EMS Around the World: Ukraine Leverages International Support To Boost Ambulance Fleet Amid War

Russia’s invasion of Ukraine has resulted in the damage and destruction of medical facilities across the country, according to data from the Ukrainian Health Ministry. However, at the same time, the nation has managed to leverage international support to overhaul and modernize its emergency medical services (EMS) capacities.

Ukraine's First Lady's Fundraising Initiative

The war has triggered a global drive to collect funds for Ukraine’s healthcare system, with institutional and individual donors worldwide joining the effort. Most recently, a fundraising initiative launched by Ukrainian First Lady Olena Zelenska brought in some $6.5 million that will allow the country to buy more than 60 type C ambulances, according to the country’s main fundraising platform, United24. The vehicles are estimated to be worth about €100,000 ($100,500) each. 

“How many [ambulances] do we need? Today’s estimated number is 400. Is that enough? I am not sure. The war will not end any time soon. [Ambulances] can rescue people under active shelling, and take out the wounded on roads otherwise broken by shells,” Zelenska said at the Summit of First Ladies and Gentlemen on July 23 as she kicked off the initiative. 

The first batch of 18 ambulances, fitted with oxygen tanks, cardio monitors, defibrillators, electrocardiographs, and ALV devices, was sent to the provinces of Sumy, Kharkiv, Mykolaiv, Chernihiv, and Rivne in September 2022. Located in the country’s eastern part, on which Russia’s military attacks have been focused, has been particularly impacted by the ongoing armed conflict. 

The vehicles are equipped with “everything required for quick and safe transportation of the most severe wounded to the hospital,” the fundraising platform said in a statement. “We are grateful to the citizens of 55 countries who joined the fundraiser, as well as the businesses that supported us: Freedom Finance, Epicenter, OKKO, AstraZeneca, PariMatch, Prom.ua.” 

Growing Healthcare Needs in Ukraine

The needs of Ukraine’s healthcare system extend beyond new ambulances, but the country’s EMS has been at the forefront of the efforts to aid the population that is targeted by the Russian military’s aggression daily. Since the war’s outbreak on February 24, United24 has facilitated the purchase of 90 type C ambulances. 

Other branches of the Ukrainian healthcare system have also benefited from robust international support. Between late February and August 2022, Ukraine secured some 8,500 tons of medical humanitarian aid worth more than UAH 12 billion ($325 million), as indicated by figures from the nation’s Ministry of Health. The combined support of 35 countries from across the world and more than 60 international and charitable organizations, medical institutions, companies, and other donors  

Meanwhile, the country’s authorities are also working on rebuilding the destroyed medical infrastructure. Speaking at an experts’ meeting last August, Ukrainian Health Minister Bohdan Borukhovskyi said that the institution was finalizing its regulatory work on developing new construction standards for the healthcare infrastructure Kyiv hopes to re-establish once the war is over.  

At the sites “of medical institutions that Russia has destroyed and continues to destroy today, Ukraine should build modern hospitals taking into account the best European practices. In order to implement our ambitious plans, today it is extremely necessary to quickly adopt new state building codes for healthcare institutions,” the minister said. 

A 2020 report by the World Health Organization (WHO) describes the structure and responsibilities of the Ukrainian EMS system which, as is the case in a number of countries in Eastern Europe, is operated by the state.  

In 2012, Ukraine’s lawmakers passed a law on emergency medicine which transformed the organizational framework of the nation’s EMS system. The legislation allocated administrative and financial responsibilities for prehospital emergency care to EMS centers at regional level, shifting away from a fragmented district-based supervision toward an approach focused on region-level coordination, according to the report.

Strategies to Improve Ukraine's EMS

Further improvements to Ukraine’s EMS came on the turn of 2017 and 2018 when the country’s authorities set up a network of hospitals with required emergency medical capabilities at regional level. Other major changes included the establishment of a new paramedic educational program, as well as the launch of a new national central dispatch system. This, in the WHO’s opinion, has led to overall improvements in the country’s EMS coordination and response efforts. As a result of these actions, Ukraine’s EMS is currently divided into 25 separate sub-systems, one for each of the country’s 25 regions.  

To advance further reforms of the system, in 2019, Ukraine’s government adopted a new strategy to develop the country’s EMS. In this document strategy, the Ukrainian Ministry of Health identified the following priority areas: 

• Developing a comprehensive system of first-aid responders; 

• Enhancing EMS dispatching and prioritization of calls;  

• Providing a new scope of practice model for EMS personnel and introduce changes to their education;  

• Setting up an EMS quality management system;  

• Implementing new principles in the organization of emergency hospital care;  

• And improving disaster preparedness and response; and prevent emergencies through EMS. 

About two years before the war’s outbreak, the organization estimated that “only nine regions across Ukraine had applied some form of centralized, computerized dispatching system, and only 12 had created a designated hospital with emergency medicine capabilities (that is, established emergency departments (EDs)) in accordance with the law."

“National standards for staffing or equipping EDs in hospitals need to be updated … [as] [c]urrent EDs function as admission departments, so access to emergency services differs greatly across regions,” according to the WHO’s report.