Emergency medicine reform in Ukraine since 2016

Ukraine has a German-Franco model of emergency medical service, in which ambulances are staffed by physicians. Some ambulances are staffed by feldshers. In Ukraine, about one-third of staff positions on emergency medical teams are vacant. The US faced a similar issue in the 1960s. The United States National Academy of Sciences published an influential report "Accidental Death and Disability: The Neglected Disease of Modern Society" in 1966. The report concluded that both the public and government were "insensitive to the magnitude of the problem of accidental death and injury" in the US. The standards to which an ambulance service were held were diverse and "often low" and "most ambulances used in this country are unsuitable, have incomplete... equipment, carry inadequate supplies and are manned by untrained attendants." The reforms inaugurated by the publication of "The White Paper" led to higher quality care provided on-scene and in transit by trained paramedics and EMTs. Active reforming of emergency medical care was initiated right after the appointment of Ulana Suprun as head of the Ministry of Healthcare of Ukraine. There are several main areas of this reform: • Improvement of the non-medical person training, • Standardisation of medical care on the principles of evidence-based medicine, • Introduction of EMTs and paramedics into the Ukrainian emergency medical service system, • Training of personnel by new programs, • Improvement of medical dispatching and • Introduction of emergency departments. == Improvement of non-medical persons training ==

To improve a patient's survival from preventable causes of death, it is necessary to strengthen the whole chain of survival. There are several levels in pre-hospital care in Ukraine: • Persons obliged to provide care for those in emergency conditions (the equivalent of the international term "Emergency Medical Responder"), • Emergency medical technicians, • Paramedics and • Emergency medicine physicians. instructors train policemen in emergency care.According to Ukrainian legislation, there are no official terms for "emergency medical responder" or "first responder." There are, though, equivalents to these positions: • Rescuers of emergency rescue service, • State fire brigade workers, • Police officers, • Pharmaceutical workers, • Conductors of passenger trains, • Flight attendants and • Other persons who do not have a medical education, but in their official duties they provide practical skills for premedical care. After police reform, National Police officers are obliged to provide emergency medical care to those who have suffered as a result of offenses or accidents as well as to those who are in a helpless condition or face dangers to their life or health. In March 2017, the Ministry of Healthcare of Ukraine approved new training programs for those who are obliged to provide emergency medical assistance and introduced two new specialties of medical instructors: pre-hospital care instructors and first aid instructors. The MOH of Ukraine is introducing new standards for supplying vehicle first aid kits. In Ukraine there are about 554 traffic accidents every day. Mortality is higher there than in other European countries. At the same time, the first-aid kit standards have not changed since 1997. These new standards are based on evidence-based medicine and Western practices. == Standardisation of medical care ==

New clinical guidelines Research by the Better Regulation Delivery Office has shown that Ukraine's regulatory landscape for providing medical care is "clogged up," with more than a third of the acts deemed "obsolete, irrelevant and ineffective." In April 2017, the Ministry of Healthcare allowed Ukrainian doctors to use international clinical guidelines to provide medical care according to world standards. Prior to this, clinical guidelines were adapted from international clinical guidelines or in some cases, based on the clinical experience of group members. Some were created on the old Soviet evidence base. In addition, Ukraine's clinical guidelines contained trade names for certain drugs, which led to lobbying of the relevant pharmaceutical companies. With the same order, the MOH of Ukraine also eliminated the need for implementation of local clinical protocols. HeRAMS (Health Resources Availability Mapping System) is an electronic system for monitoring medical resources. It is a WHO tool for standardising and assessing the availability of medical services in different countries. It is mostly used for emergency response. When conducting programs using HeRAMS, information is collected from health facilities in a specific region pertaining to four aspects: • Health care establishments (number, type...), • Resources for the provision of services (water supply, cold chain...), • Availability of medical services in certain spheres (emergency medicine at the pre-hospital and hospital stages, trauma care...) and • Reasons for the lack of medical services (lack of medical staff, poor training...). From this data, analytical reports are prepared to guide further management and allow for periodic monitoring. At first, the HeRAMS project was launched only in Donetsk and Luhansk regions. The MOH and Ministry of Defense of Ukraine established standards for medical support of the Armed Forces at every level except large hospitals. Drugs with no proven efficiency were excluded, for example. Each medical facility or military unit will have the same equipment and medicine provide consistent, high quality medical care. There is a lack of medical staff in the majority of hospitals in Lugansk and Donetsk region. To improve this situation, medical volunteers from other regions are allowed by MOH order to work there. The government believes that this measure will not only improve health and save lives for local populations but for soldiers who are treated in these hospitals. == Introduction of EMT and paramedics ==

In 2017, the MOH of Ukraine introduced two specialties: paramedics and emergency medical technicians. During the transition period, emergency medicine physicians will still work in ambulances. Currently, physicians often attend to simple cases that do not require their high qualifications; at the end of the transition period, they should be engaged only in severe cases, as it is in many developed countries. Most are expected to work in emergency departments to take advantage of the expanded medical and professional opportunities. Emergency medical technician In Ukraine, ambulances are driven by ambulance drivers. In the past, these employees were not trained in emergency care, so a new speciality, emergency medical technician (EMT), was introduced. Personnel will continue to work during a 5-year transition period until certified. New EMT professionals correspond to the EMT-Basic professionals in the US. In Ukraine, an EMT: • Works under the guidance of a physician or paramedic, • Provides care in the EMS team, • Assists the emergency department staff; • Interacts with other medical services, • Evaluates the environment regarding possible threats to him or other people, • Participates in triage, • Assesses the patient's condition, • Examines the patient for urgent conditions, • Conducts CPR, • Provides care in case of adverse reactions to medicines, • Assists in transporting patients and transports patients to health care facilities, • Provides basic medical support during large events and • Drives and prepares the ambulance for emergency care. == New training programs for emergency staff ==

. With the participation of British and American physicians, a six-day training course called "Ukrainian Trauma Life Support" (UTLS) was developed. The course is intended for physicians providing emergency medical care, including surgeons, anesthesiologists, traumatologists and emergency medicine doctors. The program incorporates the main requirements of the relevant international counterparts such as PHTLS, ALS and ATLS. In October 2017, at the NMAPE Academic Council meeting, the curriculum of the on-site training cycle of thematic improvement "Supporting life during injuries—Ukrainian program" was discussed and approved. == Improvement of medical dispatching ==

In most oblasts of Ukraine, raions or cities have their own emergency medical dispatch centres. They coordinate teams from only their own station and typically send teams out only within their area of responsibility. As a result, if accidents take place near the border of a neighboring area, the dispatcher may not be able to see it. Consequently, the dispatcher may not be able to send ambulances even if they are nearby. In some raions, calls are taken by doctors or untrained nurses. centralised dispatch centres that take calls and coordinate EMS teams of the entire oblast exist only in a few regional centres. This technology optimizes the provision of timely medical care even with limited resources. == Introduction of emergency departments ==

An emergency department (ED) is where emergency medical care is provided in a hospital or primary care centre. Patients needing such care arrive by their own means or via ambulance, most often without a prior appointment. Currently, most hospitals in Ukraine have reception departments (, ). There are often no beds for patients to stay and no conditions for providing high quality care. Moreover, there is often no physician for a full day, and at times, there are on-duty physicians from non-emergency specialties that cannot provide proper emergency care. According to the healthcare reform, an ED should be a standard part of a multi-profile hospital. Only specially trained doctors of emergency medicine should work in EDs to provide a better quality of patient care. == Russian invasion of Ukraine ==

The Russian invasion of Ukraine has left countless without proper medical care. See more Russian strikes on hospitals during the Russian invasion of Ukraine. == See also ==