Inaction that kills. Medical Forces Command saves money on military first aid kits

When a soldier is injured on the battlefield, a tourniquet is applied to stop the bleeding and give them time to evacuate to a stabilisation point. A high-quality tourniquet for less than $20 saves one life. However, the Medical Forces Command of the Armed Forces of Ukraine supplies tourniquets that break apart and do not create the necessary blood pressure. Instead of acknowledging the problem, they deny it. 

In this article, we explain how the supply of low-quality first aid kits highlights the consistent inaction in the work of the Medical Forces and the need for reforms in tactical medicine.

After July 20, doctors and volunteers began to report on the supply of low-quality first aid kits to the frontline by the Medical Forces Command of the Armed Forces of Ukraine. Images of Chinese tourniquets distributed in military units appeared online. 

Oksana Karchynska, a volunteer and coordinator of the frontline stabilisation centre, told Espreso TV channel that the military had received over 40,000 low-quality Chinese tourniquets.

Karchynska said.

Medical instructor Mariia Nazarova, People's Deputy Sofiia Fedyna, and Leleka Foundation coordinator Yurii Kubrushko also wrote about the tourniquets. Dana Yarova, a member of the Public Anti-Corruption Council at the Ministry of Defence, says that all medical equipment is purchased not by the Department of Public Procurement but by the Medical Forces Command. 

On July 21, the Command issued two statements: 

says Yurii Kubrushko, Leleka Foundation.

Instructor Mariia Nazarova writes that they did not report the poor quality of the equipment before because they understood that the state, which had not prepared stocks for eight years, would not be able to provide everyone with medicine at once at the start of the full-scale war. The military and volunteers took care of their first aid kits. But the Command should have resolved this issue in a year and a half.

says Yurii. 

Svidomi sent a request to the Medical Forces Command to find out the types and origin of the tourniquets and whether they were tested before being issued to the units. As of the time of publication, we have not yet received any response.

There is no single quality standard for medical kits in Ukraine. It was only after volunteers and medics were outraged by poor quality tourniquets that the Medical Forces Command initiated a working group to adopt one.

The volunteers follow the recommendations of the US Department of Defence's TCCC (Tactical Combat Casualty Care) Committee. 

The quality of the tested tourniquets includes:

says Yurii Kubrushko, coordinator of the Leleka Foundation. 

The wholesale price of Ukrainian Sich tourniquets is $15, while the price of American manufacturers is about $17-18. Yurii estimates that supplying the entire army could cost $30-40 million.

the volunteer concludes.

When it became clear that the Medical Forces Command did not want to face and would not solve the problems, volunteers began to talk about them more publicly. We wrote an appeal to the military leadership on eight tactical medicine issues in the Defence Forces.

There are no requirements for tactical medicine approved by the Ministry of Defence. Everything purchased and received as humanitarian aid is transferred to combat units without proper quality control or compliance with the recommendations of the TCCC Committee. This organisation is the world's most authoritative source of tactical medicine and developer of relevant standards. Due to the lack of control, low-quality medical supplies are reaching the military, which is why the number of casualties in the army is growing.

This leads to delays or prevents military units from writing off medical supplies used or lost during hostilities. Paperwork distracts medics from saving lives and creates additional workload and stress.

For example, Chinese analogues are often sent under the "CAT tourniquet" inventory name. There is hardly any provision of combat medics with the means necessary to provide care at their level. In fact, brigades with the required equipment on paper often have fewer backpacks, first aid kits, and tourniquets.

The wounded are often evacuated by personal vehicles or those donated by charities and volunteers. These vehicles are almost entirely stocked with medical equipment and machinery obtained through volunteer assistance. At the same time, military units face a complicated and lengthy procedure for writing off vehicles, equipment and medical supplies destroyed or damaged during hostilities.

Deviations from the TCCC standards make it difficult to unify the process of providing care on the battlefield. Professional training of platoon combat medics for all types and branches of the armed forces is provided by only one military unit with a capacity of up to 300 cadets per month. Military units are poorly equipped with tactical medicine training equipment, and instructors often lack proper training.

Due to the submission or inaction of the Medical Forces Command, treatment guidelines do not comply with the principles of evidence-based medicine and the standards of the Ministry of Health and partner countries. In particular, such guidelines include the protocol for treating acubarotrauma (concussion) introduced by the Command. This leads to wasted money on unproven drugs and ineffective treatment. 

For example, the militaries still get the opioid analgesic Nalbuphine. If injected during an injury at the front, when the soldier is taken to the operating theatre or a medical centre in a few hours, other painkillers will not work. In addition, the effect of Nalbuphine can lead to airway blockage.

The Medical Forces Command has accused combat medics of "illegal medical activities". Even though the military speciality of a combat medic has existed for over six years, the legal status of a medical professional has not yet been regulated. The charge of illegal medical activity will apply to most manipulations a combat medic performs following the qualification standard.

In addition, the Medical Forces Command has not procured the equipment and supplies necessary for blood transfusions. Those units that do conduct blood transfusions rely only on volunteers.

Note: Following the publication of the volunteers' appeal, on August 3 Deputy Minister of Defence Hanna Maliar said during a national telethon that combat medics would be entitled to perform blood transfusions after receiving training from the Ministry of Health.

This provides a wide scope for abuse and inaction by officials who are supposed to provide the Defence Forces with quality medical supplies. There is no state body that would be a leader and bear responsibility for the comprehensive provision of tactical medicine, the organisation of proper training of combat medics and personnel, the organisation of evacuation of the wounded and the provision of vehicles for medical evacuation.

Volodymyr Zelenskyy responded to the problems. He noted that he had "had an important conversation" with the commander of the Medical Forces, Tetiana Ostashchenko, "about the issues that are of acute concern to combat medics and soldiers". 

On July 31, the Verkhovna Rada Committee on National Security, Defence and Intelligence summoned Ostashchenko. They gave him two weeks to check all the first aid kits and replace the low-quality medical supplies.