Emergency Medicine Reform in Ukraine since 2016

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Emergency Medicine Reform in Ukraine has been a part of Ukrainian Health Reform since 2016. It is about the measures of the Ministry of Healthcare of Ukraine to provide high-quality and timely emergency medical care. [1]

Contents

General information

Ukraine has a German-Franco Model of Emergency Medical Service, in which an ambulance is staffed by physicians. A part of ambulances is staffed by feldshers. In Ukraine, about one-third of the emergency medical teams are missing. [2] [3] Young doctors don't eagerly join EMS teams, and so the majority of doctors are those of pre-retirement age. [4] [2] There is a lack of ambulances, and some are not fully equipped. [5] Some brigades also have staff without proper education. [6]

UAZ-396295 (modification of UAZ-3962). Used in emergency medical services (EMS). Ukraine. UAZ-452 Medical (EMS) 2006 G3.jpg
UAZ-396295 (modification of UAZ-3962). Used in emergency medical services (EMS). Ukraine.

The US faced a similar issue around 50 years ago. The United States National Academy of Sciences published an influential report "Accidental Death and Disability: The Neglected Disease of Modern Society" in 1966. It is considered a landmark in the development of the emergency medical services system in the United States. [7] The report concluded that both the public and government were "insensitive to the magnitude of the problem of accidental death and injury" in the U.S.; the standards to which an ambulance service held were diverse and "often low", and that "most ambulances used in this country are unsuitable, have incomplete... equipment, carry inadequate supplies, and are manned by untrained attendants." [8] 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: [1]

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 of care in pre-hospital care in Ukraine.

Patriot Defense instructors train policemen in emergency care. Zakhist Patriotiv Navchannia patrul'nikh-1.jpg
Patriot Defense instructors train policemen in emergency care.

According to Ukrainian legislation, there are no official terms "Emergency medical responder" or "First responder." But there are equivalents to these positions:

In particular, after police reform, the National Police officers are obliged to provide emergency medical care to those who have suffered as a result of offenses, accidents, as well as to those who are in a helpless condition or one which can be dangerous to their life or health.

Ministry of Healthcare of Ukraine on March 29, 2017, approved new training programs for the training of such persons, who are obliged to provide emergency medical assistance to a person in urgent need. [2] [3]

At the same time MOH of Ukraine introduced two new specialities of medical instructors:

This will standardize the teaching of relevant levels of care and attract more people to study.

The MOH of Ukraine is currently introducing new demands to be applied to the collection of supplies of vehicle first aid kits. In Ukraine, there are about 554 traffic accidents every day. Mortality is higher here than in other European countries. [5] At the same time, the first-aid kit demands did not change for 20 years. [6] New demands are based on evidence-based medicine and the best western practices. Medical supplies are mostly aimed to prevent the most possible cause of death. [7]

Standardization of medical care

New clinical guidelines

The Better Regulation Delivery Office research has shown that the Ukrainian information field is clogged up — about 35% of the acts are obsolete, irrelevant and ineffective. [8]

In April 2017, the Ministry of Healthcare allowed Ukrainian doctors to use international clinical guidelines in their work to provide medical care according to world standards. [9] [10] [11] Prior to this, clinical guidelines were developed based on the method of adaptation of international clinical guidelines. In some cases, they were developed based on the clinical experience of group members. Part of them is created on the old Soviet evidence base. In addition, Ukrainian unified clinical guidelines may contain trade names for certain drugs. This led to the lobbying of the relevant pharmacists. [12]

With the same order, the MOH of Ukraine also eliminated the need for the implementation of local clinical protocols. [8] Previously, each medical facility was forced to develop such documents. Often, they were based on sources of information about different antiquity and on the clinical experience of the developer. [8] At the same time, they were legally much more weighty than any world guidelines. The MOH has allowed each institution to translate international protocols, based on evidence-based medicine. [9] It defines a clear list of international sources for such translation and approval. [10]

HeRAMS Ukraine

In autumn of 2017, the World Health Organization launched the HeRAMS Ukraine project in cooperation with the Ministry of Healthcare of Ukraine. [13] [14]

HeRAMS (Health Resources Availability Mapping System) is an electronic system for monitoring medical resources. It is a WHO tool for standardizing and assessing the availability of medical services in different countries. It is mostly used for emergency response. [15] When conducting programs using HeRAMS, information is collected from health facilities in a specific area. The system collects information on four major contingencies related to emergencies:

Based on the data obtained, analytical reports are made and possible measures are developed to improve the situation. Periodic monitoring is possible. [15] [16]

At first in Ukraine HeRAMS project was launched only in Donetsk and Lugansk regions. [13] [14]

Military Emergency Medicine

Zakhist Patriotiv Skladannia aptechok.jpg
Compiling of military first aid kits by Patriot Defence volunteers for Ukrainian soldiers in Eastern Ukraine. 2015.
IFAK PD.jpg
Volunteer military IFAKs.

In January 2017, the MOH of Ukraine approved a modern military first aid kit, a military car first aid and backpacks for field medics. Their composition is developed in accordance with the Tactical Combat Casualty Care guidelines. [17] [7] With these means, the soldier can provide casualty care in the most frequent emergency situations. They are primarily aimed at salvation from the causes of death that can be prevented.

The MOH of Ukraine, together with the Ministry of Defense of Ukraine, worked out the standards of medical support of the Armed Forces at the level except for big hospitals. Specialists have excluded drugs that have no proven efficiency. Each medical facility or military unit will have the same equipment and medicine, so it will be able to provide high-quality medical care. [7] [2]

There is a lack of medical staff in the majority of hospitals in Lugansk and Donetsk region. [3] To improve the situation, medical volunteers from other regions are allowed by MOH order to go and work there. [4] [5] This will help to save not only health and lives of local people, but also soldiers, who are also often treated in these hospitals. [3]

Introduction of EMT and paramedics

In 2017 the MOH of Ukraine introduced two specialties: paramedics and emergency medical technicians. [6]

Paramedic

In Ukraine, paramedics are people with a level of education not lower than a junior bachelor in the field of knowledge "Healthcare" and the corresponding specialization. This means that after 11 years of school, in order to become a paramedic, the student needs to study for another 3 years. For a person with basic 9-year education, the term of training is 4 years. [7] [6]

In Ukraine, paramedics provide ALS level of care. Qualifying requirements for paramedics are higher than those for a feldsher. The paramedic training program is more focused on providing emergency medical care. They have more advanced requirements for professional skills in this area. In September 2018, there will be the first set for this speciality in medical colleges. [7]

Feldshers working in the emergency medical teams will be able to become paramedics after undergoing advanced training at the paramedic level. The Ministry of Health has defined a transitional period of 5 years for training and certification of emergency medical feldshers to the paramedic level. During this time, they may work as part of the EMS teams. [7] [18]

The introduction of paramedics concerns only the emergency teams. Feldshers will continue to work in feldsher-obstetrician stations in rural areas. [7]

During the transition period, emergency medicine physicians will still work in ambulances. However, at the moment, physicians often attend simple cases that do not require their high qualifications. At the end of the transition period, however, physicians should be engaged only in some severe cases, as it is in many developed countries. [19] [20] [21] Most of them will get a job in the emergency departments. [22] There, physicians have more opportunities to use their knowledge and skills.

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. These ambulance drivers will continue to work during a 5-year transition period. However, during this time, everyone is to be trained and certified to the level of emergency medical technician. [7]

New EMT professionals correspond to the EMT-Basic professionals in the US. In Ukraine, an EMT:

The minimum professional requirements for an EMT in Ukraine are:

The training term to become an EMT lasts about a month and includes studying in classes and practical skills training. [23] [7]

New training programs for emergency staff

Teaching modern principles of trauma care. Photo by Patriot Defence. Rozumnii pidkhid do travmi.jpg
Teaching modern principles of trauma care. Photo by Patriot Defence.

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 the professional development of doctors providing emergency medical care to injured patients, including surgeons, anesthesiologists, traumatologists, emergency medicine doctors, etc. [24] [25]

The program incorporates the main requirements of the relevant international counterparts, such as "PHTLS", "ALS", "ATLS". [24] It consists of seminars, workshops and simulations, and it is intended to systematize the approach to caring for the injured by improving teamwork and effective communication skills. [26] [27]

In October 2017, at the NMAPE Academic Council meeting, the curriculum and the program of the on-site training cycle of thematic improvement "Supporting life during injuries—Ukrainian program" was discussed and approved. [24]

Improvement of medical dispatching

In most oblasts of Ukraine, raions or cities have their own emergency medical dispatch centre. They coordinate teams from only their own station and, in typical situations, send teams out only within their area of responsibility. As a result, if accidents take place near the border of a neighbouring area, the dispatcher may not be able to see it. Consequently, the dispatcher may not be able to send ambulances for help, even if ambulances are located nearby. In some raions, calls are taken by doctors or untrained nurses. [28] Centralized dispatch centers that take calls and coordinate EMS teams of the entire oblast exist only in several regional centers. [22]

With the introduction of modern centralized dispatch centres, specially trained dispatchers at the oblast level will take calls from the whole region. Using the dispatch protocols, a dispatcher determines if there is an urgent need to send an ambulance or not. Additionally, all ambulances are to be equipped with GPS trackers. Using the modern system allows the call location to be tracked, and the dispatcher is able to see both the location of all calls and EMS teams in real-time on an interactive map. Thus, the dispatcher is able to direct the nearest crew to the patient or victim regardless of which station the crew belongs to. [28] [29] This supports the provision of timely medical care even with limited resources.

Introduction of emergency departments

An emergency department (ED) is a medical treatment facility specializing in emergency medicine: the acute care of patients who arrive, by their own means or via an ambulance, without a prior appointment. An emergency department is usually found in a hospital or other primary care centre.

Currently, most hospitals in Ukraine have reception departments (Ukrainian : приймальне відділення, IPA:  [ˈprɪjmɐljne wiˈd(j)ːilenjːɐ]).[ check stress ] 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, or, on different days, there are on-duty physicians from non-emergency specialities that can not provide proper emergency care. [30]

According to the Healthcare Reform, an ED should be a standard part of a multi-profile hospital, in order to provide care in case of emergencies. Only specially trained doctors of emergency medicine should work in ED, so that their specialized knowledge and skills may better help patients and bring a better quality of care to patients. [7]

See also

Related Research Articles

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Emergency medical technician Health care provider of emergency medical services

An emergency medical technician (EMT), also known as an ambulance technician, is a health professional that provides emergency medical services. EMTs are most commonly found working in ambulances. In English-speaking countries, paramedics are a separate profession that has additional educational requirements, qualifications, and scope of practice.

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Feldsher

According to the World Health Organization, a feldsher is a health care professional who provides various medical services limited to emergency treatment and ambulance practice. In Russia and in other countries of the former Soviet Union, feldshers provide primary-, obstetric- and surgical-care services in many rural medical centres and clinics across Russia, Armenia, Kazakhstan, Kyrgyzstan, Mongolia and Uzbekistan.

Nontransporting EMS vehicle

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British Columbia Ambulance Service

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Yorkshire Ambulance Service

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East of England Ambulance Service

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Emergency medical personnel in the United Kingdom

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Pre-hospital emergency medicine

Pre-hospital emergency medicine, also referred to as pre-hospital care, immediate care, or emergency medical services medicine, is a medical subspecialty which focuses on caring for seriously ill or injured patients before they reach hospital, and during emergency transfer to hospital or between hospitals. It may be practised by physicians from various backgrounds such as anaesthesiology, emergency medicine, intensive care medicine and acute medicine, after they have completed initial training in their base specialty.

Immediate Life Support (ILS) is a level of training undertaken in order to provide emergency medical care outside medical facilities. ILS is classed as mid-level emergency medical care provided by trained first responders who receive more training than basic life support providers, but less as advanced life support providers. Immediate Life Support is also known as Limited Advanced Life Support (LALS).

References

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  2. 1 2 3 4 "Order of the Ministry of Defense of Ukraine No. 261 dated May 5, 2017" (in Ukrainian). Ministry of Defense of Ukraine . Retrieved January 13, 2018.
  3. 1 2 3 4 "Chernivtsi doctor saved the wounded in the ATO zone" (in Ukrainian). Інформаційне агентство А.С.С.". January 15, 2018. Retrieved January 22, 2018.
  4. 1 2 3 "Order of the Ministry of Healthcare of Ukraine No. 131-Adm dated December 5, 2016" (in Ukrainian). MOH . Retrieved January 22, 2018.
  5. 1 2 3 "Order of the Ministry of Healthcare of Ukraine No. 1254 dated November 18, 2016" (in Ukrainian). MOH . Retrieved January 22, 2018.
  6. 1 2 3 4 5 6 "MOH order from 09.08.2017 р. № 918" (in Ukrainian). www.apteka.ua. November 1, 2017. Retrieved January 13, 2018.
  7. 1 2 3 4 5 6 7 8 9 10 11 Олександр Данилюк (December 1, 2017). "Paramedicine in Ukraine to be. Who is affected and how will it work?" (in Ukrainian). 112 Ukraine . Retrieved January 13, 2018.
  8. 1 2 3 4 "The Ministry of Health explained what new clinical protocols are and how they will work" (in Ukrainian). Ukrayinska Pravda. Life. April 26, 2017. Retrieved January 13, 2018.
  9. 1 2 "Як впроваджувати нові клінічні протоколи: інструкція для лікарів 1/4" [How to implement new clinical guidelines: a manual for physicians 1/4] (in Ukrainian). MOH of Ukraine. December 19, 2017. Retrieved January 13, 2018.
  10. 1 2 "Order of the Ministry of Health of Ukraine No. 1422 dated December 29, 2016" (in Ukrainian). MOH of Ukraine . Retrieved January 13, 2018.
  11. ↑ "INTERNATIONAL PROTOCOLS OF TREATMENT: BENEFITS FOR PATIENTS, HEALTHCARE SYSTEMS" (in Ukrainian). Medexpert group. Retrieved January 13, 2018.
  12. ↑ "How to implement new clinical guidelines?" (in Ukrainian). MOH of UKraine official Facebook page. December 20, 2017. Retrieved January 13, 2018.
  13. 1 2 "Monitoring of medical resources under the HeRAMS Ukraine program". Selydove city council. December 2, 2017. Retrieved January 4, 2018.
  14. 1 2 "Work of employees of the Department of Health of the Regional State Administration for 10 months of 2017". Department of Health of Donetsk Regional State Administration. 6 December 2017. Retrieved January 4, 2018.
  15. 1 2 "Health Resources Availability Monitoring System (HeRAMS)". WHO . Retrieved January 4, 2018.
  16. ↑ "Survey reveals extent of damage to Yemen's health system". OCHA. November 6, 2016. Retrieved January 4, 2018.
  17. ↑ "Order of the Ministry of Healthcare of Ukraine No. 6 dated January 5, 2017" (in Ukrainian). MOH of Ukraine . Retrieved January 13, 2018.
  18. ↑ "Emergency medical care reform will not lead to the firing of doctors" (in Ukrainian). Український медичний часопис. February 1, 2017. Retrieved January 17, 2018.
  19. ↑ "Ambulance doctor committed suicide after death of patient given wrong drug dose". Birmingham Mail. January 16, 2017. Retrieved January 17, 2018.
  20. ↑ "Team Spotlight: Tony Joy". London's Air Ambulance. October 26, 2017. Retrieved January 17, 2018.
  21. ↑ "How pre-hospital doctors are saving lives in the field as part of the NSW Ambulance Special Casualty Access Team". Daily Telegraph. October 3, 2015. Retrieved January 17, 2018.
  22. 1 2 "Medical reform in Ukraine: artificial respiration for "Ambulance"" (in Ukrainian). Deutsche Welle. December 13, 2016. Retrieved January 17, 2018.
  23. ↑ "How Ukrainians will be treated in a new way: reforming the medical sector" (in Ukrainian). Lviv portal. November 21, 2016. Retrieved January 18, 2018.
  24. 1 2 3 "of the NMPE Academic Council meeting from October 11, 2017" (in Ukrainian). NMAPE. October 23, 2017. Retrieved January 18, 2018.
  25. ↑ Микита Луцький; Сергій Запорізький (June 12, 2017). "Legend - "explosion at school": how doctors were taught to save lives in extreme conditions" (in Ukrainian). 5 Kanal (Ukraine) . Retrieved January 18, 2018.
  26. ↑ "Knowledge of price in life: "Patriot Defence" teaches Ukrainian doctors according to world standards" (in Ukrainian). www.zp-pravda.info. March 9, 2016. Archived from the original on December 26, 2017. Retrieved January 18, 2018.
  27. ↑ "Ukrainian Trauma Life Support" (in Ukrainian). Patriot Defence . Retrieved January 18, 2018.
  28. 1 2 Наталія Середюк. "Central dispatching center, call center and geolocation: how Emergency Medical Service will change in Lviv region" (in Ukrainian). Твоє місто. Retrieved January 13, 2018.
  29. ↑ "Municipal Health Care Facility "Center of Emergency and Disaster Medicine"" (in Ukrainian). Retrieved January 21, 2018.
  30. ↑ "In Uman, a 66-year-old man died" (in Ukrainian). Observer. June 2, 2017. Retrieved January 21, 2018.
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