Ukraine 7 400x300When John Holcomb, M.D., FACS, professor in the University of Alabama at Birmingham Division of Trauma and Acute Care Surgery, was asked back in April if he would join a medical nonprofit to assist surgeons in Ukraine amid Russia’s invasion, he didn’t hesitate to say yes.

After clearing his plans with division leadership, and, of course, his wife, he was on a plane four days later.

Holcomb is currently on his third trip to Ukraine with the Global Surgical and Medical Support Group (GSMSG), a nonprofit that takes medical care and training to crises zones across the world.

A new mission for a veteran combat trauma surgeon

Holcomb, a retired Army Colonel with 23 years of service, is no stranger to the combat zone. He served in multiple combat deployments, including in Mogadishu, Somalia, where he was a part of the surgical team that delivered 48-hour non-stop care to soldiers during the battle that inspired the book and film Black Hawk Down. He later served as the Commander of the U.S. Army Institute of Surgical Research and Trauma Consultant for the Army Surgeon General.

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Holcomb is also a renowned trauma researcher and his findings, including the benefits of whole blood resuscitation and tourniquets, have improved both combat casualty care and civilian trauma care. He has helped redesign the evacuation system for wounded soldiers and standardize modern military medical care.

He brings this wealth of experience and knowledge with him on his rotations in Ukraine, where there are 100 to 200 deaths a day due to the war.

The GSMSG rotations are two weeks long. A trip for Holcomb includes working with a civilian hospital and burn center in Lviv. Injured civilians have to make it to safer areas of central and western Ukraine for medical treatment by train, instead of helicopter, because of the risk of aircrafts being struck down.

Holcomb provides individual patient care in the operating room, ICU, and on the hospital floors. He advises on complex wounds, teaches combat care, gives lectures, works with medical students and residents, and is helping to refine the systems of care and propose policy updates.

So far, the GSMSG teams have trained more than 5,000 Ukrainian civilians and more than 1,000 soldiers in basic combat care like how to apply a tourniquet and stop hemorrhaging.

Doctor to doctor: sharing hard-won knowledge at Ukrainian hospitals

For the surgeons at civilian hospitals in western Ukraine, treating severe injuries caused by the mechanisms of war is a new challenge.

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As a military trauma surgeon, Holcomb has seen his fair share of combat injuries. He says the majority of the casualties in war are civilians, and the injuries he’s seen in Ukraine mirror what he saw in Iraq and Afghanistan: amputations and soft tissue defects caused by explosive weapons.

“The uniforms and country are different, but human anatomy is the same,” Holcomb said. “The destruction of the human body is the same.”

He says the processes and policy issues are remarkably similar to what the U.S. had to work through in the early 2000s. The doctors he works with in Ukraine are open to the hard-won lessons learned by the United States military. Holcomb says there’s a learning curve on the battlefield.

“Our goal is to compress that curve from a couple of years to a couple of months,” he said.

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One such hard-won lesson? The immense benefit of whole blood– not just blood products – for trauma resuscitation. He said within a few weeks of his first visit, the hospital made the switch to whole blood.

Another parallel – the creation of the Center for the Intrepid, a rehabilitation facility created for wounded military during the wars in Iraq and Afghanistan, and plans for a similar facility in Lviv.

Holcomb said there’s also an emotional component in the support he provides Ukrainian surgeons, who, while experienced in caring for the severely injured, are taking on the new toll of caring for civilians with combat injuries sustained during a war taking place in their home country.

“Sometimes it’s saying, what you’re doing is exactly right,” Holcomb explained.

What's next?

Holcomb plans to continue his involvement for at least the next five months. Working with many experts, he hopes to propose policy changes and provide input on Ukraine’s systems of care, much like he has done for the United States. He also wants to streamline the delivery of lectureships, bedside care, and equipment. He said existing military guidelines will soon be translated into Ukrainian and available for distribution.

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Holcomb credits division leadership, such as division director Jeffrey Kerby, M.D., Ph.D., FACS, and UAB Chief of Trauma Service Daniel Cox, M.D., both Air Force surgeons who have been instrumental in creating and sustaining military-civilian partnerships at UAB, with being supportive of his volunteering with GSMSG.

Most of the other volunteers with the GSMSG are retired military with the skillset and comfort level for traveling to a country in wartime, but Holcomb emphasizes that none of their efforts are possible without philanthropy.

“It’s very gratifying and fulfilling to be able to go over and help,” Holcomb said. “It’s a good mission."

To donate, visit GSMSG’s website here.