Why can’t we just observe and support?
Advances in military medicine are usually made during wartime, often paid for in blood of the wounded or even their ultimate sacrifice. Each conflict leaves its own footprint in our medical space, and the ongoing war in Ukraine has already led to critical changes in combat casualty care. With no NATO boots on the ground, we continue to observe and support the Ukrainian care process. Hereby our own learning is delayed and quite prone to error. There is simply no substitute for hands-on experience in medicine, and it’s human nature to interpret the world through the prism of prior experience. But the reality of warfare in Ukraine is very much different from the streets of Fallujah in Iraq, or the Hindu Kush mountains in Afghanistan.
So what should we do instead?
Does it mean we are doomed by staying on the sidelines, or damned to start World War III if we “were to learn”? Thankfully the situation is not that hopeless… The truth be said, we need a more dynamic and reflective collaboration with Ukraine in the domain of wartime medicine. It means that both civilian and military medical professionals should participate in a mutually beneficial knowledge translation process. An ongoing analysis and reprioritization process is a must. Things change very fast in modern day wars – what made sense in 2022, may not be as appropriate today. The more involved we are, the more and faster we learn. This way we enhance our understanding and readiness, in case of conflict deterioration. We also become capable of tailoring our support to the exact needs of our colleagues.
It does not seem it could get any more logical, goal-oriented and cost-effective, does it? So let’s gear up and begin developing such a smart collaboration. As mentioned in part 1, for a good start we need 3 critical items, and the devil is always in the details. Let’s illustrate with some tricky examples:
- CONTEXT – Imagine a French and a British neurosurgeon in the operating room discussing vascular anatomy at the base of the brain. In English we generally refer to it as “CIRCLE of Willis”, and French are more likely to call it “POLYGON of Willis”? Context is key, isn’t it?
- RELIABLE INFORMATION & DATA – Let’s take 2016 single-surgeon data for tourniquet use in 69 patients and let’s publish it in 2022. Then in 2024 let’s use this recently published 2016 data to draw conclusions for hundreds of thousands of casualties. How reliable and statistically significant would that be?
- MUTUAL BENEFIT – It’s 1907 Dr. Blumberg first describes the phenomenon of rebound tenderness in acute appendicitis. They name it the Blumberg’s sign. A year later, i.e. in 1908 a russian guy named Shchetkin miraculously “discovers” the very same finding, and they proceed to call it the Shchetkin-Blumberg’s sign. Benefit is definitely there, but would you call it mutual?
The original plan for this post included a more in-depth discussion on the medical context of war in Ukraine. But my constructive critics suggested that it requires a post of its own. It is a fundamental building block, and we have to get it right. After all, it’s our job in medicine to consider the appropriate context when making any decisions.
Today marks 1245 days of full-scale war in Ukraine… Let us take a moment of silence and ponder on the context of how russians planned it as a “3-day special operation”…
To be continued 🫡
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