Challenging journeys: Artesans ResQ strengthens Ukraine’s capacity to provide safe transport for critical care patients

Illia Bilokonov is a Ukrainian anaesthetist. He is also Medical Director of Artesans-ResQ, a German nongovernmental organization (NGO) operating in Ukraine. Since the beginning of the war, their small team of highly skilled specialists has been working around the clock to provide medical transfers for critically ill patients who must undertake journeys of often hundreds of kilometres by ambulance or intensive-care unit (ICU) bus to specialized hospitals.

Artesans-ResQ has been collaborating closely with WHO under a European Union (EU)-funded project, with the Medical Evacuation (Medevac) Coordination Unit of the Ukrainian Ministry of Health, and with the national Emergency Medical Services (EMS). Together they are building country capacity at each stage of critical-care transfer, from patient preparation to in-transit care to handover at the receiving health facility.

The organization has played a crucial role in the development of medevac processes, especially for intensive-care patients and paediatric/neonatal patients. They are also coordinating intensively with other partner organizations and the Ukrainian centres for emergency medical care and disaster medicine to ensure that each patient is matched with the right mode of transport and the correct level of expertise to support them.

Critical care transfer: a crucial stage

Illia works long shifts alongside a team of 20 other critical-care transfer experts. The day after a gruelling journey, he explained the life-saving work of Artesans-ResQ.

"Yesterday, we transferred a patient with severe trauma; he had a shrapnel injury to his head that he received near the frontline in Donetsk. There he received first aid, but he needed to go to the big regional hospital in Dnipro where there is a CT scan and specialist care. That's a distance of 300 kilometres."

After assessing the patient's condition at the hospital, stabilizing him and preparing him for transfer, the 3-person team of driver, doctor and paramedic began another challenging journey.

Artesans-ResQ monitored the patient's condition throughout, managing sedation and pain killers before delivering him to the specialized health-care facility. There, he was diagnosed with a haematoma - bleeding in the brain - and underwent emergency surgery.

Besides people with life-threatening injuries, Artesans-ResQ also transfers severely ill cancer patients and even fragile newborn babies.

"When we deliver the patient to the specialist hospital, I feel good, because we are part of a bigger mechanism. Our work is a crucial stage in the process," says Illia.

Embedding critical-care transfer skills into the national workforce

Through the EU-funded project, between September 2023 and January 2024 Artesans-ResQ trained 54 national EMS workers on an 11-day critical-care transfer course that they developed, which includes a train-the-trainer programme.

From September 2024, with support from WHO and the Norwegian Agency for Development Cooperation (NORAD), they will provide a second cycle of this hands-on training that covers a broad range of medical scenarios.

Working with WHO, the Ministry of Health and regional EMS directors, the team also developed a minimal-standards recommendation for a critical-care transfer system for Ukraine. These guidelines will strengthen the provision of services throughout the country.

Illia is positive about this collaborative process: "I never knew that you could work with high-level organizations as a team. It's been a pleasure to work with WHO every day."

Although Artesans-ResQ is a German NGO, it is committed to localizing its life-saving mission by setting up a Ukrainian branch of the organization, employing local staff and training Ukrainian EMS personnel.

"We are grateful to the Artesans-ResQ team for their incredible contribution to the development of the Ukrainian EMS," said Khrystyna Grynkiv, a doctor and EMS physician from Lviv, in western Ukraine. "After completing the course, we are actively applying the knowledge we acquired, both in the training of employees and in our everyday activities."

Nataliia Dorosheva, Head of the Training Department at the Zaporizhia Region Centre for Emergency Medical Care and Disaster Medicine, explained, "The training by Artesans-ResQ has shown that standardization of clinical protocols in critical-care transfers is crucial."

She added, "Having procedures and protocols in place, we will be able to train medical staff involved in patient transportation accordingly and apply standardized procedures at each stage of patient care, during transportation and handover."

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