Dr. John Holcomb, a well-respected professor in UAB’s Division of Trauma & Acute Care Surgery, might have thought his time for treating the wounded in war-torn countries was long past. After all, he retired in 2008 from active duty in the U.S. Army.
Holcomb joined the military as a young man to help pay for medical school, and after completing general surgery training in 1991, he deployed with the Joint Special Operations for the next decade, primarily serving in Iraq and Afghanistan.
During a deployment in Mogadishu, Somalia, he served on the surgical team that delivered 48-hour non-stop care to soldiers during the conflict that inspired the “Black Hawk Down” book and film. “Unfortunately, I’m well versed in trauma surgery because of my service,” Holcomb says.
From 2002 to 2008 he served as the Commander of the U.S. Army Institute of Surgical Research and Trauma Consultant for the Army Surgeon. After retiring from the Army, Holcomb became a renowned trauma researcher, surgery professor, clinical practitioner and entrepreneur.
He joined the University of Alabama at Birmingham in September 2019.
Then last March, Holcomb received a call from a colleague who was assisting Ukraine medical efforts. The physician wanted Holcomb to send him some slides for a presentation on the benefits of using whole blood transfusions to treat war-trauma victims.
“He called back later and asked me to just please come instead,” Holcomb says.
After Holcomb got the go-ahead from his wife and work, he traveled to Ukraine for a two-week stint with the Global Surgical and Medical Support Group, a nonprofit that takes medical care and training to crisis zones across the world. Holcomb treated patients and educated health care providers on combat wound care. By July he had served two more two-week stints. “I’ll likely go back,” he says.
Holcomb wants to help for many reasons. “Ukrainians are fighting for their life and country,” he says. “People from all over the world want to help. I’m not willing to pick up a weapon but I have a skill to share.”
He and his colleagues were gratified to assist the Ukraine in instituting the use of whole blood for traumatic injury with significant blood loss, greatly improving patient outcomes as it has in many U.S. trauma centers thanks to lessons learned by Holcomb and other military doctors. “Last March, using whole blood to treat patients, instead of blood components, was still illegal in the Ukraine,” he says. “By July, the country changed its national laws to allow its use. The Ukrainians were extremely receptive to the idea and quickly adopted its use.”
Holcomb and his military colleagues found through their experience with war casualties in Iraq and Afghanistan that using whole blood, instead of just blood components, such as platelets and plasma, improves survival rates. Blood had only been available across our nation in the form of separate components since the 1970s, Holcomb says. “Fortunately, now the use of whole blood has spread to about 50% of trauma centers across the country,” he says. “The practice continues to become more popular.”
Holcomb was impressed by how fast Ukrainian medical professionals were able to change their transfusion process at the hospital. “Typically, it takes about two years to change over to whole blood, but in a time of war they did it in about two weeks,” he says.
While most of the fighting is located in the eastern part of the Ukraine, casualties are generally sent to hospitals via train in the western part of the country, including the major cities where Holcomb was located, Lviv and Kiev. It’s too dangerous to transport through air evacuation. “We haven’t seen this kind of transport by trains since World War II,” Holcomb says. “It’s a very different experience for these patients as they take two to three days to get across this large country.”
Delays in treatment create problems such as increased infection and more tissue damage, Holcomb says. In addition, supply chain issues periodically affect the availability of antibiotics. “Civilians now are being taught tactical combat casualty care methods, including the use of tourniquets (and other Stop the Bleed techniques) to help them stabilize those who become injured,” he says.
The huge number of civilian casualties particularly alarms Holcomb. “The Ukraine’s military is well-versed after fighting in (Russian-occupied) Crimea since 2014. But this latest push by (Russian President Vladimir) Putin has spilled over to Ukraine’s civilians being targeted with artillery, mines and tanks. The majority of casualties now are civilians.”
About 600 of Ukraine’s thousands of hospitals have been targeted and hit. “We in the U.S. and other Western countries try not to hit civilian targets, but targeting civilians is a classic Russian tactic,” he says. “It’s hard to understand the logic of the tactic but it’s a classic Russian tactic.”
It’s essential that everyone supports war efforts in the Ukraine, Holcomb says. “Now is not the time to be isolationist,” he says. “What happens there affects us here on multiple levels. Ukraine is the breadbasket of Europe. The war there is contributing to food shortages and higher energy costs.”
Holcomb believes that if Ukraine falls, it potentially could be the beginning of World War III. He points to Putin’s ambitions of enlarging the Russian Federation as well of the expansionist vision of China’s Xi Jinping. “In terms of global politics, the war in the Ukraine is a big deal,” Holcomb says. “We all need to do what we can to help the Ukrainians repel the Russians.”
He sees many parallels in Ukraine to the beginning of WWII. “If you look at what is happening, it’s a lot like the mid 1930s, where you had Germany and Japan wanting to expand,” Holcomb says. “Now it’s Russia and China. If we help Ukraine, it could mean containing the problem before it becomes full blown like in 1939 to 1940. Many of my colleagues have the same concerns. It’s not a novel thought. That’s why you see NATO galvanizing around Ukraine.”
The average person can help by letting their senator and representative know they support our assistance to Ukraine. “We need to continue to support their efforts,” he says. “But the support now needs to be nonlethal, noncombat. They need medical assistance for the mass casualties.”
While the fighting is primarily in the east, including through the use of trench warfare, air raids are also being conducted in Lviv and other areas in the west. “When we see images of the war on CNN or FOX, they show the bad places,” Holcomb says. “Outside those zones if you are in a city, people are eating at the restaurants and going out for a beer.”
Where he has served, Holcomb has heard air raid sirens but, as of yet, has seen no fire. “There was in the areas I was before I was there and afterwards, but not during,” he says.
Prior to joining UAB’s Department of Surgery as a professor in September 2019, Holcomb was a professor of surgery at UTHealth Houston. He is a founder and co-CEO of a health IT company, Decisio Health. His online UAB biography says Holcomb reviews papers for more than 35 journals, has published more than 690 peer-reviewed articles, consults with several companies and serves on multiple boards.
Among his many accolades, Holcomb has received the Lifetime Achievement Award in Trauma Resuscitation Science from the American Heart Association, the United States Special Operations Command Medal, and the Service award from the American College of Surgery.
Kathy Hagood is a Homewood-based freelance contributor to Business Alabama.
This article appears in the April 2023 issue of Business Alabama.