The country has not recovered from the tragedy happened in Zaporizhya on May 24 when a mentally ill man called ambulance and attacked doctors with acid and ice-pick killing a 29-year-old pregnant paramedic, and now another incident has happened in Odessa. A mentally ill man stabbed his mother and wounded the sister and paramedics.

Having arrived on the scene the police established that a 30-year-old man first stabbed his mother and then the sister, who intervened in the fight. The mother died at the scene. Paramedics on duty were also attacked and received injuries. It has been established that the man was undergoing treatment in a mental hospital, but was released about two months ago.  The investigation continues.

Doctors and paramedics insist that government improves the legislation and strengthens responsibility for attacking ambulance crews. Lawmakers, in turn, consider to teach paramedics self-defense, equip them with non-lethal weapons and assign a police officer for visits to potentially dangerous patients.

ForUm has asked doctors, lawmakers and experts about possible measures to take in order to protect paramedics and regular citizens from attacks of insane people.

Iryna Akymova, first deputy chair of the President's Administration:

- The issue is under consideration. There are several approaches we study. One of them includes formation of central dispatch room and equipping ambulance crews with alarm button. The dispatch room will continuously monitor the ambulance and follow every move of paramedics through the equipment. In case of alarm, the dispatch will send backup.

Secondly, the electronic registry of patients will include the list of mentally ill patients. Answering a call, the central dispatch will see if a mental patients is registered at this address and  will be able to coordinate actions of police and paramedics.

Obviously, we cannot wait until the new system is implement countrywide. Thus, we already have to start preparing regulatory changes on cooperation between ambulance crews and police to minimize the number of such cases.

Tetyana Bakhteyeva, MP (Party of Regions faction), chairperson of the parliamentary committee on healthcare:

- It is very important that mass media draw attention to the security of medical workers. It is indeed a big problem. I have almost finished preparing a draft bill on amendments to the law "On emergency medicine". The draft bill obliges to quip ambulances with individual means of protection. Moreover, if an ambulance crew knows it has to visit a mentally sick patient it will be accompanied by police. The draft bill will be registered in the parliament in a week. We also initiate self-defense training for paramedics and drivers.

As for mental patients, especially dangerous ones, their hospitalization is a very complicated process, which is possible only with their written consent or by court order. We will think to amend the legislation to make their hospitalization less complicated and not to restrict their rights at the same time.

Oksana Kaletnyk, MP (Communist Party faction):

- It is clear that mentally sick people sometimes show aggression. Their behavioral responses can be changed. However, since the Soviet times, Ukraine has used different methods than the rest of the world. If, for example, schizophrenia, which sometimes has complicated forms of aggression, has been treated in Ukraine only with medication, the West resorts to treating with social environment, not excluding a mentally disordered person from society.

I believe that professional psychiatrists, physicians should give answer to your question. However, arming physicians with special means is an extreme measure. It is unlikely to help. Anyway, "armed emergency doctor" even sounds incorrectly. It is a half-step. Moreover, it is an additional risk to health professionals, because not everyone is able to physically resist another person, let alone using "non-lethal weapons." If we talk about the financial aspect, money should be directed, first of all, at purchase of vehicles, medicines and fuel for ambulances.

Zoryana Chernenko, expert on medical law of the Public Council of the Healthcare Ministry of Ukraine:

- Mentally sick patients must be registered and undergo scheduled treatment. If a doctor sees that a patients does not receive regular treatment, he can decide on patient's compulsory hospitalization. The question, however, is how motivated doctors are to trace patients who skip treatment and how interested law enforcements are in chasing these patients and bring them for treatment.   

Hopefully the implementation of family medicine will improve the situation, and family doctors will be able to detect mental disorder through regular visits of patients.

For the moment we do not have a system of monitoring mental state of patients. The patients are left to themselves. We suffer from these people, but these people suffer as well from lack of medical assistance. Moreover, patients' attacks can be avoided if law enforcements react adequately to the situation. Every ambulance unit must be accompanied by police, and not by one rookie, but by a brigade of trained professionals. The problem is that police cannot handle such duty due to lack of personnel. Moreover, we have insufficient number of ambulance crews even in Kyiv. According to the standard, counting only officially registered residents there should be 280 ambulance units in the capital, and we have only half, and it is impossible to assign police officers to each of them.

Moreover, paramedics mostly include women over 40. But I believe ambulance crews must include physically trained people who can run, lift and defend themselves. Thus, it is also a matter of training and personnel selection. 

Yevhen Zakharov, human rights activist, member of the board of the Ukrainian Helsinki Human Rights Group, co-chairman of Kharkiv Human Rights Group:

- The present procedure of hospitalization of the mentally sick people is not perfect. It requires consent of the patient. If there is no consent, it is difficult to send the person to treatment. Thus, the point is not in assigning a psychiatrist to every patient, but in changing the law on psychiatric care.
All years of existence of this document show that it is not suitable for our country. On one hand, it obstructs putting a sick person in hospital. I know a lot of horror stories about how, for example, a person with disabilities was not treated, and then he killed his parents. On the other hand, the law does not prevent putting a mental patient in hospital to deprive him of his property. Such cases do happen. That is, we need to change the system as a whole, not to adjust some aspects of the law.

Pavlo Duplenko, psychiatrist, professor of the psychiatry and narcology department  of Bohomolets National Medical University:

- The idea to arm paramedics and train them to use non-lethal weapons is not a good one. These are sick people, not criminals, we are talking about.

Speaking about mentally disturbed people who attack relatives, neighbors or passer-bys, they are usually handled by police. If there are grounds to believe a detainee is mentally sick he will be accompanied to a psychiatrist. Moreover, we have a law which regulates compulsory hospitalization and treatment of mentally ill patients. 

Volodymyr Polishchuk, independent expert, former spokesman of the Interior Ministry of Ukraine:

- To protect paramedics we need to organize complex cooperation between the Healthcare Ministry and Interior Ministry. First of all, we must create special data base of mentally sick patients and cases of attacks. It will help to prepare to the situation and be ready to react.


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