Kathleen Gallagher, second from left on bottom row, and her team worked with groups, such as these physicians and medical students in Lviv, Ukraine, on triage and mass casualty management.
Kathleen Gallagher, MD, is trained to do what most people can’t imagine – triage, evaluate and care for the casualties of combat.
Gallagher, a third-year general surgery resident at Vanderbilt University Medical Center and a graduate of Vanderbilt University School of Medicine (VUSM), served as a medic in the U.S. Army National Guard when she was an undergraduate at Bellarmine University in Louisville, Kentucky.
She was deployed to southern Iraq for a year, then to Afghanistan for a year, where she stabilized patients injured on the battlefield and assisted in evacuating them to mobile hospitals for further treatment.
So, it’s no surprise that when Russia launched a large-scale invasion of Ukraine in February, Gallagher felt the pull to do something. She took a week of vacation and traveled with the MedGlobal organization to Lviv, Ukraine, to help train emergency response medical teams for five large regional hospitals. Then, three weeks later she arranged to take a one-week leave of absence to return with the non-governmental organization to further implement the training. MedGlobal supports refugees, displaced persons and other marginalized communities in conflict-affected and low-resource settings around the world.
The hospitals are receiving trainloads of casualties from the front each day.
“I was obviously watching the invasion happen on the news (in February). It was very impactful for everybody, not just me. But with my background in combat medicine, it felt like there was something I could actually do to help,” said Gallagher, who received the Hillman Housestaff Clinical Teaching Award this year from the VUSM Class of 2022. The recipient is chosen from more than 1,100 residents and fellows at the Medical Center.
When Russia launched the invasion, they sent troops into the ex-Soviet nation of Ukraine from three fronts, firing missiles on several locations near the capital, Kyiv, in north central Ukraine, in a broad attack that has been condemned by world leaders. Ukraine has had a fraught relationship with Russia since it won independence in 1991.
The five hospitals Gallagher worked with are highly functioning regional trauma centers, but they don’t have the training or capacity to shift to wartime operations in addition to their established responsibilities. The hospitals are receiving trainloads of casualties from the front each day.
Working with physicians and surgeons, Gallagher and her team worked to refresh their knowledge on triage, then walked through their hospital space and created a mass casualty management plan that was unique to each individual hospital.
And finally, they ran training drills that focused first on accurate and rapid triage of a large number of “patients,” with medical students from Lviv Medical School filling that role. They focused on finding spaces in the hospitals to efficiently triage, evaluate and care for a large number of combat casualties which include blast and crash injuries and burns.
For example, in one scenario in the drill, a rocket lands in a nearby neighborhood and all of the casualties arrive at the hospital within 30 minutes. The drill helped physicians be able to rapidly assign a triage category (green – walking wounded; yellow – delayed; red – immediate; and black – dead) within 30 seconds.
“If a rocket lands in a neighborhood, there are no medical resources – equipment, supplies, trained professionals – available. It falls to the bystanders to move casualties away from the danger, triage them by severity of injury and provide basic life-saving first aid. If by chance, you’re a physician in that situation, it’s very likely that everyone will look to you to take the lead.”
But not all actual patients will be triaged and treated within the walls of a hospital, Gallagher said. And that’s where her experience as a combat medic came in especially handy.
“Physicians and surgeons in Ukraine are trained very similar to the way we are in terms of their specialties, but what they aren’t trained to do, and what most people aren’t trained to do, is take that skillset out of the hospital and to the point of injury in a war zone,” Gallagher said.
“If a rocket lands in a neighborhood, there are no medical resources – equipment, supplies, trained professionals – available. It falls to the bystanders to move casualties away from the danger, triage them by severity of injury and provide basic life-saving first aid.
“If by chance, you’re a physician in that situation, it’s very likely that everyone will look to you to take the lead,” Gallagher said. “This will have to happen outside of the hospital and away from the equipment and personnel support they’re used to. This was a special area of interest to me because I was able to use my experience as a combat medic to help train these physicians to function and lead in a low-resource, high-risk setting and to use their existing skills in a more efficient way to ensure that the largest number of casualties survive long enough to get to a higher level of care.”
Gallagher said she was impressed by the physicians, medical students and Ukrainians she encountered on her trips. The physicians and surgeons are a group with the means to leave, to get their families to safety and to start life in a new place, but they have committed to stay, she said.
“They’re the strongest, bravest people I’ve ever encountered,” she said. “These are normal people, like you and I, forced into the worst situation imaginable and rising, every day, to the challenge with bravery, ingenuity and this indomitable optimism – ‘we will win. And we will rebuild. That’s all there is to it.’ They’re angry at what’s been done to them, incredibly sad at what’s happening to their country, but brave is the simplest word I can use to describe them. I was just floored at their commitment to each other and to their country,” Gallagher said.
“Something that struck me is there’s not a lot of reason for a fully trained doctor to listen to anything that I have to say. Their training and their medical knowledge is equivalent to what we have here, with very few exceptions, so we certainly didn’t go to teach them medical knowledge. What they needed help with is how to apply that in a combat setting,” she said. “They were so attentive and interested in how to become these point-of-injury combat lifesavers. It was so touching,” she said. “I respect them immensely and count myself lucky to have met them and to have seen their beautiful country.”
Initially, the medical students she worked with helped the volunteer group get around the city and to the places they needed to go. But on the second trip, they helped with training.
“During war, humanity is distilled down to its very worst and its very best. The human relationships and interactions are raw, deeply meaningful and lasting.”
“It was a very special interaction. I learned a lot about how this is impacting their training. They’re going from COVID, where everything has pretty much been virtual, to a full-fledged war, which has shut down medical training,” she said, adding that women medical students can get out of the country to train elsewhere if they desire, but young men aren’t allowed to leave the country. “So, their bright futures have kind of come to a screeching halt at this point.”
And Gallagher continues to keep the people of Ukraine and victims of the war in her heart.
“The suffering of these people continues long after (the war ends) and often escalates dramatically after the eye of the American media and the fleeting compassion of our people moves on to the next tragedy,” she said. “I don’t go to these places to shine the light on myself, and I don’t go to shine the light on the situation there…I go because each individual life is valuable, and while I will never change the world in a grand way, I do believe that I can change someone’s world. Each life is valuable, and each life saved is intrinsically worthwhile. During war, humanity is distilled down to its very worst and its very best. The human relationships and interactions are raw, deeply meaningful and lasting.”
Gallagher said she’d love to return if the opportunity arises. “This was a wonderful opportunity to meet some new people and a really special opportunity to get back in touch with why I do what I do.”
Two years from now, when she and her husband, Ben Campbell, MD, a VUSM graduate and third-year VUMC otolaryngology resident, finish their training, they plan to move to a community without adequate surgical support.
“We plan to bring the great training we’ve received at Vanderbilt to a rural general practice,” she said.
All photos courtesy Kathleen Gallagher.
