By: Alex Gasper, Luca Alfatti MSc FRRHH FEWM, and Professor Mark Hannaford DSc (hc) FRRHH FEWM
Prepared by the World Extreme Medicine Fund in collaboration with Ukrainian and international clinical partners
The Dnipro River basin, a region with a long medical heritage stretching back to Scythian and Byzantine healers, has once again become a site of innovation under pressure. Here, in a landscape defined by drone warfare and prolonged evacuation delays, frontline Ukrainian medics and international clinicians are co-developing new approaches to trauma and prolonged casualty care (PCC).
This collaborative evolution (led by the World Extreme Medicine Fund (WEMF), Ukraine-based MM Rescue, and a network of Ukrainian institutions, NGOs, and international military clinicians) demonstrates how established Western medical protocols can be adapted to the unique operational realities of 21st-century conflict.
The initiative represents a shift from hierarchical instruction to mutual learning, where knowledge exchange, adaptability, and context-specific decision-making shape the future of battlefield medicine.
WEMF’s engagement in Ukraine began as a humanitarian response: the rapid delivery of haemostatic agents, tourniquets, and field kits to units without essential supplies. Yet as the conflict continued, it became clear that material aid alone could not sustain outcomes.
The Fund transitioned from equipment support to training-based interventions designed to strengthen local capability and self-sufficiency. Early trauma courses evolved into Tactical Combat Casualty Care (TCCC) instruction, which expanded to include advanced surgical modules covering maxillofacial trauma, battlefield surgery, and ultimately an eight-day Prolonged Casualty Care (PCC) programme.
This evolution illustrates how humanitarian action can progress from emergency relief to embedded education, ensuring that lifesaving knowledge remains within the hands of those working on the frontline.
The PCC initiative brings together educators and practitioners from military, humanitarian, and expedition medicine backgrounds; Ukrainian military medics and paramedics; and academic partners contributing to curriculum validation and data capture.
Training has been deliberately delivered in frontline oblasts to ensure accessibility for active personnel and to integrate medical education directly within operational environments.
This framework, grounded in partnership, reflects WEMF’s broader philosophy: building resilience through co-production, not dependency through donation.
The Ukrainian battlefield has redefined the assumptions underpinning traditional trauma systems. Under constant drone surveillance and precision artillery threat, conventional evacuation timelines, and the long-standing principle of the “golden hour”, have effectively collapsed.
In their place emerges the reality of prolonged field care, where continuous medical management may extend far beyond an hour in hostile, resource-limited settings.
As trench warfare redefined surgery in 1916, drone warfare is now reshaping casualty care in 2025.
These conditions require a decisive shift: from algorithmic adherence to flexible, physiologically grounded decision-making. The PCC curriculum, adapted from Joint Trauma System guidelines, focuses on:
Damage-control resuscitation
Wound management in delayed surgery contexts
Analgesia and infection control over extended timeframes
Maintaining physiological stability through clinical ingenuity rather than equipment density
The learning that has emerged from this collaboration is bidirectional.
Ukrainian practitioners contribute an unparalleled depth of experiential knowledge, developing innovative methods for infusion, wound management without water, and clinical improvisation under siege conditions.
International educators bring structured physiological reasoning, framework development, and external evaluation to support these efforts.
Together, this forms an iterative process of mutual adaptation. Instructors arrive as facilitators rather than authorities and leave as students of evolving doctrine. Structured feedback and post-course debriefs ensure that operational lessons are captured and reintroduced into formal trauma guidelines.
This live feedback loop has directly contributed to the creation of a new European initiative under the World Extreme Medicine banner: “PCC – Lessons Learnt in Ukraine”, which consolidates and shares these field-derived practices across clinical communities.
Measured outcomes of the training programmes include increased clinical confidence, enhanced unit-level capability, and improved psychological resilience among Ukrainian medics. The opportunity for professional recognition and development within an ongoing conflict provides significant morale and validation benefits.
Graduates frequently progress to instructor roles within their own units, enabling a cascade of expertise throughout Ukrainian systems and ensuring sustainability independent of external actors.
Beyond individual outcomes, the programme contributes to a global reassessment of trauma doctrine. The Ukrainian experience reveals the limitations of current Western frameworks and informs NATO, humanitarian, and expedition medicine communities about the realities of future battlefield and disaster contexts.
The Ukrainian collaboration provides a replicable model for delivering high-fidelity medical training in denied or degraded environments.
WEMF and its partners are now expanding the initiative through train-the-trainer programmes, regional scaling, and systematic documentation of clinical adaptations for publication and doctrinal review.
This approach signifies a broader evolution in humanitarian medicine — from short-term relief to co-developed resilience, and from the exportation of knowledge to the co-creation of new science.
As contemporary warfare continues to blur the boundaries between military, humanitarian, and expeditionary medicine, the Ukrainian experience stands as a rare real-time case study in how shared innovation under fire can redefine clinical doctrine.
In the crucible of modern conflict, the boundary between instructor and student has dissolved.
The partnership between Ukrainian medics and international collaborators represents a living laboratory of applied medicine — one in which necessity drives innovation, and every interaction refines the global understanding of Prolonged Casualty Care.
The WEM Fund’s continuing commitment to teach where others cannot go, to listen as much as it instructs, and to recognise Ukrainian operational insight as scientific contribution redefines what humanitarian medical collaboration can achieve.
The World Extreme Medicine Fund (WEM Fund) is an independent UK-based charitable initiative established with the support of World Extreme Medicine (WEM), a global leader in training medical professionals for remote, austere, and conflict environments.
Founded by Professor Mark Hannaford and Advanced Paramedic Luca Alfatti, and operating under the registered charity Humanitas (Charity No. 1114639), the Fund’s mission is to deliver targeted aid, advanced trauma education, and clinical training to medics, first responders, and civilian volunteers operating in extreme and resource-limited conditions.
Its guiding philosophy “partnership, not charity” emphasises capacity building and knowledge exchange between local and international practitioners.
Since the outset of the war in Ukraine, the WEM Fund has coordinated multi-disciplinary teams of surgeons, paramedics, and educators from across the UK, Europe, and North America. Together, they have provided sustained training and clinical mentorship to Ukrainian medical personnel while feeding hard-won lessons back into global trauma medicine practice.
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WEMF operates as a restricted fund under Humanitas (UK Registered Charity Number 1114639), Gift Aid claims are managed by Humanitas.
Abstract prepared by the World Extreme Medicine Fund in collaboration with Ukrainian and international clinical partners
