Since the year beginning, Ukrainian emergency care system has been following new rules. The law "On emergency medical care" is aimed at reduction of mortality rate among population. Five months after the adoption, all regions of Ukraine have new centers of emergency care, but specialists admit the work is not done yet. Among priority tasks there is formation of data-centers and single operative dispatching services, equipped with GPS.

So, how does emergency care system function now?

Urgent non-emergency

Along with the law on emergency care the Cabinet adopted the resolution on norms of arrival of ambulances, according to which an ambulance will come to patients within 10 minutes in cities and within 20 minutes in villages. The time limit can be exceeded by 10 minutes and only in case of bad weather conditions.

Moreover, there are new criteria, according to which dispatchers will determine whether a call is an emergency and requires immediate care or can be redirected to a relevant primary health care center.

"There are calls which fall into functions of emergency medical care and there are calls which can be covered by primary health care. Thus, a dispatcher can redirect the call to a primary health care center and the patient will be visited by a family doctor," head of the emergency care department of the Healthcare Ministry Mykhailo Strelnykov says.

Thus, ambulance will to patients in unconscious state, suffering convulsions, sudden respiratory distress, sudden heart pain, vomiting blood, acute stomachache; to patients having signs of acute infection disease, psychotic break, injuries caused by car accident, occupational accident, natural disaster; to patients suffering hypothermia, heat stroke, electric shock, animals bites. Pregnant women can also count on ambulances in case of various disorders.
Non-emergency cases include temperature rise, headache, cough, dizziness, increase of blood pressure or acute-on-chronic flare, including pain syndrome with oncology patients. Patients with above mentioned cases will be visited by a family doctor, and if not, will have to wait for an ambulance for an hour or go to a hospital by themselves.

De jure

Doctors are now working on realization of the national project "Timely Help". This project provides for the following changes in functioning of the emergency care system:

- reduction of the time of arrival of ambulances to a patient (in the city - up to 10 minutes, in rural areas - up to 20 minutes);
- introduction of a unified system of 27 regional control centers;
- creation of two data-centers;
- equipping of ambulances with GPS-navigators;
- introduction of radio as a backup;
- provision of medics with tablet PCs;
- ambulances would be called in online mode (via text messages, social networks, e-mail).

The changes will be applied both for cities and rural areas.

Ambulance units used to be controlled by district administrations, which decided whether to send a crew to another district for help or not. Now all ambulance units report to regional administrations and go to all districts. There will be no more confusion among districts and patients will not have to wait for officials to decide whether to dispatch an ambulance or not, Maryna Sholomova, representative of the project team, says. Moreover, there will be more dispatch stations for ambulances. It is especially important for regions with large rural area.  

Healthcare Ministry representative Mykhailo Strelnykov agrees. "How did it work before? We had a district, 60 kilometers in radius for example, and a central hospital with 2-3 ambulance units in it, and all of them were located in the same place. Imagine how long it used to take for an ambulance to arrive in the farthest village. For this we proposed to open more dispatch stations for ambulance units, and every station will have maximum 20-km radius to cover. Following the calculations, the help will arrive within 20 minutes, even considering poor roads," he says.

Moreover, after the formation of single operative dispatching services, patients' calls will be registered. "There will be records who called, when and which dispatcher answered the call. There will be a possibility to control the level of service, and dispatchers will bear responsible for the quality of service. Besides, patients will be sure am ambulance will come right after the call," Strelnykov explains.  

According to the head of the national project "Timel Help" Oleksiy Navrotski, the formation of regional dispatch services is planed for this year. At the same time, he informed that the system of Kyiv dispatch service will not undergo any changes, as it has proved itself to be efficient. "There can be certain improvements and amendments, but the system as it is will stay intact," he says.

In general, the reformation process will depend on regions' readiness to adopt new system and on financing. According to him, the first tranche for realization of the project in 2013 makes 50 million hryvnias.

Among other innovations of the emergency care system, there is formation of two data-centers, one of which will function as a reserve. "Data-center is the core and heart of the system. It will accumulate all information in the system of emergency care countrywide. Thanks to it one regional center will be able to  take up the system of another in case of malfunction. For example, if Dnipropetrosk server go down, Poltava region will be able to pick it up and continue answering its cases. Moreover, data-centers will be used for formation of single national medical field, including medical records of patients, emergency records, history of calls," Navrotski says.

De facto

As of today, all these innovations have been declared and are waiting for realization. Specialists note that pilot regions, where medical reform stated in January of last year, are better prepared for the formation of single regional dispatch centers.

"Pilot regions have been working on reformation of emergency medical care for over a year and are ready for implementation of "Timely Help" project," Strelnykov says.

However, the reform of the emergency medical care will be spread all over Ukraine, thus all regions must get ready for changes. When the reform is put in practice is a separate question.

Meanwhile pilot regions start reporting on results. Thus, in Vynnytsya region, for example, there have been created six emergency stations, 30 substations, 26 emergency departments and 52 dispatch stations for ambulances.

"Before the introduction of pilot project, we had two stations, 30 departments and eight dispatch stations. Ambulances were located mostly near sugar refineries," chief doctor of the regional emergency care center Anatoly Pirnykoza reports.

Similar results are reported by Dnipropetrovsk region. According to chief doctor of the regional emergency care center Radiy Shevchenko, the number of ambulance dispatch stations has increased from 91 to 138 for two years, and the number of ambulance crews - from 259 to 282.

"According to the data for the first quarter, the rate of timely arrive onsite increased up to 92.6% in cities and 92.7% in rural areas. The financing of one call has increased from 3 to 25 hryvnias," Shevchenko says.

Despite positive results reported by some regions it is hard to predict the result countrywide. Reformation is a long and complicated process...

Tetyana Matsur


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