Vice-rector of ONMedU V.R. Vastianov. Military Medicine in Ukraine Has Made a Breakthrough in Recent Years

In the five years of the war, Ukraine had to actually recreate a combat army and military medicine from ground zero. The Soviet school had long been non-demanded in peaceful Ukraine. The doctors had to study directly on the battlefield – with the first injured. Over the past years, with the help of international partners, Ukrainian specialists have put tens thousands of troops on their feet. How was the war in Donbass affecting science and training? We raised these issues to the vice-rector of Odessa National Medical University, Ruslan Vastianov, on the eve of the Sixth International Congress of Anesthetists, Black Sea Pearl.
– At the congress, one of your stated topics is hemorheology. Tell us about the issue and why you chose this topic for the report?
From the point of view of fundamental medicine, hemorheology is responsible for understanding the blood flow and the movement of plasma-weighed cells and substances in the vessels of the microcirculatory bed. This section allows, in particular, to study the features of blood flow in vessels of small diameter. Attention to it has been drawn since the 50s of the last century, the terms “microcirculation” and “hemorheology” were introduced by American and English scientists. They noticed that pathologies associated with shock and septic conditions, inflammatory processes are in violation of: a) the current of blood, mainly in the vessels of the microcirculatory bed; b) venous current; c) changes in the permeability of the vascular bed.
– Are modern hemorheological technologies available in Ukraine?
I can say that in the arsenal of our doctors there are all available technologies in the world connected with the termination of a bleeding. So, some of them depend on the purchase of expensive western drugs, and sometimes there are difficulties. For example, the drug NovoSeven Danish company “Novo Nordisk” allows surgical operations in patients with hemophilia. As to equipment, knowledge, experience – all innovative world-wide operations are carried out by us as well.
– The direction is quite closely interwoven with military medicine, isn’t it?
Certainly. In any armed conflict, when the patients begin to receive gunshot wounds, injuries from mine ruptures, the first issue is the arrest of bleeding. Military physicians, especially in the early days of the war, are not always ready for the influx of the wounded. Unfortunately, very often a wound is incompatible with life. In addition, pathological conditions can be a burden for the shock. You know that on the battlefield people often die not so much from blood loss, but from a shocked state. Our military physicians managed to adapt as quickly as possible to the situation that had arisen in the East of the country. As they say, there would be no happiness, but the misfortune helped: military medicine in Ukraine in recent years has made a breakthrough in development. We are talking about innovative developments and measures that allow most operational complexes to be rendered as quickly and as closely as possible to the advanced ones.
– How did the war affect medical science? In Odessa Medical University are there such examples in Odessa Medical University?
Numerous patents which have passed through the research department of our university and other medical universities of the country are devoted to the issues of treatment, accelerated healing of wounds, methods of bleeding arrests and other directions, including hemorheological profile. In a war, the task is not just to save the soldier of life, but to return him as soon as possible to the place of service to protect the country. There are many examples of the impact of military action on science. For example, the development of technology for the removal of defects in the vascular wall – sewing, clapping vessels, innovative methods for restoring normal blood flow. Doctors make every effort to ensure that the recovery is not accompanied by the risk of blood clots.
– At the same time, the war has lasted for five years already, and the process of unification of the protocols for providing medical aid on the battlefield in Ukraine has just begun.
Imagine an injured warrior, you need to save him not tomorrow or in a month, but right now. There is just not enough time to protocol everything. That’s how the innovative technology is being tested. Generally, they can accomplish this task, develop expertise, and popularize it among military and civilian specialists.
Here we can even give names. The head of the Department of General Surgery and Military Medicine Professor Mikhail Kashtalian, who for a long time was the chief military surgeon of our 411th Hospital. So, two of his children have already defended their Ph.D. theses on the specialized profile of the Academic Council of our country in Kiev.
– Does Odessa Medical University train military doctors?
We have transformed the Department of Disaster Medicine and Military Medicine. It is headed by a well-known military doctor, associate professor Volodymyr Pavlovych Maydaniuk. The training focuses on disaster medicine, the basic principles of assistance, evacuation from the battlefield, since highly specialized medical care is located in the rear. The Department has military training courses, our students are enrolled, starting from the 4th year. They undergo in-depth military medical training, which, at their request, facilitates entry into the Military Medical Academy after graduation. The Department of General Surgery was transformed into the Department of General Surgery and Military Medicine. It is headed by Mikhail Kashtalian, he is a colonel of the military medical service. He has a wealth of experience, assisting the wounded in the battle zone, in Iraq, and during the Yugoslav conflict.
– How many students are enrolled for the course?
I cannot give exact figures. Let’s say this, I feel some difficulties, because the guys, knowing my scientific position, often ask me to ask the head of the catastrophe medicine department to enroll them to the military course. The desire is great. They understand that even without war, these skills are needed, even for everyday injuries. Take at least the accident, in Odesa with half a million cars. If our student finds himself in the scene of such accident, he will be able to provide skilled help and save lives in such extreme conditions.
– Was the first textbook on military medicine also created in the walls of the university?
In 2016, under the editorship of the rector of ONMedU Valerii Zaporozhan, the first military field surgery textbook was published in the post-Soviet area in co-authorship with the leading generals and colonels of the medical service, Kiev colleagues. Those doctors who today render help to wounded soldiers were trained with this textbook. In addition, Valery Mykolaiovych, as a rector, purchased the highest level of equipment for laparoscopic surgery, for telecommunication medicine. That means that, we can remotely attract the best specialists in the world to the event of serious injuries, including those resulted from combat actions.
– Did students or lecturers of ONMedU directly work in the battle areas?
In 2014, at the very beginning of the conflict in the East, under the leadership of the rector Zaporozhan, brigades of military doctors were formed. Together with the military, they set up medical activities at the forefront in Luhansk and Donetsk regions. It is our military physicians led by Kashtalian, who first and only in the world conducted laparoscopic surgery in field conditions. In order for you to understand, laparoscopic surgery requires very expensive equipment, which is long configurable, good lighting. It’s clear that it’s hard to imagine it in a military tent. Mobile hospitals are now being improved in all directions, with the participation of our doctors as well. Many take a leave and go volunteers. For example, our professor Oleksandr Ivanovych Tkachenko entered the military medical battalion two years ago to help with the progression.
– Do you contact colleagues from military medicine from other countries?
Military doctors, including those of our departments, attend conferences where one or another of these issues is risen – surgical, anesthetic, and any other profile. For example, in Turkey, “Hurray” received a report by the assistant of our department Serhiy Volodymyrovych Tertyshnyj about methods of postischemic treatment after gunshot wounds of soft tissues of the lower extremities. So foreign colleagues know about us. I can say for sure that the post-Soviet and Ukrainian medicine has a lot of authority and respect in the world.