When I trained at Bellevue hospital as a medical resident in the late 1980s, we often relied on the philosophy “See one, do one, teach one” when it came to learning new techniques.
Still, I’d never believed that tenet could be extended to the combat setting, where mass casualties may come in at any time and truly experienced hands are crucial to providing both prioritization — triage — and top-level care to difficult shrapnel wounds and blast injuries.
Don’t get me wrong: All humanitarian aid is useful when it gets to the right places, and basics like chest tube insertions and sewing up wounds can be quickly taught. But more complex care requires significant experience.
Put another way, how can anyone who is not specially trained or experienced in combat injuries and high-level security provide the lifesaving care essential in Ukraine right now?
Dr. Aaron Epstein has the answer. He has been on the ground in Ukraine providing and teaching combat trauma care throughout the war-torn country for months. He is there right now.
Epstein, who has a Georgetown graduate degree in foreign service, is a former defense contractor and national-security and intelligence expert who went on to med school to become a decorated surgeon. He founded the Global Surgical and Medical Support Group, where he works with former Special Forces, combat medics and surgeons, going from his Buffalo base to humanitarian disasters and working with and training local medical teams. When I spoke with him recently — he was at an undisclosed location in Ukraine — for SiriusXM’s Doctor Radio Reports, it quickly became clear to me that his group is highly successful at training local health personnel on administering essential emergency care in the middle of the war.
Previously, he was trying to “affect populations through a national-security lens, and we would see limited effects in doing that,” he said. But that changed when he became a surgeon and founded GSMSG. “I saw a fundamental change in our approaches to the communities by just giving some of them medical attention. I mean, you treated someone’s mother, their kid, their grandmother, and they appreciated it.”
Epstein’s group began back in 2015 training Kurdish combat medics in Iraq and has been involved in multiple combat and refugee situations since, including in Venezuela. Ukraine, he told me, was a natural extension of the group’s mission and abilities. “There are plenty of groups that come in and just dump supplies and plenty of groups that come and maybe do direct medical care, but the effect is X number of people, and so I remember thinking I have the networks in place to bring these high-end providers in. How can we really shape populations? And we went off the US Special Forces model, which is basically to train participation partners.”
Epstein and his team teach local medical professionals how to become trauma specialists themselves. They have run tactical-care combat courses for several thousand Ukrainians since the war’s start. They’ve also led “train the trainer programs” where Ukrainian medical personnel who are fast learners turn around and train other Ukrainians further in the field of combat casualty care. This is an amazing example of my “Watch one, do one, teach one” paradigm.
They improvise solutions to fit the problem. They use tips of latex gloves, for example, to help provide suction valves for chest tubes. They have a “low-visibility rolling trauma surgery suite in their vehicles” that’s for emergencies as needed. On a typical day, Epstein told me, they had Russian cruise missiles hit nearby and were staged and ready for the injuries that resulted. Former special-operations combat vets make up almost his entire team.
“We were running them through chest-tube placement, even basic suturing,” he said. “You’d be surprised how few people here can do basic wound closures. At some point the air raid sirens went off, and we moved it all down into a bunker. Just continued the training in the bunker there.”
Each conflict has its particular trademark wounds, which lead to a different approach to breathing, airway and circulation maintenance, Epstein said. For Iraq and Afghanistan, it was the upper-body wounds from exploding IEDs. For this war it’s the penetrating shrapnel from artillery fire, “unlike anything we have really dealt with on a large scale since World War I.”
Since Russia’s invasion of Ukraine began Feb. 24, there have been more than 10,000 civilian casualties, close to 5,000 of whom have died. Not to mention the many thousands of troops on both sides of the conflict who have been wounded or killed. Humanitarian aid has poured in from across the globe, but it is never sufficient to stop the bloodshed or to comfort someone who has lost a loved one. Some of the best efforts go for naught, but the work of highly skilled training groups like Dr. Epstein’s continues to make a difference. “Combat-ready” means more than ready to fight — it also means ready to triage, to teach and to heal.
Marc Siegel, M.D., is a clinical professor of medicine and medical director of Doctor Radio at NYU Langone Health and a Fox News medical analyst.
