This study aims to evaluate the relationship between evacuation time, tourniquet use, and the development of post-traumatic stress disorder (PTSD) in patients with combat-related amputations. In the context of modern warfare, prolonged evacuation times and extended tourniquet application may contribute not only to physical injury but also to psychological trauma. The study will prospectively follow patients over 18 months to identify key predictors of PTSD and to assess their interaction.

Combat-related amputations are frequently associated with prolonged evacuation times and the use of hemostatic tourniquets. While these factors are critical for survival, their potential contribution to long-term psychological outcomes remains insufficiently studied.

This prospective longitudinal study will investigate how evacuation delays and tourniquet duration influence the development of PTSD symptoms in Ukrainian veterans with limb amputations. The study will also evaluate the interaction between these factors and their cumulative psychological impact.

Participants will be followed for 18 months using validated PTSD screening tools, including the PCL-5 questionnaire, combined with retrospective analysis of medical records.

Inclusion Criteria:

• Ukrainian veterans with combat-related injury (post-February 2022)
• Single limb amputation
• Admission to rehabilitation within 2-4 months post-injury
• Age ≥18 years
• Ability to provide informed consent

Exclusion Criteria:

• Prior PTSD diagnosis before current injury
• Multiple amputations
• Rehabilitation duration >3 months
• Return to active military duty before follow-up completion

The study population consists of Ukrainian military veterans who sustained combat-related traumatic injuries resulting in a single-limb amputation. Participants are recruited from rehabilitation centres within the Superhumans Center network (Lviv, Dnipro, and Odesa, Ukraine).

Eligible participants are adults (≥18 years) who were injured after February 2022 and are admitted to rehabilitation within 2-4 months following injury. The study focuses on individuals with no prior history of post-traumatic stress disorder (PTSD) to allow assessment of incident PTSD related to the current trauma.

This population represents patients exposed to high-energy combat injuries, often associated with prolonged evacuation times and the use of hemostatic tourniquets. The cohort is therefore particularly relevant for investigating the relationship between prehospital factors and long-term psychological outcomes.

Participants are followed prospectively for 18 months with repeated psychological assessment

Individual participant data (IPD) will not be publicly shared due to the sensitive nature of the study population, which includes military veterans with combat-related injuries and psychological outcomes. Although all data will be de-identified prior to analysis, there remains a potential risk of re-identification.

Data may be made available upon reasonable request to the principal investigator for scientifically valid research purposes, subject to approval by the institutional ethics committee and in accordance with applicable data protection regulations.