How Ukraine’s Ambulance Service Will Be “Decommunised”

Translated by Ollie Richardson

15:02:09
23/06/2018

strana.ua

The Ministry of Healthcare started another experiment on the healthcare of Ukrainians. This time the department intends to reform the ambulance service. The corresponding draft of the government directive was posted on the official website of the ministry for public discussion.

The most important thing is that officials suggest to reduce the number of ambulance journeys and to staff crews exclusively with paramedics, without doctors and feldshers who currently go to calls.

In parallel they want to massively teach police officers, teachers, firefighters, kindergarten teachers, and other experts who can find themselves in non-standard situations how to give first aid. It is hoped that after they participate in first aid courses they will help either the victims or will transport them to hospitals. Accordingly, ambulance crews won’t need to go to the place of emergency.

However, doctors affirm that if these ideas will be put into practice, then the mortality rate can sharply increase in Ukraine. Doctors don’t intend to sit idly by and are already preparing themselves for mass protests.

“Strana” understood how Ukrainians are going to save others in a new way, why this is happening, and what the result will be.

What is wrong with the ambulance service?

The very idea of reforming the emergency aid system looks strange in the very least. After all, the old reform, launched in 2012-2013, hasn’t yet ended. Back then it was decided to invest in the material-technical base, in particular, to create a modern dispatching system, to update the vehicle fleet, and to improve the intensive care system in hospitals. But this plan was realised only in part.

“There were purchases of medical transport, and in the majority of regions there was a dispatch system. But then the money ended. We were allocated only $100 per year for the average patient, whereas, for example, in Belarus it is $400, and in Poland – $2,500. To make things good it would be necessary to find financing and to finish what was already started, and not to start reform from scratch,” said the head of the All-Ukrainian council of defending the rights and safety of patients Viktor Serdyuk.

He estimates the “hole” in the budget for ambulances to be at least 35 billion hryvnia.

The representative of public organization “Pro S Vita” Konstantin Naduty calculated that 10-15 billion more hryvnia is needed to create diagnostic offices where ambulances can bring patients, and 50-70 billion hryvnia – to expand the network of intensive care hospitals with surgery, therapy, and children’s and maternity wards.

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Once the creation of six such centers in Kiev was planned, but only one functions – an emergency hospital.

“As practice shows, many patients die after the ambulance brings them to hospital. They simply don’t reach anyone, they die in receptions, and even in the corridor. General hospitals don’t have the necessary equipment. For example, the number of oxygen masks: one for every two patients, and defibrillators are available only for every third patient,” said Viktor Serdyuk to “Strana”.

But what experts demand only for ambulances is almost all the Ukrainian budget for healthcare (100 billion hryvnia in 2018).

Therefore the Ministry of Healthcare chose the more economical option.

Educational courses and defibrillators on every corner

Announcing the idea of reforming emergency treatment on her page on Facebook, the acting Minister of Healthcare Ulana Suprun drew attention to the following main stages.

  1. Updating the dispatching system. It is planned to change the protocol for dispatchers. If a call is indeed an emergency, an ambulance must arrive in only a few minutes,” promises Suprun. But the question is: what calls will be considered as emergency? The Ministry of Healthcare considers that often Ukrainians unnecessarily panic and call an ambulance in vain. Dispatchers will have to identify such “false” calls and not send an ambulance to “panickers”.

  2. Suprun promises to create new IT infrastructure that will allow to trace the location of ambulances in real-time and send the one that is able to reach the call most quickly. Such a system is already in operation in Kiev and in the Dnepropetrovsk, Kherson, and Kharkov regions, and pilot tests are ongoing in the Vinnytsia and Poltava regions.

  3. They plan the large-scale re-training of ambulance personnel and the subsequent external independent evaluation, the results of which will determine salaries.

  4. It is desired to involve rescuers, firefighters, police officers, tutors, teachers, and social workers in the system of emergency treatment. It is planned to train them in elements of providing emergency aid and to place defibrillators, stretchers, and other things in public places.

“These processes will take more than a year, but will give all of us better health and much higher chances of saving someone in an emergency situation,” summed up Ulana Suprun.

At the same time the Ministry of Healthcare don’t name the sum that is required for this reform. In the financial-economic justification it is optimistically specified that “the adoption of the draft bill won’t demand additional expenses of means from the state budget”.

“Although the defibrillator that is promised to be placed at every corner costs about $1,000 alone. With what money are they are going to buy them with? And, if the money actually exists, then why not give the same defibrillators to hospitals at least?” asked a perplexed Viktor Serdyuk.

Konstantin Naduty assumes that the Ministry of Healthcare will try to attract foreign grants to reform the emergency treatment system. “I think that this reform is being launched in order to receive grant money. It is possible to write off huge money on training the police, teachers, and other professions alone, after all – this is about tens of thousands of people,” said the expert.

Ambulance inspectors and healthcare revolt

One of the main arguments of the Ministry of Healthcare in favor of the new reform is, allegedly, the critical situation with providing emergency help to Ukrainians. As they say in the explanatory note to the draft bill, last year Ukraine was in second place in the world for the amount of deaths per 100,000 people. And the main reason for such a deplorable situation is untimely help in different states of emergency (accidents, crashes, and so on), and also in acute situations, such as, for example, heart attacks, strokes, and others. Last year, cardiovascular diseases killed about 400,000 citizens, and accidents and car crashes – about 32,000 more.

“But officials consider that this is not because there isn’t enough money and an ambulance can’t arrive to a call because there is no gasoline, but because the doctors are bad,” said Viktor Serdyuk.

In order to collect “compromising evidence” on doctors, the Ministry of Healthcare intends to carry out the large-scale monitoring of their work. The ministry already dispatched letters to regional administrations with a request to promote participation in the verification of ambulance dispatches to calls.

This agitated the healthcare community.

“Suprun wants in this way to sling mud at doctors and to expose them as ignoramuses in order to prove the need for ‘a new concept of development’. Certain ‘experts’ must be allowed into ambulances and to write down everything that happens there,” said Viktor Serdyuk.

He also appealed to local officials to not follow the tastes of the Ministry of Healthcare.

“Such ‘inspections’ are illegal: there is neither the criteria for evaluating the work of doctors, nor the guarantees of securing their personal information and medical secrets. In addition, serious risks for patients can be created,” he warns.

The responsible secretary of the National Medical Chamber Sergey Kravchenko said that the mass dismissal of doctors and heads of ambulance departments will become the result of such checks.

He also said emergency treatment in many countries of the world indeed works according to the scheme proposed by Suprun (decreasing the number of ambulance dispatches, forming crews from paramedics and not doctors, and so on).

“But such an option is suitable if the medical infrastructure is within reach of the patient. For example, if something happens the patient can reach the hospital themselves. But this is only realistic if the medical institution is within 5 kilometers, and not 50, like in our villages. For villagers an ambulance is not only an ambulance – it is also a ‘polyclinic on wheels’. That’s why if the reform will be lobbied after all, then for villagers medical aid will become even more inaccessible than it currently is,” he explained.

Meanwhile, protest moods are already ripening among doctors. “The strike of all doctors in the country for about 10 days would solve many of the medical community’s problems,” wrote Aleksandr Martynenko, commenting on Viktor Serdyuk’s appeal on Facebook to local authorities and doctors “to not respond to the provocation of the Ministry of Healthcare”.

Experts assume that there can be skirmishes between doctors and inspectors from the Ministry of Healthcare if they try to accompany crews during dispatches.

Finally, the doctors themselves privately admit that this contradictory reform without an adequate increase in salaries (and there is no money for the latter in the budget) risks increasing the outflow of our doctors to Europe. And then there will be simply nobody to respond to a call.

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