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IMPLEMENTASI SISTEM EMS DI INDONESIA
Tantangan dan Solusinya
ANGGUN SETYARINI,S.Kep.,Ns.,M.Kep.
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DOSEN JURUSAN KEPERAWATAN
POLTEKKES KEMENKES MALANG
PENDIDIKAN
▪ S1 PSIK FK UNIVERSITAS GADJAH MADA
▪ S2 PSMK FK UNIVERSITAS BRAWIJAYA
PELATIHAN KEGAWATDARURATAN
▪ BTCLS EMT 118 SURABAYA
▪ BLS/ACLS AHA
▪ TRIAGE OFFICER
▪ CODE BLUE
SEMINAR DAN SIMPOSIUM
▪ EMNAS and 1st PARAMEDIC ASIA, MALAYSIA, 2019
▪ ASMEN HIPGABI, YOGYAKARTA 2019
ANGGUN SETYARINI,S.Kep.,Ns.,M.Kep.
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OUTLINE
KONSEP EMS
IMPLEMENTASI DI INDONESIA, TANTANGAN & SOLUSI
KIAT MENYIAPKAN PUBLIKASI HASIL RISET
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PERNAHKAH KITA MENJUMPAI KEJADIAN SEPERTI INI?
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DATA KASUS PREHOSPITAL DI
DUNIA
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SISTEM EMERGENSI
MEDICAL SERVICES (EMS)
Sistem komprehensif yang
menyediakan personil, peralatan
dan fasilitas untuk memberikan
pelayanan dan keselamatan, yang
terkoordinasi, efektif dan tepat
waktu pada korban yang
mengalami trauma maupun pasien
yang tiba-tiba menderita serangan
akut dari penyakitnya.
(Al-Shaqsi,2010).
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MODEL EMS DI DUNIA
Model Franco-German Anglo-American
Jumlah pasien • Mayoritas dirawat di
tempat kejadian
• Prinsip “stay” and
“play”
• Mayoritas dibawa
ke RS
• Prinsip “load” and
“go”
Petugas Dokter di bantu
paramedis
Paramedis dengan
pengawasan dokter
Tujuan utama Membawa pelayanan RS
ke rumah
Membawa pasien ke
RS
Unit yang dituju
saat transport
pasien
Instalasi perawatan IGD
Negara yang
menerapkan
Jerman, Perancis, Yunani,
Ausrtria
US, Kanada, Australia
Al-Shaqsi, S. (2010). Models of International Emergency Medical Service
(EMS) Systems. Oman Medical Journal, 25(4). doi: 10.5001/omj.2010.92
Swedia mengembangkan
NURSE-LED MODEL , yaitu
menghadirkan perawat dalam
pelayanan EMS (Jonas,2018)
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14 KOMPONEN PENDUKUNG
BAGI BERJALANNYA SISTEM EMS
1. INTEGRASI SISTEM LAYANAN KESEHATAN
2. RISET
3. LEGISLASI & REGULASI
4. SISTEM KEUANGAN
5. SDM
6. MEDICAL DIRECTION
7. SISTEM PENDIDIKAN
8. EDUKASI MASYARAKAT
9. PREVENTION
10. AKSES PUBLIK
11. SISTEM KOMUNIKASI
12. PELAYANAN KLINIS
13. SISTEM INFORMASI
14. EVALUASI
Chapleau, W. (2010). Emergency First Responder: Making The
Difference. Canada: Mosby.
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IMPLEMENTASI SISTEM EMS DI
INDONESIA
PERMENKES RI NO. 19 Tahun 2016 Tentang Sistem
Penanggulangan Gawat Darurat Terpadu
Pasal 5
(1) Untuk terselenggaranya SPGDT dibentuk:
a. Pusat Komando Nasional (National Command Center); dan
b. PSC
(2) Pusat Komando Nasional (National Command Center)
sebagaimana dimaksud pada ayat (1) huruf a berkedudukan di
Kementerian Kesehatan, berada di bawah dan bertanggung
jawab kepada Direktur Jenderal.
(3) PSC sebagaimana dimaksud pada ayat (1) huruf b harus
dibentuk oleh Pemerintah Daerah Kabupaten/Kota.
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TANTANGAN IMPLEMENTASI SISTEM EMS DI
INDONESIA
Permenkes No. 19 Tahun 2016 Pasal 2
SPGDT bertujuan:
1. Meningkatkan akses dan mutu pelayanan Kesehatan
2. Mempercepat waktu penanganan (respon time)
Korban/Pasien Gawat darurat dan meruunkan angka
kematian serta kecacatan
Semakin pendek respon time berarti semakin cepat dan baik
pelayanan yang diberikan (Coster et al,2017).
Time is brainTime is life Time is
muscles
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RUMUSAN MASALAH & TUJUAN PENELITIAN
MenganalisisHubungan
faktor lingkungan
“Apakah faktor yang berhubungan
dengan total waktu prehospital pada
pasien yang ditangani PSC 119 Kabupaten Purworejo?”
Rumusan Masalah
faktor klinis
Faktor yang paling dominan
Faktor sistem
Tujuan :
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5
Memperluas manfaat sosial dan ekonomi
4
Kesehatan dan sektor Kesehatan
3
informasikebijakan & pengembanganproduk
2
Penelitian di masa yang akan
datang
Produksi pengetahuan
1
MANFAAT PENELITIAN(Donovan & Hanney, 2011; Frank & Nason, 2009)
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MERANGKUM LITERATUR
440 | pISSN: 1858-3598 eISSN: 2502-5791
Jurnal Ners Vol. 15, No. 2, Special Issue 2020 http://dx.doi.org/10.20473/jn.v15i2.19786
This is an Open Access article distributed under the terms of the Creative Commons
Attribution 4.0 International License
Systematic Review
Influence Factors of Emergency Medical Services (EMS) Prehospital Time Interval Variety: A Systematic Review
Anggun Setyarini1, Heni Dwi Windarwati2
1 Health Polytechnic of Ministry of Health, Malang 2 School of Nursing, Faculty of Medicine, Universitas Brawijaya
ABSTRACT
Introduction: Prehospital time interval was one of important indicators of EMS performance. It consisting of total prehospital time (TPT), response time (RT), on-scene time (OST) and transport time (TT) in the world is very diverse. Many factors were able to affect the duration of prehospital time. The purpose of this systematic review was to identify internal and external EMS factors that affect prehospital time which was useful as a predictor of the prehospital time interval variety.
Methods: This study was conducted with a systematic method by reviewing the literature obtained from four electronic databases namely ProQuest, PubMed, ScienceDirect, and Google Schoolar. Seven keywords were used to get some of relevance literatures. Using PRISMA flow diagram, the literatures were screened by three inclusion criteria: original research article, published in the 2007-2018 timeframe, discusses EMS prehospital time interval and the factors that influence it.
Results: Seventy-five literature were obtained, of which 14 articles met the requirements for analysis. Factors influencing prehospital time variations can be classified as two. First, internal factors which include: facilities and infrastructure, human resources, and service protocols. Second, external factors which include: natural and non-natural environment, and the patient's clinical condition.
Conclusion: Investigation at prehospital time intervals and influential factors is useful in developing evidence-informed in assessing EMS performance and correcting the obstacles found. This review also identifies the gaps in the existing literature to inform future research efforts.
ARTICLE HISTORY
Received: Feb 27, 2020 Accepted: April 1, 2020
KEYWORDS
EMS; influencing factors; prehospital time
CONTACT
Anggun Setyarini [email protected] Health Polytechnic of Ministry of
Health, Malang
Cite this as: Setyarini, A., & Windarwati, H, D. (2020). Influence Factors of Emergency Medical Services (EMS) Prehospital Time Interval Variety: A Systematic Review. Jurnal Ners, Special Issues, 440-451. doi:http://dx.doi.org/10.20473/jn.v15i2.19786
INTRODUCTION
Prehospital emergency services are fast becoming the needs of all countries in the world. The speed of prehospital time (PT) and Emergency Medical Services (EMS) are important to be assessed and discussed (Brown et al., 2016; Golden & Odoi, 2015). There are three compelling reasons to investigate the achievement of prehospital time in the world. First, the achievement of PT or EMS total prehospital time (TPT), which includes response time (RT), on-scene time (OST), and transport time (TT), varies greatly in each country, so different studies on the various
causes are needed. Second, the speed at which officers provide assistance determines patient safety. The speed of staff time is correlated with "time is life" in out-of-hospital-cardiac-arrest (OHCA) patients, "time is brain" in stroke patients, and "life-saving and limb-saving" for trauma patients (Paravar, Hosseinpour, Mohammadzadeh, & Mirzadeh, 2014; Puolakka, Vayrynen, Erkkila, & Kuisma, 2016b). Third, achieving prehospital time can be an important indicator in evaluating EMS performance (Rahman et al., 2015). In the past, response time was the only reliable indicator of performance because it was objective, easily measured and easily understood by
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KERANGKA KONSEP PENELITIAN
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POPULASI
• Seluruh catatan
pasien th 2018 =
385
• PSC 119
• PSC 119
Purworejo
• Januari s.d.
Februari
2019
LOKASI & WAKTU PENELITIAN Desain
Retrospective
Chart Review (Vassar &
Holzmann, 2013)
METODE PENELITIAN
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ANALISIS DATA
Univ
ari
at
Biv
ari
at
Multiv
ari
at
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RESEARCH FINDING
FAKTOR LINGKUNGAN
✓ Ada hubungan antara
faktor lingkungan (lokasi)
dengan TWP.
FAKTOR KLINIS
✓ Tidak Ada hubungan
faktor klinis (Jenis
kasus, dan level triase)
dengan TWP.
FAKTOR YANG DOMINAN
✓Lokasi merupakan
faktor yang paling
berhubungan dengan
TWP.
FAKTOR SISTEM
✓ Ada hubungan waktu
pelayanan & integrasi unit
respons dengan TWP.
✓ Tidak ada hubungan antara
jumlah intervensi dengan
TWP.
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SOLUSI
Improving Response Units Integration a Related Factor to
Total Prehospital Time (TPT) on Patients of Public Safety
Center (PSC) 119 in Purworejo Regency, Indonesia
Anggun Setyarini1, Respati S Dradjat2, Heni Dwi Windarwati2
1Nursing Postgraduate Program, 2School of Nursing, Faculty of Medicine, Universitas Brawijaya
ABSTRACT
Background: RapidresponseandappropriatemanagementofPublicSafetyCenter(PSC)119teamisvery
necessary for patients who experienced trauma or serious illness in prehospital area. The aim of this study
wastoidentifytheresponseunitsintegrationasrelatedfactorswithtotalprehospitaltime(TPT)ofPSC119
inPurworejoRegency.
Material and Method: ThisresearchwasconductedbyRetrospectiveChartReview(RCR)designon105
patientswhotreatedbyPSC119inPurworejoRegency.BivariatetestwasconductedbyusingSpearman
correlation test to investigate the correlation with response unit integration.
Results: Themajorityofpatientsweretraumabytrafficaccident(57.1%).ThefastestTPTwas9minutes
and the longest was 105 minutes with an average of 30.85 minutes. Bivariate test results demonstrate that
responseunitsintegrationhadavalueofp=0.000(r=0.387).Itmeantthattherewassignifica ntcorrelation
between response units integration with TPT.
Conclusion: ThisstudysuggeststhePSCleaderstoimprovetheintegrationbetweenthecallcenterunitwith
responseunits.Theimprovementofnurses’capacitythroughnursingspecialisteducationandadvancedlevel
trainingofprehospitalemergencywereveryimportantforoptimizingthequalityofprehospitalintervention.
Theresultofthisstudywasusefulinthefutureasthebasicinformationforresearch,educationandservice
of prehospital emergency.
Keywords: Public Safety Center ,Total Prehospital Time, Indonesia Prehospital Management
Corresponding Author:
Anggun Setyarini
NursingPostgraduateProgram,
FacultyofMedicine,UniversitasBrawijaya
Email:[email protected]
Introduction
Trauma contributed for 12% of disease burden in the
world,withthenumberofpatientsreachupto5million
(1). Most of trauma patients dead in prehospital phase (2).
Dataofmedicalcaseshowsmorethan356,000patients
who suffe
r
edout-of-hospitalcardiacarrest(OHCA)
annually in the US (3).Coronaryheartdiseaseandstroke
are expected to increase up to 23.3 million in 2030 (4).
Traumaduetotrafficaccidents(TA)inIndonesiaduring
2016reached108,696cases,31,195peopledied,35,285
inhabitantsgotsevereinjured,and108,945inhabitantsgot
mildinjuries(5). Data of medical case shows the number of
diagnosed patients with coronary heart disease at the age
15yearsoldisestimatedat2,650,340millionpeople(4).
The patients with hypertension that are not diagnosed in
societytotaled63.2%oftotalexistingprevalence(25.8%)
(6). People who are diagnosed with diabetes mellitus (DM)
totaled2.1%,increasefromthedatain2007.Thisindicated
thattheriskofcardiacemergencyduetohypertensionand
diabetes also increase.
The potential for emergencies due to trauma
or serious illness in prehospital area increase the
community’sneedforEmergencyMedicalServices
(EMS) system. The EMS service starts from the call
centeroffice rthatreceivesemergencycall,thenconduct
dispatchtheEmergencyMedicalTechnician(EMT),
paramedic or nurses who has been trained to intervene
in Basic Life Support (BLS) or Advanced Life Support
DOI Number: 10.5958/0976-5506.2019.02142.9
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KEBIJAKAN & PENGEMBANGAN PRODUKq Penguatan perda,
q Pengembangan pelatihan gadarprehospital
q pengembangan Strategi model pelayanan PSC
q Penguatan & penambahan jejaring first responder.
KESEHATAN & SEKTOR KESEHATANq Supervisi TWP membantu
pe pelayanan
q Survival rate
q Tersedia data untuk upaya
kes. preventif di
prehospital.
PENELITIAN YANG AKAN DATANG
q Dasar pengembanganpenelitian selanjutnyamix methods
KELUASAN MANFAAT SOSIAL & EKONOMI
qMendorong pembiayaanuntuk peningkatankapasitas petugas
q Mendorong peningkatananggaran yang memadaibagi tersedianya alat danbahan untuk pertolongandasar dan lanjutan.
PRODUKSI PENGETAHUAN
qpublikasi nasionaldan internasioanal
qBahan kajian ilmiahdi seminar danbuku-buku panduanprehospital
IMPLIKASI PENELITIAN
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MENYIAPKAN PUBLIKASI
PENELITIAN
1. Menyiapkan topik yang menarik, unik dan bermanfaat.
2. Mengumpulkan referensi dari data base yang terpercaya (misal:
Proquest, EBSCO, Pubmed, Sciencedirect)
3. Lakukan critical appraisal pada artikel yang akan kita gunakan
sebagai referensi.
4. Mempelajari gaya penulisan pada artikel yang dimuat dalam
jurnal bereputasi yang akan kita tuju.
5. Menulis artikel dari bagian yang termudah yaitu Metode, hasil,
Introduction, dan Discussion.
6. Perbaiki kebiasaan menulis kita. Gunakanlah format S-P-O-K. Hal
ini sangat membantu dalam proses alih Bahasa (translation).
7. Menggunakan citation manager (seperti: aplikasi End-note, atau
Mendeley)
8. Pilih jurnal yang akan kita tuju, IKUTI AUTHOR GUIDLINE-nya.
9. Jangan ragu untuk berkomunikasi dengan editor bila ada masalah
atau hal yang tidak dipahami.
10.BERANI MENCOBA, DAN TIDAK BOSAN BELAJAR