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“The war changed everything”: Surgeons Share Lessons Learned from Ukraine

Traumatic injuries seen in Ukraine, and the scale of attacks on civilians and hospitals, are distinct compared with wars of recent decades

October 21, 2022

SAN DIEGO: Six surgeons directly involved in caring for injured patients during the war in Ukraine shared their experiences Wednesday, October 19, during the American College of Surgeons (ACS) Clinical Congress 2022 in San Diego. Among the panelists was Hnat Herych, MD, PhD, a Ukrainian surgeon who is chief of surgery department, Multidisciplinary Clinical Hospital of Emergency and Intensive Care, Danylo Halytsky Lviv National Medical University, Ukraine. Appearing alongside Dr. Herych were several surgeons who have all traveled from the U.S. to Ukraine to assist with surgical care on the ground.

During a scientific panel session and a news briefing that followed, Dr. Herych emphasized the needs of Ukrainian surgeons and the difficulties they are facing since the start of the war.

Surgeons who have cared for injured patients in Ukraine shared lessons learned at a recent news briefing.
Surgeons who have cared for injured patients in Ukraine shared lessons learned at a recent news briefing.

“You need to understand that the war is still going in Ukraine. Doctors and surgeons of Ukraine are fighting for the lives of the people,” said Dr. Herych. “Before the war, we did modern operations. But the war changed everything.”

“We know a lot about what happened for the 20 years in Iraq and Afghanistan, but Ukraine is a very different story. The nature of the injuries that are being sustained, the targeting of civilians, the bombing of hospitals, all of which make it a very different war,” said M. Margaret “Peggy” Knudson, MD, FACS, Medical Director, Military Health System Strategic Partnership American College of Surgeons (MHSSPACS), who moderated the panel session.

The use of whole blood

John B. Holcomb, MD FACS, professor in the division of trauma and acute care surgery, department of surgery, University of Alabama at Birmingham, described the use of whole blood transfusions in Ukraine and how it is helping improve survival. “In the civilian world, it takes about 18 months to change over to whole blood. Dr. Herych and his colleagues, in a time of war, did it in two weeks,” he said.

Whole blood contains all the components of blood and is often used to treat patients with traumatic injuries who have sustained significant blood loss.*

Dr. Holcomb also noted that patients are being transported by train from eastern to western Ukraine. “We haven’t seen this kind of transport by trains since World War II. It’s a very different experience for these patients as they take two-to-three days to get across this large country.”

Coordinating surgical efforts in Ukraine

Aaron Epstein, MD, a general surgery resident at the University at Buffalo has coordinated efforts to help Ukraine through the non-governmental organization he created, the Global Surgical Medical Support Group (GSMSG). He shared his experiences in Ukraine and the information that has been gathered. “One of the things we’ve gotten out of this is really interesting data. The injury patterns that we’ve seen are very different than what was seen over the last few decades in the global war on terror. As opposed to a single IED going off, now you have artillery and rocket barrages,” he said.

“We are working with everybody, whether it was administration, nursing, medical students, residents, faculty, whoever would listen to us and whoever wanted to sit down and talk, we would take those opportunities,” said Warren C. Dorlac, MD, FACS, medical director, trauma and acute care surgery, UCHealth Medical Center of the Rockies, Loveland, Colorado.

Future needs in Ukraine

Dr. Herych emphasized the dire need for rehabilitation services in Ukraine. He said his hospital has taken in more surgical patients than ever before, but the availability of rehabilitation services is lacking.

“Our dream and our first need that we want to do is to build a rehabilitation center in Ukraine. We have thousands of patients who need rehabilitation in Ukraine,” he said.

The panelists noted that many basic supplies required for patient care are now lacking in Ukraine. Dr. Herych emphasized that his hospital was functioning at a very high level before the war, but the basic supplies needed to perform necessary operations have become increasingly scarce in the country.

Although the current war in Ukraine is ongoing, the panelists talked about the valuable lessons they have learned, which can bolster future efforts.

“It is these shared experiences of learning from each other that makes us better prepared to manage these wounds moving forward,” said Jeffrey D. Kerby, MD, PhD, FACS, Chair of the ACS Committee on Trauma and a co-moderator of the panel session.

“We’re not done improving medical and surgical care and burns until there are no deaths, no scars, and no pain. We’re not there yet. We cannot be satisfied with the status quo,” said Steven E. Wolf, MD, FACS, professor and chief, division of burn and trauma surgery, University of Texas Medical Branch at Galveston.

These surgeons and others continue to help Ukraine in many ways to enhance medical care and save lives during the conflict. Surgeons have traveled to Ukraine to teach courses such as Advanced Trauma Life Support® (ATLS®), STOP THE BLEED®, and others. Additionally, modules from a program developed by the ACS called the Military Clinical Readiness Curriculum—designed as a tool to ensure clinical readiness for surgeons in areas of conflict or disaster—have been translated into Ukrainian to help surgeons on the ground in Ukraine save lives.

View a recording of the news briefing on the ACS YouTube channel.

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* Blood Components. American Red Cross. Accessed October 20, 2022. Available at: https://www.redcrossblood.org/donate-blood/how-to-donate/types-of-blood-donations/blood-components.html.

About the American College of Surgeons

The American College of Surgeons is a scientific and educational organization of surgeons that was founded in 1913 to raise the standards of surgical practice and improve the quality of care for all surgical patients. The College is dedicated to the ethical and competent practice of surgery. Its achievements have significantly influenced the course of scientific surgery in America and have established it as an important advocate for all surgical patients. The College has more than 84,000 members and is the largest organization of surgeons in the world. "FACS" designates that a surgeon is a Fellow of the American College of Surgeons.

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