Combat Care

Aaron Epstein '04 trains medics on the front lines in Ukraine.

Andrew Faught
February 1, 2023
A group of people working together around a table.

Aaron Epstein '04 teaches trauma care in Ukraine.

They came in a roar, a pair of Russian cruise missiles flying a mere 50 feet above the Lviv, Ukraine, streetscape. Chain link fences rattled, while car alarms and air raid sirens sounded plaintive wails. For Aaron Epstein ’04, the vision of the projectiles zeroing in on their target that March evening in 2022 was in a way unreal, but he had too much work to do to consider the personal danger.

“You can imagine a telephone pole flying over your head, they’re that long,” says Epstein, a physician who, as founder of the nonprofit Global Surgical Medical Support Group (GSMSG), was in the country for five weeks to teach civilians, doctors, medical students and members of the military a crash course in combat casualty care. His primer included instructions on tying tourniquets, keeping airways open, placing trauma chest tubes and suturing blood vessels. The Russian invasion of its western neighbor had started only days earlier and everyday people were organizing en masse to prepare for every eventuality.

Moments before the flyover, Epstein was offering his medical team’s services to Ukraine security officials in the event of air raid casualties. He watched as the missiles struck an oil storage area less than 2,000 feet away. No one was injured at the explosion site, and Epstein and his rotating squad of 10 to 20 volunteer civilian doctors and nurses — many of whom had learned steely equanimity as members of military special forces — were far enough away to escape injuries.

Epstein does not blink in the face of danger. He has a job to do, and he carries it out with gallows-style pragmatism. “If a cruise missile is going to hit you, you’re not going to be able to do much to survive,” he says. “What’s the point in being worried? It’s wasted energy.”

Epstein and his team taught medical procedures daily from 7 a.m. to what was then an 8 p.m. curfew. The group spent its nights at safe houses selected by Ukrainian security services and remained on call should medical and surgical needs arise. They dined on traditional Ukrainian borscht and other Eastern European fare, such as pierogies. “I’m not going to lie, I’m not a foodie at all,” he says with a laugh. “I liked it all.”

To date, he has made three separate visits to Ukraine while the GSMSG teams of medics and physicians have maintained a continuous presence on the ground since the start of the war. In total, he and his teams have trained more than 20,000 Ukrainians in combat casualty care ranging from basic medical interventions to advanced trauma surgery.

Epstein’s work has been officially recognized back home in the United States. In July, he received the Citizen Honors Service Award from the Congressional Medal of Honor Society at a ceremony in Charleston, South Carolina, for his “commitment to providing medical relief to communities in conflict zones, austere environments, and disaster areas around the world.” He started GSMSG in 2014 and has led his volunteers to strife-torn nations such as Iraq, Syria and Venezuela. Epstein credits Exeter’s non sibi ethos with guiding his humanitarian efforts over the years. “That stuck with me from the day I got [to the Academy], and from then on,” he says.

Aaron Epstein '04

“If a cruise missile is going to hit you, you’re not going to be able to do much to survive,” he says. “What’s the point in being worried? It’s wasted energy.”

Joining Epstein on his March tour of Ukraine was fellow Exonian Rob Lim ’87, a graduate of Davidson College and New York Medical College. Lim is a retired Army colonel who served six tours in Afghanistan, Syria and Iraq as a trauma surgeon. These days Lim is a bariatric surgeon and the residency program director at the University of Oklahoma School of Medicine in Tulsa.

Lim learned about Epstein in 2017 by reading about him in The Exeter Bulletin. “I basically called him up and said, ‘Who the heck are you?’” says Lim, who eventually met Epstein at the American Association for Surgery of Trauma’s annual meeting in Baltimore. “We hit it off and have been talking ever since.”

In Ukraine, Lim helps GSMSG build relationships with local hospitals, Ukrainian police and the military, to ensure that they know why they are there. He praises Epstein and GSMSG for working with the American College of Surgeons to enlist the help of more trauma surgeons, burn surgeons and orthopedic surgeons. It wasn’t a hard decision for Lim to volunteer: “When you’re in the military, you feel a pull toward doing something like this.”

When he’s not abroad, Epstein is a fourth-year surgical resident at the University at Buffalo. But he did not take a straight path to medicine. Epstein was on a flight from his home in Miami to Boston on Sept. 11, 2001, when his plane was forced to land in New Jersey. The Federal Aviation Administration was racing to ground all flights after the attacks on the World Trade Center and the Pentagon. He and his parents drove the rest of the way to Exeter, where he was set to begin his first day as a new lower. The day’s events, Epstein recalls, shaped his worldview and set him on a path to work in national security.

He earned his bachelor’s degree in international policy and economics from Rice University in 2008, after which he got a master’s in intelligence and security at Georgetown School of Foreign Service. But his outlook changed while serving in a number of overseas internships. Doctors, rather than diplomats, were often winning the “hearts and minds” of local populations, he says. He also noticed that nongovernmental medical aid groups often didn’t have enough doctors in combat zones. The revelations helped lead Epstein to enroll at Georgetown Medical School. Now he plans to keep working with global populations in upheaval.

Helping him operate the business side of GSMSG is another member of the Exeter community, Jim Gray P’19, a Richmond, Virginia, business developer. Gray met Epstein at an Exeter parent and alumni mixer held at the National Press Club in Washington, D.C. (His daughter, Grace Gray, is an Academy alum.) Gray offered to volunteer his expertise to solicit government contracts that could help GSMSG broaden its outreach.

“GSMSG has some significant donors, but still not a lot,” Gray says, noting that the organization is funded mostly through private donors. “I’ve been trying to match GSMSG with contract opportunities so we can have a larger and more sustained presence in areas, and so we can pay our employees.”

Although Epstein is focused on trauma surgery, he’s considering changing to general surgery because, perhaps surprisingly, it’s the way he can save the most lives. “When you travel around the world, ultimately what kills people is the basic bread-and-butter surgical stuff — like your appendix ruptures or your gallbladder has a problem,” he says. “In the U.S., you have a surgery and you’re out the same day. But in the rest of the world, there are no surgical options, and people die from sepsis. General surgeons can help a huge portion of the world, and it doesn’t have to be sexy, like trauma or surgical oncology, or cardiothoracic surgery.”

Among the many memories of his time in Ukraine, one episode stands out. During the first week of the Russian invasion, Epstein was teaching a group of Ukrainian medical students how to suture blood vessels and stop major arterial bleeding. The gravity of the moment was sinking in among his pupils.

“I remember the faces of all of those students, who literally thought the next week they were going to be on the front lines against Russia, handling battle trauma,” Epstein says. “These are people who up until the week prior were normal kids and medical students. But they all showed up to learn, with the full anticipation of going to the front line. You’ve got to give them credit.”

Epstein’s work goes well beyond healing war injuries, he says. It goes to the heart of Ukraine’s future governance. “Really, my work is about building the capacities of people around the world to be able to take care of themselves,” he says. “The ability to take care of yourself is the ultimate definition of independence.


Editor's Note: This article first appeared in the winter 2023 issue of The Exeter Bulletin.

Epstein and his team on the ground in Ukraine. They have trained over 20,000 Ukrainians in combat casualty care.

“Really, my work is about building the capacities of people around the world to be able to take care of themselves. The ability to take care of yourself is the ultimate definition of independence."