Lessons from the Front: 'The Golden Hour Does Not Apply'

In January, Ukrainian medics stayed in Sweden as part of a recovery programme for personnel working close to the front lines. The programme, conducted in collaboration with the organisation Repower, has provided around 100 medics with the opportunity for mental recovery over two weeks. During one of the days, the Ukrainian field medics were visited by colleagues and medics from the Swedish Armed Forces (Försvarsmakten).

In several of the presentations held during the day, the Ukrainians described their experiences from the front. A recurring theme was how the battlefield constantly changes and how crucial adaptability is. Nordic Defence Sector met with two field medics from Ukraine, Olena and Ivan, who share their perspectives on life at the frontline.

Olena, in her mid-20s, trained as a surgeon at university and volunteered for service as a field surgeon immediately after graduation. In areas close to the front, she works both at collection points for evacuees and the injured, but sometimes also as casevac very close to the combat line. Often, it is not the medical care itself that is the greatest challenge, but rather managing to get the injured to the nearest collection point. With drones as a constant threat, every rescue operation is fraught with danger.

– Drones monitor the areas. If we lack sufficient equipment, such as unmanned ground vehicles (UGVs), we cannot proceed. Not all units have that technology. In some cases, evacuation is not possible at all. It is terrible, but sometimes people simply die because it is too dangerous to reach them, Olena explains, adding:

– Once the patients reach the stabilisation point or hospital, we often have good resources to operate and care for them. The problem is the journey there.

During evacuation, the term "golden hour" is often mentioned, referring to the critical time period when an injured person should reach medical care to maximise survival chances. However, the reality of war has made the concept increasingly difficult to apply. The imminent risks mean that the injured sometimes have to wait for hours, or even days, without adequate care.

– I have had patients who were injured five or ten days ago, sometimes even longer. In an extreme case, a patient had a tourniquet applied for over 20 days. It is utterly unimaginable how much pain and what complications they may have endured, without medical care, medication, food, or even water, says Olena.

She concludes by sharing how much it means to get away from the front, even if only for a short while. Additionally, being able to travel to another country for recovery has given her new energy.

– For me, it has meant a lot to come here. I have also visited Sweden before during my school years, so it feels safe and comfortable to be here again, says Olena.

Before the full-scale invasion, Ivan worked as a sailor and travelled the world, including to northern Sweden and Skellefteå. There, he met a Swede who wanted to learn Ukrainian and introduced him to Swedish culture and history.

– He showed us the region, told us about traditions, and took us to a church that still had Russian bullets from the Great Northern War in the 18th century. He showed us old wooden bridges and multi-storey buildings built entirely of wood. For us, it was incredible; we could not imagine that one could build five-storey buildings in wood, says Ivan.

Five years later, Ivan, also in his mid-20s, has held various roles in the war: anti-tank gunner, machine gunner, sniper, and reconnaissance soldier. Concurrently, he developed extensive medical knowledge, which led to him becoming a field medic. However, the role entailed significant physical and mental strain, and in October, he was forced to step back from the front.

– I had too many injuries. No human is made of iron or steel, especially not mentally. After losing so many of my friends, I needed to end my time as an infantryman and field medic near the front.

Ivan also highlights the crucial role that unmanned vehicles play in daily life: for deliveries, evacuation of the wounded, and reconnaissance.

– We try to keep logistics as close to the front line as possible and use many drones and unmanned vehicles. Our unit is at the forefront when it comes to new technology, but it varies greatly between different units, says Ivan and continues:

– You have to adapt all the time – every hour, every day. During my last six months as an infantryman, my main task was to take care of new soldiers and ensure their survival. My commander always told me: "Save them." And I did.

You have brought with you enormous experiences from your time at the front. What lessons are most important, according to you?

– The biggest mistake in the infantry is to be afraid. You must accept that the risk is 50/50. Accept it and move forward – always forward. Never stop, never retreat, says Ivan before elaborating:

– Drones are your worst enemy. Sometimes the infantry does not meet the enemy at all for several months. A new recruit can come to the front, sit there for two or three months, and then get injured, without ever having seen the enemy face to face. This is a drone war. The infantry functions more as a security layer: we hold the positions, for if we are not there, the enemy takes them. It is really only special forces and reconnaissance units that meet the enemy directly. For regular infantry, it is very rare today, he explains.

How did you experience the meeting with the Swedish representatives?

– It was very good. They took a lot of notes. At the same time, I saw several serious mistakes in their equipment. For example, they mark medical vehicles with red crosses, which makes them priority targets. The enemy scouts for evacuation routes with drones and sets up ambushes. Therefore, it is a big mistake to mark the vehicles in that way.

– I also saw that they use helmets resembling bicycle helmets during evacuation. This makes it impossible to safely remove body armour from an injured soldier. These were things they had not thought of before, and they took it to heart, says Ivan.

Furthermore, Ivan discusses the importance of being able to improvise and be inventive at the front. Among other things, the unit has built its own stretchers, equipped with wheels to facilitate evacuation.

– Why not? We build them ourselves, simple, homemade stretchers with large wheels. It makes tactical evacuation much easier, as it is otherwise extremely physically demanding. 

In conclusion, Ivan returns to his fondness for Sweden. Being able to change environment and mindset has meant a lot to him. The highlight of the programme was visiting museums around Stockholm and meeting Marina Trattner, a Ukrainian historian and researcher.

– For me, it was like a dream. I love history and read a lot – not only Ukrainian history but also Scandinavian history, the Roman Empire, and Ancient Greece. Meeting her was absolutely fantastic.

Do you feel that it helps you mentally to come here and do something completely different?

– Yes, absolutely. I have been able to change perspective and step out of my information bubble. It is probably beneficial for most people, says Ivan in conclusion.