In recent times ambulance emergency teams respond the calls with concern. Despite the fact that for long years of work they have seen and experienced all kinds of cases, the latest tragic events in Odesa and Zaporizhya have fueled the flame. On May 24 in Zaporizhya a mentally ill man called ambulance and attacked doctors with acid and ice-pick killing a 29-year-old pregnant paramedic. The country did not recovered from the tragedy when another incident happened in Odessa. A mentally ill man stabbed his mother and wounded the sister and paramedics.
Analyzing these events it becomes clear why judges of May competitions among paramedic teams were focusing on security issue. Finally, the problem is on the table of state officials who are working out measures and mechanisms to stabilize the situation and solve the issue.
Latest propositions
The position number one, being now considered by the MPs, concerns arming emergency teams with individual defense devices. The parliament has even registered a draft bill on amendments to the Law "On emergency medical assistance" regarding protection of emergency teams from security incidents.
One of the initiators of the draft bill MP Tetyana Bakhteyeva spoke earlier about stun guns and gas sprays, but the document does not specify the devices. The list of defense means will be defined by the Cabinet. it is only known that the devices will be given to emergency teams free of charge. Ambulances will be also equipped with special-purpose electronic means (radio communication).
If the draft bill is adopted, emergency crews will official have the right to apply physical force in case of security incidents. However, paramedics will not be able to execute this right always. The law will have a separate article stipulating for conditions and circumstances when and how personal defense devices can be used. In particular, one of the paragraphs clearly stipulates that such devices cannot be used against pregnant women, disabled and patients having immunity status. The only exception is when patients of the above mentioned categories threaten life of medical workers or any other person involved in the incident, as well as in case of armed attack.
If medical workers decide to use personal defense devices, they have to do it within the law anyway, following all conditions and circumstances, which exclude crime. Such personal defense also should be carried out with minimal damage to patient's health.
It is worth mentioning that even before the registration of the draft bill, lawyers were studying the problem as well. Thus, Radmila Grevtsova, director of the Institute of medical and pharmaceutical law and bio-ethics, president of the Ukrainian medical legal association and member of board of directors of the World Association for Medical Law, says that equipping ambulances with special devices is expedient, but patient's rights should also be taken into account.
"Profession of medical workers is self-giving, but it does not mean they have to sacrifice their lives. At the same time, personal defense devices should be used in a way not to harm patient's health."
Medical pros and cons
It is to early to speak about what medical workers will be 'armed' with, but the propositions on stun guns and gas sprays have already received both positive and negative feedbacks. Doctors seem to support the use of personal defense devices, but at the same time are concerned that these devices may work against them and in the end they will be blamed for consequences.
"Incidents often happen indoors, and if a medical worker uses a gas spray everyone present will be hurt. Moreover, stun guns are banned for use as defense means by medical associations. You can hit a patient with the stun gun but he may never regain senses. Who will be responsible for such consequences? Us, of course," Maxim Ionov, doctor of a Kyiv emergency hospital and chairman of the emergency medical workers trade union, says. According to him, 65% of paramedics are women between 45 and 55 years old. "How do you imagine them using personal defense means."
At the same time Ionov does not deny that the defense issue must be regulated at the legislative level, but the approaches must be different, in his opinion. "First of all, life and health of medical workers must be insured. Then, there must be administrative responsibility for obstructing ambulances to do their job, as well as criminal responsibility for attacking or injuring paramedics. Once there was a call to a night club. A person was drunk and aggressive. He had his face beaten up. When we arrived he started to demand medical assistance but refused to enter the ambulance, as he wanted police officers to register his injuries on video camera. He kept the ambulance team for one hour and half. So much time for one call, while there were only two ambulance patrolling the whole Darnitsa district," the doctor told ForUm.
Reform and hopes
President's Administration also stated its position on the situation. According to Iryna Akymova, first deputy chair of the President's Administration, the issue is under consideration and there are several approaches to study.
"One of approaches 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," she says.
The Healthcare Ministry also believes that innovations being implemented now will at least partially solve the problem. Thus, according to 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," she says.
At the same time Chernenko notes that without the system for monitoring mental state of patients, these patients are left to themselves. Other specialists agree. In particular, psychiatrist Semen Gluzman, president of the Association of Psychiatrists of Ukraine and member of the Public Humanitarian Council under the President of Ukraine, once said that there is no social psychiatry in Ukraine, when social workers are supposed to follow patients after their release from the hospital.
Tetyana Bakhteyeva, chairperson of the parliamentary committee on healthcare, also adds that there is more work to do. She notes that hospitalization of mental patients, especially dangerous ones, 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," she assures.
Well, the time will show what results the initiative will bring and what conclusions the experts will made of them. Meantime, what can be done is to stay alert and be patient, especially it concerns medical workers and relatives of mentally sick patients. Living in the same apartment with a sick person it is easier to follow his condition. Remember that a situation has more chances to end well if you ask for help in time, and not when even men in white robes and uniforms cannot do anything.
Tetyana Matsur
Analyzing these events it becomes clear why judges of May competitions among paramedic teams were focusing on security issue. Finally, the problem is on the table of state officials who are working out measures and mechanisms to stabilize the situation and solve the issue.
Latest propositions
The position number one, being now considered by the MPs, concerns arming emergency teams with individual defense devices. The parliament has even registered a draft bill on amendments to the Law "On emergency medical assistance" regarding protection of emergency teams from security incidents.
One of the initiators of the draft bill MP Tetyana Bakhteyeva spoke earlier about stun guns and gas sprays, but the document does not specify the devices. The list of defense means will be defined by the Cabinet. it is only known that the devices will be given to emergency teams free of charge. Ambulances will be also equipped with special-purpose electronic means (radio communication).
If the draft bill is adopted, emergency crews will official have the right to apply physical force in case of security incidents. However, paramedics will not be able to execute this right always. The law will have a separate article stipulating for conditions and circumstances when and how personal defense devices can be used. In particular, one of the paragraphs clearly stipulates that such devices cannot be used against pregnant women, disabled and patients having immunity status. The only exception is when patients of the above mentioned categories threaten life of medical workers or any other person involved in the incident, as well as in case of armed attack.
If medical workers decide to use personal defense devices, they have to do it within the law anyway, following all conditions and circumstances, which exclude crime. Such personal defense also should be carried out with minimal damage to patient's health.
It is worth mentioning that even before the registration of the draft bill, lawyers were studying the problem as well. Thus, Radmila Grevtsova, director of the Institute of medical and pharmaceutical law and bio-ethics, president of the Ukrainian medical legal association and member of board of directors of the World Association for Medical Law, says that equipping ambulances with special devices is expedient, but patient's rights should also be taken into account.
"Profession of medical workers is self-giving, but it does not mean they have to sacrifice their lives. At the same time, personal defense devices should be used in a way not to harm patient's health."
Medical pros and cons
It is to early to speak about what medical workers will be 'armed' with, but the propositions on stun guns and gas sprays have already received both positive and negative feedbacks. Doctors seem to support the use of personal defense devices, but at the same time are concerned that these devices may work against them and in the end they will be blamed for consequences.
"Incidents often happen indoors, and if a medical worker uses a gas spray everyone present will be hurt. Moreover, stun guns are banned for use as defense means by medical associations. You can hit a patient with the stun gun but he may never regain senses. Who will be responsible for such consequences? Us, of course," Maxim Ionov, doctor of a Kyiv emergency hospital and chairman of the emergency medical workers trade union, says. According to him, 65% of paramedics are women between 45 and 55 years old. "How do you imagine them using personal defense means."
At the same time Ionov does not deny that the defense issue must be regulated at the legislative level, but the approaches must be different, in his opinion. "First of all, life and health of medical workers must be insured. Then, there must be administrative responsibility for obstructing ambulances to do their job, as well as criminal responsibility for attacking or injuring paramedics. Once there was a call to a night club. A person was drunk and aggressive. He had his face beaten up. When we arrived he started to demand medical assistance but refused to enter the ambulance, as he wanted police officers to register his injuries on video camera. He kept the ambulance team for one hour and half. So much time for one call, while there were only two ambulance patrolling the whole Darnitsa district," the doctor told ForUm.
Reform and hopes
President's Administration also stated its position on the situation. According to Iryna Akymova, first deputy chair of the President's Administration, the issue is under consideration and there are several approaches to study.
"One of approaches 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," she says.
The Healthcare Ministry also believes that innovations being implemented now will at least partially solve the problem. Thus, according to 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," she says.
At the same time Chernenko notes that without the system for monitoring mental state of patients, these patients are left to themselves. Other specialists agree. In particular, psychiatrist Semen Gluzman, president of the Association of Psychiatrists of Ukraine and member of the Public Humanitarian Council under the President of Ukraine, once said that there is no social psychiatry in Ukraine, when social workers are supposed to follow patients after their release from the hospital.
Tetyana Bakhteyeva, chairperson of the parliamentary committee on healthcare, also adds that there is more work to do. She notes that hospitalization of mental patients, especially dangerous ones, 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," she assures.
Well, the time will show what results the initiative will bring and what conclusions the experts will made of them. Meantime, what can be done is to stay alert and be patient, especially it concerns medical workers and relatives of mentally sick patients. Living in the same apartment with a sick person it is easier to follow his condition. Remember that a situation has more chances to end well if you ask for help in time, and not when even men in white robes and uniforms cannot do anything.
Tetyana Matsur
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