Cite as: Archiv EuroMedica. 2022. 12; sp: e1. DOI 10.35630/2022/12/sp.iss.5
The article focuses on the need for the integration of civil and military medical institutions into the unified medical space of Ukraine. It substantiates the development of a holistic system of medical and evacuation support for the troops in combination with the resource capabilities of the civil health care system. It also defines the necessary prerequisites for the development of such a system, namely unity of views on the organization, tactics and procedure for the use of forces and means of medical services, and the capacity of civilian health care facilities for medical and evacuation support of military personnel.
The Article describes specific management approaches regarding the medical and evacuation support capabilities of the Armed Forces of Ukraine (AFU) that will contribute to the implementation of efficient medical and evacuation measures and adequate support as well as measures for the medical protection of military personnel, etc. It also proves the importance of defining and clearly demarcating levels of medical care and required resources and considers the possibility of working out interdepartmental civil and military cooperation as well as refining the system of medical and evacuation support for servicemen of the Armed Forces of Ukraine in the conditions of the unified medical space of Ukraine.
Keywords: medical and evacuation support for the Armed Forces of Ukraine, unified medical space, medical service forces and means, health care management.
During the period of martial law, the achievement of the strategic goals in the implementation of the military medical doctrine of Ukraine regarding the organization of medical and evacuation support for the Armed Forces of Ukraine in the conditions of the unified medical space is of particular importance.
Therefore, the issue of implementing state policy regarding the organization and development of the medical and evacuation support system for the Armed Forces of Ukraine in the conditions of the unified medical space based on international standards, at the current stage requires scientific supervision and relevant research aimed at the implementation of Ukraine's European integration aspirations in the field of national security and defense.
In the conditions of the full-scale war waged by Russia against Ukraine the issue of creating a competent system for medical and evacuation support of the AFU and other defense forces, capable of efficient and rational use of medical resources within the framework of the unified medical space, deserves special attention.
The challenges in the organization of medical and evacuation support for the AFU and other military formations in the field of national security and defense are highlighted in the works of such Ukrainian scholars as A. Bakay, V. Bily, M. Bilous, A. Verba, P. Volyanskyi, A. Gudyma , K. Gumenyuk, V. Dorosh, V. Zahovskyi, V. Ivanov, Ya. Radish, G. Roschin, G. Tsimbalyuk, etc.
The purpose of the study is to generalize organizational principles and methodological approaches to solving a complex of interdepartmental issues regarding the organization and development of the system of medical and evacuation support for the Armed Forces of Ukraine.
The research uses the data from official international standards, guidelines and protocols developed by international non-governmental organizations and expert-analytical centers that carry out activities in the field of Tactical Combat Casualty Care (TCCC) . The main methods of research include bibliographic, semantic and analytical methods for the analysis, generalization and systematization of legislation and regulatory legal acts of Ukraine that regulate state and sector-specific processes of civil-military cooperation; system and functional analysis of the organization of military management structures activities and medical support for the Armed Forces of Ukraine; methods of observation, forecasting, and generalization.
The military medical doctrine of Ukraine, as a document of a strategic nature, emphasizes "the formation of a holistic system and appropriate measures for the medical and evacuation support for troops (forces) in combination with the resource capabilities of the civilian health care system" . This includes a number of provisions on the organization of medical assistance to sick and wounded servicemen at the third and fourth levels of medical and evacuation support. These measures are carried out, mainly, in institutions of the civil health care system, which corresponds to the specified levels of medical care .
According to the order of the Ministry of Defense of Ukraine dated 10 December 2019 No. 624 "On Amendments to the List of Military Administration Bodies, the Jurisdiction of which Extends to the Entire Territory of Ukraine", formation of the Medical Forces Command of the Armed Forces of Ukraine provides for the unification of the medical service under the single leadership of the Medical Forces Commander, who reports to the Commander-in-Chief of the Armed Forces of Ukraine .
The basis of the health care system for military personnel is the medical services (military medical units, military health care institutions, and management bodies for medical and evacuation support). One component of this system is also a certain number of health care institutions of the civilian health care system. Medical services conduct their activities in the unified medical space of the state by complying with legislation in the field of health care, medical care standards, and clinical protocols .
The unified medical space of Ukraine is a system of organizing medical care which unites all medical resources of the state through joint management and specific financing mechanisms. This approach ensures availability, quality and efficiency of all types of medical care to all citizens of Ukraine, including military personnel .
Therefore, the integration of the system of medical and evacuation support for the troops into the unified medical space of Ukraine involves a functional combination of the forces and means of medical services and the system of health protection of the civilian population with the aim of maximally realizing their capabilities in terms of effective medical support for the troops. The structure of the forces and means of the medical services and the system of medical and evacuation support for the troops must ensure the preservation and strengthening of the servicemen’s health, timely and efficient provision of medical assistance in case of wounds, injuries and illnesses, and the fastest possible restoration of combat capability.
As for medical assistance to wounded (sick) servicemen, it is provided at those stages of medical evacuation where it can be provided in the shortest time and to the fullest degree. By type, medical assistance is provided in medical units of military bases and compounds, health care facilities, taking into account available forces and means and possibilities for medical evacuation. Medical subunits and health care facilities serve as the basis for the formation of medical evacuation stages (medical and evacuation support levels), while the number and place of their deployment, and the type and scope of medical care are determined by the conditions of the operational and combat situation and the scope of sanitary losses.
The modern understanding of the role of servicemen in the process of medical and evacuation support is that all servicemen are not only objects, but also full and equal participants, i.e. subjects of medical support. They should have practical skills in providing pre-medical care as self-help or mutual help according to the international standards of the TCCC "Tactical Combat Casualty Care" .
The implementation of advanced practices and international standards of medical support for the Armed Forces of Ukraine is implemented at the strategic management level by developing and implementing a number of regulatory documents. In particular, the Decree of the President of Ukraine dated September 17, 2021 No. 473/2021  approved the Strategic Defense Bulletin of Ukraine, a key document related to the resource provision of the Armed Forces of Ukraine.
The functional capacity of the system of medical and evacuation support of the Armed Forces of Ukraine in modern conditions of martial law has the following implementation characteristics:
In accordance with the National Security Strategy of Ukraine  as well as the Military Security Strategy of Ukraine , the Strategic Defense Bulletin of Ukraine defines the main capabilities of the defense forces that need to be achieved, and the strategic goals of their development for the period until 2025, their main tasks and expected results of their achievement.
As for the strategic goals of the defense forces development, their implementation involves performance of specific tasks. For example, strategic goal 4 provides for the development and efficiency of the medical evacuation support system, which meets the needs of the Armed Forces of Ukraine for repulsing armed aggression against Ukraine. Task 4.6., in particular, envisages the creation of an efficient medical and evacuation support system that can ensure appropriate staffing of the troops (forces) with personnel fit for military service in terms of health, preservation of life, and strengthening of the servicemen’s health. It also stipulates timely provision of high-quality and efficient medical care, and maintenance of combat capability of troops in accordance with international standards .
The expected result of the strategic goals for the defense forces development should be the creation of a system of medical and evacuation support for the Armed Forces of Ukraine, an increase in the level of interdepartmental coordination of the medical services of the defense forces in the unified medical space, and an increase in the capacity of the forces and means of medical support.
This includes, in particular, improvement of planning for the purpose of efficient management of forces and means of medical and evacuation support for troops (forces) at the adequate levels, and ensuring clear coordination and interaction of the activities of the defense forces’ medical services of the, and the public civil health care system for efficient and rational use of medical resources.