leaning health facilities, now waiting for central government agencies to act; which they will not
for various reason including a fear of losing the facility to collateral destruction or inclusion into a
newly assigned special status of separatist territories, but leaving local administrators pleading
for governmental support from Kyiv.121

Programs, such as what is just seen with the 59th MFH, now providing free outpatient care for
civilians in Severodonetsk122 are desperately required throughout the ATO and supported by a
coalition of governmental agencies and international organizations, to rebuild confidence in the
healthcare system and the government and mitigate the noncommunicable disease (NCD)
threat. The need for humanitarian support and NCD care in these vulnerable populations is
massive and still being identified and described.123 Decisions made related to Minsk II and its
policy will have lasting and severe impact on the provision of basic and public health services in
Eastern Ukraine and throughout the ATO zone and cannot freeze administrative action to serve
and reintegrate what can become a marginalized community in a frozen conflict. Indeed, the
framework of Minsk II must be followed and adhered to by all parties in order to provide an
environment for basic security, and state sovereignty.

The nature of frozen conflict throughout the post-Soviet space remains a hellscape of violence,
124
opaque business practices, people trafficking, illicit activities and no adherence to rule of law. ,
125
Democracy and security objectives as considered by the European Neighborhood Policy
(ENP) should be further explored and integrated into strategic MoD, MoH and Disaster services
in Ukraine, perhaps with support and facilitation by the respective Reforms Offices.126 For the

120
Anecdotal remarks often repeated in the East that separatist leaning hospital staff in the Ukrainian controlled areas on the
contact line cannot be trusted, therefore not supported, which we believe only further exacerbates a division that has more to do with
the lack of government support and the same desire for change seen throughout Ukraine, more so, than political leanings..
121
Video: Svitlodarsk hospital administrator pleads for governmental support non-existant 4 months after warfighting damage
https://youtu.be/017L1fFkXd0
122
59th MFH providing free outpatient care for civilians in Severodonetsk:
https://www.facebook.com/ato.news/photos/a.820671234610351.1073741828.820651001279041/1465475436796591/?type=3&the
ater
123
OBrien, S. (2017, Feb). Under-Secretary General for Humanitarian Affairs and Emergency Relief Coordinator. Statement to the
Security Council on the humanitarian situation in Ukraine pp 1-4. Viewed Febrairy 23rd, 2017 and available at:
http://reliefweb.int/sites/reliefweb.int/files/resources/ERC_USG%20Stephen%20O%27Brien%20Statement%20on%20UKRAINE%2
0to%20SecCo%2002FEB2017%20CAD.pdf
124
Nilsson, M., & Silander, D. (2016). Democracy and security in the EUs eastern neighborhood? Assessing the ENP in Georgia,
Moldova, and Ukraine. Democracy and Security, 12( 1), 44-61.
125
Ericson, R. E., & Zeager, L. A. (2015). Ukraine Crisis 2014: A Study of Russian-Western Strategic Interaction. Peace economics,
peace science and public policy, 21(2), 153-190.
126
Nilsson, M., & Silander, D. (2016). Democracy and security in the EUs eastern neighborhood? Assessing the ENP in Georgia,
Moldova, and Ukraine. Democracy and Security, 12( 1), 44-61.
millions of people caught in this misnomer frozen conflict, violence and misery they feel on a
daily basis is anything but frozen, and is certainly extremely real and very hot. Russia's actions
are designed to portray Ukraine as a failed state that doesn't deserve support from the larger
international community.127 Ukraine is NOT a failed state but its institutions remain fragile and
without consistent support, it is at risk of failure. Ukraine is making great advancements and
strides into its corruption and nepotism but will require decades of support in its democratic
institutions to continue on the road to stability.

Health Security for the Donbass communities and populations caught under the thumb of these
post-Soviet actions or any policy to prevent morbidity and mortality of disease is virtually
non-existent. In general, a unified strategy by supporting partners and certainly in
government-controlled areas, must support advocates of the prevention of disease128, buttress
the medical evacuation chain, including healthcare facilities along the contact line and it's core
infrastructure as described above, and must focus on capacity and training capabilities of all
healthcare and ancillary healthcare and disaster providers in order to mitigate suffering and
decrease the incidence and prevalence of preventable illness, injury and death.

Based on a key RAND report related to security sector engagement and reform, it was
highlighted that ministries and agencies operate independently, with little accountability and
coordination; they have their own resources, make their own decisions ... Sharing of
information is inconsistent. Individual ministries or agencies fail to specialize and instead invest
in broad ranges of capabilities. Decision making is often taken to the highest levels,
overwhelming senior officials. Organizations designed to coordinate are weak or ineffective.
129
These systematic level issues persist and have not been addressed entirely. The Reforms
Office and Reforms Committee may be able to address some of these issues throughout military
doctrine and other sustainable reforms that enable evidenced based decision making.

Cyber Defence remains a major gap in providing best practices across the medical evacuation
chain. Critical infrastructure protection, including sharing of best practices between Ukraine MoD
and NATO/NATO partners that improves capacity and thorough policies that support in
developing cyber defence capabilities, including new technologies and support to the
construction of information technology infrastructure and basic situational awareness. The
increased reliance of the global society upon the cyber domain greatly affects military
operations. The systems used by NATO/DoD to conduct mission command, maneuver,
maneuver support, medical support and national strategic operations require cyberspace

127
http://thehill.com/blogs/pundits-blog/international/319863-ukraine-is-making-progress-against-tough-odds-it-deserves-us
Kennedy, R. (2016). The limits of soft balancing: the frozen conflict in Transnistria and the challenge to EU and NATO strategy.
128

Small Wars & Insurgencies, 27(3), 512-537.

129
Oliker, Olga, Lynn E. Davis, Keith Crane, Andrew Radin, Celeste Gventer, Susanne Sondergaard, James T. Quinlivan, Stephan
B. Seabrook, Jacopo Bellasio, Bryan Frederick, Andriy Bega and Jakub Hlavka. Security Sector Reform in Ukraine. Santa Monica,
CA: RAND Corporation, 2016. http://www.rand.org/pubs/research_reports/RR1475-1.html. Also available in print form.
operations to integrate and provide information to warfighters, commanders, and national
agencies with increasing volume, velocity, and veracity.130,131

War in Ukraine may get worse and government services must be prepared for any escalation to
protect its sovereignty and its population. However, war in Ukraine will continue to kill people
even with a complete ceasefire, whether from continued hybrid tactics of subversion,
psychological disorders, unexploded ordnance (UXO) and explosive remnants of war (ERW),
the loss of hospital-based social service programs and primary healthcare services, damaged
infrastructure and cumulative neglect of basic maintenance and the corresponding loss of those
employed in those facilities. But a ceasefire, as of now, will not arrive and war continues to take
its toll and erode normal life, while those in the middle wait for it to end or for their death; indeed
those living on the front lines experience a never ending conflict.

Said simply, by addressing military and civilian disaster interoperability and the infrastructure of
their systems that manage catastrophe, it will create an environment where governmental
agencies learn to cooperate on multiple levels and make positive collective decisions for the
good of the Donbass community. By focusing on the immediate medical evacuation chain for
both military related warfighters and civilian populations caught in the middle, the system can
start at the centre of the problem and continue to make strides and focus on what further needs
to be administered from both a policy and strategy perspective for the war in Ukraine. We saw a
positive glimmer of governmental cooperation in Avdiivka and this must continue to build on
these positive achievements throughout the ATO.

Avdiivka, Humanitarian Aid

130
Murray, C. K., Hitter, S. R., & Jones, S. L. (2016). Army Medical Department at war: lessons learned. US Army Medical
Department Journal, 1-4.
131
U.S. Army Training and Doctrine Command (TRADOC), The Warfighters Science and Technology Needs, The United States
Army The Warfighters Science and Technology Needs 21 September 2016 (available at:
http://www.defenseinnovationmarketplace.mil/resources/Army_Warfighters_ST_Needs_Bulletin.pdf)
Practical and Key Recommendations
- Assessment: Accurate, accountable and transparent mortality and morbidity data
related to warfighting activity across the ATO and neighboring regions - sustainable
Medical ATO Reporting
- Integrated Trauma Registry (please see previous reports with breakdown)
- Ukraine MoD to take lead and ownership on a sustainable and best
practice platform
- Enhance disaster forecast and prevention of natural and manmade
catastrophe
- Advanced methods for the protection of critical medical and basic
infrastructure, required medical supplies and updates on medical
and support personnel
- Methodology to be in keeping with DoD Health Security core principles
- Risk management, best practices and technologies in response to
terrorism, war and warfighting
- Medical and Health Security related data sharing and preparation for
CBRN threats must be renewed and Standardized per DoD / NATO
- Clinical: Blood and Blood products provided with walking blood donor methodology
(Vampire Protocol)
- Ukraine MoD to make this process sustainable, accountable, based on
knowledge sharing, best practices and the NATO Lessons Learned Platform and
Process132
- Field evacuation equipment:
- 100 Skedco (or skedco equivalent) with NAR Hypothermia Prevention and
Management Kit (HPMK) and static rescue rope.
- FAST-1 IO kits (1000 units minimum) for frontline medics and a training program
to ensure continuity of care (please see European Frontier medical proposal,
available April 2017)
- M113 Armored Personnel Carrier (APC) Ambulance or Ukrainian MT-LB.
Number requires additional assessment of hotspots such as Zaitseve, Pisky,
Marinka, Novotroitske, Shyrokyne and several other locations in the Mariupol and
Lugansk Sectors.
- Acceptance of the core standards and principles found in:
- Damage Control Surgery (DCS) and Damage Control Resuscitation (DCR);
International Trauma Life Support (ITLS); Advanced Trauma Life Support (ATLS)
and TCCC courses through Ukrainian Military Medical Academy (UVMA); Kyiv,
Lviv, Odessa, Vinnytsia and Kharkiv Military Medical Centres; and civilian
institutions supporting military training such as Ternopil State Medical University
and Lviv National Medical University;

132
Please see previous Medical ATO Reports, as well as presentations in the Appendix of this Report for
full details
 -and the Desna and Yavoriv training grounds (which are a great resource
to organically grow such medical and clinical standards without significant
investment).
- EMEDS for pre-planned rapid deployment to area hotspot for the 59th MFH in
Severodonetsk, the 65th MFH in Bakhmut, the 66th MFH in Pokrovsk and two for the
61st in Nikolske for forward deployment in the Mariupol Sector to Mariupol and
Volnovakha.
- Systems: NATO MILMED COE Lessons Learned integration into Ukraine Military
Medical Doctrine and core processes
- Medical Evacuation Command and Control - immediate action point to integrate systems
and include:
- Legislation to clarify the operational chain of command and create a Joint
Operations Center (JOC) to centralize responsibilities for ongoing military
operations.
- Specify roles and responsibilities of the JOC133
- Cyber Defense and Situational Awareness: Lessons Learned on a
two-way communications data sharing and medical evacuation chain,
gaps in communication and command and control efforts
- NATO and NATO Partner nations interactions, interoperability and LL
process
- Military and Civilian such as Ukraine Ministry of Defense (MoD); Ministry of
Health (MoH); Ministry of Interior (MoI) which oversees the National Guard, State
Emergency Services, National Police, State Border Services; medical institutions
such as Mechnikov Hospital and academic institutions such as Ternopil Medical
Institute, Shupyk National Medical Academy of Postgraduate Education
Department of Disaster Medicine and the Ukrainian Resuscitation Council, and
civil responders such as the Ukraine Red Cross and their elite Rapid Reaction
Brigade for medical and health asset assessment, data sharing and disaster
preparedness platform.

Summary and Conclusion

In basic summary, Ukraine is at war with Russian and Russian-backed proxies. The morbidity
and mortality for both military and civilian health security are not clearly defined, and very few
mechanisms exist to see this to fruition. NATO Nations States, NATO partner nations and all
those parties in defence of core democratic principles, Westphalian world order and certainly
regional interests: Ukraine is at war with Russia. But internal sabotage, obstruction, pointless
competition that have their own resources, make their own decisions, and set their own tasks
134
, the self-serving entrenched interests of persons, local and regional agencies is nothing less
than elucidating, especially in a time of war. This must be addressed with international pressure

133
RAND - Security Sector Reform in Ukraine. Recommendations to Improve Warfighting Table S.2
http://www.rand.org/pubs/research_reports/RR1475-1.html

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on the status quo to move away from the norm and move rapidly forward with institutional
changes.

Problems in Ukraines current evacuation and health support systems across ministries and
agencies operate independently, with little accountability and coordination. They have a
tendency to act as separate fiefdoms, with their own resources, decision-making procedures,
and tasks.135 Medical and health diplomacy for the evacuation chain in Ukraine may serve into
NATO and NATO partner nations core principles and regional strategic efforts. Specifically, such
further and continued support for emergency services and provision of civilian support through
enhanced cooperation with international actors and enhanced awareness of security
developments through early warning, with a view to preventing further crisis. Emergency
preparedness is mutually beneficial for the regional and cooperation on issues of common
interest such as health and health security addresses emerging security challenges.

Disclosures
The underlying methodology of the Medical ATO Report Series has no political, party or other
orientation. The authors state and claim here that we have no Ukrainian institutional or
governmental affiliations; have no official or unofficial association or affiliation with any
governmental or nongovernmental groups. The statements and conclusions are of the authors
alone and may not represent the views or platforms of any supporting or presented agency. The
authors do not work with any intelligence agency or service, past, present or future, and have
not accepted any financial support from any body, agency or group for this current assessment
report.

Patrick Chellew is lead paramedic in disaster medicine and Olia Romaniuk is lead researcher for
the Medical ATO Report Series. Both worked for Medsanbat based in Ukraine in 2014-2015.
John Quinn was medical director for Medsanbat and is now medical advisor to the Medical ATO
Report Series. Both Dr. Quinn and Mr. Chellew have at times been paid and unpaid advisers to
persons, various organizations and institutions including the Ukrainian World Congress (UWC)
and were the initiators and authors of the first report on Ukraine military medicine and the war
with Russian: Medical Assessment - Ukrainian World Congress. July 28th - August 8, 2014.

Acknowledgments
The authors would like to thank all of the active Ukrainian warfighters, military, non-military and
ancillary service elements supporting of this assessment and all previous Medical ATO Report
Series documents. There are amazingly talented people in Ukraine and we would specifically
like to mention the strong work performed by Dr. Sergii Ryzhenko and his excellent team at
Mechnikova Hospital, the team at the 66th Mobile Field Hospital and all the medics working
under the most extreme conditions on the front lines who wake every day to prevent death on
the battlefield.

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Language
This report is presented here in English. The Medical ATO Report Team would like to have it
translated into the Ukrainian language to spread recommendations as wide as possible across
medical providers and supporters. This process is costly and requires funding. Please see
sections below.

Funding and Support

The Medical ATO Report Team has previously been funded in whole and in part by the UWC,
the Canada Ukraine Foundation CUF), Medsanbat and personal finance. The Medical ATO
Report Assessment methodologies and process have been offered to the Ukraine MoD and
Reforms Office to make recommendations in line with a sustainable process, encouraging
feedback of data to institutions and decision-makers able to make evidenced-based and data
driven decisions. This was in hopes of making medical processes accountable and to improve
the Medical Evacuation Chain in the ATO Zone. Funding to complete this 100 Meter
installment of the Series is completely without institutional backing or funding due to the rapid
nature and requirements to the get this information to partners, stakeholders and to support the
frontline warfighter as fast as possible. Please send any and all donations for travel expenses,
translation and research efforts to: Patrick Chellews PayPal account at: paypal.me/PChellew
Photo Annex

Natalia Khoruzha, RN/combat medic,

54th Brigade, KIA Feb 2, 2017, Svitlodarsk Bulge

Medic, Dmytro Tryteykin, wounded on Feb 02 in Avdiivka,

died in Dnipro hospital, Feb 21st, 2017
Some of the Avdiivka Medics
Svitlodarsk Bulge Collection Point and Bakhmut Receiving Hospital.
Photo Credit: Sergey Ermakov
Past Reports / Links / References / Cited Works / Presentations /
Additional Resources

Medical ATO Report Series: past reports

Medical ATO Report, Fall 2015 - Winter 2016
https://www.scribd.com/doc/309297065/Ukraine-Medical-ATO-Fall-Autumn-2015-and-Winter-20
16

Ukraine Medical ATO-Summer, 2015

https://www.scribd.com/doc/285198051/Ukraine-Medical-ATO-Summer-2015

Medical ATO Ukraine, April, 2015

https://www.scribd.com/doc/285212052/Medical-ATO-Ukraine-April-2015

Medical ATO, Ukraine, Feb-March, 2015

https://www.scribd.com/doc/285362420/Medical-ATO-Ukraine-Feb-March-2015

ATO Medical Evacuation-Jan 2015

https://www.scribd.com/doc/285576613/ATO-Medical-Evacuation-Jan-2015

Medical Assessment - Ukrainian World Congress. July 28th - August 8, 2014

https://www.scribd.com/document/333814775/Medical-Assessment-Ukrainian-World-Congress-
July-28th-August-8th-2014

Other References, as well as those in each footnote and cited in multiple formats due to
the rapid nature of this assessment:

Fierce battle of Avdiivka: soldiers evacuated journalists. Published on Jan 19, 2017
https://youtu.be/Hsglw9zACfw

Video from Dec 17th, 2016 - Shots in the dark. Ukraine war prom zone Avdiivka
https://youtu.be/rKn3KblsENc

Tanks Breach the line

https://www.unian.net/war/1751686-shahta-butovka-opyitnoe-i-peski-popali-pod-samyiy-moschn
yiy-tankovyiy-obstrel-so-vremen-boev-za-dap.html

State of emergency was declared in Avdiivka. http://en.censor.net.ua/n426329

"People get hot meals and tea. Average temperature in apartments 15 degrees. No panic in
town," Governor Zhebrivskyi on situation in Avdiivka
http://en.censor.net.ua/news/425712/people_get_hot_meals_and_tea_average_temperature_in
_apartments_15_degrees_no_panic_in_town_governor

19 Ukrainian military killed in Dec 2016 journalist

https://www.unian.info/war/1712696-19-ukrainian-military-killed-in-dec-2016-journalist.html

7 KIA, 1 MIA in Svitlodarsk - Dec 18th and 19th

http://censor.net.ua/resonance/420138/boi_pod_svetlodarskom_18_i_19_dekabrya_7_ukrainski
h_voinov_pogibli_1_propal_bez_vesti

Video Svitlodarsk evacuation: https://youtu.be/rVkOKVTIGNE

Volodymyr Groysman, Prime Minister of Ukraine believes healthcare reform to increase life
expectancy in Ukraine by at least seven years
http://en.censor.net.ua/news/429467/pm_hroisman_believes_healthcare_reform_to_increase_lif
e_expectancy_in_ukraine_by_at_least_seven_years

Mine "Butovka" - extreme position of the Ukrainian army

Url: http://www.youtube.com/watch?v=Y0tVIvhpksU

Tzvi Arieli, a military instructor, explains what is required in the Ukrainian Armed Forces
http://www.dsnews.ua/politics/tsvi-arieli-pochemu-nevozmozhno-pobedit-na-donbase-bez-uvazh
eniya-20022017220000

Where is the Equipment:? Volunteer appealed to the President and Minister of Defence
http://news.liga.net/video/politics/14268972-gde_tekhnika_volonter_obratilsya_k_prezidentu_i_
ministru_oborony.htm

Defense Ministry spokesman confirmed the death of Ukrainian who was injured February 2 in
Avdiivka
http://www.5.ua/suspilstvo/motuzianyk-dvoie-viiskovykh-zaznaly-poranen-vnaslidok-boiovykh-dii
-shche-semero-pidirvalysia-u-vantazhivtsi-139096.html

Russia wounded evacuation to Debaltseve: https://youtu.be/Xia7vWce-Rg

Forty-eight hours of hell near Svitlodarsk

http://euromaidanpress.com/2016/12/24/forty-eight-hours-of-hell-near-svitlodarsk-ukraine-battle-
donbas/

26 Ukrainian military, wounded in the fighting in the Donbas, were flown to the capital's military
hospital, transported from the Dnipro and Kharkiv,
https://inforesist.org/v-kievskiy-voennyiy-gospital-na-samoletah-dostavili-26-ranenyih-boytsov/

KIA:
http://censor.net.ua/news/421043/polnyyi_poimennyyi_spisok_boyitsov_pogibshih_v_boyah_po
d_svetlodarskom_1822_dekabrya

Verba on mil/med 2017, Jan medical teams worked quickly and professionally
http://na.mil.gov.ua/43573-hto-ne-hoche-bachyty-zmin-u-vijskovij-medytsyni-toj-yih-ne-pobachyt

Renewed Fighting in Eastern Ukraine Presents Challenge for Trumps Plans With Russia
https://www.wsj.com/articles/renewed-fighting-in-eastern-ukraine-presents-challenge-for-trumps-
plans-with-russia-1486152949

Russian separatist military Eduard Basurin eighteen fighters have been killed and 26 wounded
http://edition.cnn.com/2017/02/03/world/ukraine-fighting-intensifies/index.html

ttp://rdcr.org/publications/
THOR The Hemostasis and Oxygenation Research Network h

Blood Mobile http://www.peoplesproject.com/en/bloodmobile/

72nd Brigade FB page https://www.facebook.com/72.brigade.best/?hc_ref=SEARCH

A visit to combat positions near Yasinovataya road police post (photos)

http://eu.eot.su/2016/03/25/a-visit-to-combat-positions-near-yasinovataya-road-police-post-phot
os/

OSCE SMM Details and Reporting

http://www.osce.org/ukraine-smm/297816?download=true
http://www.osce.org/ukraine-smm/296961

Russian tanks staging in Makiivka, Donetsk Oblast, 25 Km from Avdiivka

https://twitter.com/GirkinGirkin/status/827553647676497920/photo/1

NAR HYPOTHERMIA PREVENTION AND MANAGEMENT KIT (HPMK)

https://www.narescue.com/military-products/hypothermia-prevention/nar-hypothermia-preventio
n-and-management-kit-hpmk

Frozen Alive
https://www.outsideonline.com/2152131/freezing-death

Medic killed by anti-tank missile on Ambulance

https://www.facebook.com/permalink.php?story_fbid=1237732046264393&id=10000082827675
0

Separating Fact and Fiction in the Svitlodarsk Bulge

https://medium.com/@DFRLab/separating-fact-and-fiction-in-the-svitlodarsk-bulge-bbb7253346
94#.auipva57s

At Svitlodarsk bulge militants attack Ukrainian positions yet again Ministry of Defense
http://uacrisis.org/51108-andrij-lisenko-260

Ukraine's Army units took new positions in Svitlodarsk salient, - Motuzianyk

http://en.censor.net.ua/news/422856/ukraines_army_units_took_new_positions_in_svitlodarsk_
salient_motuzianyk

Bloodiest battle in 5 months': Ukrainian troops repel 3 militant attacks near Svitlodarsk
https://web.archive.org/web/20161220221743/http://uatoday.tv/society/bloodiest-battle-in-5-mon
ths-ukrainian-troops-repel-3-militant-attacks-near-svitlodarsk-849788.html

Fighting Near Debaltsevo, Ukraine, Rages For Third Day

http://www.interpretermag.com/day-1037/?pressId=15795

Battle of Svitlodarsk
https://en.wikipedia.org/wiki/Battle_of_Svitlodarsk

Ukraines Bloodiest Battle of the Winter

https://medium.com/@DFRLab/ukraines-bloodiest-battle-of-the-winter-28dc4f7c1218#.95ru3r3b
d

Battle of the Bulge Svitlodarsk

https://dangerzoneblog.com/2016/12/23/battle-of-the-bulge-svitlodarsk/

Svitlodarsk City Hospital https://goo.gl/maps/XqqsEefti522

Minsk II:
http://www.europarl.europa.eu/RegData/etudes/BRIE/2016/573951/EPRS_BRI(2016)573951_E
N.pdf and https://www.ft.com/content/21b8f98e-b2a5-11e4-b234-00144feab7de

Vuhlehirska Power Station - Svitlodarsk

http://www.centrenergo.com/en/divisions/vug/

Separating Fact and Fiction in the Svitlodarsk Bulge

http://www.stopfake.org/en/separating-fact-and-fiction-in-the-svitlodarsk-bulge/
Gunman described as running away from the soldiers on the ATO Svetlodarsk Bulge
http://zik.ua/news/2016/12/24/boyovyk_rozpoviv_yak_tikav_vid_biytsiv_ato_na_svitlodarskiy_du
zi_1014723

Latest from OSCE Special Monitoring Mission (SMM) to Ukraine, based on information received
as of 19:30, 18 December 2016 http://www.osce.org/ukraine-smm/290026

Latest from the OSCE Special Monitoring Mission to Ukraine (SMM), based on information
received as of 19:30, 31 January 2017 http://www.osce.org/ukraine-smm/296961

OSCE shows "DPR's" artillery near Svitlodarska Duha bulge (Video)

https://www.unian.info/war/1721222-osce-shows-dprs-artillery-near-svitlodarska-duha-bulge-vid
eo.html

Volunteers join with the 36th Brigade in Mariupol to repair military vehicles
https://www.facebook.com/photo.php?fbid=1846778738936874&set=pcb.1846779352270146&t
ype=3&theater

Ukraine: not quiet on the Eastern front. Fighting persists despite the two-year anniversary of the
Minsk 2 cease-fire agreement
http://www.politico.eu/interactive/ukraine-not-quiet-on-the-eastern-front-crisis-eastern-ukraine-ru
ssia/

Medical and Health: Humanitarian Needs Assessments and Reports

http://reliefweb.int/sites/reliefweb.int/files/resources/ukraine_humanitarian_snapshot_checkpoint
s_20170214.pdf

http://reliefweb.int/sites/reliefweb.int/files/resources/humanitarian_response_plan_2017_eng.pdf

Photo credits and Additional Photos / Videos

UKRAINE'S WINTER WAR HEATS UP

http://www.reuters.com/news/picture/ukraines-winter-war-heats-up?articleId=USRTX2ZVUF

Avdiivka Apartment heavily damaged

http://euromaidanpress.com/wp-content/uploads/2017/02/avdiyivka.jpg

Avdiivka. Life in war-torn town. PHOTOS+VIDEO

http://en.censor.net.ua/photo_news/426109/avdiivka_life_in_wartorn_town_photosvideo

Sergey Ermakov ( ) - witness/reporter/photos - Facebook posted photos

https://www.facebook.com/photo.php?fbid=361901950843287&set=pcb.361910977509051&typ
e=3&theater

Video: OSCE SMM UAV: 5 howitzers firing in direction of Svitlodarsk

https://youtu.be/mHQQd6DYwT0

The magic forest. Frontline at the Svitlodarsk outskirts. https://youtu.be/PokFZDH6g3E

Medic in Avdiivka Feb 2

https://www.facebook.com/photo.php?fbid=581610428669835&set=pb.100004626493573.-220
7520000.1487682179.&type=3&theater

Turchynov flying into Avdiivka

https://photo.unian.net/ukr/themes/70498

Tanks in Ukraine,
http://sprotyv.info/ru/news/kiev/tanki-dlya-peskova-lozh-spikera-kremlya-oprovergayut-sugubo-r
ossiyskie-modifikacii

Angel Savior
http://www.mil.gov.ua/news/2017/03/06/tetyana-ivanenko-%E2%80%93-angel%C2%ADryativni
k-z-peredovoi/?attempt=1

A tread of news stories on soldier killed in the ATO from LB.ua

https://lb.ua/tag/13661_pogibshie_v_ato

Ukrainian servicemen have recorded a video message in which showed the living conditions in
at Desna training center in Chernihiv region, which they called "bestial."
https://www.obozrevatel.com/crime/51809-huzhe-chem-v-ato-kontraktniki-vsryili-skotskie-usloviy
a-v-uchebnom-tsentre-desna.htm

Kyiv Research Institute of Clinical and Experimental Surgery.

http://www.surgery.org.ua/

NEW DATA ON UKRAINE CONFLICTS ENVIRONMENTAL RISKS SUPPORTS CALLS FOR

COMPREHENSIVE ASSESSMENT
http://www.trwn.org/new-data-on-ukraine-conflicts-environmental-risks-supports-calls-for-comprehensiv
e-assessment/
Previous Presentations Related to the Medical ATO Report Series and Ukraine
1) International Press Conference: Ukraine Crisis Center, September 11th, 2014 Medical
Assessment Findings from the East, available at:
www.youtube.com/watch?v=AGVlsdMhryk
2) International Press Conference: Geneva Press Club, October 16th, 2014 Ukraine and
Kazakhstan Healthcare support from Swiss and NATO countries -
http://2013.pressclub.ch/fr/conference/achievements-swiss-and-nato-states-medicine-health
care-delivery-ukraine-and-kazakhstan
3) Field hospital for MoD medical officers and civilian volunteers at Kyiv Main Military Hospital.
October 22, 2014 http://www.medsanbat.info/2014/10/
4) Field hospital training for the instructors and students of Vinnitsa Medical University, Ukraine
October 28, 2015
http://www.medsanbat.info/trening-medsanbat-dlya-podgotovke-prepodavateley-meditsinski
h-kolledzhey-so-vsey-ukrainyi-i-prepodavateley-vinnitskogo-meditsinskogo-universiteta/
5) Five-day tactical medicine training for combat medics started in Dnipropetrovsk and Triage
in disaster and conflict medicine: a systems approach. December 10th, 2014, Mechnikova
Hospital, Dnipropetrovsk Trauma Hospital, Dnipro, Ukraine
http://www.antiaids.org/eng/about/fondnews/five-day-tactical-medicine-training-for-combat-m
edics-started-in-dnipropetrovsk-10226.html
6) 200 people participate in the field hospital training field hospital in Nikolaev, Ukraine.
January 28, 2015
http://www.medsanbat.info/200-chelovek-prohodyat-trening-medsanbata-v-nikolaeve/
7) Perspectives from the ATO and Contact Line NATO Conference: International Medical
Rehabilitation, Mental Health, Institution and Policy and Tactical Battlefield Medicine Support
in Ukraine. May 1st, 2015
8) News Conference Interview: Battlefield Medicine in Ukraine lessons learned.
Hromadske.tv / October 19th, 2015
(https://www.youtube.com/watch?v=-62LWTsykcw&feature=youtu.be, minute 02:02 /
https://youtu.be/-62LWTsykcw?t=17m11s).
9) Tactical Combat Casualty Care (TCCC) in the civilian setting for emergency medical
practitioners: what to and not to do. Northwick Park Hospital emergency Department,
Harrow, London UK, April 16th, 2016 (1.5-hour teaching session)
10) Lead and Chaired Main Keynote Panel Discussion: Global Health Forum in Prague, 2016,
Prague Center for Global Health, Prague, May 5th and 6th 2016
11) Medical ATO Report Series and Disaster Medicine, Emergency and Disaster Medicine
Conference, June 23rd-24th, 2016, Uzhhorod, Zakarpattia Region, Ukraine. Funded by the
Canada Ukraine Foundation.
12) Clinical Governance Presentation, Northwick Park Hospital, Dr. Yash Gupta and Dr. John
Quinn, Query meningitis in a family of 11 in a two bedroom apartment, August 26th, 2016.
Northwick Park Hospital
13) Battlefield medicine and Reform in Ukraine. The NATO Centre of Excellence for Military
Medicine (MILMED COE), Multinational Medical Lessons Learned Team, the 4th iteration of
the Medical Lessons Learned Workshops, in Budapest, Hungary on 6 - 7 September 2016,
direct support of the MILMED COEs POW, ACT, ACO and COMEDS:
http://www.coemed.org/news-a-events/conferences/396-1st-multinational-medical-ll-team-m
eeting

14) Conflict and Disaster Medicine: the State of Battlefield Medicine in Ukraine, October 19th -
21st, Prague, Czech Republic, Future Forces Forum Prague (FFF2016):
http://www.future-forces-forum.com/delegation/people/1723_quinn?lang=en

15) The State of Battlefield Medicine in Ukraine: Prolonged Field Care in Hybrid War, World
Extreme Medicine, Edinburgh, Scotland, Monday, November 21st, 2016 12:00-13:00
(http://www.extrememedicineexpo.com/conference-workshops/conflict-and-disaster-medicin
e-the-state-of-battlefield-medicine-in-ukraine/)

Contact Info

Patrick Chellew
chellew.patrick@gmail.com
Kyiv, Ukraine

Dr. John Quinn

cuinne@gmail.com
john.quinn@lf1.cuni.cz
+420 608246032 M
+380 681 978 294 M
+1 630 747 9081 VM
Charles University
Praha, Czech Republic
RESEARCHGATE: https://www.researchgate.net/profile/John_Quinn_V
LinkedIN: https://www.linkedin.com/in/johnmquinnv

Olia Romaniuk
olia.romaniuk@gmail.com
Lviv, Ukraine
--- END REPORT ---