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Caruhel JB, Haen P, Pavlychuk T, Kopchak A, Bertolus C, Khonsari RH. Facial surgeons and high-intensity conflict scenarios: Let us be ready to face the challenge. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2024; 125:101978. [PMID: 39047909 DOI: 10.1016/j.jormas.2024.101978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/11/2024] [Accepted: 07/20/2024] [Indexed: 07/27/2024]
Affiliation(s)
| | - Pierre Haen
- Maxillo-Facial Surgery Department, Laveran Military Hospital, Marseille, France
| | - Tetiana Pavlychuk
- Department of Maxillo-Facial Surgery and Innovative Dentistry, Bogomolets National Medical University, Kiev, Ukraine
| | - Andrii Kopchak
- Department of Maxillo-Facial Surgery and Innovative Dentistry, Bogomolets National Medical University, Kiev, Ukraine
| | - Chloé Bertolus
- Maxillo-Facial Surgery Department, Pitié-Salpêtrière Hospital, Paris, France
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Milford EM, Gurney JM, Beckett A, Strandenes G, Reade MC. Type-specific whole blood still has a role in the era of low-titer O universal donor transfusion for severe trauma hemorrhage. J Trauma Acute Care Surg 2024; 97:e23-e27. [PMID: 38764142 DOI: 10.1097/ta.0000000000004369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/21/2024]
Abstract
ABSTRACT Whole blood can be ABO-type specific (type-specific whole blood (TSWB)) or low-titer O universal donor (low-titer O whole blood (LTOWB)). Having previously used LTOWB, the US Armed Forces Blood Program began using TSWB in 1965 as a method of increasing the donor pool. In contrast to military practice, the Association for the Advancement of Blood and Biotherapies formerly the American association of blood banks (AABB), from its first guidelines in 1958 until 2018, permitted only TSWB. Attempting to reduce time to transfusion, the US military reintroduced LTOWB in the deployed environment in 2015; this practice was endorsed by the AABB in 2018 and is progressively being implemented by military and civilian providers worldwide. Low-titer O whole blood is the only practical solution prehospital. However, there are several reasons to retain the option of TSWB in hospitals with a laboratory. These include (1) as-yet ill-defined risks of immunological complications from ABO-incompatible plasma (even when this has low titers of anti-A and -B), (2) risks of high volumes of LTOWB including published historical advice (based on clinical experience) not to transfuse type-specific blood for 2 to 3 weeks following a substantial LTOWB transfusion, (3) uncertainty as to the optimal definition of "low titer," and (4) expanding the potential donor pool by allowing type-specific transfusion. Several large randomized controlled trials currently underway are comparing LTOWB with component therapy, but none address the question of LTOWB versus TSWB. There are sufficient data to suggest that the additional risks of transfusing LTOWB to non-group O recipients should be avoided by using TSWB as soon as possible. Combined with the advantage of maintaining an adequate supply of blood products in times of high demand, this suggests that retaining TSWB within the civilian and military blood supply system is desirable. TSWB should be preferred when patient blood group is confirmed in facilities with a hematology laboratory, with LTOWB reserved for patients whose blood group is unknown.
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Affiliation(s)
- Elissa M Milford
- From the 2nd Health Brigade (E.M.M.), Australian Army, Victoria Barracks, Sydney, New South Wales; Medical School and Royal Brisbane and Women's Hospital (E.M.M. and M.C.R.), Faculty of Medicine, University of Queensland, Herston, Queensland, Australia; Joint Trauma System (J.M.G.), Defense Health Agency, Joint Base San Antonio-Fort Sam Houston, Texas; Department of Surgery (J.M.G.), Uniformed Services University of the Health Sciences, Bethesda, Maryland; Canadian Forces Health Services (A.B.), Ottawa, Ontario, Canada; Department of Surgery (A.B.), St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada; Department of Immunology and Transfusion Medicine (G.S.), Haukeland University Hospital, Bergen; Medical Services (G.S.), Norwegian Armed Forces, Sessvollmoen, Norway; and Joint Health Command (M.C.R.), Campbell Park Offices, Canberra, Australian Capital Territory, Australia
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Onderková A, Quinn J, Meoli M, Taylor D, Nesterenko S, Schramm JM, Gimpelson AJ, O'Kelly A, Parks S, Rizek J, Davis T, Surkov D, Cherniawski B, Fernando R. Enhancing Prehospital Care During the Conflict in Ukraine: NATO's Role in Global Health Engagement. Mil Med 2024:usae380. [PMID: 39163204 DOI: 10.1093/milmed/usae380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Revised: 06/28/2024] [Accepted: 07/22/2024] [Indexed: 08/22/2024] Open
Abstract
INTRODUCTION The conflict in Ukraine, ongoing since 2014 and escalating with the Russian invasion in 2022, has unveiled profound challenges in prehospital care essential for the survival and recovery of warfighters and civilians alike, necessitating a detailed examination of the current medical response mechanisms and their effectiveness. MATERIALS AND METHODS This study provides an overview of these challenges and examines how these critical vulnerabilities have impacted the delivery of medical care in war-torn regions. It also explores the role of NATO and its member states in addressing these challenges, focusing on the efforts to standardize prehospital care, enhance training, and foster interoperability among medical services. Furthermore, it explores the role of global heath engagement through NGOs in addressing these prehospital care gaps within the Ukrainian conflict zone, drawing from direct observations, expert testimonials, and secondary data. RESULTS Findings reveal significant enhancements in prehospital care through improved training, interoperability, and logistics management, despite ongoing challenges in medical infrastructure and extended evacuation times, which continue to impact the quality of care. CONCLUSIONS The study underscores the critical role of international collaboration and standardized protocols in bolstering prehospital medical responses in conflict settings, highlighting the need for continuous adaptation and support to mitigate the complexities of modern warfare. The insights gained from the Ukraine conflict offer valuable lessons for future military and humanitarian medical responses in similar conflict settings.
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Affiliation(s)
- Anna Onderková
- Otorhinolaryngology, Imperial College London Healthcare Trust, London, W6 8RF, UK
| | - John Quinn
- Emergency Department, East Surrey Hospital, Redhill, RH1 5RH, UK
- Center for Global Health, Charles University, Prague, 121 08, Czech Republic
| | | | | | | | - Jessica M Schramm
- Neurocritical Care, University of Florida Health Shands Hospital, Gainesville, FL 32608, USA
| | - A J Gimpelson
- Global Flight and Tactical Medical, Manchester, NH, USA
| | - Aebhric O'Kelly
- College of Remote and Offshore Medicine Foundation, 55543, Germany
| | - Steven Parks
- Hungarian Army Medical Center, NATO Liaison, Budapest 1143, Hungary
| | - Jamla Rizek
- Beth Israel Deaconess Medical Center, Boston, MA 20850, USA
| | - Terri Davis
- Florida State University, Tallahassee, FL 32306, USA
- Tallahassee Memorial Hospital, US Army National Guard, Tallahassee, FL 32308, USA
| | - Denys Surkov
- National Association of Emergency Medical Technicians, St Nicholas Children's Hospital, Lviv 79059, Ukraine
| | | | - Rajeev Fernando
- Heal-Corp, Society of Disaster Medicine and Public Health, Jersey City, NJ 07307, USA
- Special Interest Group, Infectious Diseases, World Association of Disaster Emergency Medicine (WADEM), Madison, WI 53705, USA
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Butler F, Holcomb JB, Dorlac W, Gurney J, Inaba K, Jacobs L, Mabry B, Meoli M, Montgomery H, Otten M, Shackelford S, Tadlock MD, Wilson J, Humeniuk K, Linchevskyy O, Danyliuk O. Who needs a tourniquet? And who does not? Lessons learned from a review of tourniquet use in the Russo-Ukrainian war. J Trauma Acute Care Surg 2024; 97:S45-S54. [PMID: 38996420 DOI: 10.1097/ta.0000000000004395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/14/2024]
Abstract
BACKGROUND Extremity tourniquets have proven to be lifesaving in both civilian and military settings and should continue to be used by first responders for trauma patients with life-threatening extremity bleeding. This is especially true in combat scenarios in which both the casualty and the first responder may be confronted by the imminent threat of death from hostile fire as the extremity hemorrhage is being treated. Not every extremity wound, however, needs a tourniquet. One of the most important aspects of controlling life-threatening extremity bleeding with tourniquets is to recognize what magnitude of bleeding requires this intervention and what magnitude of bleeding does not. Multiple studies, both military and civilian, have shown that tourniquets are often applied when they are not medically indicated. Overuse of extremity tourniquets has not caused excess morbidity in either the recent conflicts in Iraq and Afghanistan or in the US urban civilian setting. In the presence of prolonged evacuation, however, applying a tourniquet when it is not medically indicated changes tourniquet application from being a lifesaving intervention to one that may cause an avoidable amputation and the development of an array of metabolic derangements and acute kidney injury collectively called prolonged tourniquet application syndrome. METHODS The recent literature was reviewed for papers that documented the complications of tourniquet use resulting from the prolonged casualty evacuation times being seen in the current Russo-Ukrainian war. The literature was also reviewed for the incidence of tourniquet application that was found to not be medically indicated, in both the US civilian setting and from Ukraine. Finally, an in-person meeting of the US/Ukraine Tourniquet Working Group was held in Warsaw, Poland, in December of 2023. RESULTS Unnecessary loss of extremities and life-threatening episodes of prolonged tourniquet application syndrome are currently occurring in Ukrainian combat forces because of nonindicated tourniquet use combined with the prolonged evacuation time seen in the Russo-Ukrainian war. Specific numbers of the complications experienced as a result of tourniquet use by Ukrainian forces in the current conflict are treated as classified information and are not available, but multiple sources from the Ukrainian military medical personnel and from the US advisors providing medical assistance to Ukraine have all agreed that the problem is substantial. CONCLUSION Unnecessary tourniquet morbidity might also occur in US forces in a variety of potential future combat scenarios in which evacuation to surgical care is delayed. Prehospital trauma training programs, including but not limited to tactical combat casualty care, place insufficient emphasis on the need to avoid leaving tourniquets in place when they are not medically indicated. This aspect of training should receive emphasis in future Tactical Combat Casualty Care (TCCC) and civilian first responder curriculum development. An interim ad hoc training solution on this topic is available at the websites noted in this articles. Additional training modalities may follow in the near future. LEVEL OF EVIDENCE Therapeutic/Care Management; Level V.
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Affiliation(s)
- Frank Butler
- From the Defense Health Agency Joint Trauma System (F.B., J.G., H.M., S.S., J.W.); University of Alabama at Birmingham (J.B.H.), Birmingham, Alabama; Medical Center of the Rockies (W.D.), University of Colorado Health; Los Angeles County + University of Southern California (K.I.); Trauma Institute (L.J.), Hartford Hospital, Connecticut; Texas A+M Health (B.M.); NAEMT TCCC Affiliate Faculty for TCCC Training Centers in Ukraine (M.M.); University of Cincinnati Medical Center (M.O.); Uniformed Services University (M.D.T.); Department of Surgery (M.D.T.), Naval Medical Center, San Diego, California; Medical Forces of the Armed Forces of Ukraine (K.H.); and Surgeon of the Medical Forces of the Armed Forces of Ukraine (O.L., O.D.)
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Pallett SJ, Mistry R, Lambert ZL, Woolley SD, Abbara A, Breathnach AO, Lamb LE, Williams A, Mughal N, Moshynets O, Hughes SJ, O'Shea MK, Moore LS. Conflict and catastrophe-related severe burn injuries: A challenging setting for antimicrobial decision-making. J Infect 2024; 89:106224. [PMID: 38986748 DOI: 10.1016/j.jinf.2024.106224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2024] [Accepted: 07/04/2024] [Indexed: 07/12/2024]
Abstract
Severe burns are a major component of conflict-related injuries and can result in high rates of mortality. Conflict and disaster-related severe burn injuries present unique challenges in logistic, diagnostic and treatment options, while wider conflict is associated with driving local antimicrobial resistance. We present a targeted review of available literature over the last 10 years on the use of systemic antimicrobial antibiotics in this setting and, given limited available data, provide an expert consensus discussion. While international guidelines do not tend to recommend routine use of prophylactic systemic antibiotics, the challenges of conflict settings and potential for polytrauma are likely to have ongoing impacts on antimicrobial decision-making and use. Efforts must be made to develop a suitable evidence base in this unique setting. In the interim, a pragmatic approach to balancing selective pressures of antimicrobial use with realistic access is possible.
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Affiliation(s)
- Scott Jc Pallett
- Centre of Defence Pathology, Royal Centre for Defence Medicine, Queen Elizabeth Hospital, Birmingham, UK; Clinical Infection Department, Chelsea and Westminster Hospital NHS Foundation Trust, SW10 9NH London, UK.
| | - Rakhee Mistry
- Department of Pharmacy, Chelsea and Westminster Hospital NHS Foundation Trust, SW10 9NH London, UK
| | - Zoe L Lambert
- Britannia Royal Navy College Dartmouth, College Way, Dartmouth, Devon TQ6 0HJ, UK
| | - Stephen D Woolley
- Centre of Defence Pathology, Royal Centre for Defence Medicine, Queen Elizabeth Hospital, Birmingham, UK; Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, Merseyside, UK; Academic Department of Military Medicine, Royal Centre for Defence Medicine, Queen Elizabeth Hospital, Birmingham, UK
| | - Aula Abbara
- Faculty of Medicine, Department of Infectious Diseases, Imperial College Praed Street, London W2 1NY, UK
| | - Aodhan O Breathnach
- Infection Care Group, St George's University Hospitals NHS Foundation Trust, Blackshaw Road, London SW17 0QT, UK; International Health Regulations Strengthening Project, UK Health Security Agency, South Colonnade Canary Wharf, London E14 4PU, UK
| | - Lucy E Lamb
- Academic Department of Military Medicine, Royal Centre for Defence Medicine, Queen Elizabeth Hospital, Birmingham, UK; Infectious Diseases Department, Royal Free Hospital, Pond Street, London NW3 2QG, UK
| | - Andrew Williams
- Burns Unit, Chelsea and Westminster Hospital NHS Foundation Trust, SW10 9NH London, UK
| | - Nabeela Mughal
- Clinical Infection Department, Chelsea and Westminster Hospital NHS Foundation Trust, SW10 9NH London, UK
| | - Olena Moshynets
- Institute of Molecular Biology and Genetics of National Academy of Sciences of Ukraine, Kyiv 03143, Ukraine
| | - Stephen J Hughes
- Department of Pharmacy, Chelsea and Westminster Hospital NHS Foundation Trust, SW10 9NH London, UK
| | - Matthew K O'Shea
- Centre of Defence Pathology, Royal Centre for Defence Medicine, Queen Elizabeth Hospital, Birmingham, UK; Academic Department of Military Medicine, Royal Centre for Defence Medicine, Queen Elizabeth Hospital, Birmingham, UK; Institute of Immunology and Immunotherapy, College of Medical & Dental Sciences, University of Birmingham, Birmingham, UK
| | - Luke Sp Moore
- Clinical Infection Department, Chelsea and Westminster Hospital NHS Foundation Trust, SW10 9NH London, UK; National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, Hammersmith Campus, London, UK
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Lurin I, Vorovskiy O, Makarov V, Khoroshun E, Nehoduiko V, Ryzhenko A, Chobey S, Gorobeiko M, Dinets A. Management of thoracoabdominal gunshot injuries by using minimally invasive surgery at role 2 deployed field hospitals in Ukraine. BMC Surg 2024; 24:183. [PMID: 38877409 PMCID: PMC11177506 DOI: 10.1186/s12893-024-02475-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Accepted: 06/06/2024] [Indexed: 06/16/2024] Open
Abstract
The Russia-Ukraine war is associated with critical and severe thoracoabdominal injuries. A more specific approach to treating patients with thoracoabdominal injury should also include minimally invasive technologies. It remains unclear about the utility of using video-assisted thoracoscopic surgery (VATS) and laparoscopy in patients with thoracoabdominal injury. The aim of this study was to investigate and evaluate the utility of video-assisted thoracoscopic surgery, laparoscopy as well as magnetic tool applications for the management of severe thoracoabdominal injury in combat patients injured in the ongoing war in Ukraine and treated in the Role 2 deployed hospital. Patients and methods 36 male combat patients thoracoabdominal injury were identified for the study during the first 100 days from February, 24 2022. These individuals were diagnosed with thoracoabdominal GSW in the Role 2 hospital (i.e. deployed military hospital) of the Armed Forces of Ukraine. Video-assisted thoracoscopy surgery (VATS) and laparoscopy with application of surgical magnetic tools were applied with regards to the damage control resuscitation and damage control surgery. Results In 10 (28%) patients, VATS was applied to remove the metal foreign body fragments. Both thoracotomy and laparotomy were performed in 20 (56%) hemodynamically unstable patients. Of these 20 patients, the suturing of the liver was performed in 8 (22%) patients, whereas peri-hepatic gauze packing in 12 (33%) patients. Massive injury to the liver and PI 2.0-3.0 were diagnosed in 2 (6%) patients. Lethal outcome was in 1 (2.8%) patient. Conclusions Thoracoabdominal gunshot injuries might be managed at Role 2 hospitals by using video-assisted thoracoscopy (VATS) and laparoscopy accompanied by surgical magnetic tools. Damage control surgery and damage control resuscitation must be applied for patients in critical and severe conditions.
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Affiliation(s)
- Igor Lurin
- National Academy of Medical Sciences of Ukraine, Kyiv, Ukraine
- State Institution of Science "Research and Practical Center of Preventive and Clinical Medicine", State Administrative Department, Kyiv, Ukraine
| | - Oleh Vorovskiy
- National Pirogov Memorial Medical University, Vinnytsya, Ukraine
| | - Vitalii Makarov
- Department of Thoraco-Abdominal Surgery, Military Medical Teaching Center of the Northern Region of Ministry of Defense of Ukraine, Kharkiv, Ukraine
- Department of Surgery #4, Kharkiv National Medical University, Kharkiv, Ukraine
| | - Eduard Khoroshun
- Department of Thoraco-Abdominal Surgery, Military Medical Teaching Center of the Northern Region of Ministry of Defense of Ukraine, Kharkiv, Ukraine
- Department of Surgery #4, Kharkiv National Medical University, Kharkiv, Ukraine
| | - Volodymyr Nehoduiko
- Department of Thoraco-Abdominal Surgery, Military Medical Teaching Center of the Northern Region of Ministry of Defense of Ukraine, Kharkiv, Ukraine
- Department of Surgery #4, Kharkiv National Medical University, Kharkiv, Ukraine
| | - Andrii Ryzhenko
- National Pirogov Memorial Medical University, Vinnytsya, Ukraine
- Military medical clinical center of the central region, Vinnytsya, Ukraine
| | - Stepan Chobey
- Department of Surgery, Uzhgorod National University, Uzhgorod, Ukraine
| | - Maksym Gorobeiko
- National Academy of Medical Sciences of Ukraine, Kyiv, Ukraine
- Department of Healthcare, Faculty of Postgraduate Education, Kyiv Agrarian University, Kyiv, Ukraine
- Department of Surgery, Lancet Clinic and Lab, Kyiv, Ukraine
| | - Andrii Dinets
- National Academy of Medical Sciences of Ukraine, Kyiv, Ukraine.
- Department of Healthcare, Faculty of Postgraduate Education, Kyiv Agrarian University, Kyiv, Ukraine.
- Department of Surgery, Verum Expert Clinic, vul. Demiїvska 13, Kyiv, 03039, Ukraine.
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Peng HT, Singh K, Rhind SG, da Luz L, Beckett A. Dried Plasma for Major Trauma: Past, Present, and Future. Life (Basel) 2024; 14:619. [PMID: 38792640 PMCID: PMC11122082 DOI: 10.3390/life14050619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 04/26/2024] [Accepted: 05/08/2024] [Indexed: 05/26/2024] Open
Abstract
Uncontrollable bleeding is recognized as the leading cause of preventable death among trauma patients. Early transfusion of blood products, especially plasma replacing crystalloid and colloid solutions, has been shown to increase survival of severely injured patients. However, the requirements for cold storage and thawing processes prior to transfusion present significant logistical challenges in prehospital and remote areas, resulting in a considerable delay in receiving thawed or liquid plasma, even in hospitals. In contrast, freeze- or spray-dried plasma, which can be massively produced, stockpiled, and stored at room temperature, is easily carried and can be reconstituted for transfusion in minutes, provides a promising alternative. Drawn from history, this paper provides a review of different forms of dried plasma with a focus on in vitro characterization of hemostatic properties, to assess the effects of the drying process, storage conditions in dry form and after reconstitution, their distinct safety and/or efficacy profiles currently in different phases of development, and to discuss the current expectations of these products in the context of recent preclinical and clinical trials. Future research directions are presented as well.
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Affiliation(s)
- Henry T. Peng
- Defence Research and Development Canada, Toronto Research Centre, Toronto, ON M3K 2C9, Canada; (K.S.); (S.G.R.)
| | - Kanwal Singh
- Defence Research and Development Canada, Toronto Research Centre, Toronto, ON M3K 2C9, Canada; (K.S.); (S.G.R.)
| | - Shawn G. Rhind
- Defence Research and Development Canada, Toronto Research Centre, Toronto, ON M3K 2C9, Canada; (K.S.); (S.G.R.)
| | - Luis da Luz
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON M4N 3M5, Canada;
| | - Andrew Beckett
- St. Michael’s Hospital, University of Toronto, Toronto, ON M5B 1W8, Canada;
- Royal Canadian Medical Services, Ottawa, ON K1A 0K2, Canada
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Lawry LL, Korona-Bailey J, Juman L, Janvrin M, Donici V, Kychyn I, Maddox J, Koehlmoos TP. A qualitative assessment of Ukraine's trauma system during the Russian conflict: experiences of volunteer healthcare providers. Confl Health 2024; 18:10. [PMID: 38268019 PMCID: PMC10809523 DOI: 10.1186/s13031-024-00570-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 01/16/2024] [Indexed: 01/26/2024] Open
Abstract
BACKGROUND The Russian Federation's invasion of Ukraine is characterized by indiscriminate attacks on civilian infrastructure, including hospitals and clinics that have devastated the Ukrainian health system putting trauma care at risk. International healthcare providers responded to the need for help with the increasing numbers of trauma patients. We aimed to describe their experiences during the conflict to explore the gaps in systems and care for trauma patients to refine the Global Trauma System Evaluation Tool (G-TSET) tool. METHODS We conducted qualitative key informant interviews of healthcare providers and business and logistics experts who volunteered since February 2022. Respondents were recruited using purposive snow-ball sampling. Semi-structured, in-depth interviews were conducted virtually from January-March 2023 using a modified version of the G-TSET as an interview guide. Interviews were transcribed verbatim and deductive thematic content analysis was conducted using NVivo. FINDINGS We interviewed a total of 26 returned volunteers. Ukraine's trauma system is outdated for both administrative and trauma response practices. Communication between levels of the patient evacuation process was a recurrent concern which relied on handwritten notes. Patient care was impacted by limited equipment resources, such as ventilators, and improper infection control procedures. Prehospital care was described as highly variable in terms of quality, while others witnessed limited or no prehospital care. The inability to adequately move patients to higher levels of care affected the quality of care. Infection control was a key issue at the hospital level where handwashing was not common. Structured guidelines for trauma response were lacking and lead to a lack of standardization of care and for trauma. Although training was desired, patient loads from the conflict prohibited the ability to participate. Rehabilitation care was stated to be limited. CONCLUSION Standardizing the trauma care system to include guidelines, better training, improved prehospital care and transportation, and supply of equipment will address the most critical gaps in the trauma system. Rehabilitation services will be necessary as the conflict continues into its second year.
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Affiliation(s)
- Lynn Lieberman Lawry
- Preventive Medicine and Biostatistics Department, Uniformed Services University, 4301, Jones Bridge Rd, Bethesda, MD, 20814-4799, USA.
| | - Jessica Korona-Bailey
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., 6720A Rockledge Drive, Bethesda, MD, 20817, USA
| | - Luke Juman
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., 6720A Rockledge Drive, Bethesda, MD, 20817, USA
| | - Miranda Janvrin
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., 6720A Rockledge Drive, Bethesda, MD, 20817, USA
| | - Valentina Donici
- Preventive Medicine and Biostatistics Department, Uniformed Services University, 4301, Jones Bridge Rd, Bethesda, MD, 20814-4799, USA
| | - Iurii Kychyn
- Bogomolets National Medical University, 13, T. Shevchenko Blvd., Kyiv, 01601, Ukraine
| | - John Maddox
- Preventive Medicine and Biostatistics Department, Uniformed Services University, 4301, Jones Bridge Rd, Bethesda, MD, 20814-4799, USA
| | - Tracey Perez Koehlmoos
- Preventive Medicine and Biostatistics Department, Uniformed Services University, 4301, Jones Bridge Rd, Bethesda, MD, 20814-4799, USA
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Holcomb JB, Dorlac WC, Drew BG, Butler FK, Gurney JM, Montgomery HR, Shackelford SA, Bank EA, Kerby JD, Kragh JF, Person MA, Patterson JL, Levchuk O, Andriievskyi M, Bitiukov G, Danyljuk O, Linchevskyy O. Rethinking limb tourniquet conversion in the prehospital environment. J Trauma Acute Care Surg 2023; 95:e54-e60. [PMID: 37678162 PMCID: PMC10662576 DOI: 10.1097/ta.0000000000004134] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 08/20/2023] [Accepted: 08/23/2023] [Indexed: 09/09/2023]
Abstract
We have highlighted the issue of overuse of tourniquets and described why tourniquet conversion and replacement should be taught and done in the prehospital setting.
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