Emergency medicine reform in Ukraine has been part of Ukraine's healthcare reform program since its launch in 2016. Managed by the Ministry of Healthcare of Ukraine, the program is meant to improve the quality and speed of Ukraine's emergency medical care.
General information
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. Young doctors do not frequently join EMS teams so the majority of doctors are those of pre-retirement age. There is a lack of ambulances and some are not fully equipped. Some brigades have staff without proper education.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.
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.