HISTORY OF THE FORMATION OF HIGH ART OF MODERN MILITARY MEDICINE OF UKRAINE

HISTORY OF THE FORMATION OF HIGH ART OF MODERN MILITARY MEDICINE OF UKRAINE Mykhailo BADIUK, Ukrainian Military Medical Academy, Kyiv (Ukraine), Igor BIRYUK, Higher State Educational Establishment of Ukraine „Bukovinian State Medical University”, Chernivtsi (Ukraine), RESEARCHER ID B-4028-2017 ORCID 0000-0003-3032-8202 Bogdan ZHUPAN, National Military Medical Clinical Centre, Kyiv (Ukraine), Igor TSYRKOT, Iryna KUKOVSKA, Tatyana SYKYRYTSKA, Higher State Educational Establishment of Ukraine „Bukovinian State Medical University”, Chernivtsi (Ukraine) ISSN: 2411-6181(on-line); ISSN: 2311-9896 (print) Current issues of social studies and history of med cine. Joint Ukrainian-RШmaЧiaЧ scieЧtific УШurЧaХ, 2017, No:2(14), P. 117-122 UDK 61:355(091)(477) DOI 10.24061/2411-6181.2.2017.52 History of medicine І ія е ц н


History of medicine
Introduction. The urgency of studying the problems of the formation history of military medicine at the present stage of development is due to the fundamental qualitative changes in warfare and significant restructuring in the organizational structure of the armed forces. Any illconsidered reforms of military medicine can cause new problems during military operations and this radically changes adopted rules and regulations on the organization of medical support of troops. Therefore, there is a need for careful study of the past experience of military medicine and its further usage according to the todaв's requirements. Detailed study of modern military medicine offers a rich material for theoretical generalizations and practical consequences of opening patterns and trends in the principles development of medical care, and how to predict the future direction of military medical science.
Nowadays defense reform in Ukraine is carried out under hard military-political, operational-and-strategic and economic conditions as a result of military aggression of Russia against Ukraine, the occupation of the sovereign territory of Ukrainethe Autonomous Republic of Crimea and Sevastopol by the Russian Federation. The transformation of the Armed Forces of Ukraine and its medical service is going on under conditions of warfare on the part of the Donetsk and Lugansk regions within the framework of antiterrorist operation (ATO). Despite the difficulties of the present and relatively short (25 years since Ukraine gained independence) historical period, Ukrainian military medicine has already had extremely difficult way of transformation. At the same time, given the level of acquired own experience and its direct impact on the organization and principles of medical support of the armed forces in the ATO, it became possible to improve significantly and upgrade the measures and means of providing medical care in the prehospital phase.
The objective of the study is an attempt to analyze some methodological issues that point to approaches to the investigation of connections and relationships in the history of national military medicine and how it can be used for explaining certain events and facts that affected essentially the major milestones of the present stage of the military medicine formation and development.
The object, materials and methods. The object of the research is the medical support system of the Ukrainian Armed Forces and the methods of the study are system and historical analyses. Legislative, legal and regulatory docu-ments related to reforming the medical support system of the Ukrainian Armed Forces serve as materials of the given research. Scientific publications with information on reforming the military have also been used. Philosophical methods are a means of disclosure of military history and medical measures and promote the full use of the whole arsenal of knowledge to disclose the patterns of the processes and phenomena development in the history of military medicine.
Results and discussion. In accordance with the documents (the reform program and development of the Armed Forces of Ukraine), the development of the Armed Forces of Ukraine is officially 1 divided into five main stages: 1st (1991)(1992)(1993)(1994)(1995)(1996) the basis formation of the Armed Forces of Ukraine;2nd (1997-2000 development of the Armed Forces of Ukraine;3rd (2001-2005 reform of he Armed Forces of Ukraine; 4th (2006-2012)development of the Armed Forces of Ukraine; 5th (from 2013)improvement of the Armed Forces of Ukraine. Of course, the aforementioned division of historical periods that meets the terms of government programs is rather conventional. However, in our opinion, this division is logical because all state programs were formed by the new leadership of the Armed Forces of Ukraine introducing certain mechanisms of financial support.
According to O. Melnyk 2 , the first stage of the Ukrainian Armed Forces development, in general, was characterized by the simultaneous introduction of administration control structure, the creation of the legal framework, the structures and number troops reduction. This phase began with the adoption of relevant Resolution by Verkhovna Rada of Ukraine, August 24, 1991 3 which took control of "all militarв units stationed in the republic" started the creation of a national army and Ministry of Defense. The first attempts of reformation or transformation of the military grouping of the former Soviet armв didn't have a clear strategic vision for the future model of the national army and, thus, were limited mainly to indiscriminate cuts. The magnitude of the reduction was unprecedented: only in the first five years of independence over 3500 different military structures, almost 410,000 people personnel have been reduced. The number of weapons and military equipment was significantly reduced: combat aircraftby 600 units, helicoptersalmost by 250, tanks and armored combat vehicles were reduced by 2400 and 2000 respectively. From 1992 to 1996 the number of troops was reduced by 48% and to 370 thousand people. In parallel with the processes taking place in the Armed Forces of Ukraine, there was a transformation of military medicine.
The main objectives of the military medicine establishment during the first phase of laying the foundations of the Ukrainian Armed Forces (1991)(1992)(1993)(1994)(1995)(1996) were the following: a) awareness of the need for a modern health care system; b) formation of the highest governing body; c) the concept development of combining disparate types of medical services of the former USSR Armed Forces; d) examination of ways of the plan practical implementation.
After The first results of a new system of medical provision were not the only association of separate health services into a single national health service of the Armed Forces, but also the governing body exclusion (MMMD) from the direct subordination of the Ukrainian Armed Forces Rear, resulting in further medical care formation as a separate species of comprehensive troops support.
In the same period, creation of a national system of military medical education and research in Ukraine begins. The decision of the Cabinet of Ministers of Ukraine dated August 19, 1992, №490 "On the Reform of Militarв Education" stated: "p.9. To the Ministrв of Education, Ministrв of Health and the Ministry of Defensefor preparing officers with specialties that are not in military schools, to form a Military Medical Branch (MMB) at the Ukrainian State Medical University at the military departments of the Kiev Medical Institute and the Kiev Institute of improvement of doctors eliminated".
Later this date was seen as establishing the Day of Ukrainian Military Medical Academy. According to the order of the chief of General Staff of Ukraine an organizational group, which began processing the MMB staff, methods and techniques of teaching and educational process, curricula and training programs for students, approval and introduction of the MMB staff, was formed. The enormous preparatory work made it possible to conduct a first intake of students and adjunct in July-August, 1993.
Furthermore, the teachers of Military Department of Bogomolets Kiev Medical Institute, Kyiv Institute of Postgraduate Doctors, and military doctors who come from Ukraine and served in the various regions of the former Soviet Union and returned to his native Ukraine, played a fun-damental role in the organization of this work.
In a further development, the decision of the Cabinet of Ukraine dated October, 16, 1995, №820 "On Creation of Ukrainian Militarв Medical Academв" was officiallв recognized the fact of the Ukrainian Military Medical Academy (UMMA) establishment, determined the organization and system components of military medical education and science in Ukraine. The UMMA first chief became a candidate of medical sciences (MDin 2002), Professor (2003) Vladimir Pasko. In July, 1994, the Ukrainian military medics got the emblem of medical servicethe staff of Asclepius, a snake entwined and a wreath and viburnum leaves, embedded in the bottom of the Armed Forces of Ukraine Emblem.
The Thus, during the period of forming the foundations of the Armed Forces of Ukraine (1991)(1992)(1993)(1994)(1995)(1996), Military medicine of Ukraine has managed to form a "skeleton" of the health care system, has got a capable governing body and has come from the Armed Forces of Ukraine Rear subordination and introduced its own training of personnel resources.
The According to the State program of construction and development of the Armed Forces of Ukraine, measures to further reform of the military health service, reorganization and improvement of medical support in peacetime and wartime were conducted. However, in this period a number of unpopular measures on planned reduction of medical units, establishments and personnel was carried out. Only in the period from 1996 to 1999, the medical service of the Armed Forces of Ukraine held a number of organizational measures for the disbandment and reorganization of 141 military medical units, eliminated all kindergartens (49), which were held by state health service. In result of organizational activities medical service personnel number was reduced to 62% of the total.
During 1998 such administration verticals as medical diagnostic, sanitary-epidemiological and medical supplies vertical were actively developed. The levels of medical service were determined: Main Military Clinical Hospital (MMCH), Kyivhighly specialized medical care; Central Military Hospital (in Odessa, Lviv, Chernihiv, etc.)specialized medical care; basic hospitalsspecialized and qualified medical care; garrison military hospitalsquality medical care. The main essence of the formation of diagnostic and treatment vertical was an organization of care and treatment in the area of responsibility of health care institution for the specified level (regardless of species identity).
Due to the permanent downsizing of medical services (primarily due to military hospitals), typical staffing hospitals at the appropriate levels were developed. If necessary, there were personnel cuts military hospital, the latter was transferred to the state hospital of a lower level. Temporary provisions on the organization of the military hospitals on a territorial basis were developed.
In order requirements of the Ministry of Defense of Ukraine territorial principle of medical care giving in established Kiev and Vinnitsa military medical centers was prac-tically implemented. In particular, the task of creating new functional association (Kiev Military Medical Center) were defined innovation of: the creation of medical-and-economic and legal foundations of the system of medical provision on the territorial principlethe development of regulations, guidelines, medical standards development, implementation and monitoring of quality of medical care giving; reorganization of primary health care through the mechanism of territorial districts; reorganization of hospital care for periods of patient care and more.
The system of medical care for the territorial principle was later approved by the Minister of Defense of Ukraine. According to this order for the first time, using the territorial principle of health care, respective military units, regardless of their specific submission, were assigned to the military hospitals.
Under Military medical service within the specified period continued the development of a new health care system, and to solve it, four major objectives were set: • improve the health of militarв personnel; • improve the qualitв and efficiencв of medical care; • more efficient use of available resources; • ensure free access of militarв personnel, their families and military retirees and population to modern means of diagnosis and treatment.
For this purpose creation of a unified military medical service in the administration of three verticals: medical diagnostic; sanitary and epidemiological; military medical supplies and two systems: military medical education and research, was envisaged.
The special features of the medical service of that period include the active participation of Ukrainian military doctors in international activities and medical support peacekeeping contingents. As of 2003 Ukrainian peacekeepers were in Kosovo (323 troops) and Iraq (1621 people), Sierra Leone (680 people), Lebanon (657 people), where medical care was organized with the requirements of the UN and NATO and presented by medical units of the first and second levels. Medical support of Ukrainian peacekeeping contingents provides with 132 medical professionals, including doctors -51, nursing staff -63, nurses -18 people.
Based on years of experience, a concept of medical support of Ukrainian peacekeeping contingent has been developed and implemented.
At the end of the third stage of reforming the Armed Forces of Ukraine for 2003-2005. a significant amount of current events in the Armed Forces of Ukraine was held: conducting of the Defense Review and implementation of defense planning; completion of the transition to Brigadierforces battalion structure; beginning of functions separation of the Ministry of Defense and the General Staff and the beginning of a gradual transition to civilian Ministry of Defense. During this period, there was a transition in the Armed Forces of Ukraine, from the four-typed structure in three-typed one: 1. Army; 2. Air; 3. Naval forces. However, there was a further reduction in the total number of Armed In June 2005, the Military Medical Department of the South and West operational command (OC) were reorganized into Regional Medical Administration (RMA) and subordinated directly to the Department of Health of the Ministry of Defense of Ukraine. The following tasks were put at the regional medical administrations: organization of medical support training and daily activities of the region troops (forces); interaction with operational commands and main types commands of Armed Forces of Ukraine on troops medical support (forces); control and coordination of treatment and diagnostic process in medical institutions in the region.
In accordance with the requirements of Directive the Ministry of Defense of Ukraine, medical service identified basic prospective indices of formation of "Reformation Programme of medical provision system of Armed Forces of Ukraine for the period 2006-2011".
To improve medical support of military units and efficiency of medical care under the territorial principle, the experiment was conducted in military units and institutions of Kiev and Vinnitsa garrisons, to improve the efficiency of medical staff usage. The basis of the experiment was the idea to include doctors and nursing staff of medical units to staffs (outpatient departments) of military hospitals. The use of medical personnel in the military units was viewed as a business trip to the hospitals. Thus, the chief of a military hospital was assigned responsibility for all health care units in the zone of responsibility.
Since the beginning of the fourth phase (2006 -2012), governing body of the Armed Forces of Ukraine enhanced significantly its legislative work. Among the set of priority measures, conducted by military medical service, there was, reorganization of the Central Military Clinical Hospital in Military medical clinic regions centers (MMCC) (Western, Central, Southern, Northern, Crimean and Main) with determination of regional areas of responsibility; RMA of OC dissolution and introduction of MMCC staffs, in June 2007, operational health departments (OHD), which served as the governing body of the medical support on a defined territory; establishment of the regions (except the Main -Kyiv) of five military mobile hospital (MMH) at MMCC; establishment of Scientific Medical Council at DHC of the Ministry of Defense of Ukraine ; establishment of the regional evacuation and transport departments at MMCC; creation of air-transport unit of air ambulance; reforming of military health centers in rehabilitation centers with relevant specialized departments and others.
It should be noted that the implementation of the Program of development of medical support of the Armed From 2013 the final stage of development (stage of improvement of the Armed Forces of Ukraine) began whose starting point could be the approval of the Strategic Defence bulletin of Ukraine. Of course, this was preceded by extensive and painstaking work of central executive bodies, involved in solving the problems of security and defense of Ukraine. However, with the beginning of the aggression of Russia (2014) in the south and east of Ukraine, statute of the aforementioned defense bulletin was abolished and gradually lost their validity.
At the request of President of Ukraine Decree №240 / 2016 dated June 6, 2016, a new Strategic Defence Bulletin of Ukraine was put into operation. It identified the need to establish the principles and standards adopted in the statesmembers of NATO, effective, mobile, equipped with modern weapons, military and special appliances of Defense forces with model of the year 2020, which can ensure state defense as well as respond adequately and flexibly to military threats to Ukraine's national security, using efficiently the available capacity (ability) and resources of the state.
The main direction of further development of military medicine defined by objectives and major tasks of defense reform is to develop a system of medical support of the Armed Forces of Ukraine, capable to support all components of the defense forces of the state.
Conclusions. 1. The study made it possible to determine the phasing of military medicine of independent Ukraine, to identify the main achievements and challenges accompanying the transition process. 2. In conducting the investigation of medical provision and effectiveness of medical care to wounded and sick in a particular war or military operation, it is necessary to consider the decisive influence of the complex of factors, among which the leading role belongs to the nature of the society's political system and level of economic development. 3. During the period of forming the foundations of the Armed Forces of Ukraine (1991)(1992)(1993)(1994)(1995)(1996), Military medicine of Ukraine has managed to form a "skeleton" of health care sвstem, got competent governing bodв and come from subordination of Ukraine's Armed Forces Rear and introduced its own training of personnel resources.