In Kharkiv, Ukraine, a medical rescue squad treats the wounded

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KHARKIV, Ukraine — When paramedics arrived at the scene of the latest Russian bombardment, there were two victims on the ground. One was facedown in the dirt, with a trail of his blood flowing into a puddle of water. He was already dead.

The other was someone who Stepan Yaremko and Natalia Mykytenko could save, so they turned quickly to him. The man no longer had a right foot, and his shin was mangled. He told the paramedics his back from him hurt — a piece of shrapnel was lodged in it.

In the ambulance, Mykytenko asked for his name. He said it was Sasha. He had stepped out to feed the stray cats when the Russian artillery shell landed. It just felt as if something hit him, he told her.

Ten minutes passed as Mykytenko and Yaremko applied a tourniquet to Sasha’s leg, hooked him up to morphine drip to numb his pain and kept him talking. All that time, parked in the middle of a field with no cover around, the medics themselves were in the line of fire if another round of bombardment started. There’s always the risk of a “double tap”: Russian forces tend to strike the same place twice within the hour, to finish off the target or perhaps deliberately target first responders.

“When you’re working, you only think about the person you’re treating,” Yaremko said. “Of course, if we come under direct shelling, we drive off to somewhere else. But if in the moment it seems more or less calm, we do what’s needed for the patient. And then we get out of there.”

Ukraine’s first responders have some of the most dangerous jobs of this war. They’re not armed or behind a fortified military position. But for the past two months, they’ve worked at the front lines of battles with Russia, driving into danger with nothing more than a bulletproof vest to protect themselves as they treat the wounded.

The Washington Post shadowed a brigade of paramedics for a 24-hour shift in Kharkiv, the eastern Ukrainian city about 25 miles from the Russian border that has been heavily battered by airstrikes and artillery since the first day of the war.

The sounds of incoming and outgoing fire reverberated around their ambulance station all day. But Yaremko and Mykytenko’s phones were silent until almost 6:30 pm, when they got the call that dispatched their ambulance toward the dark smoke suddenly rising in the distance.

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The shift started at 8 am with a lesson. The medics crowded into the lobby of their ambulance station for a demonstration of how to properly apply a tourniquet. With the number of catastrophic bleeding cases they now face, the refresher was needed.

The station dog, Zhuzha, lay down in the middle of the room. She’s a rescue pup, and the medics say she can sense shelling, seeking out a place to hide from the loud blasts. Her collective masters of her do not have that option.

Yaremko’s day starts with a different tradition—a call from his wife. She, his two daughters and two granddaughters are now in western Ukraine, considered the safest part of the country because it’s farthest from the fighting in this eastern region. She scolded him for not calling her to let her know he’s all right. He’s supposed to check in every morning and every night. She worries, he said.

“Our jobs have always been dangerous and serious, even in peacetime,” he said with a shrug.

Yaremko’s home is still standing, but the windows were shattered from Russian artillery strikes nearby. In the early days of the war, he and others were living at the ambulance station — sleeping on creaky spring mattress beds upstairs. He has since moved to a friend’s house when he’s not on duty.

He’s the veteran, steady hand at this station. A former military combat medic, Yaremko has experience from Ukraine’s 2014 conflict with Russia — war between Kyiv’s forces and Russian-backed separatists in eastern Ukraine’s Donbas region. He tends to get the tougher calls, as his colleagues have gotten younger since the start of this war.

Many ambulance workers left the city, moving to safer areas in the country or out of it entirely. That left a large contingent of 23-year-old medical students thrust into more action and responsibility.

Now they each have photos on their phone of shrapnel they’ve observed at places to which they’ve been called.

“It was very tough at first,” Anastacia Boldyr said. “I couldn’t wrap my mind around the fact that in the 21st century, some crazy neighbor could just attack you. But now you just go out every time and think, ‘Who, if not you?’ Who will do this if we don’t?”

Those first days of the war were daunting. Dmytro Kolesnyk, a doctor, had called to destroyed apartment buildings where his childhood friends lived. As he tried to focus on treating the wounded, he spotted the place where he and his buddy sat and had a beer together on a bench. Except now the bench was gone, and his friend’s home was destroyed.

Nazar Marynychenko, also 23, is still shaken by the shifts that sent his ambulance directly into shelling. Now even the most routine runs — to help an elderly person with a minor ailment or tend to a drunk person — have an added layer of danger to them. But there are fewer calls for ambulances, too, because people are often scared to leave their homes.

“Being afraid is normal,” Kolesnyk said. “We’re afraid just like normal people, but we have to keep doing our job to save as many people as possible.”

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The paramedics are superstitious about anyone wishing them “good luck” before a run. Since the start of the war, the World Health Organization has reported at least 175 attacks on health-care facilities, including ambulances.

At the Kharkiv strike site Wednesday night, the goal was for Yaremko and Mykytenko to get their patient to a hospital within 30 minutes of the call. As the ambulance drove up to the apartment block, residents directed it to the back of the building.

Police who got to the scene first told Yaremko the first man was dead, so he went straight for Sasha. In the ambulance, Yaremko asked his patient whether he could feel any pain.

“I don’t feel anything,” Sasha replied.

“That’s good,” Yaremko said.

Sasha was a civilian casualty, but they raced him to the local military hospital because it has more experience with shrapnel-related injuries. Ever-changing blockades for military checkpoints are another obstacle: The ambulance driver expected to get to the hospital down one road but had to turn around and look for a different way after running into an unexpected barricade.

They made it in time. Sasha is expected to live, albeit with part of his right leg gone. Another ambulance crew arrived at the scene later to pick up the body of the deceased man. He was the city’s lone civilian fatality for the day — considered a fairly quiet day of war here.

“As much as you can, you get used to this,” Yaremko said.

Back at the station, Mykytenko carefully cleaned and disinfected the inside of the car while Yaremko filled out an incident report. When she was done, she stood with her hand at her hip and took a deep breath. Just the one call was exhausting, and her back hurt.

She brushed her shoes against a metal grate in front of the station entrance—in case there was still blood on them—and then went inside to wait for the next call.

Maria Avdeeva contributed to this report.

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