Paramedicine and Donbas conflict: How it works?

Author : Iryna Sampan

Respondent : Oleksandr Danyliuk

Source : 112 Ukraine

In the fourth year of the war, a new occupation, "paramedic," was introduced in Ukraine
12:52, 6 December 2017

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Facebook Oleksandr Danyliuk

November 1, 2017, Ukraine introduced a new occupation, "paramedics," but only from September next year, the medical schools will begin to recruit people in this specialty.

Related: Healthcare refom: Step forward or liquidation of welfare state in Ukraine

In the first years of Donbas war, Oleksandr Danyliuk served as  a military surgeon at the front. During the events in Debaltsevo, worked on the wounded, wrote a memoir about 9 days in trenches. When Ulyana Suprun came to the Ministry of Health, she invited Oleksandr to her team. He is now responsible for the medical support of anti-terrorist operation, and he became the chief specialist of the coordination and medical assistance department of the Emergency Medical Service and the Ministry of Health during the anti-terrorist operation.

The greatest direction of his work is to improve emergency medical care and the introduction of paramedicine in Ukraine.

Those who are now involved in the medical assistance evacuation or is a member of various volunteer battalions in Donbas are not paramedics, right?

No. They correspond to another profession, which was also introduced on November 1. This is an emergency medical technician. This is a person without medical education, but with specialized training (120-hour training course), this training should be carried out by the centers of emergency medical care in Kyiv and regions, as well as medical colleges. They provide medical assistance and help doctors provide professional medical assistance. That is, they are full members of the medical team.

Should every member of the team, be a paramedic, including driver?

In 5 years, system of emergency medical care will not include drivers at all. All drivers in the emergency medical care system of the Ministry of Health and medical services of the Defense Forces will become emergency medical technicians. They will both manage the car and work in the team, providing assistance to all who need it. This is about civilian medicine, which will be interoperable with the medical forces of the defense forces.

Related: Ukrainian Parliament approves bill on telemedicine in rural areas

Do they need to undergo additional training in order to work in the ATO zone?

Combat conditions would still include a tactical component (medical care during shelling, etc.). The civil emergency medical technician cannot immediately become a military emergency medical technician. Military emergency medical technician will be called a military medical officer. So, we do not have this at the moment, so I would kindly accept criticism about it. The European countries have already conducted all these transitions, 20-25 years ago. Some of them have just recently implemented this system. And we are just starting to deal with it. And although we are lagging behind, we are introducing the latest technologies, we jump over the stages that the countries have been developing for a long time. This is positive. These people will be taught by instructors at the emergency medical aid centers and medical colleges, and the military - at the training centers of the defense forces.

Ministry of Defense of Ukraine

Do we have enough instructors?

Unfortunately no. We still need the instructors to be trained. Actually, Ukraine has a dozen emergency medical technicians trained in the United States. Some emergency centers already have such instructors, for example, our main department does. But the number of these people is reasonably insufficient, so a 5-year transition period is foreseen.

And what is the starting point for this period?

We start counting from this year, 2017. And by 2022. Gradually, all medical assistants in the emergency medicine will become paramedics, of course, I mean those who will pass the qualification requirements. Those drivers, who want to stay in the system, will improve their level and become emergency medical technicians. Those, who do not want to do it, will leave the system.

Related: Ukrainian military to receive 40 medical Humvees

Where will the work of paramedic employee finish?

At the Emergency Department. In the medical system of the forces of defense, paramedics can also work in the hospital. They are educated as nurses, medical assistants, they can work at all stages of emergency medical care, they will be trained specifically for emergency medical care. They mainly provide assistance on the scene, on the road, and bring them to the hospital, where the battalion sends doctors to the hospital, medical company or medical center.

The military unit has a slightly different specificity, though it will go parallel to the civilian link. The powers of military paramedics and military doctors will be greater than paramedics and emergency medical technicians in the civilian sphere.

Counselors from which countries help the Ministry of Health reform this direction?

Canada, the US, and the United Kingdom. Also, WHO helps us or freelance counselors. We also have two nearest neighboring countries, which have passed this way, Poland and Lithuania. They also had a transition period, but they are all right now. Therefore, Lithuanian and Polish paramedics also help a lot.

Open source

The first-aid kit of the Armed Forces and the one approved by the Ministry of Health are two different medicine kits. Why?

Ministry of Health develops a document, and then we agree or disagree with it. But situation with the first-aid kits was completely different: the Ministry of Health developed the first-aid kits. However, there is an old order of the General Staff, it has updated old first-aid kits. That is, based on our orders, they make their own order. Now there is a difference between ours and the General Staff order.

Related: "Lost" Russian military medics detained in Donbas, — ATO deputy commander

During the last trip to Donbas you collected information about your direction of reform. For what these data and what they showed?

This is an analytical data in order to understand what we had, what is available today and what stages need to be improved. We studied whether the wounded was delivered with or without a tourniquet, whether an occlusive bandage was applied, or whether a decompression needle was used. We saw that the self-help and mutual assistance have improved, and the survival of heavy patients increased. Unfortunately, we still can witness relatively high level of deaths due to a chest injury. Providing airways is an even bigger problem. If we have already learned the right wat to stop the bleeding, then freeing the airways, providing breathing (with the same pneumothorax) is still a challenge.

112 Agency

This war is positional. For such a long time, the soldiers have been trying to occupy favorable positions. And every day we still suffer from the losses. Why these irrecoverable losses in terms of providing home health care are still taking place? Have there been any cases, at least as in 2017, when someone was not saved because of the inability to do it?

Medicine plays little role in this matter. Problematic issues are more or less resolved. I mean, by the stage of evacuation, the level of assistance, the knowledge of the soldiers themselves to provide assistance. There are no such cases when a wounded man shouts "Doctor! Doctor!", Because his limb is bleeding, and none of the other soldiers standing next to him knows how to help him. I was a witness of a similar situation in Debaltsevo, when everyone was shouting "Doctor, doctor!" No one knew that it was necessary to pinch that artery with the fist and keep it so that it would not bleed. And while you bleeding, no one comes to save you. There are no such gross things now: soldiers, doctors, volunteers are already preparing and basically can provide this help. If we analyze the losses near Debaltsevo and the losses near Avdiyivka in 2017, we will see is a colossal difference. Earlier,  those that were wounded of medium severity, were transported to Bakhmut , majority of them died, and only few wounded people reached Bakhmut, only the strongest survived, those who were not in extremely critical condition. And in 2017, Avdiyivka received patients with severe shocks, with a pressure of 50-60, but almost all of them survived. This means that the first aid was provided correctly at the first stage, so the wounded could reached the hospital.

Related: Protests under Ministry of Health against medical reform

At the next stages, little things depend on medicine. Positional war is also a war, and shelling earlier or later result in wounds and deaths.

Related: Russia's political prisoner Sentsov experiences health problems

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