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Enhancing Trauma Care in Ukraine Amid Conflict: A Successful Implementation of Modified ATLS Course in Active War Zone
Ali Dzhemiliev1,2, Beck Lienau3, Nelya Melnitchouk1,2, Alexis Schmid4, Oleksii Lopatniuk5, Gideon Loevinsohn6, Noah Carton-Rossen2, Meaghan Sydlowski5, Anton Darnytskyi5, Kathleen Murray7, Olha Kushner5, Jonathan Strong6, Lindsey Martin8, Javed Ali5, John Roberts5, Sean Kivlehan6,7, Geoffrey A. Anderson2,3
1Division of General and GI Surgery, Department of Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, 2Center for Surgery and Public Health, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, 3Division of Trauma, Burns, Surgical Critical Care and Emergency General Surgery, Department of Surgery, Brigham and Women’s Hospital, Boston, MA, 4Global Health Program, Boston Children’s Hospital, Harvard Medical School, Boston, MA, 5International Medical Corps, 6Department of Emergency Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, 7Emergency Health Systems, Harvard Humanitarian Initiative, Boston, MA, 9Global Disaster Response and Humanitarian Action, Massachusetts General Hospital, Boston, MA

Background: Since the 2022 Russian full-scale invasion, Ukraine has endured a significant burden of trauma, with over 700 medical facilities attacked, exacerbating challenges in it's underfunded healthcare system. Ukrainian physicians, lacking standardized trauma training, were forced to provide trauma care. Responding to this urgent need for action, our goal was to enhance trauma care skills among Ukrainian physicians while assessing the feasibility of conducting ATLS in active war zones.

Methods: A consortium was formed, including International Medical Corps, Harvard Humanitarian Initiative, Mass General Brigham, Boston Children's Hospital, and Global Medical Knowledge Alliance. ATLS was the chosen curriculum, translated into Ukrainian, with an additional day focusing on war injuries. US-based instructors conducted 10 courses over 3 months in various Ukrainian cities. Course effectiveness was evaluated through pre- and post-knowledge tests, self-confidence assessments, and post-course surveys.

Results: Over 3 months, 10 courses were conducted in Northern (Kyiv-4), Eastern (Dnipro-3, Zaporizhzhia-1), and Southern Ukraine (Odesa-2). Over 189 educational hours, 27 instructors taught 213 students. Knowledge improved from 64% to 75% and self-reported confidence rose from 53.3% to 73.1%. Student confidence improved in 19 of 20 areas, with a post-survey average of 94%. No casualties occurred among instructors or students.

Conclusion: Our program demonstrated the effectiveness of in-person trauma education despite security and logistical challenges. Strong partnerships between international and local trauma experts contributed to our success. Future plans involve training local instructors to integrate ATLS sustainably into Ukrainian healthcare. Our teaching model offers valuable lessons for implementation in LMICs and active conflict zones.
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