In line with the NATO standards, Ukrainian doctors working in field should get a different training, while the authorities establish cooperation between the respective institutions for this.
Kyiv, October 13, 2016. The objectives of Ukrainian tactical medicine in the coming years are to adapt the best practices of NATO countries, to establish cooperation between military and civil medicine and ensure proper training of all those on whom the life of a wounded soldier depends. “This summer, we adopted Strategic Defense Bulletin which sets out how we will approach NATO standards till 2020. It clearly specifies the ways to reform the medical service of the Armed Forces. […] A Ukrainian marine should receive the same level of health care as a US marine,” stated Ulana Suprun, Acting Minister of Healthcare of Ukraine, at a press briefing held at Ukraine Crisis Media Center.
Panelists noted that Ukrainian military field surgeons had gained invaluable experience over two years of the so-called anti-terroristic operation (ATO). A huge role in this is played by voluntary organizations such as “Patriot Defense”, “Hospitallers”, the first volunteer mobile hospital, who work at the front and have organized tactical medicine training for the military and doctors. The current task is to advance such courses from the level of volunteer initiatives to a systematic level corresponding to Western standards.
Task One: Teach all participants of the “chain” to deliver medical care
“We have to adopt protocols for delivering care and tactical medicine training so that we have a unified quality standard for all,” said Ulana Suprun. These best standards of care should be for all chain “links” of providing medical aid – from the moment a serviceman was wounded on the battlefield to the operating room in hospitals.
Oleksandr Linchevskyi, Deputy Minister of Healthcare of Ukraine, noted that about 90 percent of the dead wounded die because they do not get the necessary first aid on time. “173 Ukrainian military died in 2016. 15 percent of them were likely to have survived until the arrival of a doctor, if everyone had proper training and a Western-style kit,” specified Ms. Suprun. “Without any compromise, each fighter must have such a kit and must be able to use it. We will insist that it be a priority for our power forces. ”
Another important “link” is people who provide evacuation to hospital. The task of this team is to correctly assess the state of a fighter, so that he could be taken to hospital alive and with the least damage to health. One of the pressing problems is that volunteers who work on the front lines are properly trained but not always legally protected in case a serviceman dies on the way to hospital. “Now the department of emergency medicine and disaster medicine thinks how to make it reliable that skilled care can be provided on the evacuation stage and people, providing it, are trained in accordance with modern standards and can legally justify their actions in the provision of medical care,” said Maksym Tsyganok, trauma surgeon, Kyiv City Clinical Hospital #17.
“We already have both negative and positive experience. The main thing is to select the achievements and implement them,” added Maksym Tsyganok. One of such achievements is, for example, cooperation between the “Hospitallers”, first volunteer mobile hospital and our hospital. “Hospitallers” did everything possible and brought servicemen from the red zone; doctors of the first volunteer mobile hospital stabilized the condition of the wounded to transport them to a specialized hospital, and when the latter was notified of the number of wounded by telephone, it was preparing to take them. “In fact, it was like a drill of the NATO Forward Surgeon Team,” he noted.
Military doctors require a specialized training
Oleksandr Linchevskyi stressed that a military doctor has to undergo specialized training. “Medical education and even surgical experience do not mean that a doctor is automatically a tactical medicine instructor and a military surgeon. It is different. We have to study the nature of injuries, to understand how to help the injured, who and how should deliver medical care – starting with a soldier and ending with a surgeon,” he stressed. The NGO “Patriot Defense” has conducted such courses for 97 military and 105 civilian doctors.
“Now the death toll decreases in large part because people are trained in tactical medicine both for delivering care on the battlefield and in health care institutions,” noted Oleksandr Danyliuk, military surgeon, intern at Coordination Department for Medical Logistics in ATO and Emergency Situations, Ministry of Healthcare of Ukraine.
Task Two is to establish cooperation between the Ministry of Healthcare and power agencies
For the whole “chain” to work effectively cooperation should be established between the Healthcare Ministry and power structures. Protocols fall within the Ministry’s competence; organization of training and appropriate logistical support – within power officials’ competence.
“We are initiating establishment of a single headquarters at the Cabinet of Ministers with the participation of representatives of security, defense and law enforcement departments. It will not be a stadium of all involved. 5-7 decision-makers from each department should take decisions in one headquarters in the normal atmosphere,” stated Oleksandr Linchevskyi.
Task Three is to establish cooperation between civilian and military medicine
Ulana Suprun noted that it is incorporated in the Strategic Bulletin as one of Western standards. “It specifies that military doctors should cooperate with the civilian ones, and civil protocols, civil education and civil licensing should be applied in military medicine. We would like to organize civilian and military medicine so that they complement each other, and our military doctors could work as doctors in civilian life,” noted Ulana Suprun. Now this training is carried out mainly through social organizations or volunteer groups. “We are cooperating with power structures to harmonize everything. In a short time, TCCC, ТЕСС, 68W protocols and the military doctor protocol will be approved. Thus, our military will have permission to use in practice the knowledge gained on the courses,” she added.
Oleksandr Danyliuk noted that at the front-line area such cooperation has emerged as a spontaneous grassroots initiative of doctors. They began to set up military and civilian medical and nursing teams at central, district and city hospitals near the front line. One of the pressing problems is that many people are working there, but legally they are not. “Our task is to remove all bureaucratic barriers that do not allow these doctors to be sent on an official mission to avoid 10 mediator,” he noted.