Surviving the Zero Line

Sasha, a soldier from the 3rd Brigade, ZSU, explains what to do when you’ve been spotted by drones.

“My comrades and I had more than 40 bombs dropped on us by drones over two hours. You can’t hide from drones in a trench, but you can’t outrun them either. Your only hope to live is to zigzag, to be cleverer than the drone. When you hear a drone, you run as fast as you can and see if you can reach any trees. If you’re out in the open, you try to get the drone behind you, so it won’t destroy your face. It’s not panic, this running; it’s a professional response. You know what you have to do to save your life and you do it.”

Sasha made it to the trees and was able to dodge the FPV drones, so the Russians switched to bombs. He survived by wrapping his arms around a tree and only received a shoulder wound. The surgeon at the field hospital a few kilometers from the front took an hour to remove the shrapnel with the help of a magnet. Sasha wants to know when he can return to his unit. A doctor said,

“Infantry, these guys are the guts of war. They go into hell every day. I’ve seen guys injured for the tenth time and they still go back, because this is their land they are fighting for.”

The jobs of the medics on the zero line is to delay the death of seriously wounded soldiers. The field hospital stabilizes the seriously wounded before sending them on to long-term care. Being so close to the front, the majority of Ukrainian field hospitals has basements for protection during bombardments. However, the medical staff can’t always use them.

“We have a rule when we hear the sirens,” a doctor says. “If you’ve started, you don’t stop, not once the patient is anesthetized.”

A soldier with shrapnel in his lung somehow survived hours after he was wounded. Drones don’t just kill soldiers when they attack, they kill wounded soldiers that cannot be evacuated because of the threat of more drone attacks.

Helicopters in Korea and Vietnam were able to evacuate seriously wounded soldiers to field hospitals within the ‘golden hour’ and helped preserve life. Drone coverage by both sides make timely evacuations difficult. Sometimes the best the front line soldiers can do for their wounded comrade is carry them to the cover and wait until dawn or dusk when the twilight is poor for thermal and optical drones. The evacuation can be delayed hours or days, and sometimes soldiers bleed to death when they otherwise would have been saved. One Ukrainian soldier with a tourniquet could not have been evacuated from the no man's land of Vovchansk for 36 days, until bad weather grounded the drones. That soldier knew he was going to lose his leg but he wanted to survive for his family.

Mykola did not know his fate. He was running from drones. Two missed him but the third wounded him. He ran into the trench and yelled, “My leg!” and passed out. His comrades put a tourniquet on it but drones trapped them for three days. Normally, it is a wound that can be repaired but at the field hospital, electrical currents applied by electrodes showed that the muscles were dead. They needed to send him to Kyiv for amputation.

Mykola suffered a leg wound and was saved from bleeding to death by a tourniquet but they could not evacuate him in time to save the leg. At the field hospital Mykola isn’t told that the leg can’t be saved. He still hoped that the leg would heal as soon as possible so he could return to his unit and fight again.

Triage doesn’t just apply to wounded soldiers, it also applies to the skills of doctors, too. A neurosurgeon tried to join the 3rd Brigade’s medical team. The brigade’s chief medical officer, a former obstetrician, let him spend a few days in the field hospital before telling him, “Your skills are needed in Kyiv. I won’t employ a doctor who can do more good in their specialty back home.”

80% of wounds are caused by shrapnel. Traditionally, large incisions are made near the location of the shrapnel and the doctor searches for it to pull it out. Looking for shrapnel is like “looking for a needle in a haystack”. It’s not always successful, it can delay treatment for other patients in need, and it increases the time they spend above ground and in danger of being shelled.

Increasingly, magnets are used to pull the shrapnel to the surface and then a small incision is made to remove it. Magnets were first used to remove metal back in the Crimean War, but a lawyer worked with medical teams to develop flexible extractors for abdominal surgery, micro-extractors for delicate work and high-strength extractors for shrapnel stuck in bones. 3,000 of the tools have been built for both hospitals and front-line units and they’ve saved lives, even though they haven’t been medically certified.

A piece of shrapnel grazed a soldier’s kidney, pierced his lung and entered his heart. He didn’t realize where the shrapnel went, he just felt short of breath. In his case, doctors made a small incision in his heart and then used a magnet strong enough to lift a sledgehammer to pull the shrapnel out.

Other nations are taking notice. A US report discusses a case where a soldier was injured by artillery, provided first aid and reached the field hospital within the Golden Hour. The two pieces of shrapnel are 1 x 1 cm and 2.5 x 2 cm in size. They entered his lower right side and lodged in his upper left lung. An hour later, he was transported to a hospital in Kyiv.

Since the Second World War, chest injuries were the cause of a third of all combatant deaths. 80% of the chest wounds are resulting in injuries to the lungs. Usually, they are accompanied by damage to ribs, bacterial contamination. In this war, there is a 37% mortality rate due to massive hemorrhage and acute respiratory failure.

In Kyiv, they used the entry holes in the body to insert a camera and a magnetic tool to remove the small piece of shrapnel. The other piece was too large to exit the wound channel so an external magnet held the shrapnel in place while it was removed by forceps. Because the surgery created little additional trauma and infections were prevented, the soldier was discharged two weeks after surgery and given 30 days of vacation for recovery.

For those that wish to see, the imagery of that surgery is available on this link.