Author: Sofia Sereda, Ukrainska Pravda, 17th January 2024
Original interview: https://www.pravda.com.ua/articles/2024/01/17/7437671/
“I understood that I would not forgive myself if, at such an important moment for the country, when there is a national struggle, I – a healthy and young man – would not be join the army, to not defend the country. It was unacceptable for me. On the other hand, I had a very strong fear for my life, because I had absolutely no knowledge about the war, about the army as a whole,” says the “hospitaller” [combat medic from the Ukrainian Hospitallers Medical Battalion] Oleksandr.
He is 24. Before the full-scale invasion, he was studying medicine and planned to become a surgeon.
On February 24, 2022, Russian troops entered Oleksandr’s home-city, and he was forced to flee from the occupation. That is why the man now does not show his face in public and does not give his last name in general.
Having found himself in the territory controlled by Ukraine, Oleksandr joined the volunteer medical battalion “Hospitallers” . Currently, he saves the lives of wounded Ukrainian soldiers.
On the full-scale Russian invasion, escaping Russian occupation and studying tactical medicine
– What did the first days of a full-scale invasion look like for you?
– Like everyone else, I was scared, shocked, confused, I didn’t know what to do. Within days, my city was under occupation, and I was basically stuck there.
I was worried about how to get to Kyiv, how to do something to help and be useful at that moment.
– Did you immediately decide that it was necessary to leave [the Russian-occupied territories] for the territory controlled by Ukraine?
– At first, I didn’t really understand how it could be done. But at a certain moment, the “green corridors” for the departure of civilians began to work, and I took advantage of this opportunity. I got to Kyiv already after the end of the Kyiv campaign [end of March 2022].
– Why did you decide to become a “hospitaller” [volunteer at the Hospitallers Medical Battalion]?
– I had friends from this volunteer battalion. They offered to join them, and I agreed.
Oleksandr had to flee from the occupation. That is why the guy now does not show his face in public and does not give his last name in general
– Then you did not have specific knowledge about warfare, but you had a medical education. Is this enough to work in tactical medicine?
– It’s not enough, but it was the only thing I had under my belt when I went to war at that time. Of course, there was some training to be done: I finished the four-day training on a very, very accelerated program and immediately went on my first rotation.
In general, I started studying tactical medicine even when I was in the occupation: knowing English, it was easy for me to master the TSSS [Tactical Сombat Сasualty Сare] protocols, watch a bunch of videos, and watch various presentations.
– Does a combat medic have enough knowledge only in tactical medicine to work effectively on the front line?
– Not enough. To be effective at the front, one must have general tactical knowledge of firearms training, understand military topography, and how military communication works. Digital security should be highlighted as a separate point, especially if you transfer some important data somewhere.
It is necessary for a person, in principle, to understand how a battle is conducted, what are its main types (defence, offensive, assault), to understand weapons and what “exit” and “arrival” [coming under enemy’s artillery shelling/missile attack] are, how and where to hide.
Some of this knowledge can be gained by reading something, some by hearing from someone, and some only by experiencing it.
According to Oleksandr, only knowledge of tactical medicine is not enough for a combat medic to work effectively at the frontline
– How much time did it take you personally to master all this?
– I don’t think that I have mastered everything at a sufficient level. But I can say that from April 2022, when I joined the battalion, to now, I have grown a lot (mostly, not medically, but as a fighter). Now I continue to gain knowledge and develop.
On volunteering as a combat medic, the Hospitallers Medical battalion and his first time at the frontline
– How was your first rotation?
– Our commander Yana Zinkevich distributed the “kittens” (those who had never been on rotations before), and I got into a very, very experienced crew that was working in the South at that time.
I bought a ticket to Odesa, packed all my equipment (at that time – very heavy: with metal cut-off plates [for the bulletproof jacket] and a huge medical backpack) and left. From there, the volunteers took me to Mykolaiv Oblast, where I already met with my commander. He met me with a big dog – a German shepherd named “Kitty” and the first thing he asked me was: “Why do you want to join the war?”.
He began to “burden” me with questions like: “Do you understand that you will return from the war as a different person, that you may return disabled or not at all?”, “What is the war for you, a promising young surgeon, at all?”. Probably wanted to test my motivation or make sure I wasn’t just a random person in the war.
– Were you scared before the first rotation?
– I will not say that it is exactly fear. It’s just a feeling of the unknown. A certain even excitement. But I had no dread. It was the usual excitement, as before something new.
– There are different stages of evacuating the wounded. Which of them specifically do you work on?
– I work in an ambulance. It takes the wounded from a “keysevak” [casualty evacuation] – a pick-up truck or some kind of armoured vehicle that takes the wounded directly from the battlefield. And the “medic” [medical evacuation] then takes this wounded person to the nearest field hospital, headquarters or hospital.
The ambulance is maximally equipped to stabilize the injured person and provide them with resuscitation assistance.
The ambulance on which Oleksandr and his crew work during rotations
– How many people are on your crew?
– Our crew mainly consists of three people: a driver, a doctor and a paramedic (my assistant, who helps me in all medical manipulations and, in principle, performs all other necessary tasks for the life of the crew).
We use an ambulance that has been flown in from Europe, repainted green and equipped by us as we need it.
Blood transfusions at the frontline save lives
– In 2023, there were lively discussions about whether or not combat medics should be allowed to transfuse blood during the evacuation stages .
What can you say about this based on your experience? How critical is the need for medics working on a casualty or medical evacuation to be able to transfuse blood to the wounded?
– I fully support this initiative. It is necessary to understand: if a person loses a lot of blood, they can be helped only by replenishing the blood.
Ideally, given the current circumstances with maximally prolonged evacuations, a combat medic with a backpack should be able to transfuse blood directly in the trench.
– It is obvious that this requires specific equipment. Does it exist to work in such conditions?
– Yes, the blood must always be refrigerated. Transporting it to the front, storing it at the front in conditions where there is no power is a problem. For this we use small transport refrigerators.
To deliver the blood as close as possible to the trench, specialized equipment is also necessary – small transport cases that can maintain a certain temperature for a day/two/three days.
In addition, it is necessary to understand that cold blood cannot be poured into the victim. It should be warm. For this, there are blood warmers – expensive devices that raise the blood temperature from 5 degrees to 38 degrees in a matter of seconds, while you directly infuse it through the system. Such a heater should work without an outlet and be compact.
Therefore, it is a scarce and very expensive equipment.
– What amounts are we talking about?
– The heater itself costs about 60k UAH [$1590]. But the problem is that for each blood transfusion, one disposable blood vessel is used, and the price of such blood vessel is about 8 UAH [$215]
That is, 10 wounded soldiers, to whom you will conduct a blood transfusion, is, roughly speaking, already 80k UAH [$2150], if you do not take into account the cost of the heater itself.
It is quite expensive. But it saves lives.
– Can you give an example from your work experience when a blood transfusion really helped to save a soldier?
– Yes. It happened in the South. I performed a hemotransfusion directly in the car, under fire.
Three tourniquets were placed on the wounded man, he was in severe haemorrhagic shock . Thanks to the fact that we gave him one vial of blood, we managed to get him to the hospital alive. After all, of all the wounded that we had at that moment, he was the most stable afterwards.
Eastern and Southern fronts: the most memorable moments
– You gave an example of your work in the South. And in general, during this time, where else did you have to work?
– I participated in the defence of Severodonetsk in the summer of 2022, Bakhmut in December 2022. I was in many directions of Donetsk region, in the South. Took part in the Kharkiv counteroffensive.
– Your most difficult evacuation during this time?
– It is difficult to single out one, but probably the most memorable evacuation in the South.
We waited a long time to take the wounded soldier. The moment we got him, I immediately saw that he had upper airway obstruction. He could not breathe normally.
I immediately performed a cricothyrotomy , an operation where an incision is made in the neck to insert a breathing tube, but during the evacuation he had 7 cardiac arrests. We resuscitated him 7 times, restarted his heart, did everything possible, but, unfortunately, he did not survive.
The fighter was younger than me and the fact that he could not be saved hit my psyche very hard.
Oleksandr during the evacuation of one of the wounded soldiers
– As a combat medic, do you have to work with non-combat injuries of soldiers or with their diseases?
– Yes, a lot. Because, in addition to wounds, soldiers receive a lot of other injuries. Everyone has a different state of health, a lot of different sores. Therefore, of course, we have to provide help, trivially, for colds, poisonings, and some sprains.
That is, I can say that during this time I worked as if in a large multidisciplinary hospital, where there is a therapist, a proctologist, an ophthalmologist, almost a dentist. Probably, except that there was no gynaecology.
– The work of a combat medic is very difficult and high responsibility. But maybe there is something positive about it or something that inspires you personally?
– The most inspiring moments are when you have the opportunity to visit the wounded in the hospital, when you see how they recover, how they feel better.
It is a great honour for me to help the soldiers. What they are going through cannot be compared to my experience. They are those who liberate our land, those who defend it. We are an integral, but still an additional element. We are the ones who are a little behind. But we work for them.
“At a certain point, the tourniquet starts to hurt more than the wound itself”
– Speaking in general about the level of knowledge of fighters in tactical medicine, what did you see during this time?
– I would say that the situation is not the best. Sometimes there are critical mistakes that can cost someone health and life.
– For example, a tourniquet that is incorrectly applied or not applied at all.
– What case personally impressed you the most, when your comrades provided first aid to a soldier in such a way that it only made further work of combat medics more difficult?
– In Bakhmut, a soldier was given a substance of unknown origin. I can quote: “It was either morphine or amphetamine.”
Under such conditions, it is very difficult to talk about any further narcotic “relief”. This distorts the picture in general: you cannot adequately assess the level of consciousness of the wounded.
– Do the wounded themselves obstruct your work when you try to help them?
– Some interfere, and some, on the contrary, help so much that it is sometimes surprising.
There was a case in Bakhmut, when the wounded man had an almost complete traumatic amputation of his arm, and during the evacuation he held this arm all the time, was completely calm. And when I had to do something, he said: “Please, can you hold this hand?”. He didn’t even forget to mention that he has contact lenses in his eyes, so that they must be removed. He even warned [us] about this detail.
He was absolutely calm, did everything that was required of him, helped as much as possible, and it just amazed me.
– And if we talk about the cases when they tell them not to cut their clothes, because these clothes are expensive, or when they ask to drink, but they cannot drink, because there is a concussion, and it is not desirable to drink liquid. How common is it?
– What you described is a classic. You pay little attention to this.
If the injured person is agitated, you can apply certain drugs to, firstly, to anesthetize them, and secondly, to calm them down so that they allow a certain manipulation to be done.
Another very frequent example is when the wounded try to release the tourniquet, because at a certain moment the tourniquet starts to hurt more than the wound itself. And here it is very important that someone is with them constantly and does not let them do this. Because if you unscrew it, the bleeding will open again, the wounded person will begin to lose blood.
Tactical medicine: Ukraine vs Russia
– How would you rate the level of combat medics in Ukraine?
– Our combat medics are heroic.
In general, the community of Ukrainian combat medics is constantly striving to develop, forums of tactical medicine are being created in Ukraine.
But there are certain problems. The first is the insufficient number of instructors and insufficient training potential to renew the pool of combat medics, who, like other fighters, are very often injured and often leave the ranks. Someone has to replace them.
The second problem is the lack of quality means of tactical medicine.
In general, we still have room to grow. Now it is especially important to focus on providing assistance to the wounded for a prolonged period of time while in the field, given that now it is very difficult to evacuate from the battlefield.
Well, we want more and more combat medics not to be afraid to use blood and treat haemorrhagic shock by blood transfusion.
– Do you follow the work of Russian combat medics and how would you characterize it?
– If you compare the Ukrainian and Russian armies in general, then medicine and tactical medicine are probably the only thing in which we are so far superior to them that, in principle, they are still very, very far from us.
But they also develop. In many units, especially of special purpose, both combat medics and correct tactical evacuation are already appearing.
But in general, we are head and shoulders above them: we work according to international protocols, we have expensive, high-quality equipment.
In such a refrigerator, Oleksandr and his crew transport blood to the front, which is transfused to wounded soldiers. According to him, this is expensive equipment
– If a wounded Russian soldier comes to you, will you help him?
– Yes, because the decision to let him live was not made by me, but by the fighter who captured this Russian. He risked his life to bring this Russian to me. Therefore, I have no right not to provide assistance.
This is our exchange fund. This Russian can be useful to us both with information and with the fact that we will exchange him for someone of ours.
That’s why he needs to be helped at the level that he can live and be useful to us.
– Have you ever had to work with such wounded people?
– I personally did not work with prisoners. But colleagues from my crew did.
On current challenges at the front, combat medics shortage and FVP drones
– Is there currently a shortage of combat medics in the army?
– Yes. Why is it acute? Combat medics get injured just like other soldiers, and training a new combat medic is a huge endeavour.
– Doctors of what specialties are currently in greatest shortage at the front?
– There will always be the greatest need for surgeons of various profiles and anaesthesiologists. But doctors of all other specialties are also needed.
– How do you feel the war has changed over the past two years?
– Our level of knowledge and combat experience is growing. But the level of Russians’ expertise is also increasing.
Now the most acute problem is FPV drones, which drastically complicate evacuation. And there are already cases when the seriously wounded are in positions for three or even more days, because they cannot be taken to the next evacuation link.
– When they say that tactical medicine is needed only for people who take a direct part in the war, do you agree?
– No. Because the war is all over the country. We are being bombarded with rockets. Therefore, I insist that all civilians take the Stop the bleed course (on average it lasts from an hour and a half). There, the instructor will teach you how to use a tourniquet to stop bleeding from the extremities and they will teach you how to tamponade wounds on the neck, under the arms and in the groin.
Even now, sitting here in the studio, I have a tourniquet with me, I carry a tourniquet with me all the time. And I believe that every civilian should do the same.
– What is your biggest dream now?
– The biggest dream is the de-occupation of my home. It’s just that I buried my iPhone there (smiles). Therefore, if someone unearths it, please return it. But I want to do it personally.
Interview by: Sofia Sereda, Ukrainska Pravda, Ukraine, 2024