West takes note as Ukraine war transforms battlefield medicine

PARIS — Four years of World War I left more than 50,000 French soldiers without arms or legs. By comparison, around 100,000 Ukrainians have endured amputations since Russia launched a full-scale invasion three years ago.

In Ukraine, "amputation rates are absolutely monstrous," a French officer recently told a briefing in Paris, speaking on condition of anonymity.

Western countries including France have been closely studying battlefield medicine in Ukraine as they aim to prepare better for any possible future conflict with Russia.

"The lessons coming out of Ukraine are fundamentally changing how military medicine is going to be practised for every country," said the Lancet medical journal, quoting Aaron Epstein, president of the Global Surgical and Medical Support Group which provides medical care in conflict zones.

Western medical services do not have the ability to treat so many injuries.

"The losses are massive and way above NATO terms of reference, what we are used to handling," said the French officer, referring to Ukraine.

"And, what's more, there are multiple injuries."

Delayed evacuations 

The war in Ukraine is also starkly different from NATO or unilateral military operations seen in Iraq, Afghanistan, or Africa where injured soldiers are rapidly airlifted.

The intensity of the fighting in Ukraine often makes it impossible to evacuate the wounded fast.

According to the US Department of Defence, in Iraq and Afghanistan medical teams followed the "golden hour" policy by getting the troops off the battlefield and into military hospitals within about an hour, which guaranteed best survival rates.

Due to delayed evacuation Ukrainian authorities have set up a network of medical stabilisation points, sometimes less than a kilometre from the front line.

"In Ukraine, there are delays that easily exceed 24 hours," said the French officer.

In future conflicts, large numbers of injured troops might have to be evacuated by hospital trains or boats, said the French officer.

Military medics and hospitals have been among prime targets in Ukraine.

Around 70 per cent of healthcare personnel "deployed in the field at the start of the war have now died or are unfit for combat," said chief physician Pierre-Antoine of the French Military Health Service, the SSA.

He was identified by his first name only in line with French military policy.

Wounded soldiers must rely on themselves or buddy aid to dress wounds and place tourniquets to stop massive bleeding, the primary preventable cause of death. But prolonged tourniquet times often lead to amputations.

"It is assumed that the critically wounded do not survive, while the less seriously wounded must extract themselves independently," wrote chief physician Paul Balandraud in the SSA's in-house magazine, referring to high-intensity large-scale hostilities.

Use of robots 

Western armies are looking into ways to prolong care on the battlefield.

"We are working to provide telemedicine" and deploy "very light ultrasound scanners" to assess bleeding, said Michael, chief physician with the French Special Operations Command (COS), who was also identified by his first name in line with military policy.

Such ultrasound equipment can be operated by untrained personnel because it is remotely controlled by a specialist. But electromagnetic radiation emitted during such procedures can be detected by the enemy.

The use of drones is also being considered to deliver "blood, antibiotics and equipment" to a medical team in the field, said the chief physician with the French Special Operations Command.

Medics have been trying to retrieve the injured at night or under the cover of fog or rain.

"The evacuation procedure must be planned carefully and often requires the use of artillery," said the Royal United Services Institute (RUSI), a London-based defence think tank.

In order to avoid exposing troops, Ukrainian and Western armies are testing robotic vehicles that transport the wounded to secure locations.

"At present, however, the reliability of these systems is insufficient for forces to be confident in such methods," said RUSI.