A. Dzhemiliev1,2, B. Lienau4, N. Melnitchouk1,2, A. Schmid5, G. Loevinsohn9, O. Lopatniuk6, N. Carton-Rossen8, M. Sydlowski6, A. Darnytskyi6, K. Murray10, O. Kushner6, J. Strong3, L. Martin11, J. Ali6, J. Roberts6, S. M. Kivlehan10,12, G. A. Anderson2,4 1Brigham And Women’s Hospital, Surgery, Boston, MA, USA 2Brigham And Women’s Hospital, Center For Surgery And Public Health, Boston, MA, USA 3Brigham And Women’s Hospital, Emergency Surgery, Boston, MA, USA 4Brigham And Women’s Hospital, Division Of Trauma, Burns, Surgical Critical Care And Emergency General Surgery, Boston, MA, USA 5Children’s Hospital Boston, Global Health Program, Boston, MA, USA 6International Medical Corps, Boston, MA, USA 7Harvard School Of Medicine, Emergency Health Systems, Brookline, MA, USA 8Harvard School Of Public Health, Boston, MA, USA 9Harvard Affiliated Emergency Medicine Residency at Mass General Brigham, Boston, MA, USA 10Harvard Humanitarian Initiative, Emergency Health Systems, Boston, MA, USA 11Massachusetts General Hospital, Global Disaster Response And Humanitarian Action, Boston, MA, USA 12Brigham And Women’s Hospital, Emergency Medicine, Boston, MA, USA
Introduction: Since the 2022 full-scale Russian invasion, Ukraine's trauma burden surged, with over 700 medical facilities attacked, straining its underfunded healthcare. The absence of standardized trauma training compelled Ukrainian physicians to deliver care. Needs assessments underscored the urgency for action, requiring in-person, hands-on trauma training due to wartime obligations of Ukrainian physicians and the ban on males leaving Ukraine. Our aim was to enhance Ukrainian physicians' trauma care expertise while evaluating ATLS course effectiveness in an active war zone.
Methods: A consortium was established, including the International Medical Corps, Harvard Humanitarian Initiative, Mass General Brigham, Boston Children’s Hospital, and the Global Medical Knowledge Alliance. At the request of our Ukrainian partners, Advanced Trauma Life Support (ATLS) was the foundation for the curriculum, with all 10th edition traditional materials translated into Ukrainian. Teams of US-based ATLS instructors were deployed to Ukraine for regular teaching. The US team flew to Poland and drove to the Ukrainian border. In western Ukraine, instructors had war orientation. Ongoing missile attacks prompted hotels and ATLS centers to be as far as possible from potential targets and have an accessible bomb shelter. The war curfew further intensified the challenges. Course effectiveness was evaluated through paper-based exams, self-efficacy surveys, and evaluations. The pre- and post-knowledge exams were a modified version of the ATLS exam, proctored by the ATLS course director. The self-confidence surveys consisted of a 20-question Likert scale survey, and post-course satisfaction was measured with an 8-question evaluation.
Results: Over 3 months, we conducted 10 courses in Northern (Kyiv-4), Eastern (Dnipro-3, Zaporizhzhia-1), and Southern Ukraine (Odesa-2). With 27 instructors, we taught 213 students for a total of 189 hours. Students' knowledge increased from 64% to 75% (p < 0.05), and self-reported confidence rose from 53.3% to 73.1% (p < 0.05). Student confidence improved in 19 out of 20 areas. The post-course satisfaction survey yielded an average positive score of 94%. There were zero morbidities or mortalities among instructors or students.
Conclusion: Limited data on teaching ATLS during war highlights our study's novelty: successful and safe in-person ATLS teaching by US instructors within an active war zone. Our team overcame security and logistical challenges. Close partnerships between international and local trauma experts contributed to our success. Despite numerous obstacles, the course enhanced students’ knowledge, aligning with Kirkpatrick's initial two learning evaluation levels. Future plans involve training local instructors and integrating the program into Ukrainian healthcare, serving as a valuable model for challenging contexts in low- and middle-income countries and conflict zones.