Maksym taught people how to trade cryptocurrency in Kyiv until Russia launched its all-out invasion of his homeland last year. Now, as Ukraine prepares to mount a major counter-offensive, he is a combat medic learning from military instructors how to save lives on the frontline and, for three days this month, learning from a team of experts from Ireland.
It was the second time that the Irish-based medics and advanced paramedics have visited Ukraine, to teach a course devised by the Centre for Emergency Medical Science at University College Dublin in response to a request from Ukrainian colleagues.
They were asked to supplement training received by the country’s military medics with skills familiar to advanced paramedics in Ireland, which can dramatically improve the chances of surviving major trauma – for soldiers and civilians alike – as Ukraine braces for an intense phase of fighting and potentially years of devastating war with its vast neighbour.
“I don’t think anyone can ever know everything or be 100 per cent ready for combat… There is always something more to learn and I want to learn,” says Maksym (26), who is now training as a tactical medic and giving basic medical instruction to his comrades in the Azov assault brigade of Ukraine’s national guard.
“Of course, I’m sharing all the knowledge I get with the comrades that I’m training, because you never know what you will need to do,” he adds.
“It was definitely useful,” Maksym says of the course that 60 Ukrainians attended in Kyiv. “New skills and new contacts are always useful… Whenever we get the chance to learn new things from new people, we will take the opportunity, that’s for sure.”
I’ve been a doctor for 40 years and involved in training medical students and postgraduate students for 30 years, and I can say this was the most rewarding and dynamic teaching experience I’ve ever had
— Spokesperson for the Irish project who is also a clinical professor at UCD
The course focused on how to counteract the kind of severe haemorrhaging that data from recent conflicts shows is the cause of more than one third of all combat deaths and about 80 per cent of all preventable fatalities on the battlefield.
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Members of the Irish initiative, which is called the Ukraine Trauma Project, say the six medics who taught the course in Kyiv – and those who ran a one-day pilot course in Lviv last November – were strongly affected by the experience.
‘Overwhelmed’
“We were so highly impressed – overwhelmed, actually – by the commitment, the focus, the enthusiasm to learn and the courage of the participants that we met,” a spokesperson says.
“I’ve been a doctor for 40 years and involved in training medical students and postgraduate students for 30 years, and I can say this was the most rewarding and dynamic teaching experience I’ve ever had,” adds the spokesperson, who is a clinical professor at UCD’s School of Medicine.
“They were… patriotic, committed, focused and really intent on saving the lives of their comrades. It was really humbling to encounter medics and paramedics who are actually putting their own lives at substantial risk to look after their colleagues – it was heart-stopping, in fact.”
After one young soldier gave the entire class what the professor describes as an “A-plus performance” on what he had learned and how to teach it to other troops, he was asked what he did before the war. “I was a barman,” he replied.
“The men and women in your unit will be privileged to have you as their medic,” the professor told him.
Several trainees went directly from the class to the front line, which drove home to the Irish trainers the brutal reality of the war and strengthened their determination to secure Government funding for the project and to keep their own names out of the media when discussing it.
The Irish medics taught trainees how to use tranexamic acid (TXA) – a medicine to control heavy bleeding – in patients suffering such severe blood loss that it cannot be put into their veins
“I’ve never come across anything like this in my life, in terms of courage, motivation and dedication to patient care,” the professor says. “I feel humbled by it, and we want to work hard for these people but we don’t want to promote ourselves in any way.”
The Irish medics taught trainees how to use tranexamic acid (TXA) – a medicine to control heavy bleeding – in patients suffering such severe blood loss that it cannot be put into their veins.
The method involves using a special kit to drill into the upper arm or leg and insert a needle through which TXA can be administered directly into the bone, along with fluids and other drugs that a critically injured patient may need.
As soon as possible
Advanced paramedics in Ireland’s statutory ambulance services have used TXA for a decade, and UCD’s Centre for Emergency Medical Science played a key part in teaching them how to use a drug that must be given as soon as possible after trauma and is ineffective after three hours.
Ukraine is in urgent need of such life-saving skills, with heavy fighting predicted for the spring and summer and 14 months into a full-scale war which, according to US estimates, may have killed more than 15,000 Ukrainian soldiers and injured 100,000. Casualties on the Russian side are believed to be about twice as heavy.
“The course was really useful and timely – though half a year ago would have been even better,” says Oleksiy Dronov, a trainer with the Serhiy Prytula Foundation, a major Kyiv-based charity that hosted the classes.
Army medics in Ukraine are familiar with TXA and often have it in their packs, but few know how to administer it through the bone, and the drill and needles required are not part of their standard kit, Dronov explains.
Ireland has declined to join other Western states in providing arms to Ukraine, but has committed tens of millions of euro to Kyiv in humanitarian, political and financial aid and non-lethal military supplies
“Thanks to this training, those present realise that [this method] is absolutely safe and if they can’t find a vein then they must go straight to the bone to administer TXA,” he says.
“The trainees also learned a lot about chemical, radiological and other burns… and a lot of tips and tricks from Irish paramedics with 20-plus years of experience. I know that all these things will have gone straight back to the regiments right away.”
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The Irish team delivered some much-needed equipment to their Ukrainian colleagues, including kits that each cost about €1,000 and contain TXA, a drill to access the bone, and needles for four patients.
‘Minuscule cost’
Ireland has declined to join other Western states in providing arms to Ukraine, but has committed tens of millions of euro to Kyiv in humanitarian, political and financial aid and non-lethal military supplies such as body armour and medical kit via an EU programme.
“When you look at the cost of military hardware being made available [to Ukraine], the cost of this (TXA) equipment is minuscule. That’s why we would like more formal support,” the UCD professor says.
“We recognise the phenomenal humanitarian response that the Irish Government has made to the war in Ukraine, and we feel that this highly targeted project – aimed at saving lives by supporting the training of front-line combat medics and paramedics and supplying the equipment and drugs they need – should now be part of that response both operationally and at an advocacy level in the EU.”
The training visits have been supported so far by UCD; the Tullamore-based Critical Healthcare firm that provided equipment; An Post, which hosted several fundraising concerts in Dublin’s GPO; and by public donations, including many from Ukrainians in Ireland.
But stable funding is needed to make the project sustainable, according to a Ukrainian-born member of the initiative who has lived in Ireland for six years.
“We need to think about how to provide them with the equipment they need to use the skills that we teach them. A lot of supply chains in Ukraine are disrupted because of the war, and people rely on Western and international help to bring in medical equipment and medications,” says the GP, who also asked not to be named.
“We have to realise that if we are training them to do something, we are also accountable to ensure they have some sort of access to the equipment they need,” she adds.
“It’s a great morale booster to have foreign experts come in, on their own time and without looking for any recognition, to train them and to help however they can. For Ukrainians to know they have Western support and are not forgotten – that’s a huge thing.”
