US military doctors must learn from the experience of their Ukrainian counterparts, as the United States must prepare for “potential conflicts with adversaries close to their peers – hostile countries with equivalent military strength.” In a report by the Global Surgical and Medical Support Group (GSMSG), published in the Journal of the American College of Surgeons, these countries are Russia and China.
The GSMSG has been working in Ukraine since the start of hostilities, training Ukrainian military doctors and soldiers to help the wounded and organize field hospitals. It consists primarily of former United States military doctors, including those who worked with special forces. The organization’s president, Dr. Aaron Epstein, said it coordinates its actions in Ukraine with the US Special Operations Command in Europe.
According to Epstein, the conflict in Ukraine is an example of “what the next war will be like” – “every incident will be accompanied by massive casualties” with a death rate five times higher than that which the United States has experienced in Iraq and in Afghanistan.
The GSMSG chief warned that US military doctors must be prepared to treat the wounded in the face of increasingly precise artillery strikes, electronic interference and possible attacks on medical vehicles.
Ukrainian surgeons interviewed for the report said 70% of all injuries and deaths in the war zone are caused by artillery and rockets. A Ukrainian source quoted in the report claims that strikes against unarmored or lightly armored vehicles and military vehicles typically result in the death of 70% of those inside.
In Afghanistan and Iraq, the US military encountered primarily improvised explosive devices (IEDs), small-caliber firearms, mortars, and short-range missiles. During the 20 years the American contingent was in these countries, American casualties amounted to 7,076 people killed and 53,337 people injured, with 79% of the injuries being due to wounds caused by explosions.
Compared to pipe bombs, Russian weapons are “significantly more lethal”, say the report’s authors.
As an example, they cited the case when a thermobaric projectile instantly killed 12 people at a distance of 20 meters from the point of impact. 60 meters away, another person suffered burns over 80% of the body surface, from which he died within 72 hours, despite attempts to evacuate and resuscitate him.
The fire load itself is also different: “Russian forces in this conflict fire nearly 60,000 artillery shells a day. The U.S. military hasn’t seen this much firefighting since World War II.”
Due to the large number of injured, surgeons have to work around the clock, the report said. One of the doctors interviewed said he and his colleagues had 200 patients a week, or about 28 patients a day, and there were often multiple casualties with life-threatening injuries requiring surgery.
“Bullet-proof vests and helmets are useful in preventing injuries, but the lack of full torso protection is a problem: approximately 60% of penetrating chest and stomach wounds are received by soldiers from the side , between the front and back plates of the body armor, and 30% below them. In 10% of the wounded, the protection was either pierced by shells or absent,” the report states.
The report’s authors note the difficulty of providing medical assistance to military personnel hit by artillery fire, as they often have serious concomitant injuries – fatal shrapnel wounds, craniocerebral injuries, and bruises or broken bones from the impact on the ground due to the shock wave. The condition of almost all the injured is complicated by a concussion.
The GSMSG reports that Ukrainian military doctors do not have special communication equipment that allows them to receive information through secure channels that are not affected by “jammers”.
Moreover, according to the report of the organization, in field hospitals they try not to use electric generators, fearing that Russian troops will detect them using thermal imagers.
“This means that, despite the high need for blood transfusion, Ukrainian surgeons cannot store blood supplies in refrigerators or heat freeze-dried blood,” GSMSG staff wrote. An alternative option – a “walking blood bank”, i.e. the use of donor soldiers of universal blood group 0 (I) – is impossible due to high human casualties.
The evacuation of the wounded by air and road is difficult due to the frequent bombardments, so that the doctors have an even heavier load: they are obliged to treat the victims who cannot be evacuated, and at the same time to treat the new patients coming to them.
The GSMSG believes that US military doctors should be prepared to work under the same conditions – caring for large numbers of casualties near the front lines, caring for them for long periods of time.
The organization’s report highlights that for more than 20 years in Iraq and Afghanistan, the US military and its medical corps have been in conflict with insurgent and terrorist organizations that have used unconventional strategies and tactics because of their very uneven combat capabilities. This disparity guaranteed the Americans relative freedom of movement when evacuating the wounded.
“The situation in Ukraine shows that it is necessary to prepare for work with the wounded in completely different conditions”, summarize the authors of the report.
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