A medical evacuation can look simple on paper: a vehicle, a route, a patient. In reality, it depends on a chain of people working in sync, field crews who stabilise, coordinators who manage requests and routes, teams at stabilisation points and hospitals preparing to receive the patient. At every step, information has to travel with the patient, so treatment and decision-making don’t get lost during the transfer. Speed matters, but so does consistency: the same core interventions, airway support, bleeding control, pain management, monitoring, have to be delivered in tight spaces, at night, in bad weather and on damaged roads, which is why MOAS teams lean on training, repetition and shared protocols to keep decisions clear when conditions are not. Fatigue is treated as a practical reality, not an afterthought. Shifts can run long, sleep is often broken, and there is no guarantee of downtime. Where possible, teams rotate and build in recovery time; when they can’t, they rely on routines designed to reduce mistakes, clear role assignments, checklists, structured communication and short resets between calls. The aim is straightforward: protect decision-making, protect safety and keep care consistent even when people are tired. Risk, meanwhile, is not theoretical; it is part of the operating environment. MOAS has reported strikes near staff facilities, which underlines a basic reality of this work: the security situation can change fast. Safety, therefore, is not only about protective gear or where a team is based, it is also about everyday discipline: checking updates, planning routes, limiting exposure, keeping communications clear and changing plans quickly when conditions shift. Taken together, the accounts that follow show what keeps medical evacuation functioning: professional judgement, teamwork and the routines that help a crew stay ready for the next call.
Coordination Behind the Calls: Alina Bilous
Alina Bilous joined MOAS with what she describes as a simple motivation: “a desire to be useful to my country and people” and to help protect “what matters most: human life”. She started in 2022 as a paramedic and now leads a regional division as a team leader, a role that is less visible than front-line medicine but essential to making evacuation work at all. Her days run in a near-continuous rhythm, “24/7, seven days a week until vacation”, spent coordinating between crews, team leaders, forward surgical teams, evacuation departments and receiving hospitals. When a request comes in, she responds quickly, dispatching the crew, keeping information moving between teams and updating the logs that track each case. In the background, she manages the practical essentials that keep ambulances operational: maintaining stocks of IV solutions and medicines, checking expiry dates and arranging resupply. When teams return, she makes sure they can restock, take a breath and reset before the next call. “The essence of my work”, she says, is readiness and organization, keeping communication clear so “the entire system functions as a single coordinated mechanism”. When asked what makes the biggest difference to patient outcomes, Alina doesn’t point to speed or drama, but to fundamentals: “training, knowledge and teamwork,” supported by solid logistics, ongoing analysis and learning from mistakes, and a commitment to continuous improvement.
Before the war she worked as a physical therapist in neurological rehabilitation; since then, she says, “absolutely everything has changed”, including the loss of weekends and the shift from an eight-hour day to a “practically 24-hour mode”, along with a reordering of values and a sharpened sense of “here and now”.
On the hardest days, she holds on to “hope, the last thing to die” and draws strength from “family, friends and colleagues”, returning to an image she uses to describe Ukraine’s endurance: “without electricity, heating, running water, but with warmth and light in people’s hearts… despite the sheer darkness, we raise our heads and reach for the light.” And if someone believes the emergency has passed, her answer is blunt: “They are wrong… we are still HERE, on the front line”. She adds that even when the fighting ends, the workload won’t disappear: demining, reconstruction and addressing the consequences of the war will come next.
Readiness Without a Routine: Serhiy Zakharchenko
Serhii joined MOAS with a civic logic he returns to more than once: in wartime, he says, “society must unite”, and everyone should help “with what they do best.” An anaesthesiologist and crew leader, his work centres on the most fragile patients, those who are critically wounded or ill and need to be moved from stabilisation points to the nearest hospitals without losing time, information, or clinical control. In the region where his crew operates, he says there is no reliable routine. “We do not have a ‘typical shift’” because the team has to be ready to work at any hour. Much of that readiness is built long before a call arrives: he checks and maintains medical equipment, ensures the ambulance carries the necessary medicines and consumables in sufficient quantities and, together with the driver, monitors the vehicle’s technical condition. Between missions, there are the quieter tasks that keep a team functioning: laundry, cooking, rest, and the steady work of staying connected. “Communication with colleagues, relatives and friends is very important”, he notes, describing it as part of the job’s sustainability, not separate from it.
Asked what matters most for patient outcomes, Serhii argues against ranking one step above another. “There are no more or less important links in the chain of care”, he says; each stage has its own demands, but survival depends on “the right actions of each specialist in their place”. It is a view shaped by years of practice. From 2008 to 2022 he worked as an anaesthesiologist at the Dnipropetrovsk Regional Hospital; in December 2022 he joined MOAS. Since then, he says, “everything has changed. Completely”. What remains constant is “the profession and the desire to help those in need”, especially defenders wounded on the battlefield. Outside the clinical work, his grounding is personal: he is married and a father of three and he counts on regular contact with family and friends, along with small routines that punctuate intense weeks: coffee, cooking “something tasty,” reading and “looking forward to every leave and to coming home”. He also emphasises the professional support inside the organisation: doctors stay in “constant communication”, discussing cases and problem-solving together online, “we share, discuss, laugh, support each other.”
And if someone assumes the emergency is over, his reply is blunt. “Our difficulties are not over,” he says. “Moreover, they are gaining momentum.” The country, in his view, must adapt to a long-term reality, prepared, resilient and ready for what comes next.
Every Link Matters: Natalia Kapytsa
Natalia Kapytsa says she joined MOAS for one reason: “the desire to help our defenders defend the country from the enemy invasion.” She works as an anaesthetist (feldsher) on a resuscitation team, providing critical care at the point where time, distance and instability all collide, when a patient is too fragile for treatment to wait until the hospital. The schedule reflects that urgency. Teams deploy for long periods, taking “two weeks’ leave after 2.5 months of work” and operating on 24-hour shifts. The rhythm can change overnight: intense fighting can bring a sudden rise in casualties and a heavier workload; at other times, the team stays on standby, monitoring readiness and waiting for the next call. Asked what has the biggest impact on patient outcomes, Kapytsa refuses to single out one step. “It is impossible to highlight the most important,” she says, because survival depends on a continuous chain of care, from self-help and mutual aid at the contact line, through tactical evacuation and pre-hospital first aid, to medical evacuation and, finally, hospital treatment. What matters most, in her view, is that “all these links” work together, without gaps.
Before the war, she worked in anaesthesiology and intensive care at a children’s hospital, a background that anchored her clinical skills even as the setting shifted dramatically.
Away from the ambulance, her support comes from the closest circle, “my family” and “people close to me”, she says, steadying her through the hardest days. And when she hears the suggestion that the emergency has passed, she doesn’t soften her response: “this is not the reality”. The work, she adds, is far from over, there is still “a lot of work to do”.
Keeping Pace with Change: Mykyta Buryak
Mykyta Buryak arrived at MOAS with a clear reference point: the patients he had already been seeing in ambulance work and the moment he realised the need was shifting closer to the contact line. He had worked in Dnipro as part of a resuscitation team, but after the 2023 counteroffensive the cases became heavier, polytraumas, complicated injuries, amputations, and he felt he was most needed where the first hospital-to-hospital transfers begin. “I saw that I was needed there,” he says, “as close to the contact line as possible,” so that “more fathers and sons would return home… with quality medical care.” At MOAS, he adds, he could put his skills to use in exactly that space: the long, unstable stretch between emergency surgery and definitive hospital treatment.
As a paramedic, Buryak describes his role as keeping pace with change. “The speed of medical care matters”, he says, because during evacuation a patient’s condition can shift quickly, new bleeding, worsening shock, a sudden drop in blood pressure, requiring constant reassessment, new medications and close monitoring. Many of the patients he escorts have multiple injuries; some are resuscitation cases after CPR and need specialised care throughout the journey. The work starts before the stretcher is even loaded. The team requests key clinical details, vital signs, what treatment has already been given, blood results, whether transfusion has started, so they can prepare what might be needed on the road, including additional blood and blood components. In winter, preparation is also physical: warming the cabin, laying out electric blankets, checking equipment. Then comes the drive, often “hundreds of kilometres” from a forward surgical hospital to a larger receiving facility, while treatment continues in motion: infusion therapy, monitoring, transfusion if necessary.
Asked what most shapes patient outcomes, Buryak points to the chain rather than a single clinical intervention. “Each stage, the actions of the medical staff and the driver play their decisive role,” he says, because even the best medical care depends on getting safely from one point of care to the next.
What weighs most now for Buriak is the distance from home and “the long separations” from his wife, mother and grandmother, eased by video calls when he can make them.
And when he hears the assumption that the emergency has passed, he answers with a hard-earned caution: since 2022, he says, many have hoped each year would be the last. “But every year of the war shows that this is not the end.”
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