Ukraine war study adapts wound-care research to active conflict

Researchers running a clinical study in Ukraine have adapted their methods to the conditions of an ongoing war, according to a presentation published by rethinkingclinicaltrials.org. The PACT-ARROW study examines the prevention and treatment of antimicrobial resistance in traumatic wounds, with research taking place across civilian hospitals positioned along active evacuation routes.

The project brings together emergency medicine, acute-care research and Ukrainian clinical partnerships established before the war. Its development also reflected funding opportunities from the US Department of Defense. The resulting study was built with Ukraine’s Ministry of Health and Ministry of Defense and involves five civilian hospital sites.

Patients in the study are treated after being moved through evacuation systems from areas affected by fighting. The median interval between an injury at the frontline and enrollment at a participating hospital is approximately six days. That timing is central to the study’s operating environment: researchers are not working at a fixed point immediately after injury, but with patients who have already passed through a difficult and changing chain of care.

A trial shaped by wartime conditions

Corey Bills, MD, MPH, FACEP, shared the implementation lessons described in the presentation. He is associated with the Colorado School of Public Health, where he serves in emergency medicine and global health roles, including as director of the Global Emergency Care Initiative and the CU-WHO Collaborating Centre for Acute Care. He also directs a fellowship in global emergency medicine and public health and is a co-principal investigator of the ATLAS Research Program.

Bills’ recommendations focused on making the research workable rather than adding layers of procedure that could be difficult to sustain during conflict. The team kept the amount of information requested from sites and participants small, using what he described as a minimum necessary dataset. Follow-up was also limited.

Those choices address the practical demands of studying patients whose care is taking place during a war. A larger data collection requirement could place additional pressure on hospitals and research staff. More extensive follow-up could likewise be difficult when patients, clinicians and facilities are operating amid disrupted conditions. The approach described in the presentation instead prioritised the information needed for the study while reducing its administrative load.

The study’s subject matter adds to that challenge. It concerns wounds caused by traumatic injury, their treatment and the risk of antimicrobial resistance. The research therefore sits at the intersection of emergency care, infection treatment and military conflict, while being conducted in civilian hospitals serving evacuation routes.

Partnerships and local problem-solving

The investigators also treated logistics as a local task. Rather than relying on a single outside solution, Bills recommended resolving operational problems with partners in the setting where the research is taking place. The project’s work with Ukraine’s health and defense ministries reflects that model of collaboration.

The presentation also emphasised working with partners to move through regulatory processes quickly. This was not presented as a reason to lower research standards. Instead, the lesson was that established relationships and cooperation can help a study respond to the pace of events in an active war zone.

Those relationships predated the conflict. The trial grew partly from existing partnerships between researchers in the United States and Ukrainian clinician-researchers. That earlier connection provided a foundation for the project when the opportunity and need for the study came together.

The combination of pre-war collaboration, Department of Defense funding opportunities and expertise in global acute care research helped make the trial possible. Its five-site structure then placed the study in civilian facilities along evacuation routes, where patients could be enrolled after reaching hospital care.

Why the model matters

The account published by rethinkingclinicaltrials.org presents PACT-ARROW as an example of research designed around the realities of conflict. Its operational lessons are straightforward: collect only the data required, limit follow-up, solve delivery problems with people working locally and rely on established partners when speed is important.

The study’s setting gives those decisions particular weight. A research protocol must function across hospitals connected to active evacuation routes, while the patients involved have experienced serious traumatic wounds and arrive at a median of about six days after frontline injury. The project therefore has to preserve a workable research process without separating it from the conditions shaping patient care.

For the teams involved, the experience offers a practical account of how clinical research can be organised during active war. It links the study’s scientific focus on traumatic wounds and antimicrobial resistance with an implementation strategy built for limited time, constrained data collection and locally managed logistics.