Civil–Military Medical Support in War | Lessons from Ukraine

How to Reign Over Chaos: Organising Civil–Military Medical Support in War

Speaker: Dr. Roman Kuziv, Lieutenant Colonel of the Medical Service; Commander, Medical Forces Sustainment Group East (Ukraine)

When the “golden hour” is a mirage and the battlefield shifts by the minute, medical systems either adapt—or fail. Dr. Roman Kuziv leads medical support across Ukraine’s eastern theatre: 1,076 km of frontline, 143,000 km² of contested ground, ~135 firefights a day, and care for hundreds of thousands of soldiers and civilians. His talk distilled what it actually takes to keep people alive in modern, drone-saturated warfare.

The Reality at the Point of Injury (POI)

• NATO doctrine assumes rapid pickup within 60 minutes, but in Ukraine the golden hour rarely exists.
• Airspace near the POI is contested, FPV drones hunt vehicles and medics.
• CASEVAC from POI to the first safe node is the most dangerous link in the chain.

The Pathway of Care in Contested Air and Constant Fire

• POI → Casualty Collection Point (CCP): ~1–3 km, gather the wounded.
• CCP → Exchange Point (XP): Last CASEVAC leg using anything available—armoured vehicles, pickups, bikes, even tanks.
• XP → Role 1 Stabilisation Point: Emergency physicians and anaesthesiologists deliver DCR and DCS to buy time.
• Role 2 Forward Surgical Teams: 12–35 staff, positioned ~12–15 km from the line, often underground due to strikes. Surge proven up to 520 casualties/day.
• Role 3 Field Hospitals: Broader specialties, critical care, 21–23 days’ capacity.
• Role 4 Civil–Military Hospitals: Comprehensive care and rehabilitation, leveraging civilian networks.

Strategic Evacuation Without Air

• Rail is the backbone for large-scale evacuation; air medevac is rare.
• Volunteer organisations (e.g. MOAS) are embedded, providing lift between nodes.

Why the Golden Hour Breaks—and How They Compensate

• In one five-month period, only 42 red cases reached surgery within 1–2 hours.
• Response: push DCR/DCS forward, upgrade Role 1, and automate patient-capacity visibility for triage.

Data as a Weapon for Coordination

A theatre-wide Medical Information System (MIS) tracks casualties from first contact, linking military and civilian hospitals. Commanders see where patients are, what they need, and where to send them in near real time.

The Drone Era Changes Everything

• FPV drones cause 35–63% of injuries in some months.
• Fibre-tethered drones bypass jamming, enabling precise strikes and re-targeting.
• Training, SOPs, and layouts must assume drone observation and attack at every stage.

Civilian Partnership by Design

• Civilian hospitals are mapped into the military chain as Role 3/4 equivalents.
• Daily bed and specialty availability drive routing decisions.
• Flexibility and integration outrank rigid tradition.

Lessons for Global Healthcare Systems

• Build redundant evacuation pathways (rail, road).
• Push surgical capability forward and rehearse fortified setups.
• Plan for drones: concealment, deception, hardened loading zones.
• Fuse civil–military care with pre-contracted capacity.
• Instrument the system with live dashboards.
• Prepare for chronic conditions as well as trauma.

Key Numbers at a Glance

• Frontline span: 1,076 km
• Area covered: 143,000 km²
• Daily engagements: ~135
• Max single-day surge (Role 2): 520 casualties
• Red (ventilated) proportion: ~10%
• Air evacuations: ~200 (vs thousands by rail)
• Drone-attributed injuries: 35–63%

Conclusion: Medicine in the Age of Drones

Ukraine’s medical forces have rebuilt the evacuation chain around contested skies, mass drone threats, and unpredictable demand. The doctrine that survives is the one that pushes capability forward, shares the load with civilians, and tracks the entire system live.

In a world where the golden hour can’t be guaranteed, this is how you still bring people home.

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