Speaker
Corey Bills, MD, MPH, FACEP
Department of Emergency Medicine
Associate Professor | Emergency Medicine
Director | Global Emergency Care Initiative
Director | CU-WHO Collaborating Centre for Acute Care
Fellowship Director | Global Emergency Medicine and Public Health
Co-Principal Investigator | ATLAS Research Program
Colorado School of Public Health
Senior Investigator | Center for Global Health
Keywords
Conflict; War; Wounds; Wound Care; Antibiotics; Antimicrobial Resistance; Master Protocol; Ukraine
Key Points
- Armed conflict has been shown to contribute to the development of antimicrobial resistance, which poses a major threat to human health. In the war in Ukraine, prolonged casualty-care in facilities with high circulation of resistant organisms, weak stewardship, and limited infection control increase the risk of infection.
- There is little trial evidence for wound care in active conflict. Factors like data completeness, clinical priorities, logistics, layered approvals, an unstable environment, and attacks on healthcare make it difficult to conduct research. Without trials, treatment must rely on extrapolation and caution.
- A master protocol facilitates research conducted during an armed conflict by pre-positioning ethics approvals, infrastructure, and standard outcomes. The PACT-ARROW master protocol applies a platform model to acute wound care in Ukraine, providing a framework for testing the safety, efficacy, and effectiveness of wound care interventions.
- The research team began with an observational cohort, collecting longitudinal data from 905 adults with acute traumatic wounds: wound biospecimens, standardized photographs, clinical care data, and clinical outcomes. This showed which data were feasible before any intervention was tested. They found that many isolated bacteria had at least 1 concerning resistance gene to known commonly used antibiotics.
Discussion Themes
Dr. Bills shared lessons learned from implementation in an active war zone. He recommended keeping the data burden small with a minimum necessary dataset and limited follow-up; solving logistics locally; and working with partners for the sake of regulatory speed.
The trial developed from a confluence of U.S. Department of Defense funding opportunities, global acute care research expertise, and established pre-war trial partnerships with Ukrainian clinician-researchers.
The team partnered with Ukraine's Ministry of Health and Ministry of Defense to select 5 civilian hospital sites along active evacuation routes, where the median time from frontline injury to hospital study enrollment is approximately 6 days.