EMS World Q&A: Kasia Hampton, MD

When Russia invaded Ukraine in February, many in the western emergency medical community rallied to help. Some raised funds, some sent supplies, and some even traveled to the war zone and adjoining countries to deliver care and direct assistance.

The latter group includes emergency physician Kasia Hampton, MD, ABEM, EBCEM. A 2022 EMS fellowship graduate at the Washington University School of Medicine in St. Louis and chair of the National Association of EMS Physicians’ Prehospital Ultrasound Task Force, Hampton—whose background includes ED medical direction of US military posts in Europe and fellowships in both emergency ultrasound and pediatric emergency medicine—remained there into the summer, working with both frontline troops and impacted civilians and helping muster aid for Ukrainian caregivers.

In this Q&A Hampton talks about her experiences over the war’s first few months and how to help effectively as it continues.

EMS World: Have you been home at all since February or in Eastern Europe the whole time?

Hampton: Well, my home is in Germany, but I haven’t been there since June 27, 2021, when I went to the US for my EMS fellowship. I had planned to return at the end of June, but it didn’t work out that way. In the meantime I’ve been either in the US or in Ukraine, and I won’t be back home for good probably until September.

When the war started, how did you get involved? What did you do?

Hampton: Initially a lot of the response started in Poland, where I’m originally from and still have friends and family. Poland absorbed the majority of the humanitarian impact of the war in its first weeks and months. It wasn’t the government—it was the people of Poland who literally said, ‘OK, we’ll do for the people of Ukraine what nobody did for us in 1939.’ And they opened their borders and homes to those fleeing Ukraine. There were Facebook groups where people were offering rooms and apartments, and they were spontaneously driving to the border, picking people up, and taking them into their homes.

I first got involved helping my colleagues in Poland with various arrangements and providing support in terms of contact with companies that provide tactical medical equipment. Very quickly I was approached by a number of American nongovernmental organizations. They knew me from Special Operations Medical Association circles—they knew I had ties to this area and contacts and the linguistic and organizational skills to help. I was kind of like a guiding hand initially when they were setting up their operations in Poland.

There was a major problem at that time with people self-dispatching out of the US. They were just packing up their stuff and going to Poland. I don’t know what they imagined they were going to do there, but they got there and had nothing to do, because the war wasn’t in Poland! Ukraine has hospitals, and they can take care of their own people, so it’s not like you have millions of wounded coming. You have people displaced for humanitarian reasons, and they don’t need doctors; they need a place to stay and a hot meal. They don’t need emergency medical care—they need humanitarian care.

People seemed to think it was like a Hurricane Katrina situation, where all of a sudden they’re trying to reorganize things locally, but people were streaming into a pretty well-functioning country. Since Poland joined the European Union, a lot has improved.

So their imagination of what they were going to find in Poland was completely different than reality. I had one team upset that the Polish Minister of Health wasn’t there to meet them personally when they walked into the building. I had another NGO that advertised on Polish social media that they were looking for doctors to collaborate with them and write prescriptions so they could treat patients in Poland. I was like, ‘Do you even understand this is illegal? And both you and the Polish doctors could end up in jail, because malpractice in Poland is a criminal offense and not a civil lawsuit? So how about you don’t do that?!’

Even going straight into Polish homes, many of the evacuees were elderly. With a lack of real emergency medical needs, did they have chronic needs and conditions to contend with?

Hampton: Yes, exactly. Imagine, you leave Ukraine, and everything you own is in a carry-on-size suitcase, and you don’t have your asthma inhaler, you don’t have your high blood pressure medications, you don’t have other things you need. And of course in all of this, anxiety plays a role. Some of these folks had waited for 2–3 days on the Ukraine side of the border to cross.

At that time I did some triage consults on the phone as people arrived in Poland and friends and family and colleagues were calling me: ‘Hey, this person has this chronic condition—do they need to see a doctor tomorrow, or do we have a week to arrange it?’ I would do those video teleconsults for them and try to figure out if they were acute and needed to see a doctor or just needed to pick up their meds.

Generally it was a lot of anxiety and fatigue. A lady was telling me how she spent 3 days on a passenger train, but it was so packed, they had to stand for almost 3 days, like sardines in a can.

Are you anticipating stress reactions among these people now?

Hampton: Definitely. Initially you’d call it an acute stress reaction. It takes time to diagnose PTSD, but absolutely, especially for people who came from eastern and central Ukraine, where they were heavily bombed. You’ve seen the degree of damage on TV and in the media.

At the hospital where I’m working now, there is a girl who came from Mariupol, which was completely bombed out. She told me she spent a month in a basement with a bunch of people where they cooked with fire and a pot. She’s a speech therapist, and we went to conference here locally about PTSD that was organized at a local castle. And to make it fun for the participants, they prepared dinner in an old-style way: They cooked in big kettles hanging over a fire. And she told me, ‘I know this is normally fun for people, but you don’t even know how stressful it is for me to see it.’ So something as innocent as a kettle over a fire can bring up very vivid and painful and stressful memories.

The other aspect of this is the people who are coming back from the front lines. A lot of the Ukrainian military members, like the militia and territorial defense types, are actually civilian volunteers. They’ve never been through anything like this. And some people thrive in it and do phenomenal things, but I know some have been returned back and rotated out because they were just not handling it.

I understand you’ve also been doing some combat medicine education.

Hampton: Yes, we were training the territorial defense units deploying to the front lines. The problem we’ve had is, a lot of organizations from all over the world have been sending tourniquets, combat gauze, and all kinds of other tactical medical equipment that we take for granted and know how to use. But if you talk to people here, they say it’s great they got it, but they’re never going to use it because they don’t know how.

That’s a terrible thing to think about, that we’re sending all this support and those people won’t use it. But it’s not just us [teaching them]; plenty of other organizations are devoting their time to training those volunteer tactical medical providers—and that’s what you have to call them—to provide care and use these awesome lifesaving resources.

One of my colleagues from St. Louis, a SWAT medic, was initially going to deploy with an organization that does medevac. There was some miscommunication, and he ended up coming with us for training. Before he left he said, ‘Oh, my God, I thought I’d do all these sexy things, being in a combat zone, medevac, all that.’ And he realized that sharing this knowledge and training all these trainers and growing the capability over here was even more needed. He said, ‘That’s what we can do to improve outcomes for the Ukrainians.’ Because a lot of them just don’t have that training.

People hear ‘Send money, send equipment,’ but training really is the missing piece.

Hampton: Exactly. And you need to come here and show them how it’s done, because that’s the only way it’s going to work.

You always have to consider the cultural aspect, right? Ukraine is a very proud nation, and they don’t easily accept, ‘This is how you should do it.’ You have to learn to function in more of an advisory role. You have to respect their culture, or you’re not going to be accepted. By now I’ve learned to speak Ukrainian. I’ve tried to show them, ‘Look, in the middle of war, I am here—I’m not with my family at home, I’m here because I care and want to help you. And because we’ve had the opportunity to learn this, we want to share it with you, so you can save lives of your people.’

Does being from Poland and that part of Europe give you an advantage in that regard?

Hampton: Absolutely! I’m old enough to remember the Soviet times in Poland. It was a communist country when I was born. There are a lot of post-Soviet remnants in the way certain things are done over here, and also the culture—how you interact with people, how you approach them, how you do things together, how you talk to one another.

My best teachers are my Uber drivers. They get very excited that I can have a whole conversation in Ukrainian with them. For $3 I get a ride to work and a Ukrainian lesson and a whole conversation about what’s new!

You mentioned a colleague from St. Louis. Are there others from US EMS community there?

Hampton: There have been a lot of US organizations deployed over here, and most of them have focused on the mission training. I have awesome paramedics who run the medevac program—they evacuate patients not just in western Ukraine but have started venturing out toward central and eastern parts as well.

It’s like transport medicine on steroids. I’ll tell you one of our latest stories.

We had a patient who had to be transported from a hospital 800 km from the Polish border. The plan for this patient was to go to the Netherlands for further care. He was a soldier, he’d been shot and was paralyzed from the waist down. He needed a lot of support and treatment they could no longer provide here.

The problem was the patient got sick before we were going to transport him. So the day we were to get him transported, an hour into the drive, we had to abort because I realized—not from his doctors but from speaking with his wife in a different part of Ukraine—that he had a high fever. I was like, ‘Oh, crap—if he has an almost 40ºC fever while on 4 different IV antibiotics, that’s a disaster.’

There had been another patient a few days earlier from the same hospital and ward who barely made it through Ukraine to Poland when they had to abort the transport because he went into full-blown septic shock. And then we realized, OK, we grow all kinds of really nasty bugs out of these cultures, and these cultures are probably much more informative than cultures from a different patient—much more informative about what’s going on with this patient than some of this laboratory nonsense that happens in Ukraine. Sometimes when we look at those Ukrainian hospital results, they really just make no sense—like, they’re medically impossible.

So we contacted the hospital and went, ‘Hey, listen, I’m not trying to impose anything, but we suggest we treat him with this and this and this.’ ‘Well, we don’t have that.’ OK, fantastic. So a Dutch colleague and I, within 24 hours, made that medication show up at the hospital from Romania.

So this patient was treated, and everything turned out fine. But here’s the thing: Look at the convoluted course of prehospital transport medicine for this one patient! And there are hundreds and thousands of patients like this, who local hospitals have treated for a long time, until complications develop or they no longer have the resources. Then they allow us to evacuate them. They don’t understand that early evacuation to a really high level of care is actually what is most beneficial.

The No. 1 rule of combat medicine is, once the patient is stabilized hemodynamically, they get pushed up to higher echelons of care. You push them up as soon as you can, because in a combat hospital you need beds for the next patients.

So it was a big cultural struggle to try to explain this. ‘Look, I know you’ve got this. That we’re questioning this is not about you. You’re doing a tremendous job under the circumstances. It’s just we know we can take this off your hands so you can focus on the new patients coming in, and we’ll give this person more resources, more capabilities, and a better chance of recovery, because there’s no war going on over there.’

So with diplomacy and politics, we’re trying to get them to embrace the concept that we’re not doing this because we think they’re not capable. They really are doing a tremendous job. We’re doing this because we’ve seen over years of military operations in this century that this is how you get the most long-term benefit to the patient.

Your daughter Livia is a medical student in Poland. When the two of you spoke to the Gathering of Eagles meeting in March, she described some of her work with Ukrainian children. What is she doing now?

Hampton: At this point she’s actually focusing on her exams. But what she’s been doing is working to develop an individualized support system for the pediatric hospital at the University of Krakow, where she is a student. She’s helped get funds donated, and whenever they admit a Ukrainian child who has specific needs—like they don’t have underwear, for instance—and limited financial resources, they call my daughter, and she helps meet those needs.

She’s also been at the border at the worst of times. When it was -11ºC, she was there at night helping on the Ukrainian side, taking 12- to 14-hour shifts. Most of the time it was just providing encouragement and hot soup and a blanket, but she told me at times she was the most experienced medical person there.

Understanding that people shouldn’t just show up and shouldn’t just send random items you may not need, what is the best way for the American EMS community to help Ukraine now?

Hampton: In general people should reach out first, and I’m happy to help direct them. There may be something I need, and people will say, ‘I don’t have this, but I can give you that.’ And even if I don’t need what they offer, I can channel it. I always know someone who knows someone who knows where it will be a perfect fit.

One of the biggest issues is ambulances being targeted. They go through ambulances like they’re going out of style—they get shot at and destroyed. So equipment for inside ambulances is always a need—monitoring equipment and all kinds of things.

The most important thing is to make sure what you’re sending is going to specific people, and you’ve discussed with them that that’s really what they want. It doesn’t help when people send things we can’t use. I know people have a lot of expired COVID filters, but expired COVID filters are not a necessity right now in Ukraine. Don’t treat Ukraine as your place to dispose of things nobody needs.

Some expired things we can use for training purposes, because we need that. But when it’s betadine that’s expired by 7 years, that’s kind of an insult. There’s better ways to dispose of garbage than sending it across the ocean.

So talk to a person, find an organization you feel passionate about, find individuals you feel passionate about, and reach out. I’m more than happy to receive those inquiries, and if I don’t need something, I will channel it.

Contact Hampton through her LinkedIn. 

Sidebar: Advancing Medical Education in Ukraine

Want to support your fellow providers in Ukraine? MedEd Ukraine is a nonprofit NGO started by Hampton and an educator colleague, Natalia Zachynska, to help advance medical education in the country even as the war continues. Based in Khmelnytskyi in central Ukraine, its goal is to build educational partnerships and provide a “booster shot” for Ukrainian emergency medical education.

One of MedEd Ukraine’s early projects will focus on ultrasound-guided central venous access, using 4 simulators donated by Simulab. Others are in the works as well.

See a short video marking the organization’s debut here, and find MedEd Ukraine on Facebook here.

John Erich is the senior editor of EMS World.