• Sean M Kivlehan, Michelle Niescierenko, Kathleen Murray, Javed Ali, Geoffrey Anderson, Carolyn Baer, Serhii Baranov, Aziz Baig, Viktoriia Borysiuk, Morgan C Broccoli, Katherine Biniki, Noah Carton-Rossen, Kevin Collopy, Anton Darnytskyi, Oleksandra Demetska, Katherine Doyle, González MarquésCatalinaCHarvard Humanitarian Initiative, Cambridge, Massachusetts, USA.Harvard Medical School, Boston, Massachusetts, USA.Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA., Donell Harvin, Roman Holivets, Alona Goncharova, Jill John-Kall, Yelyzaveta Kalnybolotska, Bohdan Kanzeba, Kyrylo Kliukach, Olha Kushner, David Lewander, Janet Lienau, Gideon Loevinsohn, Oleksii Lopatniuk, Amelia Lozano, Lindsey Martin, Oleg Martyshyn, Nelya Melnitchouk, David Mills, Iryna Pidhorna, Anna Poriechna, John E Roberts, Alexis Schmid, Lea Sinno, Jonathan Strong, Meaghan Sydlowski, Dmytro Tsurbin, Eleonora Ukrainets, Michael VanRooyen, Eric Goralnick, and Timothy Erickson.
• Harvard Humanitarian Initiative, Cambridge, Massachusetts, USA smkivlehan@bwh.harvard.edu.
• Emerg Med J. 2025 Jan 2.

IntroductionCivilian healthcare workers (HCW) and medical facilities are directly and indirectly impacted by armed conflict. In the Russia-Ukraine war, acute trauma care needs grew, the workforce was destabilised by HCW migrating or shifting roles to meet conflict needs, and facilities faced surge events. Chemical, biological, radiological, nuclear and explosive (CBRNE) exposure risks created unique preparedness needs. In response, an academic and international non-governmental organisation partnership was formed to design, implement and evaluate a locally prioritised training programme in Ukraine.MethodsSeven in-person training courses (Advanced Trauma Life Support, Trauma Nursing Fundamentals, Pediatric Trauma Fundamentals, Prehospital Trauma Fundamentals, Stop the Bleed, Mass Casualty Management and CBRNE Preparedness) were adapted, translated, taught and evaluated in seven Ukrainian oblasts (regions; Kyiv, Dnipropetrovsk, Zaporizhzhia, Odesa, Lviv, Chernihiv and Mykolaiv) during the war. Topics were determined by available needs assessments and further adapted based on course participant feedback and evolving logistic and security challenges. Change in participant knowledge and confidence levels was assessed through precourse and postcourse knowledge and self-confidence evaluations and follow-up surveys. Initial courses were taught by international instructors and transitioned to Ukrainian instructors as they were trained. Web-based asynchronous videos in Ukrainian were developed to complement and reinforce in-person training.Results4368 participants were trained in 164 courses from August 2022 to April 2023. 223 instructors were trained. Aggregate participant knowledge and self-confidence significantly improved in all courses. Interval follow-up responses indicated that the training was useful and 83.3% had used the skills within 8 weeks of training. Twenty-seven training videos were created which, as of April 2023, have been viewed over 1 700 000 times in 500 cities throughout Ukraine.ConclusionsLocally prioritised training can be rapidly developed and delivered in an armed conflict setting providing civilians and frontline HCW with the skills and knowledge required to care for patients. Logistics, communication, equipment and security challenges can be overcome through strategic in-country partnerships. Short asynchronous video learning can complement and scale in-person training.© Author(s) (or their employer(s)) 2025. No commercial re-use. See rights and permissions. Published by BMJ Group.

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