EMS Around the World: EMS Upgrade Creates Questions in Ukraine

Ukraine continues to reform its domestic EMS industry, which involves a shift toward a Western model of organization and improvement of the quality of services, according to recent statements by senior state officials and local analysts. 

Part of the reform is replacing doctors with paramedics in emergency crews and working to reduce the number of responses. Plans call for these paramedics to focus on the provision of initial care to patients and delivery to the hospital.

Prior to the last few years, the EMS industry serving Ukraine’s 45 million people was based primarily on outdated Soviet principles. However, leaders hope the recently initiated reform will help improve the current situation. According to the Ukrainian Ministry of Health, the state agency responsible for implementing the reform, there are plans to adopt a U.S.-style model of delivery.

According to Ministry of Health data, false and unfounded calls to the Ukrainian emergency medical service account for about 73% of its overall volume. This has resulted in unnecessary responses by emergency crews, taking them out of service and posing a risk to the lives of patients who truly require immediate medical care.

As part of the reform, there are plans to launch a new dispatch system. Dispatchers will be responsible for sending emergency crews in accordance with incoming calls, assessing their degree of severity in advance. Plans call for a single electronic national system.

In addition, the reform involves a complete modernization and renewal of the ambulance fleet used by Ukrainian EMS. That means massive purchases of new ambulances. Construction to meet this demand is underway: Modern ambulances are already being assembled in at least one factory, based on the model of Hyundai H350 vans. Authorities hoped to have 500 of the new vehicles assembled by the end of 2019. In 2018 Ukraine also received about 50 new ambulances as a gift from China. 

Improved Training

The reform also involves the introduction of various training courses for Ukrainian doctors and paramedics. One, for example, is known as Ukrainian Trauma Life Support and was developed with the participation of British and American physicians to improve care for the injured. 

According to Ulana Suprun, a physician who served as Ukraine’s Minister of Health from 2016–2019, the total cost of the reform is estimated at U.S. $300 million. About $35 million was spent in 2019, but most of the funds will be provided during 2020 and 2021. 

According to Suprun initial reforms will begin on a pilot basis in six regions of the country, including the capital of Kyiv, before spreading elsewhere. New standards will be based on evidence-based medicine and best Western practices, she added, noting the Ukrainian approach to emergency assistance hadn’t changed in 20 years.

Part of the plan is also a significant increase in salary for all members of emergency crews and setting response-time standards at 10 minutes within the city and 20 minutes outside it. At the same time, call processing times are not to exceed one minute.

Domestic Opposition

Despite the numerous anticipated advantages of the planned reform, its implementation has already been criticized by some leading politicians and analysts.

According to Yulia Tymoshenko, a former prime minister of Ukraine and head of the Batkivschchyna political party, the transition to the U.S. model is unacceptable because ambulances will respond only to serious patients who require hospitalization. This will lead, she said, to 100% of emergency medical responses resulting in patient hospitalization. Under the current model, which Tymoshenko supports keeping, ambulances also respond to nonemergency calls, and the hospitalization rate is just 20%–25%. 

In the meantime, according to some independent analysts, the current skill level of paramedics and feldshers—a type of medical professional often used on ambulances in Europe and Asia, with training roughly equivalent to U.S. physician assistants—remains low and inappropriate as a replacement for doctors. However, the transition to paramedics may be required, as in recent years Ukraine has faced an acute shortage of doctors and high-skill medical workers.

According to some analysts’ assessments, due to a series of economic and political crises in Ukraine over the last five years, about 10,000 highly qualified doctors and at least 20,000 experienced nurses have left the country. A significant number of them emigrated to E.U. states, others to neighboring Russia despite ongoing tensions between the two countries. In addition, a significant number of medical workers have departed the profession due to a decline in their salaries and image.

The situation is also complicated by the large number of doctors working in the Ukrainian EMS industry who are approaching retirement age. 

According to Miroslav Somok, a deputy head of Patients 2019, a public organization that defends the rights of patents in Ukraine, the ongoing reform may result in an increased mortality rate due to paramedics’ lack of skills, especially in caring for serious patients.  

Eugene Gerden is an international freelance writer who specializes in coverage of the global firefighting, EMS, and rescue industries. He has worked for several industry titles and can be reached at gerden.eug@gmail.com.