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Medical Emergency Response
*H Hendro d W Wartatmo t t
1
Medical Emergency Response
Hospitalisation area
Transportation - Transfer
Damage area
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Pusbankes – 118 -Pusat Siaga Bantuan Kesehatan –118 ( Centre of Emergency Support ) -Collaboration of Emergency Dept. of all hospitals in Jogjakarta Province. -Networking of Pre-hospital Emergency Services
Red Cross/Red Crescent Community Health Post H pit l Hospital
Health Center Field Hospital
3
Medical Emergency Response
Pre Hospital Hosp.
Hospital Hosp.
Hosp.
Reff. Hosp. Hosp.
p Hosp.
Hosp.
Local management 4
2
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Pusbankes – 118 Pra Hospital DP ( regional )
Control & Coordination ( sectoral )
Regional Management
( Intra ) Hospital Response
Pre Hospital DP ( Local ) Control & Coordination ( regional )
Sectoral Management
Medical Emergency Response
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Initial Assessment • • • • • • •
M = major incident standby / declared E = exact location T = type of injury H = hazard, present and potential A = Access N = number of casualties E = emergency services, present and required 6
3
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Major Injury Medical and Management Support • • • •
C ommand S afety C ommunication A ssessment
• T riage • T reatment • T ransport
Management Suport
Medical M di l Suport
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Regional Management • • • •
Coordinating Team Medical team Surveillance Management back up
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Disaster Plan
Pre Hospital Disaster Plan M = major incident E = exact location T = type yp of injury j y H = hazard, A = Access N = number of cas E = emergency services, present and
Hospital Disaster Plan • • • • • • •
C ommand S afety C ommunication A ssessment T riage T reatment T ransport
Regional Disaster Plan • • • •
Coordinating Team Medical team Surveillance Management back up
required 9
Partisipasi masyarakat pd penanggulangan bencana • Tingkat Ti k pengendali d li • Tingkat pimpinan satuan kerja • Tingkat pelaksana • Fase tanggap darurat • Fase Pemulihan • Fase Kesiagaan
• Military Mili • Government • Non Government Organization ( NGO ) • Private Sector • Academia
• Profesional Profesional,, • Petugas Petugas,, • Relawan 10
5
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Response of Health Sector
Control and Coordination
Medical Responses
Administration Back up
Logistics Management
Public Health Responses
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Trunkey’s curve Trauma deaths
Immediate deaths
0
1
2
hours
Early deaths
3
4
5
6
Late deaths
1
2
3
4
weeks 12
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Lesson Learnt from Merapi eruption, 1994 No victims attended by medical personnel during evacuation
No pre-hospital emergency system Time needed : 2 years Leader : Director of GenHosp National meeting : 4 Local meeting : ? Strategy : joint corp..
Pusbankes - 118 13
Pusbankes – 118 • • • • •
• • • •
Road accident Airplane crash Riot Fire
ATLS* ( 1996 ) ACLS* ( 1996 ) Basic Life Support ( 1996 ) Emergency Physician ( 2000 ) : General Emergency Life Support ( 2002 )
1994 - 2003 14
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Meulaboh, 2004 Solidarity Humanity
Isolated City: Blocked communication Destroyed y land roads Destroyed runway Insecure situation Distance Finance Professionalism
Delay of Responses
Low resilience Lack of buffering g & absorbing g capacity p y No pre-existing emergency system / networking Lack of Health Services No preparedness
Relatively Slow Recovery And Development 15
Bantul, 2006
- Wrong scenario for Preparedness - Large number of victims - Bantul as “ open “ area
- Good transportation - Good communication - Pre-existing of emergency services networking - Quick response of local, regional and international team
Rapid Responses but U Uncoordinated di t d Works
Quick recovery
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Lessons Learnt from Bengkulu g Earthquake, q 2007 from Padang Eartquake Eartquake,, 2007
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Lessons Learnt : • “ The problem of disaster response was not
lack of any single resources but inadequate management “.
Regional Management !
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Disaster Response Team • • • • • • •
SARS, 2003 Bali Bombing I, 2003 Tsunami, Aceh, 2004 Landslide, Banjarnegara, 2005 Earthquake, Bantul, 2006 Tsunami, West Java, 2006 E th Earthquake, k B Bengkulu, k l 2007
2003 - 2007 19
Military – Civil Collaboration during Disaster Response: a Lessons learnt from volunteer’s perspective.
Hendro Wartatmo Center of Public Health Management Faculty of Medicine – Gadjah Mada University HAD R TTX, Armatim – US Navy PACFLEET, 2009
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Advantages of Military • • • • •
Secure budget Specialized equipment Specialized equipment Trained and quickly deployable workforce Self sufficient Highly organized and hierarchical structure ( Damon P Coppola, 2007: Introduction to International Disaster Management
• Tradition of publishing their work Surgical Response to Disaster. Surgical Clinics of North America, June 2006,vol 86, No 3 Guest ed.: LTC Robert M Rush, Jr, MD 21
Disadvantages of Military Role • • • • •
Can not be absolutely neutral Fixed command Difficult access for volunteer Difficult personal aproach to local people Mistaken image / perception of community
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Earthquake 2006, Jogjakarta: The firm order.
When more than 2000 victims and their families surged the hospital within 10 hours, hours transfer of victims and pile of garbage became the problems which needs more personnel. This shortage of personnel can not be fixed by the arm forces because there was no order to do it. The volunteer then fixed it.
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What Expected from Civil ( Volunteer ) – Military Collaboration • Open policy concerning the collaboration in the form of: – – – – –
Coordination Transportation support Protection / Safety Data sharing Joint operation
• Expected to take places not only during acute phase, but also during preparednes
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Management Course • Non N Degree D • S1 • S2, S3
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Summary 1. 2. 3. 4 4.
Disaster Responses p must be relied on Local capacities. p Local networking is mandatory. All aids activities should be conducted to support the local capacities, not to replaced it. Volunteers have a special place in disaster response Evaluation and Development of the National concept and guideline on DRR must be performed systematically . 26
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Thank You
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