Assessing the Trauma System in Ukraine Through the Perspectives of International Healthcare Volunteers and Ukrainian Healthcare Workers: Application of an Observational Tool

Introduction Ukraine's health and trauma care system has been devastated by the Russian Federation's invasion in 2022. Previous research shared insight of returned volunteers into changes in the system; however, as the war continues there is the need to understand how the observations of United States (U.S.) volunteers and Ukrainians working in healthcare in Ukraine may differ regarding perceptions of the trauma system's current strengths and challenges. Materials and Methods We conducted structured interviews with U.S. healthcare or healthcare-adjacent returned volunteers and Ukrainian healthcare workers using the Ukraine Trauma System Assessment Tool Study Region Observation (TSAT SRO) Tool. Mean scores were calculated for each trauma system domain among both Ukrainian and U.S. groups. t-tests were used to determine if there were any statistical differences between these means among the 2 groups. Results The overall score for the Ukraine trauma system combining scores from U.S. volunteers and Ukrainians was 1.89 out of a possible 3.00. The domains with the highest combined scores included Prehospital, Chemical, Biological, Radiological, Nuclear, and Explosive (score = 2.33), Prehospital Training (score = 2.25), and Definitive Care Facilities: Blood Product Use (score = 2.38). Domains with the lowest combined scores included Injury Prevention (score = 1.55), Definitive Care Facilities: Disease and Non-Battle Injuries (DNBI) (score = 1.60), and Logistics and Supply (score = 1.55). U.S. volunteers scored every domain lower compared to Ukrainian respondents. All differences between U.S. volunteers and Ukrainian responses were statistically significant except Definitive Care Facilities: Telemedicine, Definitive Care Facilities: Blood Product Use, and Definitive Care Facilities: DNBI. Conclusions TSAT SRO component scoring from observations of U.S. volunteers and Ukrainian healthcare workers suggests the current Ukrainian trauma system is in development. Domain scores differed between U.S. volunteers and Ukrainians; most were statistically significant, demonstrating the importance of including citizens of a nation versus only foreign healthcare workers in assessing a healthcare or trauma system.