Prehospital Whole Blood Transfusion Training in Ukraine: A Case Study Highlighting the Efficacy of Collaboration and Advocacy

Introduction: Early in the Russian-Ukrainian conflict, the Ukrainian Ministry of Health (MoH) implemented policy reform to allow for pre-hospital whole blood transfusion (pWBT). Team Rubicon (TR) worked with a multinational group of experts to disseminate training that accelerated the implementation of pWBT across the country. Method: TR utilized an assess, align, and act (A3) approach to drive the pWBT implementation. TR established relationships with Ukrainian providers to understand current needs, restrictions, and protocols for pWBT. TR aligned pWBT advocacy efforts, working with the disaster medicine program at Ivano-Frankivsk Medical National University to create a local lead advocate. Existing and novel coordination mechanisms were used to unite and inform MoH, World Health Organization, Non-Governmental Organizations, and local health systems. Finally, TR coordinated a multispecialty, multi-national team of healthcare providers who developed and delivered a training package in alignment with national guidelines utilizing a combination of didactics, videos, and demonstrations. From August to October of 2022, TR conducted pWBT trainings across Ukraine. Pre- and post-surveys were utilized to determine comfort with pWBT and usefulness of the training. Results: TR emerged as the point of reference for pWBT in Ukraine. 109 individuals from over 14 organizations were trained. Participants included 69 physicians, 23 paramedics, 7 nurses, and 10 other professionals. 95% of those surveyed had not received prior pWBT training. Participants reported increased comfort levels, with average pre- and post-course comfort scores of 1.7 and 3.2 (4=very comfortable), respectively. The majority of participants found the training useful (average score of 3.8, 4=very useful). Feedback demonstrated high satisfaction ratings and an increased awareness of the regulatory changes. Conclusion: TR utilized the A3 model to drive a coalition that supported policy reform and trauma system improvements in Ukraine. TR’s ability to leverage international medical expertise, work collaboratively with MoH, and provide material resources supported local implementation of pWBT.