Sitting in a field hospital in the eastern part of the country, Lieutenant Colonel Roman Kuzic watches real-time medical statistics of the war scenario on his phone. One of them is a pie chart dominated almost entirely by red. The drawing confirms the revolution caused by the massive use of remotely piloted aircraft (UAS) on the battlefield and, consequently, in his field: military medicine.
The almost entirely red chart indicates that now 98% of the injuries are due to shrapnel. Victims of what was once defined as war - gunfights - occupy a minimal portion in the recreation. "We only receive 1.9% of gunshot wounds. Everything is trauma from shrapnel and explosions," Kuzic points out.
"The NATO doctrine is based on the so-called golden hour [the golden hour], in which it is assumed that the wounded should be evacuated. [In Ukraine], the actual average evacuation time from the death zone [the increasingly broad area under UAS threat] is between five and six hours. This means that soldiers spend much more time with a tourniquet than advised," explains the head of the medical forces in the eastern part of the country.
The conversation is interrupted when the hospital receives a soldier from the front line. He has two wounds on his leg: one on the foot and another on the thigh. They bring him without a tourniquet, but with the shrapnel-crushed areas covered with Israeli bandages.
The new techniques of Ukrainian combat medicine deviate from NATO's maxim, which always recommends "placing the tourniquet as high and as tight as possible because they will evacuate you in an hour," recalls Kuzic.
The circumstances of modern warfare faced by Ukrainians have led them to recommend a restrictive use of tourniquets and, whenever conditions allow, complement their use with less aggressive hemorrhage control methods (such as hemostatic gauze or the aforementioned Israeli bandage).
"If the bleeding returns, the tourniquet is placed again, but as close to the wound as possible, knowing that the limb will have to be amputated, but this way you won't lose it entirely," adds Kuzic.
The application of the tourniquet far beyond what is recommended in NATO manuals is one of the reasons - although by no means the only one - for the huge number of amputations faced by Ukrainian military personnel. Experts estimate that tens of thousands of soldiers have lost a limb: between 30,000 and 100,000, according to estimates from various NGOs and some Ukrainian institutions. In comparison, the US Department of Defense notes that in the conflicts in Iraq and Afghanistan, over a 16-year period, their troops only recorded 1,705 amputations.
The data handled by Kuzic is a continuous plea that questions all the lessons learned over the past decades in terms of conflicts. Figures that even raise doubts about the adequacy of the usual bulletproof vests worn by military personnel or rescuers. "Drones usually explode at head level. We have a 20% rate of eardrum injuries. Another 20% with neck and head injuries. These are very serious wounds. Many people lose their vision. We need to consider modifying the design of helmets to cover the face," says the lieutenant colonel.
Kuzic is one of the many military personnel who have been warning their counterparts in the armed forces of European countries integrated into NATO for months about the absolute gap they have perceived in the tactics of those armies, which have been training Ukrainian soldiers.
Since the start of the general Russian invasion, over 100,000 Ukrainian military personnel have been trained in dozens of NATO member countries.
Former chief of the Ukrainian military and current ambassador to the UK, Valerii Zaluzhnyi, issued the same warning in the spring, alerting that - in his opinion - the Atlantic Alliance has become completely "obsolete."
Last May, Zaluzhnyi participated in a conference in the British capital where he pointed out that the lag of European armies will not be solved with "some rearmament" or a "transformation of the arms industry."
"You need a new state policy. The nature of modern warfare is far from how NATO currently operates. It requires new tactics, new organization, new doctrine, new training, and defense plans," he stated, estimating that even if the alliance changes its military methods now, it would need five years to catch up with how warfare was conducted in 2024.
As stated in a recent analysis by the Modern Warfare Institute at West Point (USA), part of the military academy of that country, NATO "risks becoming irrelevant by training Ukrainians for idealized battles, not for chaotic, attrition-based warfare based on the use of drones. The Russo-Ukrainian war has revealed an uncomfortable truth: Ukraine may be teaching more to NATO than the other way around."
The experts' assessment was very similar to Zaluzhnyi's: European armed forces are trained with "discipline" for the "defeat" anticipated in the report.
Ukrainian military personnel interviewed for this report repeatedly complain that NATO forces use models based on the wars in Iraq and Afghanistan in their exercises, where drones did not play the omnipresent role they do today.
"The reality of modern warfare shows us that training abroad, unless adapted to Ukrainian conditions, is not only ineffective but dangerous," wrote the newspaper Ukrainska Pravda in an analysis of the casualties suffered by units trained in Europe.
The roads leading to another hospital center, also part of the system established by Kuzic, are filled with new models of mangal (vehicles covered with metal plates and even spikes in a Mad Max style) and anti-drone nets that define the new landscape of the regions near the enclaves where Ukrainians try to halt the Russian advance.
Along the route, new anti-tank ditches, endless lines of dragon's teeth (cement obstacles), and barbed wire appear, although the absence of armored vehicles in the area is another reflection of the drastic turn the conflict has taken.
The underground chamber is the second one installed in the front line area. Nothing hints at the fact that beneath the mounds of earth lies a complex of over 300 square meters equipped with operating rooms and an intensive care unit, despite being within the range of Russian drones.
"We now have almost 30% of stabilization points [another level of assistance before transfer to hospitals] hidden underground," Kuzic mentions.
The last time the team under the command of Mikola - Ukrainian military personnel usually do not provide their last name - received a gunshot wound victim was "a week ago."
One of his subordinates, Igor, 36, trained for six months at the Toledo Military Academy last year. He says that some tactics, such as camouflage, have been "useful," but overall, the training ignored the crucial role of drones in modern warfare.
His opinion on that course is almost identical to what is repeatedly heard among Ukrainian ranks: "Our military should be the teachers of those NATO instructors, they have much more experience."
Kuzic specifies that the current main efforts of Ukrainian military personnel are focused on creating a new procedure to evacuate the wounded. This is what is known in military jargon as Casevac. Until a few years ago, it was usually done with equipped ambulances. However, UAS have turned them into a top priority target, preventing their access to combat zones.
'Robot-Stretchers' for Evacuating Casualties
"The first thing we did was to increase the medical training of soldiers. We went from eight hours to between 24 and 36 hours," he points out.