Kharkiv. A siren that saves

When it is necessary to hide in basements, emergency medics in Kharkiv go around the city to save those who are waiting for help

Only in the first month of the major war in Kharkiv, as a result of the Russian shelling of the city, more than fifteen hundred buildings were destroyed. Among them are 70 schools, 54 kindergartens and 16 hospitals. Most of the buildings in these statistics are residential buildings of Kharkiv residents. Russian troops have been firing on the city every day for nine months, killing and injuring its civilians.

However, Kharkiv ambulance medics do not leave their posts when the air raid alarm sounds, when Kharkiv is shelled and when the city has time to recover. They start their shift in the morning and return home the next day. Doctors have to sleep in the breaks between visits. Some of their colleagues left, saving themselves and their loved ones. Those who stayed, in the first weeks of the major war, walked to work, spent the night in hospitals, but continued to work. They stay in Kharkiv because they love their city, because, they say, they once made a choice to help people.

Even dogs feel the effects of war

Svitlana Takhnenko has been working at the Kharkiv emergency station for 15 years – since she moved from her native Toretsk in Donetsk region. Svitlana Viktorivna calls working in the ambulance service a vocation. She is responsible for replenishing medicines for teams, documentation and disinfection of equipment. In addition, she reminds colleagues in the work chat, who and when to go on duty.

On the night of February 23, in her small room at the station, Svitlana Viktorivna sat at her desk, covered with magazines and medical cards, and watched on the monitor how red and green dots - ambulances - moved through the city. Dog Zhuzha, a large shepherd with dark fur and black eyes, was sleeping nearby. A few years ago, Zhuzha was hit by a car, and was taken away by doctors, so the dog stayed at the station.

In the morning, Zhuzha jumped up and started howling.

"I heard some kind of rumbling, but I didn't pay attention to it. Zhuzha approached me. "What," I asked, "do you want to eat?" It's early, only five in the morning." And then I heard: bang-bang," the woman says.

The dog Zhuzha still hides in the corner of the room during air alarms.

In the morning of February 24, the senior driver of the station named Vitaly started his shift. He is from Kharkiv and a former taxi driver, has been working in the ambulance service since 2014.

"His team immediately went to the next emergency call that they received," says the man. – In the morning, as soon as we arrived, planes appeared over the city. We did not immediately understand what was happening. Later, the manager called and said that the war had started. I did not think that this would happen. No one thought that there would be a war. No one really expected this. At first, they thought that everything would be over quickly, but this terrible war has been going on for so long. This is madness!'

During our interview, Vitaly speaks quickly, walks quickly and swiftly prepares for an ambulance call. When asked whether he wanted to resign from work during the shelling, he answered with a short and definite "no". When he talks about his hometown Kharkiv, he starts to cry. In a city that is struck by Russian missiles every day, men cry too. Although the man feels shy and a little embarrassed during the conversation, he does not shed tears.

Vitaliy's eldest son also started working as an ambulance driver. He said he wanted to help his father.

"Everyone helps as they can: some work in the ambulance service, other people sell bread. My son was worried at first, because I told him that there was blood, bodies, and shelling. Sometimes all these things happen at the same time," says the man.

Some of Vitaliy's colleagues resigned after all. Those who stayed were at first afraid to attend an emergency after shelling. "But, no matter what, our team is still concerned about Kharkiv residents and many other things. Every time we wonder if we will have the time to do everything? I am worried about the team. Most of all, about the team. It is important to be attentive, help doctors carry out the wounded and react quickly, because people are immediately allocated to where they need to be taken, according to the nature of the injury," says Vitaly.

However, the war has taught us everything.

"When our doctors arrived after a shelling, where a five-month-old baby died, or where six were killed, our paramedic said that in 25 years of work, she had never seen anything like this," recalls Svitlana Viktorivna.

The attacks, which the woman tells about, happened in the spring and summer of this year. On May 26, when the Russians shelled Kharkiv, eight people died and 17 were injured. Among the dead there was a man and a five-month-old baby. The police found the child's body on the roof of the house, it was torn from the hands of the father by the explosive wave. Another shelling took place on July 11. That day, enemy artillery attacked houses in the Kyivsky and Saltivsky districts of the city. Then 31 people were injured.

"And this, by the way, is potassium iodide. We give out pills under prescription in case of radiation danger, - adds Svitlana Takhnenko. - One pill - one dose. Just in case it happens, God forbid. God forbid."

The 141st in the queue

Outside the ambulance window, in the cold winter sun, the windows of Kharkiv high-rise buildings can be seen. In some, light is reflected in the glass, as if giving its warmth to the city, which has seen a lot of pain and fear since February. In others, the frames are covered with wooden shields. There is no glass there. Where the explosions were very recent, a day or two ago, it remains in small pieces on the ground. It crunches underfoot and cuts through the air with a subtle sound.

In 2014, when Russia started the war in Donbas, Polina Kovaliova studied in the 11th grade and planned to enter the Kharkiv Medical University. Her specialty is general family medicine. Now she is undergoing an internship and works as a paramedic in an ambulance.

On February 23, Polina returned home late. The next morning, when she woke up and read the news, she went to donate blood. "There was a queue. I was 141st in that queue. After that, I walked home, because there was no public transport, and I walked for four hours. The next day, I went on a shift in the same way," recalls the paramedic.

When the bombs hit near Kovaliova's house, in two nearby streets, she decided that she would still work. "Fear probably comes later, because when you work, you only think about what and how you need to do something. Only after some time you analyze the situation, you already understand how terrible it was, that it was an enemy attack. Someone got hurt during the shelling, but you were not. You are just lucky," says Polina.

On September 8, Polina Kovaliova's day began with the morning shift. There were no sirens in the city. Calls to the emergency service were "ordinary": old women with heart problems, someone having a heart attack, a stroke. Polina's team received an emergency call to the area of the Kharkiv Tractor Plant, the so-called KhTZ, to a woman with a fractured femoral neck. When the doctors were on their way to this call, explosions rang out in the city. After that, the air alarm went off.

At that time, a 20-year-old girl was leaving the house. She was wearing dark jeans and a light jacket, walking along a narrow path leading towards an asphalt road. The girl walked no more than three meters and after the explosion was left lying on it and bleeding. She was hit by a fragment that entered the femoral artery, and began to bleed profusely.

"I was number two in the team then. I was inside the vehicle. My paramedic colleague sat next to the driver. It was very noisy in the street. When we passed that house, a girl was already lying near it, we heard someone shouting that there was a wounded person there. We turned there. About 30 seconds passed between the shelling and the moment when we approached the wounded girl. Everything happened very quickly," recalls Polina.

She immediately put two tourniquets on the girl to stop the bleeding. Then, together with the driver, they loaded her on a stretcher to the ambulance carriage. The wounded girl had lost a lot of blood while lying in the street, and this loss had to be restored. Since donor blood deteriorates quickly, doctors carry saline solution with them. They began to drip it to the girl through a catheter that was placed in her arm.

In general, during the time since the girl was found near the house and until the moment when she was brought to the hospital, she received two liters of saline solution.

"If you look at your hand, the femoral artery is the size of the little finger. It is quite large, and the blood circulates there under great pressure. When we put the girl in the ambulance, with a normal blood pressure of 120 over 60, she had 60 over 30. She would have died if we had not turned around and sent another ambulance there. In a situation where there is such pressure and when a person has lost a lot of blood, hypovolemic shock occurs. This means that the remnants of those erythrocytes that carry oxygen, those elements that remained there, are simply not enough to ensure a normal level of oxygen in the brain, kidneys, liver and lungs. Also, at this point, the heart very quickly stops functioning properly, because our heart is used to throwing out a certain amount of blood per pulse wave. If at this moment there is a lack of blood, the heart begins to contract faster, in order to compensate for the lack of volume with the reduction frequency. However, there is no blood in the body either. As a result, this can lead to the heart working inefficiently, the organs do not receive oxygen, the person dies from multiple organ failure, i.e. lack of oxygen in the body," says Polina Kovaliova.

After providing assistance, the girl was taken to the hospital, the doctors were informed that the patient was serious. Thereafter, the ambulance car went for another emergency call, and the team barely had the time to wash it off. Polina went to the next emergency call covered with blood. Her medical uniform and the small bag in which she keeps her gloves and masks were soiled.

"Although, it's okay, I soaked it at home in cold water, and everything washed off. There was a case when the stains remained, but on a different uniform, namely the summer one. Our team then went to the suburbs of Kharkiv, where a woman was working in the garden and after being fired upon, she was wounded in the stomach by shrapnel, which might have hit the liver. That's why there was a lot of blood. However, since our uniform is red, those stains that have not been washed are almost invisible," says Polina.

"You will not notice your death"

It is morning at the emergency substation. It's not yet nine o'clock. The manager calls the employees to a general meeting. Everyone is here: Polina, Svitlana Viktorivna, and the driver Vitaly, who manages to make a cup of coffee. The dog Zhuzha is lying nearby, with its muzzle on the front paws.

"The enemy is launching rockets at the Ukrainian infrastructure. The light was restored. Such are the affairs, such is life. However, let it be better without light, but also without them," the director says loudly.

"There is no need to panic. It is true that we don't have electricity and water...but we have a generator. In addition, there is plenty of technical water," someone from the ambulance medics adds in response.

After the Russians started launching missiles at the electrical infrastructure in Ukraine, emergency medical personnel are also getting used to new conditions. Svitlana Viktorivna Takhnenko says that when the lights were turned off in Kharkiv last night, her computer did not work, so she kept in touch with the ambulances in a manual mode, by the phone. She also says that she had candles and a charged flashlight on duty.

The lack of electricity significantly slows down the work of emergency medics. All the more so, as in the case of saving lives, time passes by minutes.

“It was one of my most difficult emergency calls, when we arrived at night to an empty house with no lights. –  says Polina Kovalyova. – We came to an elderly woman with a heart attack, she lived on the 14th floor. The elevators were not working. We took her down the stairs and made breaks to measure her blood pressure. The house was empty, there was no one to help us. She was getting worse. We lost time going down the stairs, because we would have done it much faster with the elevator."

When everyone leaves the general meeting, a woman remains sitting on the sofa near the entrance. Natalya Boyarintseva. Once a pediatrician with ten years of experience, now an emergency physician. She started her work in May 2022. The war in Kharkiv also found her in a hospital, which was fired upon several times by Russian troops.

After the liberation of Kharkiv region, Natalya began going to the territories previously occupied by Russian troops. Her first trip was to one of the villages of the Kupiansk district. At night, an ambulance was supposed to pick up the patient and take him to Kharkiv. At that moment, it was dark not only outside, but also inside the car. When the driver started the car, shelling began.

"It is impossible to get used to it. The fear subsides, but the sense of responsibility to do one's work remains. An order was given, it must be carried out, Natalya says. –  I was very much afraid to go on these emergency calls, but one soldier told me: "You will not notice your death."

Now Natalya is going to take her daughter from Istanbul back to Ukraine. They had not seen each other for five months. This is the second attempt of the woman to go abroad, the first time the flight was canceled in Budapest, which was part of the route to Turkey. Three days on the road, one night in Istanbul and then home to Kharkiv. Natalya was invited to stay and rest, but she says that she does not understand how it is possible to rest now. "In our ambulance service, all employees have the same opinion," says Natalya. –  When there is a war in your country... There is no time for a vacation. And where, by the way, should I go? Where to go on vacation? If it were possible to travel with the family. Of course, I want to go somewhere with my family. Every year in August, we went to the Sea of Azov and its spits, these were our favorite places. Now what is this vacation for? All the same, you will worry about your relatives and about everyone."

The sounds of ambulance sirens are not about peace, but rather about the fact that everyone's life in this city matters. People in red uniforms rejoice at the victories of the Ukrainian army and at the same time they know the price of this victory. Rescuing civilians in cities and villages, they were among the first to go to the liberated territories of Kharkiv region and help wounded soldiers. It seems they no longer know how to do otherwise.

Read this article in russian and Ukrainian.