The ongoing war in Ukraine and the resulting stream of casualties flowing into Ukrainian hospitals has forced nearly every physician in the country to be at the ready for taking on trauma cases — something well outside the expertise of most doctors.
“Everyone in some way has been redeployed because of this war. You have pediatricians with no experience treating trauma cases, for example, suddenly responsible for pediatric trauma,” said Dr. Kristopher Brickman, director of the Global Health Program in The University of Toledo College of Medicine and Life Sciences. “They’re on the front lines, doing everything they can to get their country through this.”
From left, Cristina Alvarado, Dr. Stephen Markowiak, Dr. Kristopher Brickman and Kristin Calkins are among a group of UToledo physicians and nurses traveling to Warsaw to train Ukrainian and Polish doctors in Advance Trauma Life Support.
Brickman, also a professor of emergency medicine and the college’s senior associate dean for innovation and simulation, is spearheading a UToledo-led effort to build those critically needed skills by taking training directly to those doctors.
On July 16, he and a small group of other UToledo physicians and nurses will travel to Poland to lead a pair of two-day Advance Trauma Life Support classes at the Medical University of Warsaw.
They’ll be teaching a mix of Polish physicians, Polish paramedics and Ukrainian physicians who are traveling from Bukovinian State Medical University in Chernivtsi, Ukraine, a city near the Moldovan-Romanian border.
Developed and managed by the American College of Surgeons, Advance Trauma Life Support provides a comprehensive overview of the skills and techniques needed to properly evaluate and manage serious injuries.
The class is generally intended for emergency medicine physicians, surgeons and other doctors who regularly are confronted with trauma patients.
In Ukraine and neighboring Poland, the need goes far beyond that.
“You’re asking physicians who don’t typically specialize in trauma to start taking care of trauma patients and teach others to be prepared for it. They desperately need this training. They’re living it,” said Cristina Alvarado, a registered nurse and director of Immersive and Simulation-based Learning at UToledo.
Soon after the Russian invasion, Alvarado connected with Dr. Olena Korotun, a Ukrainian pediatrician and associate professor at Bukovinian State Medical University, to check in and ask how UToledo might be able to help.
Though Korotun’s university has an advanced simulation center, it had never focused on tactical medicine or trauma care.
“Very soon we realized that trauma life support is at the moment the most essential skill for any Ukrainian doctor,” she said. “It has also been realized by our Ministry of Health, and they declare that any doctor in Ukraine should become a traumatologist now.”
To help bridge that gap, Korotun and Alvarado worked to put together virtual trainings that could be streamed live from the University’s Interprofessional Immersive Simulation Center to physicians in Chernivtsi, which has emerged as a key training site for physicians because of its relative safety.
Those trainings, led by Dr. Paul Rega, an assistant professor of emergency medicine and public health; Dr. Carolina Wishner, an associate professor in the College of Medicine and Life Sciences; and Dawn Green, a registered nurse with the simulation center, spurred an idea to provide on-the-ground training.
An April trip to Poland to meet with Medical University of Warsaw leadership helped set the stage for the type of training the UToledo Team would be doing in July.
Advance Trauma Life Support is offered in more than 80 countries, including sites in Europe. The courses being taught by UToledo, which have been fully certified by the American College of Surgeons, will be the first in Poland.
“The goal of this trip truly is to give them the knowledge, training, education and the tools to not only handle traumas better but teach others how to handle them better as well,” Alvarado said.
Among the skills taught are how to establish an airway and initiate assisted breathing, addressing collapsed lungs and placing a central line. The course also focuses heavily on how to triage injuries, rapidly assess a patient’s condition and how and when to make decisions on specific interventions.
Because of Ukrainian martial law men of military age are not able to leave the country, all eight of the Ukrainian physicians are women. Among them is Korotun, who said the offer from UToledo to do in-person training has been a blessing.
“When it comes to me personally as a pediatrician and medical doctor, I want — I need — to be ready and confident to face trauma. It is an essential skill in my country today,” Korotun said. “Too many children have gone during this war already. We need to do all that is possible to not increase that number.
When she and the other Ukrainian doctors return to Chernivtsi from Poland, they’ll begin training other Ukrainian healthcare providers the same principles and skills they learned from the UToledo team.
“We’re making a contribution we felt we were capable of doing,” Brickman said. said. “We have a medical college, a medical center and one of the country’s most advanced simulation centers. Hopefully we’re able to provide a tangible, long-lasting effect that will make a real difference.”
In addition to Alvarado and Brickman, the UToledo team includes Kristin Calkins, a registered nurse and director of trauma services at The University of Toledo Medical Center, and Dr. Stephen Markowiak, a general surgeon at UTMC.
Dr. Stanislaw Stepkowski, a Warsaw native and professor of medical microbiology and immunology at UToledo, and Dr. Ivan Kaspruk, an emergency medicine resident at UToledo who is originally from Ukraine, will join the team to assist in translation.
Once in Poland, UToledo’s team will be joined by physicians from Missouri, Cyprus and the Netherlands.
The project also is being supported by Gaumard Scientific, which is sending key simulation equipment to Warsaw to assist in the hands-on training that clinicians will undertake. The Florida-based company is one of the leading producers of patient simulators and is providing the materials free of charge.
Through the planning, the College of Medicine and Life Sciences also established an affiliation with the Medical University of Warsaw and Bukovanian State Medical University. Brickman said the three entities are working on putting together a medical conference related to the war in Ukraine this fall, and UToledo will be assisting with the development of a simulation center in Warsaw.
