Scars of War: Dealing with the Alarming Rate of Unnecessary Amputations in Ukraine

Retired Brigadier General Mark Arnold was struck by something unexpected when he walked around the streets of Kyiv last November. Everywhere he looked, there were amputees.  

Ukraine is at war, so seeing amputees isn’t entirely surprising. What was surprising to Arnold was that most of the amputations were close to the shoulder or close to the crotch. “Why,” he wondered, “weren’t more of the amputations performed close to the knee or the elbow?”

Looking into this question, he made a number of disturbing discoveries. There was a reason for both the number of amputations and the severity of the amputations. Among the biggest things he learned from his counterparts in the Ukrainian armed forces was that 70% of the amputations were avoidable. Further, many of the shoulder or crotch-level amputations could have been done below the elbow or knee.

How did this dire situation come about? And is there anything that can be done to change it?

The answer to the first question has several layers. One of the biggest reasons is, in the first few months of the current invasion, the Russians deliberately targeted and destroyed Ukraine’s medical schools. Before the invasion, Ukraine had five medical schools where military physicians, nurses, and combat medics taught. Today only one remains.

Brigadier General (retiried) Mark Arnold, looks at the body bags of Ukrainians murdered during the occupation of Izyum. 

Before the invasion, these five medical schools trained the doctors and nurses needed to provide medical care for Ukraine’s roughly 225,000 soldiers.  Today, the Army has grown to 800,000, yet the country’s ability to train medical personnel is only 1/5th what it was two years ago.

That’s layer one of the problem. Layer two is that as many as half the medics who in the past could train new medics have been killed or incapacitated. Ukraine’s ability to train new medics has been tragically degraded.

The final major layer of the problem is so evil it’s almost hard for people in the West to grasp.  The Russians have a deliberate, conscious policy of targeting the ambulances that take wounded Ukrainians from the front lines to areas where they can get medical help.  

To see the impact of this, suppose one morning a soldier in Bakhmut whom we’ll call Andriy Shevchenko, is bleeding profusely from a leg wound. He needs medical care, but he can’t be removed from the front lines until dark, because the Russians will target any rescue vehicle that could take him to safety.  

Shevchenko will be treated by one of his comrades. His fellow soldiers all know how to apply a tourniquet, and they know if they apply it “high and tight” that they can twist the tourniquet windlass enough to stop the blood flow.  They’ve probably saved Shevchenko’s life, they’ve done it under fire, and they’ve done it as rapidly as possible. 

However, if the tourniquet is kept on for more than a couple of hours, the tissues in Shevchenko’s leg below the tourniquet will start to die. He may lose his leg. If the tourniquet stays on for over four hours, loss of his leg is certain. Given that his injury happened in the morning, and he may have to wait 12 hours to be taken to medical care away from the front line, Shevshenko has lost his leg – all of it.  

He will face not only months of rehabilitation, but he also may also be up against the psychological scars of not feeling like a whole person. The young man may find that even though he has the same need for physical intimacy and emotional closeness that he had before his injury, he may hesitate to approach a girl for a date.

What can be done to address this tragedy?

Arnold is working with his counterparts in Ukraine to create 22 dispersed medical training facilities, all in secret locations. They’re also working on creating up to 10 mobile instruction teams. 

With the right training, people on the front lines would be able to prevent 70% of the amputations. The instruction involves controlling bleeding with a pressure bandage, or if a tourniquet is necessary, the tourniquet may be released for short periods to allow blood flow to the affected limb, thereby reducing the risk of tissue death due to prolonged lack of blood flow.

Front line medics can learn how to release and then, if necessary, reapply tourniquets. This cycle can be repeated, balancing the need to control bleeding with the need to preserve tissue viability. With this skill, they can successfully avoid up to 70% of all amputations.

The program is based on Ukrainians training Ukrainians and managed by the Ukrainian Military Medical Academy and Medical Corps, so it is far more sustainable and accountable than foreign civilians attempting the same. And the curriculum is the same 90+ skills training course used for training medics in the U.S. Currently the Ukrainians are training 150 instructors. 

Arnold is raising money to help support this Ukrainian medical instruction program. The need is intense. As he says, describing the mass casualty events the Russian bombings are causing, “What they’re up against is akin to a Boston Marathon bombing occurring 15 times per day across each region of the United States. The need for medical education is urgent and dire, but it is also addressable.”

He invites you to donate by coming to: www.cbusfdn.org/frontline-medical-ukraine