The Scots doctor helping to train Ukraine medics for the battlefield

It is some distance to the nearest Ukrainian medical point and a wounded soldier is at risk of bleeding to death on the battlefield.

The combat medic who is trying to save his life is coming under attack from Russian artillery fire.

His first mission is to keep the wounded soldier alive until he can get him to the nearby ambulance – a standard 4×4 rough terrain vehicle – and then on to the next stage.

If they reach the Role One first aid station and a doctor working in the basement of a bombed-out building, the soldier’s chances of survival improve.

Two years earlier this Ukrainian tactical combat medic was an instructor on an Outward Bound course in the Carpathian mountains, where his biggest problem was the weather.

But his remote emergency medical training, taught four weeks earlier by a specialist doctor from Inverness, has now given him the skills to handle catastrophic war wounds.

Dr Tom Mallinson, a Pre-hospital Immediate Care and Trauma (Pict) specialist based at the city’s Raigmore hospital, reveals his mission to train combat medics on Ukraine’s battlefield.

His normal “beat” of attending casualties in the Highlands was swapped for a training unit in Malta where he taught the advanced medical courses to the Ukrainian tactical medics last month.

Dr Mallinson is senior lecturer in prolonged field care at the College of Remote and Offshore medicine.

The parallels between rural Scotland and the frontline of the war in Ukraine are the skills required to keep seriously injured or ill patients alive until they can reach hospital, albeit in very different locations.

“These Ukrainian combat medics are working under enormous pressure on the battlefront to keep wounded soldiers alive and make it safely to a casualty collection point,” Dr Mallinson said.

“Keeping them alive until they get there, and after arrival, involves good medical treatment and judgment. They must stop the wounded bleeding to death on the battlefield by using tourniquets and then avoid what we call compartment syndrome, where tissue begins to die if the blood supply is cut off for too long.

“Training medics on how and when to safely remove tourniquets can be lifesaving.

“It is a steep learning curve for civilians who two years earlier ran Outward Bound courses with a working knowledge of first aid.

“Three years into the war in Ukraine a number of doctors have been killed by artillery fire and drone attacks in frontline combat and a considerable amount of pre-hospital emergency care has fallen to civilians.

“They are fast learners and hugely committed to caring for their casualties and work under the constant risk of artillery fire and being blown up.”

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Despite medics being protected by the Geneva Convention of 1949, the painful reality is that they can sometimes be among the first casualties while caring for the injured or dying.

Many stopped wearing uniforms with red crosses and ambulances have been camouflaged due to the number of casualties they were sustaining.

The UK’s Lancet medical journal has carried reports of attacks on Ukrainian hospitals and of doctors being tortured after being captured and detained in Russian-run prisons in Donetsk.

Casualties and medics who reach the first station en route to military hospital are triaged into those who need emergency surgery, those whose injuries are severe but not life-threatening, and those so badly injured they cannot be saved.

“The corridors of the basement hospitals are lined with casualties being kept alive in the hope of being moved on to Ukrainian hospitals further back from the frontlines,” said Dr Mallinson.

“One of the biggest risks is bleeding to death and some medics are donating it in ‘buddy to buddy’ transfusions to their patients.

“They have the technology to crossmatch and transfuse blood by the bedside with some ability to screen for bloodborne viruses like HIV.”

Medical devices used on remote and rural patients in Scotland are also part of the Ukrainian army medic’s medical armoury.

The Butterfly IQ handheld ultrasound device can scan and then send images of patients’ internal injuries through mobile phones to senior doctors miles away in military hospitals.

It is identical to one that was used to diagnose the injuries of an Inverness-shire woman who was crushed by a horse last year.

A Ukraininan combat medic said: “We have a learned a lot about septic shock, a great deal more on diagnostics and airway skills for casualties.

“We gathered a group of first aid and tactical medicine instructor and joined the Extra-Ordinary Tactical Medical volunteer medical organisation run by our army.

“We have trained 19,000 already.”