17th March 2022, Brussels/Lviv – On Sunday 13 and Monday 14 March a surgical team from Médecins Sans Frontières / Doctors Without Borders (MSF) provided mass casualty influx training and advice for the staff in the 750-bed Okhmatdyt paediatric hospital, one of the largest in central Kyiv. An MSF surgeon with experience in war surgery also assisted in the operating theatre and gave advice to the surgeons about approaches to war-trauma surgery.
“Our surgeon did one quite delicate operation, and straight afterwards the surgeons in the hospital came and proactively asked to be trained on those techniques,” says Anja Wolz, MSF Emergency Coordinator in Ukraine. “Most of the surgeons in this hospital are specialists but they do not have trauma surgeons. So they have not had experience doing significant debridement [wound cleaning] which is essential for bullet and shrapnel wounds. If a bullet or shrapnel wound is not dealt with quickly or correctly infection can set in fast and it requires some experience to know how to approach this type of surgery - to ensure the wound is effectively cleaned and will heal properly, and to avoid further infection.”
From 2,000 staff to a core team of 200
With curfews, frequent bomb-alert sirens and staff sheltering in bunkers and having difficulties to travel to the hospital, the usual 2,000 personnel has reduced to a core team of around 200. The hospital has discharged or referred elsewhere most of the former patients and the staffing levels feel OK for the moment given that the hospital is setting itself up to be ready for treatment of people with trauma wounds. At the time of the MSF team’s visit, the hospital was receiving several wounded patients per day. Expecting the numbers of wounded to increase, the staff was keen to benefit from MSF’s war-medicine experience to be better prepared in several ways:
- Mass casualty events: The hospital staff wanted to sharpen their plans for triage and organisation in the event of the simultaneous arrival of multiple trauma patients – otherwise known as a Mass Casualty Plan (MCP). MSF’s conflict-experienced Emergency Room doctor provided classroom training on best practices for mass casualty plans for 40 of the hospital’s remaining 200 staff. And the MSF team advised on changes to the patient-flow circuits in the hospital in the event of large numbers of casualties.
- Trauma-surgery: The surgeons in the hospital are mostly rather specialised, so MSF’s conflict-experienced vascular surgeon provided training to hone skills in rapid life-saving trauma stabilisation and surgery, such as removal of bullets or shrapnel, preventing internal bleeding, effective wound-cleaning and other core essentials of trauma-surgery. This was done via hands-on training while assisting in the operating theatre.
- Supplies: The hospital requested advice on how to manage their supply lines and organisation of the basic essentials to be able to manage high numbers of war-trauma patients over an extended period. The MSF team assessed the quantities of supplies the hospital has, and made recommendations about continued supply of war-trauma essentials.
“We intend if possible to return soon to build on what we could do in the first short visit,” says Wolz. “We have not been able to fully finalise the mass casualty training and there is more to do to help map out the best patient pathways in case of simultaneous arrival of large numbers of casualties. We also want to continue looking into the hospital’s supply chains. These are some of the principal things that the hospital has asked for. We would also like to do more hands-on training and advice for the surgeons – practical bedside and operating theatre training.”