Emergency medicine reform in Ukraine since 2016
This article needs to be updated.(October 2022) |
Emergency medicine reform in Ukraine has been part of Ukraine's healthcare reform program since its launch in 2016.
General information
Ukraine has a German-Franco model of
Active reforming of emergency medical care was initiated right after the appointment of
- 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.[2]
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.
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
The
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."[8]
In April 2017, the
With the same order, the
HeRAMS Ukraine
In autumn 2017, the
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.[15] 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.[15][16]
At first, the
Military emergency medicine
In January 2017, the
The
There is a lack of medical staff in the majority of hospitals
Introduction of EMT and paramedics
In 2017, the
Paramedic
In Ukraine, paramedics are people with a level of education not lower than a junior bachelor in the field of healthcare and the corresponding specialisation. For example, after 11 years of school, a student needs to study for another 3 years to become a paramedic. For a person with basic 9-year education, training lasts 4 years.[7]
In Ukraine, paramedics provide an 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, the first classes of paramedic candidates began study in medical colleges.[citation needed]
Feldshers working in emergency medical teams will be able to become paramedics after undergoing advanced training at the paramedic level. The MOH has defined a transitional period of 5 years for training and certification of feldshers to the paramedic level. During this time they may work on EMS teams.[18]
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.[19][20][21] Most are expected to work in emergency departments to take advantage of the expanded medical and professional opportunities.[22]
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.[citation needed]
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.[7]
The minimum professional requirements for an EMT in Ukraine are:
- Full secondary EMT education and training,
- Possession of a certificate of EMT training and
- A driver's license appropriate for driving an ambulance.[7]
The training term to become an EMT lasts about a month and includes classroom and practical skills training.[23]
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
The program incorporates the main requirements of the relevant international counterparts such as
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.[24]
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.[28] centralised dispatch centres that take calls and coordinate EMS teams of the entire oblast exist only in a few regional centres.[22]
With the introduction of modern centralised dispatch centres, specially trained dispatchers at the oblast level will take calls from the whole region. Using the dispatch protocols, a dispatcher determines whether there is an urgent need to send an ambulance. Additionally, all ambulances are to be equipped with
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 (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, and at times, there are on-duty physicians from non-emergency specialties that cannot provide proper emergency care.[30]
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.[citation needed]
See also
References
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- ^ a b c "The Ministry of Health started the reform of emergency medical care" (in Ukrainian). Government of Ukraine. October 6, 2016. Archived from the original on December 26, 2017. Retrieved January 13, 2018.
- ^ Ministry of Defense of Ukraine. Archivedfrom the original on January 6, 2018. Retrieved January 13, 2018.
- ^ a b c d "Chernivtsi doctor saved the wounded in the ATO zone" (in Ukrainian). Інформаційне агентство А.С.С.". January 15, 2018. Archived from the original on January 22, 2018. Retrieved January 22, 2018.
- ^ MOH. Archivedfrom the original on January 22, 2018. Retrieved January 22, 2018.
- ^ MOH. Archivedfrom the original on January 22, 2018. Retrieved January 22, 2018.
- ^ a b c d e f "MOH order from 09.08.2017 р. № 918" (in Ukrainian). www.apteka.ua. November 1, 2017. Archived from the original on January 11, 2018. Retrieved January 13, 2018.
- ^ Ukrayinska Pravda. Life. April 26, 2017. Archivedfrom the original on January 21, 2018. Retrieved January 13, 2018.
- ^ MOH of Ukraine. December 19, 2017. Archivedfrom the original on January 12, 2018. Retrieved January 13, 2018.
- ^ MOH of Ukraine. Archivedfrom the original on January 1, 2018. Retrieved January 13, 2018.
- ^ "INTERNATIONAL PROTOCOLS OF TREATMENT: BENEFITS FOR PATIENTS, HEALTHCARE SYSTEMS" (in Ukrainian). Medexpert group. Archived from the original on January 6, 2018. Retrieved January 13, 2018.
- from the original on January 20, 2021. Retrieved January 13, 2018.
- ^ a b "Monitoring of medical resources under the HeRAMS Ukraine program". Selydove city council. December 2, 2017. Archived from the original on January 1, 2018. Retrieved January 4, 2018.
- ^ a b "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. Archived from the original on 15 January 2019. Retrieved January 4, 2018.
- ^ a b "Health Resources Availability Monitoring System (HeRAMS)". WHO. Archived from the original on December 26, 2017. Retrieved January 4, 2018.
- ^ "Survey reveals extent of damage to Yemen's health system". OCHA. November 6, 2016. Archived from the original on January 5, 2018. Retrieved January 4, 2018.
- MOH of Ukraine. Archivedfrom the original on January 1, 2018. Retrieved January 13, 2018.
- ^ а. в, Устинов (February 1, 2017). "Emergency medical care reform will not lead to the firing of doctors". Український медичний часопис (in Ukrainian). Archived from the original on January 23, 2018. Retrieved January 17, 2018.
- ^ "Ambulance doctor committed suicide after death of patient given wrong drug dose". Birmingham Mail. January 16, 2017. Archived from the original on December 26, 2017. Retrieved January 17, 2018.
- London's Air Ambulance. October 26, 2017. Archivedfrom the original on December 25, 2017. Retrieved January 17, 2018.
- ^ "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. Archived from the original on January 20, 2021. Retrieved January 17, 2018.
- ^ a b "Medical reform in Ukraine: artificial respiration for "Ambulance"" (in Ukrainian). Deutsche Welle. December 13, 2016. Archived from the original on December 20, 2017. Retrieved January 17, 2018.
- ^ "How Ukrainians will be treated in a new way: reforming the medical sector" (in Ukrainian). Lviv portal. November 21, 2016. Archived from the original on December 25, 2017. Retrieved January 18, 2018.
- ^ a b c "of the NMPE Academic Council meeting from October 11, 2017" (in Ukrainian). NMAPE. October 23, 2017. Archived from the original on December 26, 2017. Retrieved January 18, 2018.
- 5 Kanal (Ukraine). Archivedfrom the original on December 26, 2017. Retrieved January 18, 2018.
- ^ "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.
- ^ "Ukrainian Trauma Life Support" (in Ukrainian). Patriot Defence. Archived from the original on January 19, 2018. Retrieved January 18, 2018.
- ^ a b Наталія Середюк. "Central dispatching center, call center and geolocation: how Emergency Medical Service will change in Lviv region" (in Ukrainian). Твоє місто. Archived from the original on January 25, 2018. Retrieved January 13, 2018.
- ^ "Municipal Health Care Facility "Center of Emergency and Disaster Medicine"" (in Ukrainian). Archived from the original on January 25, 2018. Retrieved January 21, 2018.
- ^ "In Uman, a 66-year-old man died" (in Ukrainian). Observer. June 2, 2017. Archived from the original on January 22, 2018. Retrieved January 21, 2018.