Emergency care needs to be improved: results of independent quality evaluation

The experts provided their recommendations based on the evaluation results. These recommendations mainly concerned the training system, qualification requirements for emergency care medical staff as well as emergency care medical aspects.

How the emergency care quality evaluation was conducted     

For the first time, the quality of emergency medical care was evaluated by an independent study as opposed to paper statistics. Volunteers observed the work of Emergency Response Teams for 3 days in each region of Ukraine. The research and evaluation methodology of the results was developed by the World Health Organization (WHO) experts.

The observer groups worked in 26 arbitrarily selected Ukrainian settlements (with a population of more than 10,000 people), and 30 Emergency Response Teams. They spent 72 hours of duty together with the teams and traveled mainly to challenges involving injuries, loss of consciousness, complaints of cardiovascular or pulmonary problems.

The research was conducted with the help of the “action observation method".

“The best way to assess the pilot’s ability to fly the plane is to get on board on the same plane with him. Of course, various simulations, online-tests etc. allow to evaluate the pilot’s preparation, however they do not resemble the real competency. That is why action observation is the best observation method” – commented the research supervisor, American surgeon and expert in emergency medicine, Dr. Colin Megou.

Experts from the Ministry of Health discussed the results of the study with scientists and practitioners - heads of regional Emergency Care Centers. Acting Minister of Healthcare Ulana Suprun emphasized that the purpose of the assessment was to obtain objective data on the state of affairs in emergency medicine, which will help to plan the most effective measures in advance.

The average arrival time of the ambulance is 8,5 minutes, one in two patients is taken to the hospital

According to the summarized data results, emergency teams respond promptly to challenges, while treatment protocols need to be revisited.

Some facts from the assessment:

• Average response time of the Emergency Response Team to the call (from the moment the message was received and before the first contact with the patient) - 8.5 minutes;

- 56% responses take place within 10 minutes;

- 94% responses take place within 20 minutes;

• Average time on location is 17 minutes;
• Average transit time to the hospital is 10 minutes;
• 54.1% of emergency calls resulted in patients’ transit to the hospital and further hospitalization.
• Medical solutions used in emergency medical care do not always have proven effectiveness and expediency in specific cases.

For example, the most commonly used drug in cases of chest pain is magnesium glycinate (32.6% among patients > 40 years and 29.4% among all ages). At the same time, the ineffectiveness of magnesium glycinate in cases of acute myocardial infarction, cardiac rhythm correction and community-based circulatory arrest has already been proven by scientists.

What needs to be addressed in emergency care, according to the expert recommendations

In addition to the general recommendations to increase the financing of the Emergency Medical Care system, the experts expressed the following:

• To devote attention to the system of training and certification training of emergency care medical personnel, in particular to create training centers in all regions of the country.

It is extremely important for the emergency care medical personnel’s training to have a practical nature. This is impossible without practical training and simulation of specific situations. Special mannequins and equipment are used in such training around the world to ensure that every movement has been repeatedly practiced and learned. In 2019 specially-equipped training centers will appear in the regions of Donetsk, Odesa, Ternopil, Poltava, Vinnytsia as well as in Kyiv.

• To develop requirements and provide resources for the establishment of emergency medical care departments in hospitals across the country

Effective emergency assistance is only possible provided that it is continuous and comprehensive. It is inacceptable to have a patient delivered to a hospital where he cannot be accepted. An emergency care department must be established in each intensive care hospital, where the patient will be able to receive a full range of diagnosis and treatment procedures within 24 hours. The requirements for equipment and personnel of such departments are developed by the Ministry of Health, they are to be approved next year. It will be the task of local authorities to provide or construct facilities for intensive care hospitals, as well as to procure the equipment required.

• To update the qualification and develop psychophysiological requirements for Emergency Care medical personnel.

Such measures will allow the Directors of the Emergency Care and Medicine Centers to conduct a human resources audit and ensure that professional and motivated employees are working in the system.

• The protocols of providing emergency care to the patients have to be revisited

Protocols are algorithms by which the emergency response team should examine the patient's condition, provide him with assistance and transport him to the hospital. Experts from the Ministry of Health have already begun work on the translation and adaptation of modern international protocols for emergency medical care. The list of medicines used in specific situations, as well as the sequence of medical personnel’s actions will undergo a revision as well in order to ensure that all modern practices are applied in the process.