American College of Emergency Physicians
Ukraine Trauma Care Training
Sean Kivlehan, MD, MPH, and Jonathan Strong, MD, MPH
Affiliation (same for both): Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA, and the Harvard Humanitarian Initiative, Cambridge, MA.
On February 24, 2022, Russia launched a full-scale invasion of Ukraine. Surging numbers of trauma patients have strained Ukraine’s emergency care system – a system already under duress after eight years of ongoing conflict in eastern Ukraine. Attacks on healthcare facilities and other critical infrastructure have interrupted health services, further compounding challenges in providing acute medical and trauma care. Medical personnel trained in non-trauma specialties and civilians have become trauma first responders regardless of prior training. As the full-scale invasion enters its second year, fighting remains fierce and the threat of chemical, biological, and nuclear weapons looms.
In response, the Harvard Humanitarian Initiative (HHI) and International Medical Corps (IMC) partnered to provide training in clinical trauma care, mass casualty management (MCM), and preparedness and response to chemical, biological, radiation, nuclear, and explosive (CBRNE) incidents. Trauma training was divided into four-course streams: a modified version of Advanced Trauma Life Support for physicians (supported by the American College of Surgeons), a new trauma nursing fundamentals course for nurses (created with some support from the Emergency Nurses Association), a new prehospital trauma fundamentals course for prehospital, and the Stop the Bleed course from ACS for civilians. Additionally, the MCM course from the World Health Organization was utilized to train emergency care system leaders and key stakeholders to develop hospital mass casualty plans. Finally, a new CBRNE course was developed to train a diverse cohort of students in CBRNE preparedness and response.
All courses were delivered in person with live bidirectional English-Ukrainian interpretation and course materials translated into Ukrainian. In phase one of the project, courses were delivered largely by international experts who traveled to Ukraine to teach. High-performing students were identified in each class and offered additional instructor training. Phase two of the project, currently in progress, focuses on strengthening these newly trained Ukrainian instructors’ teaching and course management skills with direct international expert support. Phase three will be wholly led by the Ukrainian instructors, with international expert support tapering off as appropriate. Equipment required for each course was procured by HHI and IMC and donated to local organizations for use in future courses.
Phase one of the project trained over 2,000 Ukrainians across the six-course streams with training delivered in Kyiv, Dnipro, Zaporizhzhia, and Odessa. Phase two will increasingly utilize Ukrainian instructors to train an additional 2,000 Ukrainians in several additional cities. Course feedback has been overwhelmingly positive, with over 90% of participants reporting that the trainings were relevant, expanded their knowledge, and improved their confidence in the areas of instruction.
Additionally, twenty-six educational videos that cover key content from the courses were created to complement in-person instruction. These videos will enable just-in-time training and serve as a resource for those who could not attend in-person courses. The videos, all in Ukrainian, have already been viewed in Ukraine over a million times.
The HHI/IMC Ukraine Trauma Training Program will continue to transition to Ukrainian leadership over the coming year. This training will complement other important efforts to strengthen emergency care in the country. Further, the training and the videos can be adapted to train others around the world who face similar challenges.
We are thankful to all our team members who have made these trainings possible. We are inspired by the tireless efforts of our instructors, coordinators, logisticians, and students in Ukraine to improve the quality and access to emergency care.
