Acting Healthcare Minister and her team presented plan to reform emergency medicine, starting with training other agencies that arrive faster than paramedics, modernizing dispatch system and ambulances, retraining of emergency units personnel.
Reform of Ukraine’s emergency medicine aims at providing coordinated and professional action at all stages: from the call to the ambulance to assistance at the specialized unit. “We have to be drastically changing our vision (the vision of both medics and patients) as to the behavior of medics and future paramedics at each of the stages. We have to clearly define what happens on the spot, how the emergency call is handled, how quickly the ambulance arrives, who and what is inside, what happens as the ambulance rides, where the ambulance is heading to, who meets it and with what medicines,” said Oleksandr Linchevskyi, Deputy Healthcare Minister speaking during the public discussion of the reform at Ukraine Crisis Media Center.
Such coordinated system is already successfully functioning in many developed countries, in the U.S. in particular. “When the patient arrives, people know exactly where they are supposed to be, what their roles are and what they are supposed to do. This allows us to determine accurately and quickly what’s needed for that patient, and then move that patient into therapeutic scenarios, they result in the most efficacious outcome,” said Blake Vandelan, surgeon from the USA, trainer at the “Patriot Defense” civic initiative.
Task one: due training of those who get on the spot earlier than medics
Drivers, policemen and firemen are the ones who find themselves first on the spot, that’s why they must know what to do with the casualty before medics arrive. “First minutes can sometimes be decisive. Statistics of deaths demonstrates that this stage cannot be neglected, otherwise the patient does not survive until arrival to hospital,” emphasized Oleksandr Linchevsky. “First aid training for policemen and firemen has already been approved,” said Ulana Suprun, Acting Healthcare Minister of Ukraine.
She noted that the “Patriot Defense” NGO has already taught this course to policemen in Poltava, Kremenchuk, Kharkiv, Odesa, Lviv and Kyiv. It is to be now introduced as compulsory. Training course for drivers is still being developed, it will last for six weeks.
Task two: to modernize the dispatch system and filter out irrelevant calls
Ideally arrival time to the patient of the ambulance must be four to eight minutes. To achieve this the network of emergency substations needs to be expanded and the automatized dispatch system needs to be introduced so that the nearest ambulance will be directed to the spot in the most efficient way. “The Ministry has already introduced its suggestions as to the next year’s budget, thus, it concerns additional financing of the dispatch system. We have serious plans and we will be working on them,” said Oleksandr Linchevskyi. He added that at regional level local authorities often start improving the dispatch system without waiting for directions from the top.
Linchevskyi noted that out of the nine million calls that the ambulance gets annually, seven million do not end with ambulance coming. In order to decrease the workload of phone operators, call centers will be established where people will be able to turn for consultations. The stage of primary medical assistance also needs to be reinforced to achieve that.
Task three: to modernize the ambulances and conduct vocational training
Third task is to improve the quality of assistance at the stage when medics arrive and transport the casualty to hospital. Oleksandr Linchevskyi said that changes to the decree on improving emergency medical assistance have been already introduced. These changes include upgrade of the medicine list provided to ambulances and of the ambulance equipment as well as harmonizing the protocols of assistance provision with modern standards.
Moreover vocational training will be offered to the personnel. “A four-module program has been developed to retrain medical assistants and ambulance doctors. I hope it will be approved soon,” Deputy Minister noted. “They will not be fired, we are only trying to achieve higher standards of assistance provision,” emphasized Ulana Suprun. “We plan to make this course compulsory for all ambulance doctors and for the doctors who work at emergency units and deal with trauma. Such courses are being constantly held in Europe, in the U.S. and in Canada.” The course will last for four weeks, its final exam will be the same as the one that western paramedics pass. “Patriot Defense” NGO has been holding such course for over two years, over 250 doctors have been trained.
Narrow subspecialties: paramedics and emergency medical technicians
“We are changing the list of occupations, introducing both paramedic and emergency medical technician to start training professionals of narrow subspecialties who are being trained for this job from the very beginning of the learning course,” Linchevskyi noted.
“Currently there are myths on paramedics, some say that a policeman who was trained for two weeks or eight hours became paramedic. Paramedics are people with a university degree, who practice for many academic hours, who get specialized knowledge and certification as to the provision of medical assistance. Training of emergency medical technician is a shorter course, it takes six weeks. It is for those who may be providing basic assistance at the pre-hospital stage,” the Acting Minister explained.
Combat paramedics will be able to work in civilian medicine
Opportunity for combat medics to retrain into civilian ones is also planned. “We would like them to be able to work as paramedics or emergency medical technicians, and fill in the need for professionals in pre-hospital assistance in civilian life,” Suprun said.
Success depends on feedback from medical staff and local authorities
Ulana Suprun noted that speed and quality of the changes that are being introduced depend on assistance of medical staff locally as well as on whether local authorities will provide the required financing. “We are able to do formal institutional issues but we need assistance of our medical staff,” emphasized the Acting Healthcare Minister.
Vira Nanivska, head of the analytical center “Anna Yaroslavna Collegium” and Oleh Rybachuk, head of “Center UA” NGO, co-founder of “Anna Yaroslavna Collegium”, reminded that the discussion was held as part of the public policy cycle. Its task is to understand and bring together the vision of reforms as seen by the government and by all stakeholders, so that the most balanced joint vision is found.
Representatives of civil society as well as professional community present at the discussion agreed to the proposed model however they emphasized the problematic issues that include low salaries and enormous workload of dispatchers as well as the critical state of many emergency substations. The issue of the safety of medics who go on the spot was raised. Acting Minister Suprun agreed to the fact that the problem of protection and medics rights should be introduced for discussion at the state level.
Ulana Suprun noted that the concept of the new financing system and of the State Insurance Agency has been submitted to the Cabinet of Ministers, both draft documents were earlier discussed publicly. Draft decrees on hospital districts and on autonomous financing of medical institutions have also been submitted for government’s consideration. She added that the day earlier the Cabinet of Ministers adopted the decrees on reference pricing and reimbursement of medicine prices.