ВОЄННО-МЕДИЧНА ДОКТРИНА УКРАЇНИ - MILITARY MEDICAL DOCTRINE OF UKRAINE

Oleg Shekera, 

 medical colonel of reserve

MD, Professor

 

Military Medical Doctrine of Ukraine 

  Protecting national security is of strategic importance for each independent country and takes priority in policy of its political and state institutions. The national security of Ukraine is aimed at the safeguarding of vital interests pertaining to the citizen, the society and State of Ukraine, the ensuring of favourable conditions for the existence and development of the nation, the preservation and enhancement of its material and spiritual values.

An important component and resource of the national security of Ukraine is a constant concern for improving the citizens’ health, including military personnel, ensuring the efficient functioning of the Armed Forces of Ukraine medical support system and other state security institutions as a combination of national and sectoral medical and social measures to create the military broad availability of medical care in peacetime and wartime.

These state functions performing under martial situation needs coordinated efforts and capabilities of the Armed Forces of Ukraine Medical Services in Ukraine and other security state institutions, and mobilization institutions of civil health and medical organizations other ownership within a single medical space about consolidated main regulatory instrument – the Military Medical Doctrine of Ukraine.

The Military Medical Doctrine of Ukraine is exclusively peaceful in nature and is based on the Geneva Convention Protection of War Victims.

 CHAPTER I

 

GENERAL PROVISIONS

Article 1. The Military Medical Doctrine of Ukraine (hereinafter - Military Medical Doctrine) is one of the main documents of strategic health planning in the State and is a system of officially accepted views on the state public health and army medical support during the preparation and during the armed defense of the country.

Article 2. The legal platform of the Military Medical Doctrine of Ukraine is the Constitution of Ukraine, Laws of Ukraine, Military Doctrine of Ukraine and other normative legal documents on healthcare, the state defense and the Armed Forces of Ukraine.

Article 3. The provisions of the Military Medical Doctrine of Ukraine extends to healthcare of the people, medical support for the Armed Forces of Ukraine and other state security sector institutions. It is the platform for the development of other normative legal documents and guidelines.

Article 4. The number of military and civilian health care institutions, involved for army medical support in wartime, is determined by the Government of Ukraine in accordance with the Laws of Ukraine.

Article 5. The Military Medical Doctrine of Ukraine defines the responsibilities of government bodies for the development of the medical service of the Armed Forces of Ukraine and civilian health care institutions and their capacity for health protection of individuals, society and the state in case of  internal and external military threats, involving the use of force or threat of force and the ability to resist.

Article 6.The following basic concepts are used in the Military Medical Doctrine:

medical service combat readiness is  general medical service readiness as well as  readiness of medical detached force, its institutions to perform the tasks of medical support for troops combat activity;

military medical education is  the system of well-directed training and education of different medical specialists in special military medical training institutions;

a serviceman is one of the categories of work forces which is required to perform its military functions;

military medicine is the field of medicine and health care, which combines  scientific knowledge (complex scientific disciplines) and practical activity of military medical service to provide comprehensive medical support;

Military Medical Service is a special organization that includes medical units, medical detached force, institutions, bodies of troops and control agencies for medical support of troops (forces) in peacetime and wartime;

military health care is a system of measures taken by the medical services of the armed forces, their officials, health care institutions, military medical and pharmaceutical specialists and servicemen to preserve and restore physiological and psychological functions, optimal efficiency and social activity of a serviceman;

State Disaster Medicine Service (hereinafter - Service) is a special type of state rescue service, whose main task is to provide free medical care for victims of emergency situation caused by a man-made impact and natural disasters (hereinafter - emergency), rescue workers and persons involved in the liquidation of consequences of emergencies;

Armed Forces recruitment is  a system of measures aimed at identifying and implementing ways of selecting personnel and sending it to the troops, and comprehensive training of service personnel, rational use of commanders during the service, training and maintenance of reserves;

medical and evacuation support is a  system of measures to provide medical care for the casualties, their treatment and preparation for further evacuation destination in war time;

medical and social expertise is a determination of the level of health loss of an individual which is based on the comprehensive examination of all body systems as well as determining the degree of physical dysfunction caused by persistent disorder of body functions, disability group, reason and time of its occurrence and according to personal health indicators recommending types of work and working conditions, the need for social care, appropriate types of sanatorial treatment and social protection for the most complete recovery of all physical functions of individuals;

medical care (in the field) is a complex of treatment and prophylactic measures implemented by military medical service in order to preserve life of the casualties, to prevent medical complications and  provide health resumption of patients for returning casualties to duty;

medical care is an activity of  trained health professionals, which is aimed at prevention, diagnosis, treatment and rehabilitation because of illness, injury, poisoning and pathological conditions, as well as due to pregnancy and childbirth;

medical rehabilitation is a system of medical measures which is  aimed at restoring impaired or lost body functions of a person,  identifying  and activating compensatory capacity of the organism to ensure normal life activity of a person, to prevent complications and relapses;

medical protection of Civil protection is a complex of healthcare measures for service personnel units and the population to maintain an adequate level of sanitary and epidemiological status of service personnel units, workers and employees of economic agents and the population, to provide timely medical care for the injured and patients and their evacuation and treatment, and prevention of  spreading infectious diseases;

health care is a system of measures by state and local government bodies and their officials, health care establishments, medical and pharmaceutical workers and citizens to preserve and restore physiological and psychological functions of individuals, optimal efficiency and social activity at maximal biologically possible individual's life expectancy;

paramedics (emergency technician) is a  certified specialist who works in emergency medical care, rescue service or military units and  is able to provide  emergency medical care in the prehospital stage;

returning to duty is  the return of servicemen to perform their duties in the Armed Forces after recovery, due to an injury or disease, which  means full restoration of their combat capability;

a wounded - a man (a servicemen) that  was injured  in result of  mechanical injurious effects, caused by cold and fire weapons;

principles of medical support are the  fundamental ideas, the most important recommendations on ways and forms of medical support to preserve, strengthen and restore strength and health of the service personnel which are the most important factors determining the high combat capability of the army;

vocational rehabilitation is a system of measures which are aimed at preparing individuals for professional work, restoring or gaining employability through adaptation, rehabilitation, training, re-training or job retraining with possible further employment and necessary social support based on personal inclinations and desires of a person;

mental health is a condition of well-being in which every person can realize their own potential, to cope with life's stresses, to work productively and contribute to the society;

rehabilitation is a socially necessary functional recovery, social and working adaptation of the patients, the injured and disabled by implementing  complex of medical, psychological, educational, professional, legal, governmental, social and other measures to return victims to normal life and work, according to their condition;

medical service resource is a number of personnel, property, equipment, units, formations and institutions of the Armed Forces Medical Service on responsibility of the chief medical officer;

social rehabilitation is a system of measures which are aimed at creating and providing conditions for the return of persons to active life, the restoration of social status and capacity for independent social and family activities through social orientation and adaptation, social provision of technical and other means of rehabilitation;

special medical training is theoretical and practical improvement of knowledge and skills of the personnel of the Armed Forces Medical Service in accordance with the specialty and the duties on organization and provision of medical support to the troops;

structure of the state security includes the Armed Forces of Ukraine, the Ministry of Internal Affairs of Ukraine, the Interior Troops Ukraine, the National Guard of Ukraine, the Security Service of Ukraine, the State Border Guard Service of Ukraine, the State Service for Special Communications and Information Protection of Ukraine, the Foreign Intelligence Service of Ukraine, the State Special Transport Service, the State Emergency Service of Ukraine, the Administration of State Guard of Ukraine;

territorial hospital base is a number of medical institutions that make up the group of civilian medical institutions, which are used for the treatment of wounded and sick servicemen;

injuries (in Military Medicine) are the human disabilities caused by physical, chemical or biological substances;

Civil Protection (CP) is a system of national defense activities carried out in peacetime and wartime to protect the population from possible enemy attack and sustaining the national economy and includes measures to protect the health of people from all modern weapons and provide medical care for the injured.

 Article7. The provisions of the Military Medical Doctrine can be corrected and adjusted within strategic planning in military and military medical fields.

 Article 8. The Purpose

 8.1. The purpose of the Military Medical Doctrine of Ukraine is to prevent and minimize casualty incidents, to protect and preserve life and health of the population, including the servicemen, which is achieved by creating a unified system of medical support the armed forces and population on the basis of an efficient level of organization, modern technical equipment, comprehensive resources supply.

 

CHAPTER II

THE FUNDAMENTALS OFORGANISATION OF MEDICAL SUPPORT TO THE ARMED FORCES

 Article 9. Principles of medical support to the armed forces

9.1. the Military Medical Doctrine of Ukraine is based on the following basic principles:

recognizing life and health of every citizen (servicemen) of Ukraine as the highest value;

recognizing the Armed Forces Medical Services and other state security sector institutions activity as one of the priorities of the society and the government;

upholding the rights and freedoms of  man and citizens (servicemen) in the field of healthcare, and keeping the related government guarantees;

guaranteeing the equality of citizens (servicemen), democracy and accessibility of health care;

developing and implementing state policy in the field of military and civilian medical education;

developing and implementing  state policy in the field of military medicine and civilian health care;

taking preventive and integrated approach to social, environmental and medical problems in health care;

focusing  on current standards of health and medical care, a combination of local traditions and international achievements in the field of military medicine and civilian health care;

taking systematic approach to the organization of the medical service of the Armed Forces and civilian health care while strategic planning;

unified approaches to organizational principles of the medical service of the Armed Forces Medical Services and other state security sector institutions, civilian health care institutions, regardless of subordination and complete use of the potential of macro conditions concerning  efficient medical support in wartime;

comprehensive and purposeful activity of the medical service of the Armed Forces and state security institutions, civil health care institutions;

forming an accessible, versatile and effective system of medical support to the Armed Forces, which provides medical care on an area basis through united efforts and coordination of military medical services involving mobilization and civilian healthcare institutions and medical organizations of all forms of ownership;

providing efficient medical and evacuation, sanitation and anti-epidemic measures, all elements of medical support on the basis of proper organization, the modern technical equipment, comprehensive resources supply;

ensuring mixed economy of military medicine and civilian health care and their multi-source funding combined with state guarantees;

ensuring high mobilization and combat readiness of the Armed Forces Medical Services and other state security sector institutions which means providing efficient transfer of peace in martial law and ensure the proper level of readiness for their use;

scientific, logistical, financial and economic substantiation of the activity of the Armed Forces Medical Services and other state security sector institutions, civilian health care institutions.

Article10. The requirements for medical support system

 10.1. The system of the medical support to the Armed Forces of Ukraine and other state security sector institutions, mobilization and civilian healthcare institutions and medical organizations of other forms of ownership within a unified medical space is based on: strict hierarchy and centralization; clear separation of functions; effective cooperation.

 Article 11. Organizational foundations of medical support

 

11.1. Organizational principles and effectiveness of the medical service of the Armed Forces and other structures of the security sector of the state and civil health care, building patterns and functions of medical support of the troops are determined by the Military Doctrine of Ukraine, the principles and provisions of the military and medical science.

11.2. Functioning of the system of medical support is based on:

preserving the required level of the population’s health as a determinant of readiness and combat capability of military forces of the State;

unified organizational requirements to methods of prevention, diagnosis and treatment of the sick and wounded (national medical standards, clinical protocols and military medical standards);

timeliness, continuity and sequence of medical care and treatment of the sick and wounded;

divarication of a unified medical-evacuation process into a number of successive interrelated activities that meet certain levels of care combined with the evacuation of the wounded and sick as intended;

echeloning and approaching of medical care, including specialized care to the wounded (sick) through the use of modern medical technology and reducing the number of of medical care stages;

the principle of territoriality in a single medical space of the country;

relative autonomy, high mobility of the forces and facilities of medical service of the Armed Forces and other structures of the security sector of the state and civil health care;

high combat and mobilization readiness (forming the required reserve), maneurability and rational use of the forces and facilities of medical service of the Armed Forces, other structures of the security sector of the state and civil health care;

maintaining constant readiness of the forces and facilities of medical service of the Armed Forces and other structures of the security sector of the state and civil health care concerning medical support of the troops;

optimization of national and sectoral medical and social measures (physical, psychosomatic and social rehabilitation to prevent disability and incapacitation, return to the Armed Forces or employment);

optimization of direct and indirect financial costs by reducing soldiers’ morbidity and mortality;

ensuring the constitutional rights of all categories of the population, including soldiers and their families.

 11.3. The Military Medical Doctrine of Ukraine determines the unity of views on organization, tactics and the application of forces and facilities of medical services of the Armed Forces and other structures of the security sector of the state and civil health care in wartime.

11.4. The strategic objective of medical services of the Armed Forces and other structures of the security sector of the state and mobilized institutions and civil health  facilities and medical organizations of other ownership is to bring their composition, structure and strength to the medical support of the troops (forces) in wartime.

 Article 12. Structure and main activities of the medical service of the Armed Forces of Ukraine

 

12.1. The organizational structure of the medical service of the Armed Forces of Ukraine depends on the organizational structure, objectives and nature of the hostilities and kind of the Armed Forces, the characteristics of health care as well as on the tasks assigned to its appropriate formations. The general management of the medical service is performed by the Armed Forces of Ukraine through subordinate military medical leaders.

12.2. Medical Service of the Armed Forces of Ukraine is to fulfil the tasks as follows:

medical support of  combat training of the troops (forces);

high level of combat and mobilization readiness of forces and facilities of medical service;

participation in the Armed Forces healthy replenishment;

organization and implementation of measures for the preservation and enhancement of personnel’s health;

sanitary and epidemiological support of the troops (forces);

delivery of health care and treatment of the military;

organization of combat training and advanced training of the  medical service personnel;

provision of the troops (forces) with  medical property;

military medical training, promotion of hygiene knowledge, healthy lifestyle;

scientific support for the system of medical support of the troops.

Article 13. Organization of medical and evacuation support 

13.1. Medical care is delivered to the wounded (sick)  at medical subdivisions of military units and formations, military and civil health care facilities which form the basis of the stages of medical evacuation. A number of medical evacuation stages, place of the deployment as well as types and quantity of medical care delivered are to be determined by the operational and combat conditions and size of losses.

13.2. The basic principles of medical evacuation deployment stages involve the maximum approaching to foci of health losses, echeloning and reducing the number during treatment and evacuation process.

13.3. The organization of medical diagnostic work involves a solution to the problems as follows:

optimization of the capacity and structure of  hospitals to meet the needs, given the characteristics of the region;

improving the efficiency of specialized medical care through the introduction of modern technologies, quantity and quality of medical care standards compliance;

distribution of interregional diagnostic and rehabilitation facilities (centers) network;

providing leadership of research institutions in development and implementation of advances in medical science, technology, innovative technology for the benefit of the Armed Forces.

13.4. Medical service of the Armed Forces of Ukraine and civil health care operate in a single medical space through the unified  state legislation regarding health care, compliance with national health standards, clinical protocols and military medical standards of care delivery.

 Article 14. Preventive principles of medical support system of the troops

14.1. Prevention contents of medical support system  is seen as a complex of state measures to create  healthy lifestyle and provide a favorable environment, the introduction of preventive technologies in health care settings and sanitary-epidemiological activity.

14.2. The state promotes the military and  general population’s healthy lifestyle through spreading scientific knowledge about health care, the organization of health, environmental and physical education, the implementation of measures aimed at improving hygienic culture of the  military and general population, creating the necessary conditions, including medical monitoring, physical training, sport and tourism, development of medical and athletic facilities network, dispensaries, recreation centers and other health facilities to combat harmful habits, establishing a system of social and economic incentives for people who lead healthy lifestyle.

14.3. In order to protect the military and  general population’s health, military and medical service and health care authorities and  institutions  are required to implement special measures for prevention and treatment of socially dangerous diseases (tuberculosis, mental health, sexually transmitted diseases, AIDS, leprosy, chronic alcoholism, drug addiction) and quarantine diseases.

Procedure for admission and treatment of patients, including those in the enforcement procedure is established by legislative acts of Ukraine.

14.4. Commanders at all levels are responsible for the implementation of measures to prevent disease and injuries in subordinate to the Armed Forces units and other structures of the security sector of the state.

 Article 15. Drug, procurement and logistic support

15.1.The condition and development of drug, procurement and logistic base of the medical support system depends on military-technical policy, economic opportunities of the state and developing national science in all areas and is to be provided through:

military medical orientation of  science, technology and innovation policy for the development of new medical technologies and new drugs, medical and technical means of dual use;

scientific, technical, information and resource independence, which involves the development and useof  medical devices, equipment and property of domestic production in wartime.

15.2. Production of new drugs and immunobiological preparations of dual use for medical purposes is allowed with the permission of the central executive body that implements the state policy in the field of health after establishing therapeutic or prophylactic efficacy.

The quality of medicines and immunobiological preparations of dual use is to meet the requirements of the  State Pharmacopoeia of Ukraine and specifications approved according to the established procedure.

The quality control of medicines and immunobiological preparations of dual use manufactured in Ukraine is to be carried out by the central executive body that implements the state policy in the field of quality control and safety of medicines.

15.3. Policy of drug, procurement and logistic base development of the  medical support system is to be based on the following activities:

availability, quality, safety of medical software as an important component of the military’social protection programs;

introduction of state protectionism policy for medicines and medical equipment of  domestic production (their compliance with European standards of quality and proven bioequivalence);

improving the system of control, standardization and certification of medical and pharmaceutical industries.

15.4. The system of standards in health care comprises state norms and industry standards.

15.5. State social standards in health care are governed by the Law of Ukraine “Regarding State Social Standards and State Social Guarantees”.

15.5. The industry standards in healthcare and military medicine include:

the standard of health care (medical standard) - set of rules, regulations and norms as well as values (indicators) of  appropriate type medical care quality,  which are developed based on world-class development of medical science and practice and accepted European standards;

military medical standard of  medical care (Military Medical Standard) -  set of rules, regulations and norms as well as values (indicators)of  relevant type medical care quality during the warfare, which are developed based on world-class development of medical science and practice;

clinical protocol is a unified document which specifies the requirements for diagnostic, therapeutic, preventive and rehabilitative methods of health care and the sequence;

table of material and technical equipment is a document that defines the minimum set of machinery, equipment and tools needed to equip specific type of health facility, the  affiliates and support  activities of individuals - entrepreneurs who conduct economic activity in medical practice in some specialty (specialties);

medicinal form is a  list of registered medicines in Ukraine, including drugs with proven efficacy, acceptable level of safety, the use of which is economically acceptable.

Industry standards in health care are developed and approved by the central executive body which provides public policy in health care and military medicine.

Meeting standards of medical care (medical, military- medical standards), clinical protocols, tables of material and technical equipment is required for all health care institutions in wartime and for individuals – entrepreneurs who conduct economic activity in health practice.

 Article 16. Socio-economic and legal components

 16.1. Social protection of the military involves meeting the requirements of  the Ukrainian legislation and the development of state legislation pertaining  medical support of the military.

16.2. Government policy is aimed at maintaining and improving the military’s  health and involves:

creation of appropriate living, working, rest and recovery conditions, appropriate level of financial security for the military;

implementation of state measures for environmental sanitation, environmental welfare;

responsibility of the State for the efficient operation of medical support, the preventive orientation;

restructuring the system of medical support of the troops;

meet the needs of the military in a guaranteed level of care;

funding of medical support at levels appropriate to the scientifically justified needs and adequate compensation of military and civil healthcare workers;

compulsory life insurance, health and social insurance of military and civil healthcare workers;

protection of professional, property, personal rights and other rights of medical professionals.

Article 17. Computerization of medical service 

17.1. Computerization defines the main directions of development and principles of information-analytical systems in military and medical service and includes the development and implementation in practice  new forecasting and analytical systems,  automation of technological processes of medical diagnostic and other types of military and medical services, automation of control, etc.

17.2. Computerization ensures the creation of appropriate information systems, including the management of medical service at all levels, creating the registry of the medical data of the military of the Armed Forces and other structures of the  security sector of the state (except for the Security Service of Ukraine, the Foreign Intelligence Service of Ukraine) as well as providing military entry of  medical information system to the state field computer network.                                               17.3. To identify the wounded, casuaties and killed and create a unified system of medical logistics (evacuation, treatment and rehabilitation) there is  applied a unified implanted electronic identifier of the individual.

Article 18. International cooperation and humanitarian law 

18.1. Ukraine participates in international  health cooperation, is a member of the World Health Organization (WHO) and other international organizations. The State guarantees the specified organizations the relevant  conditions of activity in Ukraine, promotes the expansion and deepening of Ukraine's participation in the held events.

18.2. Participation of military medical services in medical support of coalition and multinational forces.

18.3. International cooperation for the development and improvement of medical support.

18.4. General principles and requirements to the medical support of the troops are to be  developed and implemented on the basis of the legislation of Ukraine in Health, national medical standards and clinical protocols of care delivery given the requirements of the United Nations, WHO, Geneva Conventions On the Protection of Victims of War.

18.5. Unlawful restriction of international cooperation by the public authorities and officials may be appealed to the established order, including the court.

 Article 19. Integration and management of medical support

 

19.1. For the period of  local armed conflicts (counterterrorism) or during emergencies under the National Security and Defense Council of Ukraine there is established the Center of  Interagency Coordination of  Civilian and Military Health Care (hereinafter - the Center).

19.2. The Center provides operational management, interagency coordination and control in the system of medical support of the Armed Forces of Ukraine, other structures of the security sector of the state and participating institutions, civilian health facilities and medical organizations of  other ownership within a single medical space.

19.3. The authorithies and functions of the Center are developed and approved by the National Security and Defense Council of Ukraine.

19.4. The consolidated guidance of  medical support of the Armed Forces of  Ukraine and  other structures of the security  sector of the state and participating institutions,  civil  health facilities and medical organizations of other ownership within a single medical space in wartime is conducted by medical leadership of the Armed Forces of Ukraine.

 Article 20. The Authority and Responsibility for Management of Medical Support

20.1. The government develops the legal and regulatory framework of the medical services of the Armed Forces of Ukraine, other national security and civil health care system organizations, ensures its implementation and provides finance and resources provision in accordance with the needs of medical support for the forces and civilians in wartime.

20.2. The medical services of the Armed Forces of Ukraine, other national security and civil health care system organizations develop joint regulations and policies concerning the implementation of the provisions of this Doctrine, apart form the required set of capabilities and means of medical services of the Armed Forces, other national security and civil health care system organizations, train state order for the required number of medical and logistical resources, create and keep in constant readiness certain number of the forces and means of medical service.

20.3. The Ministry of Health of Ukraine together with the Ministry of Defence of Ukraine creates and maintains a certain amount of local hospital bases according to their powers for medical support for the forces and civilians in wartime.

Article 21. The financial and resource support

21.1. The State Budget of Ukraine and local budgets allocated to the health care are used to provide a guaranteed level of public health care, funding for the state target and local health care programmes and fundamental research studies on these issues.

21.2. The finance and resources provision for the medical service of the Armed Forces and other national security organizations is guaranteed and realized on the basis of target budget financing with economically sound its combination with the insurance and other forms of financing. The medical services of the Armed Forces and other national security organizations provide achieving an optimal level of medical, social and economic efficiency.

21.3. The medical service of the Armed Forces and other security state institutions, civil health care are equipped health medical equipment and technology mostly dual-use module-based and modern sanitary equipment, ensuring their autonomy and mobility. Equipment (upgrading) of the Medical Services of the Armed Forces and other security state institutions, civil health care are provided through software-based method.

21.4. The state provides guidance of industry of the countries to meet the individual needs of the Medical Services of the Armed Forces and other security state institutions, civil health care in the design and production of domestic land, water and air transport, which easily adapts to the needs of the evacuation of the wounded and sick.

21.5. The state forms the rational volumes immutable and mobilization stocks to provide Medical Services of the Armed Forces and other security state institutions, civil health care.

21.6. The state provides the servicemen with reasonable guaranteed hospital volume and participates in their compulsory life insurance, medical and social insurance.

21.7. To maintain and improve conditions, increase the quality of medical care delivery for servicemen there was made provision for additional extrabudgetary funding sources, including introduction of medical insurance of persons serving and working in the Armed Forces of Ukraine and other national security organizations, and military retirees.

21.8. Health care facilities and health services subjects of management of the Armed Forces and other security state institutions, civil health system, producing required for support of health care facilities on medical support military personnel and civilians in wartime, enjoy tax and other benefits provided by the law.

21.9. Subjects to mandatory health insurance: military personnel, certain categories of employees of the Armed Forces and other security state institutions, volunteers.

21.10. Compulsory health insurance is on the principles of:

provision, regardless of health status and income of the insured persons, equal right to access to care provided by insurance contributions;

health care free of charge;

creation equal conditions for health care providers regardless of ownership level playing field in the market of mandatory health insurance;

provision of state-guaranteed funding og the compulsory health insurance;

targeted use of the compulsory health insurance funds;

medical care of insured persons in accordance with sector’s standards in the field of military health care;

parity state representatives, insured persons and insurers in the management of compulsory health insurance;

inevitability liability of insured persons, insurers and health care providers for offenses committed in the compulsory health insurance.

21.11. Compulsory health insurance of military personnel provides by Military insurance company and\or insurance companies, members of the medical-insurance pool and\or insurance company that has received this accreditation.

21.12. Nothing in this Doctrine may be interpreted as being aimed at narrowing the duty of the State to ensure adequate funding of medical care of military personnel, including the reduction or cancellation of existing programs in this area.

 Article 22. Scientific Support

 Scientific support of the medical service of the Armed Forces of Ukraine and other national security organizations is carried out by the National Academy of Medical Sciences of Ukraine together with the Ministry of Defence of Ukraine, Ministry of Health of Ukraine, Ministry of Education and Science of Ukraine and other relevant ministries and agencies which:

organize and direct activities of the research institutions and establishments of Ukraine on solving the problems of military medicine;

ensure the development and implementation of modern medical technologies of medical care, treatment and rehabilitation of servicemen and civilians in the event of injuries, traumas and diseases, both in the field and at the hospital;

carry out scientific support of the development of national medical equipment, property and dual-use technical equipment, medical and maintenance products for the Armed Forces of Ukraine and other national security organizations.

22.2. Formulation and implementation of the state target programmes of civil and military medicine using their scientific and technological potential by encouraging fundamental, applied and exploratory research for the medical support of the Armed Forces of Ukraine and other national security organizations.

CHAPTER III

STATE DISASTER MEDICINE SERVICE

Article 23.

23.1. To provide emergency medical assistance for the populations suffered natural and man-caused emergencies in peacetime there was created State Disaster Medicine Service.

23.2. The State Disaster Medicine Service (hereinafter – the Service) is formed:

at the national level – the Ministry of Health of Ukraine (hereinafter – MH of Ukraine);

at the regional level – the Autonomous Republic of Crimea, regional, Kyiv and Sevastopol city state administrations.

23.3. The key tasks of the Service are:

provision of free medical care in the prehospital and hospital stages for victims of emergencies, rescue workers and persons involved in the emergency recovery;

relief of the medical and sanitary consequences of emergencies;

participation in the organization of the complex of sanitary and anti-epidemic measures in the areas of emergency situations, which are carried out by Sanitation Service of MH of Ukraine;

cooperation arrangements of medical forces, aids and medical institutions according to the national and regional level in the field of population health protection in the event of emergencies;

coordination of the activity on preparedness of public health authorities, communications and reporting systems to the emergencies;

prediction of the medical and sanitary consequences of emergencies and development of recommendations for the implementation of the measures concerning the reduction of the negative impact of such situations;

accumulation and analysis of information on the medical and social consequences of emergencies within Governmental Information and Analytical System for emergencies;

creation and rational use of the reserve of material and technical resources for the accomplishment of measures of the Service at the national and regional level;

participation in the preparation and certification of medical units and their personnel;

conduction of research projects related to the improvement of forms and methods of providing emergency medical care in case of emergencies.

23.4. Operating modes of the Service are set depending on the extent and characteristics of the emergency, which is predicted or has happened.

23.5. Medical and evacuation support in the relief of the medical and sanitary consequences of emergencies is organized on the basis of the staged treatment of victims, which provides medical care in the area of emergencies and during medical evacuation, evacuation to medical establishment where the victim receives adequate treatment of the lesion. During the medical evacuation medical units of the Service, which are deployed on the evacuation routes, ensure reception of victims, provide certain regulated for this stage level of medical care and prepare to the further evacuation.

23.6. Cost funding associated with the operation of the Service is carried out within the appropriations provided for in the State Budget of Ukraine, republican budget of the Autonomous Republic of Crimea and local budgets for the health care, through the charitable contributions of corporate and private persons, as well as other non-prohibited legislation funding.

23.7. Prevention and treatment facilities which are part of the Service, form and accumulate operational reserve of medicines, medical supplies, etc. for work during the relief of the medical and sanitary consequences of emergencies through and within the funds allocated for their maintenance.

CHAPTER IV

POPULATION PROTECTION

Article 24. Training of the Population and Medical Personnel

24.1. Increased military medical training is carried out in the following areas:

military medical education of the population;

training paramedics;

training, retraining and advanced training of medical and pharmaceutical workers of the civil health care;

training, retraining and advanced training of medical and pharmaceutical workers for the purposes of the medical services of the Armed Forces and other national security organizations.

24.2. Military medical education of the population (servicemen, reservists, unfit for military service and socially disadvantaged groups) is developing skills in first aid.  

24.3. Training of the population is realized by relevant specialized secondary and higher educational and research establishments, as well as certified institutions of different proprietary forms.

24.4. Organize and implement a system of paramedical care in Ukraine.

24.5. Training, retraining and advanced training of medical and pharmaceutical workers is realized by relevant specialized secondary and higher educational and research establishments, institutions of advanced training and retraining, as well as the internship, residency, specialization, postgraduate and doctoral studies by law on education.

24.6. Training, retraining and advanced training of medical and pharmaceutical workers for the purposes of the medical services of the Armed Forces and other national security organizations is realized at the Ukrainian Military Medical Academy and relevant specialized secondary and higher educational and research establishments, institutions of advanced training and retraining on the state order . The level of training and qualification of medical personnel must meet nationwide requirements and standards, modern developments in science and technology and peculiarities of medical support of the forces.

24.7. Educational plans and programmes of training, retraining and advanced training of medical and pharmaceutical workers and paramedics in the prescribed manner are agreed with the central executive body that provides forming public policy in education and health care.

24.8. Combat training of the personnel of subdivisions, units, establishments and regulatory bodies of the medical service of the Armed Forces and other national security organizations to carry out their tasks concerning medical support of combat operations is realized according to the troops training.

24.9. Medical personnel is taken on the military records according to their training profile and is included to the mobilization reserve. 

Article 25. Medical, Biological and Psychological Protection of the Population

25.1. Medical protection states:

major directions and ensuring sanitary and epidemiological welfare of the population;

medical assistance to the victims of emergencies, rescue workers and other persons involved in the accident rescue operations and other emergency operations;

medical and psychological rehabilitation of the victims;

identification of the need for measures to prevent adverse impact of hazards and environmental consequences of emergencies, as well as conditions of occurrence and spread of infectious diseases on public health.

25.2. Medical aid is assumed to the medical service of civil protection (CP), which is a special organization in the system of health care and is designed to ensure medical support of the population suffered natural disasters, accidents and catastrophes. It performs the following tasks:

timely provision with all types of medical care and treatment of victims for their full recovery;

prevention of contraction and spread of mass infectious diseases among the population;

provision of sanitary protection of the population and overcoming the adverse sanitary effects of industrial accidents, natural disasters or modern weapon of destruction used by the enemy.

25.3. Biological protection of the population, animals and plants involves setting epidemic, anti-epizootic and anti-epiphytotic regimes and their enforcement by business entities, health care institutions and the population.

25.4. Measures of psychological protection of the population are aimed at reducing and neutralizing negative mental states and reactions among the population in the event of threats and emergencies.

Article 26. Mental Health Support

 26.1. Public mental health protection in Ukraine requires:

standardizing the world evidence-based protocol care;

modern paradigm of mental health taking in account the personality’s affection by  psychotrauma and admitting the human being ill or mentally ill;

implementing the program of raising awareness in mental health in general, and posttraumatic stress disorder, in particular;

preventing alcohol and drug consumption;

coordinating stakeholder (ministries and agencies, non-governmental and voluntary organizations, designated companies) relations in the field of mental health;

establishing the National Database of traumatic events relief (personnel, institutions, logistical support).

26.2. Public mental health protection system in Ukraine includes:

the military and their families;

children and elderly people;

people with special needs;

internally displaced people;

people affected by stressful factors;

people rendering assistance to victims.

 Article 27. Sick, Injured and Wounded Rehabilitation

 27.1. The rehabilitation is required for patients:

after injuries and in musculoskeletal deformities, cardiovascular, neurological and psychiatric disorders;

in acquired defects;

after surgery;

in infectious and chronic diseases.

27.2. The main objectives of the rehabilitation are:

functional recovery (full or compensation in case of  incomplete recovery or when there is no recovery);

adaptation to daily life and work;

job involvement;

follow-up monitoring of the patients.

27. 3. The rehabilitation process includes three interrelated components, i.e.  medical, social (common) and professional (operating).

27.4. The complex of individual rehabilitation action is carried out over inpatient treatment and is continued after discharge in the rehabilitation centers, specialized health centers, clinics etc.

27.5. Rendering prosthetic care.

The military are provided with prostheses, orthopaedic appliances, prescription glasses, deaf-aids, physical therapy facilities and wheelchairs for disabled people on account of budget and insurance funds.

The priority list of the victims who are not military is fixed by the legislation of Ukraine.

27.6. Ukraine's national rehabilitation policy:

providing the coordination of the rehabilitation system, that is realized through the timeliness, consistency and comprehensiveness of the remedial measures and techniques, as well as the availability of rehabilitation technical and other means and medical supplies, rehabilitation services; their content, level and volume conformity to the physical and mental capabilities and the state of health of sick, wounded and disabled people;

regulating the legal, economic and social conditions of rendering rehabilitation services to the disabled people and disabled children taking into account their functional abilities, healthcare products requirements, technical and other convalescent facilities;

ensuring logistical support, financial assurance, staff assistance and science service of the  rehabilitation system;

determining the conditions for occupational skills recovery or acquisition, education, occupational therapy and resettlement taking into account the functional abilities of disabled people, assistance in the business processes and non-governmental organizations activities;

providing equal terms for  the rehabilitation institutions regardless of which departments they are subordinate to, the pattern of ownership, to rehabilitate sick, wounded and disabled people;

formulating requirements for social infrastructure and information to create the unhindered access for disabled people by removing natural, communication and architectural barriers;

promoting the participation of non-governmental organizations, including the non-governmental organizations of disabled people in the formation and implementation of the national rehabilitation policy.

27.7. The implementation of the national rehabilitation policy is vested in the executive authorities and local self-government; in association with non-governmental organizations they  provide for the development and fulfillment of the programs for the prevention of disability, create the conditions for eliminating the human functional defects and disorders by means of the medical, psychological and pedagogical, physical, vocational, occupational, sports and physical training, social therapy of the disabled people.

Chapter V

BRINING UP TO STRENGTH OF ARMED FORCES

 Article 28. Brining Up to Strength of Armed Forces

28.1. The priority of the Armed Forces manning and equipping is to make full use of centralized staffing and to upgrade the recruitment.

28.2. The citizens of Ukraine are divided into the following universal military duty categories:

young men below the conscription - people who are subject to be registered at the military recruiting station;

conscripts - people who are registered at the military recruiting station;

the military - people who serve military obligations;

military reservists - people who are reserved.

28.3. The universal military duty includes:

military service training;

mobilization designee assignment;

military induction and military entrance;

active duty by order or voluntary military service;

reserve military service;

abidance by military registration rules.

The wartime universal military duty includes the general mandatory training obligation of the citizens.

28.4. There are three recruiting subsystems: occupational selection of servicemen; manpower training; reserve training and holding.

28.5. The occupational selection of servicemen determines the service aptitude rating; it carries out such tasks as:

determining the medical fitness of the young men below the conscription;

determining the medical fitness and qualification of the conscripts to serve military obligations in accordance with the current legislation (potentially fit for military service);

determining the armed forces demands for the service manpower, selecting the required number of people among those who are potentially fit for military service; sending them to the disposal of the troops;

selecting the required number of people among those who are potentially fit for military service whereas the servicemen health status and qualification allow them to take in the commander sergeant education and training program, identifying their possible further education.

The training and maintenance of the reserves are provided in accordance with the Military Doctrine of Ukraine.

 Article 29. Military Physician Expertise

 29.1. The military physician expertise qualifies conscripts, the military and military reservists; infers the cause-and-effect relationships between the diseases, wounds and injuries and military service; it ascertains if the military need medical and social rehabilitation and aid, and specifies the conditions conducive to that goal.

29.2. The military physician expertise is carried out by the military physician boards, including the representatives of military registration and enlistment offices, the health care facilities of the Ministry of Defense of Ukraine, the Security Service of Ukraine and other military forces, the State Service for Special Communications and Information Protection of Ukraine.

29.3. The procedure for organizing and conducting the military physician expertise is established by the Cabinet of Ministers of Ukraine.

 Chapter VI

GENERAL ISSUES RELEVANT TO HEALTHCARE PRACTITIONERS AND PHARMACISTS ACTIVITIES

 Article 30. Professional Duties of Military and Civilian Healthcare Practitioners and Pharmacists

30.1. The military and civilian healthcare practitioners and pharmacists are 

responsible for:

favoring health protection and promotion, prevention and treatment of diseases, rendering timely and professional medical assistance;

rendering free emergency medical care to the military and the citizens of Ukraine in peacetime and in time of war;

raising public scientific and medical awareness, promoting a healthy lifestyle, as well by personal example;

keeping up with demands of professional ethics and deontology, keeping doctor-patient confidentiality;

improving their knowledge and skill;

providing advisory assistance to their colleagues and other health professionals.

30.2. The state provides the reputation of the military and civilian healthcare practitioners and pharmacists medical activities in peacetime and in time of war.

 Article 31. Doctor-Patient Confidentiality

 31.1. The healthcare practitioners and other people who, being bound by a general professional duty of confidentiality, obtain information of the disease, medical supervision, examination and its results, the privacy of a citizen, have no right to release the confidential information, except as required by the applicable legislation.

31.2. When using the confidential information in teaching, research work, including its publication in the literature, one should ensure anonymity of the patient.

 Article 32. Consent to Medical Intervention

32.1. The consent of the informed patient is required to apply the methods of diagnosis, prevention and treatment. If the patient is under the legal age (under 14) or the patient has been declared legally incapable, the medical intervention is carried out subject to the consent of their legal representatives.

32.2. The consent of the patient or his/her legal representative to medical intervention is not required only if there is an instant danger to life of the patient, on conditions that it is impossible to obtain the consent of the patient or his legal representatives for reasons beyond control.

32.3. If the absence of the consent can lead to the drastic consequences for the patient, the doctor is bound to warn. If being warned the patient turns down treatment, the doctor is entitled to take the patient’ written confirmation, and if it is impossible to obtain, the doctor is entitled to register the refusal with the appropriate report in the presence of witnesses.

32.4. An absolutely competent patient is entitled to turn down the treatment.

32.5. If the refusal is given by the legal representative of the patient, and it may lead to the drastic consequences for the patient, the physician should inform the custody and guardianship agency.

 Article 33. The state health care control and supervision in the Armed Forces of Ukraine and other national security structures

 33.1. Through the offices of designated authorities the state supervises the execution of the compliance on the health care, state standards, criteria and requirements aimed to protect the environment and sanitary-epidemiological welfare of the military, the health care standards of professional activities, the requirements of the State Pharmacopoeia, standards of medical service, medical supplies and technologies.

33.2. The healthcare authorities and facilities are required to facilitate the realization of the citizens' right of participation in managing health and carrying out the expertise on these issues.

33.3. Under the jurisdiction of the healthcare authorities and facilities (except the Security Service of Ukraine, the Foreign Intelligence Service of Ukraine) there can be created public advisory or steering committees to facilitate their work and ensure public awareness and control in health care.

33.4. To determine the content and ways for fulfilling the state special-purpose and local health care programs, to implement the appropriate specific measures, address personnel, scientific and other matters concerning the government activities arrangement there can be involved health care public organizations and other associations of citizens, including the international ones.

 Chapter VII

FINAL CLAUSES

Article 34. Final Clauses

34.1. The implementation of the Doctrine makes it possible to create common national medical area and increase the efficiency of the military medical support system in peacetime and in time of war; ensure the public access to health care; gives support to the medical component of the combat readiness; enables to bolster logistical situation; to supply the mobilization needs of the medical service of the Armed Forces and other security structures, the civil health care of human and logistical resources; to optimize the operationally ready date in time of war.

34.2. The Doctrine underlies the legal framework of the medical service of the Armed Forces and other security structures, the civil health care in peacetime and in time of war.

34.3. The provisions of the Military Medical Doctrine of Ukraine may be revised and supplemented when creating and implementing the state policy in the field of the national security and defense and the health care of Ukraine.

33.4. The implementation of the Doctrine is carried out by the Cabinet of Ministers of Ukraine and the state government bodies by virtue of the authority vested in by the Constitution and laws of Ukraine.

34.5. People guilty of violating the Military Medical Doctrine of Ukraine are subject to civil, administrative or criminal sanctions by law.