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The dangers of drone warfare have forced to Ukrainian medics to learn new ways of tending to wounded soldiers.

Current first aid manuals were developed after 9/11 but must now be updated for new technology and threats.

Innovations like drone blood delivery could be applied in other wars, natural disasters, or medical deserts.

Every day on the front lines, Ukrainian combat medics perform a kind of small miracle never before seen in the history of war or healthcare.

They use drones to deliver life-saving blood to wounded soldiers pinned down in frontline positions too treacherous for helicopter evacuation. Fellow soldiers—not medics—can deliver the transfusion, with coaching from medics via satellite connection.

It's just one of numerous ways Ukraine’s innovative approach to frontline medicine can give us insight into how urgency and creativity can revolutionize future healthcare across many extreme contexts.

“It really works, and I think it would work in other wars,” said Rina Reznik, a medic from eastern Ukraine. She studied neurobiology at university, and currently serves as the head of medical supplies in the Azov Brigade. “It’s cutting-edge technology.”

Blood transfusions, delivered by drones

Blood transfusions date to the early 1900s, with the British Army being credited with creating the world’s first blood bank during World War I.

While methods have improved across World War II, Vietnam, Iraq, and Afghanistan, it wasn't until 2023 that the Azov Brigade demonstrated the first drone-delivered field transfusion. It's one of the few units able to use drones for this advanced procedure. Reznik and medics like her have been perfecting these methods for the past two years.

The front lines of the war stretch more than 1,000 miles along the Russia-Ukraine border. The “kill zone” extends up to 15 miles back from the contact line between both armies. It is patrolled by lethal short-range drones, making it impossible to send medics to care for wounded soldiers.

In these regions, three to four soldiers often cluster in the basement of a house to fight together.

Meanwhile, at bases, blood is stored in refrigeration at 4 degrees Celsius (about 39 Fahrenheit). Medics now teach drone pilots how to warm blood to 39 degrees Celsius (about 102 Fahrenheit), and secure it in special packages with calcium, syringes, and instructions for soldiers on how to use them.

About one-third of those deliveries are shot down en route by enemy drones. Depending on the situation, drone pilots might fly the blood with a one-way quadcopter, or with a bomber that drops the package via parachute.

“If combat medics are in the position, that’s the easiest way to do it because they know what to do,” Reznik said. “If not, we use a telemedical consultation. Most of the positions have Starlink, and we have someone on duty on a medical point every time, just to consult the guys on what to do with the situation and evacuation.”

In recent wars, such as in Afghanistan, casualties were usually evacuated by helicopter to hospitals within one to two hours of their injuries. Because that’s not possible with drones patrolling the front lines, all soldiers must be trained in tourniquet conversion every several hours. “Our longest time a casualty was in a position was eight or nine days,” Reznik said.

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Rewriting the training manual

The drone-delivered transfusions practiced by Reznik's unit are part of a wider upheaval in practice.

“The tactical medicine that I've been learning and studying up through 2022 is totally different from the tactical medicine that is being taught in 2026,” said Olena Ryzh, a senior combat medic in the 412th Brigade "Nemesis." “Of course a lot of the structure is the same, but a lot of the details are being changed.”

Ryzh leads her battalion’s efforts in medical evacuation, as well as teaching tactical medicine. She notes that for decades, international first aid trainers have used the acronym “MARCH,” which refers to the priorities in massive hemorrhage, airway constriction, respiration, circulation, and hypothermia. It begins with massive hemorrhage because 90 percent of U.S. military combat deaths after 9/11 occurred due to bleeding.

On the front lines, especially in winter, hypothermia is one of their most acute concerns, with so much of the work taking place in cold basements. Ryzh recommended that the “H” of MARCH be moved higher in the priority list. “We need no longer have the structure of having a combat medic in your company, so we are dramatically changing our preparation program for soldiers,” Reznik said.

One new technique is training regular soldiers in what’s called intraosseous access, or IO. This is an emergency process to deliver life-saving medicine or fluid into the patients’ bones, an important method when it isn’t possible to do so through an IV.

Approaches beyond Ukraine

Delegations from foreign countries’ militaries or healthcare systems frequently visit Ukrainian units to study their methods and bring these new cutting-edge practices home.

In late 2023, two years into the full-scale war, Ryzh went to the United Kingdom for a training event. Medics there had a hard time understanding that in drone warfare situations, evacuating soldiers with helicopters is impossible.

“A lot of foreigners struggled with the idea of there being no evacuation helicopter for you. They really, really couldn't understand how it is possible,” Ryzh said.

What Ukrainian medics are learning can be reapplied for widely varying purposes around the world. Outside of combat, for instance, drone deliveries have proven viable in humanitarian uses in Africa.

Zipline, an American company that launched in Rwanda in 2016, delivers blood, vaccines, and medical supplies via drone to remote areas. Tens of millions of rural Africans live in “medical deserts,” areas in which clinics can lack key resources and infrastructure isn’t well developed. Delivering blood via drone is therefore critical in saving lives, perhaps most often with women after giving birth. Postpartum hemorrhage is a leading cause of maternal mortality.

This December, Zipline inked a $150 million deal with the U.S. State Department to scale up its operations to provide blood to 15,000 health facilities serving 130 million residents across the Ivory Coast, Ghana, Kenya, Nigeria, and Rwanda.

Problem-solving on the front lines shows that in many cases, the most effective innovations can actually be decidedly low-tech, according to Ryzh, who trains combat medics. She noted that with constant blackouts, people who camped or hiked recreationally were quicker to adapt and could coach others. With drone strikes affecting the whole country, society has changed: Medics now recommend that every civilian should carry a tourniquet and be trained in basic first aid for accident scenes.

During these drastic shifts in daily life, one of Ryzh's most cherished grounding rituals is writing in her diary. Each day, the first paragraph is the same:

I'm always grateful to the universe that I'm alive and that I've survived, and I have all of my limbs and most of my body parts.

“Before I would have never, ever thought that I would be grateful and appreciate such things,” she reflected.

Maria Samoryezova contributed to this article as a translator for interviews conducted in the field.

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