Evacuating wounded troops is a perilous and necessary job on any battlefield. Now the Ukrainian army is taking a hard look at its battlefield medical practices—and searching for ways to improve.

The medical situation is awful, to put it mildly.

Field hospitals are poorly maintained, and the journey from the front line is long and hazardous. The Ukrainians’ losses in armored vehicles and helicopters is also cutting into the army’s ability to get its wounded troops out of danger.

That’s according to new report by the Ukrainian World Congress and the Ukraine Ministry of Defense. It’s not comprehensive, but based on a 12-day study of the army’s medical evacuation and care procedures in what Kiev terms the zone of Anti-Terrorist Operations, or ATO, in eastern Ukraine.

“Ukraine definitely has its work cut out for it to even begin to meet basic standards for adequate military combat medical capability,” according to Patriot Defense—a pro-Ukraine activist group that provides medical supplies to soldiers—in a summary.

One of the most serious problems is that many wounded soldiers don’t receive medical care until far too much time has passed. A soldier can wait an average of 20 minutes to one hour before receiving any first aid at all.

The average time before a Ukrainian soldier reaches a field hospital is a shocking 12 to 18 hours, the summary stated.

For the most serious injuries, this can be a death sentence. By contrast, NATO armies train to rapidly evacuate wounded soldiers to a field hospital within a so-called “golden hour,” when chances of survival are highest with surgical care.

The Ukrainian military trains some of its medical teams to reach the golden hour, but the training is inconsistent, and not all teams have this knowledge.