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Medical Emergency ResponseMedical Emergency ResponseMedical Emergency ResponseMedical Emergency Response

* H d W t t* H d W t t* Hendro Wartatmo* Hendro Wartatmo

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Medical Emergency Response

Damagearea

Transportation- Transfer

Hospitalisationarea

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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

H pit lH pit lHealth Post

Red Cross/Red Crescent

Community

HospitalHospital

Field Hospital

Health Center

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Medical Emergency ResponseMedical Emergency Response

Pre HospitalPre Hospital

Hospital Hospital

Hosp.

Hosp.

Hosp.

Hosp.

Hosp.

Hosp.

Reff.Hosp.

p

Local management4

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Control &Coordination ( sectoral )

Pre Hospital DP ( Local )

( Intra ) Hospital Response

Pusbankes – 118Pra Hospital DP ( regional ) Regional Management

DP ( Local )Response

Control &Coordination( regional )

SectoralManagement

Medical Emergency Response 5

Initial AssessmentInitial Assessment

•• M = major incident standby / declaredM = major incident standby / declared•• E = exact locationE = exact location•• T = type of injuryT = type of injury•• H = hazard, present and potentialH = hazard, present and potential•• A = AccessA = Access•• N = number of casualtiesN = number of casualties•• E = emergency services, present and requiredE = emergency services, present and required

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Major Injury Medical and Management Major Injury Medical and Management SupportSupport

•• CC ommandommand•• C C ommandommand

•• S S afetyafety

•• C C ommunicationommunication

•• A A ssessmentssessment

•• TT riageriage

ManagementSuport

M di lT T riageriage

•• T T reatmentreatment

•• T T ransportransport

MedicalSuport

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Regional ManagementRegional Management

•• Coordinating TeamCoordinating TeamCoordinating TeamCoordinating Team

•• Medical teamMedical team

•• SurveillanceSurveillance

•• Management back upManagement back up

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Disaster PlanDisaster Plan

Pre Hospital Pre Hospital Disaster PlanDisaster Plan

Hospital Hospital Disaster PlanDisaster Plan

M = major incident E = exact locationT = type of injury

•• C C ommandommand

•• S S afetyafety

•• C C ommunicationommunication

RegionalRegionalDisaster PlanDisaster Plan

•• Coordinating Coordinating TeamTeam

•• Medical teamMedical teamyp j yH = hazard, A = AccessN = number of casE = emergency services, present and required

•• A A ssessmentssessment

•• T T riageriage

•• T T reatmentreatment

•• T T ransportransport

Medical teamMedical team

•• SurveillanceSurveillance

•• Management Management back upback up

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PartisipasiPartisipasi masyarakatmasyarakat pd pd penanggulanganpenanggulangan bencanabencana

Ti kTi k d lid li MiliMili•• Tingkat Tingkat pengendalipengendali•• Tingkat Tingkat pimpinanpimpinan satuansatuan kerjakerja•• Tingkat Tingkat pelaksanapelaksana

•• FaseFase tanggaptanggap daruratdarurat

•• MilitaryMilitary•• GovernmentGovernment•• Non Government Non Government

Organization ( NGO )Organization ( NGO )•• Private SectorPrivate Sector•• AcademiaAcademia

•• FaseFase PemulihanPemulihan•• FaseFase KesiagaanKesiagaan •• ProfesionalProfesional, ,

•• PetugasPetugas, ,

•• RelawanRelawan

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Response of Health SectorResponse of Health Sector

Control andCoordination

Medical Administration Logistics Public HealthMedical Responses

AdministrationBack up

LogisticsManagement

Public HealthResponses

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Trunkey’s curveTrunkey’s curve

Trauma deaths

hours weeks0 1 2 3 4 5 6 1 2 3 4

Immediatedeaths

Early deaths Late deaths

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Lesson Learnt from Merapi eruption, 1994Lesson Learnt from Merapi eruption, 1994

No victims attended by medical personnel during evacuation

No pre-hospital emergency system

Time needed : 2 years

Pusbankes - 118

Leader : Director of GenHospNational meeting : 4Local meeting : ?Strategy : joint corp..

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Pusbankes – 118

•• Road accidentRoad accident

•• ATLS* ( 1996 )ATLS* ( 1996 )

•• ACLS* ( 1996 )ACLS* ( 1996 )

•• Basic Life Support ( 1996 )Basic Life Support ( 1996 )

•• Emergency Physician ( 2000 )Emergency Physician ( 2000 ) ::•• General Emergency Life Support ( 2002 )General Emergency Life Support ( 2002 )

•• Road accidentRoad accident•• Airplane crashAirplane crash•• RiotRiot•• FireFire

1994 - 2003

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SolidarityHumanity

Meulaboh, 2004

Isolated City:Blocked communicationDestroyed land roads

Delay of Responses

yDestroyed runwayInsecure situation

DistanceFinance

Professionalism

Low resilience Lack of buffering & absorbing capacity

Relatively Slow RecoveryAnd Development

g g p yNo pre-existing

emergency system / networkingLack of Health Services

No preparedness

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- Good transportation- Good communication

- Pre-existing of emergency services networking

- Quick response of local, regional and international team

Bantul, 2006

Rapid Responses

butU di t d

- Wrong scenario for Preparedness

- Large number of victims- Bantul as “ open “ area

UncoordinatedWorks

Quick recovery 16

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Lessons LearntLessons Learnt

from Bengkulu Earthquake, 2007from Bengkulu Earthquake, 2007g qg qfrom Padang from Padang EartquakeEartquake, 2007, 2007

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Lessons Learnt :Lessons Learnt :

•• “ The problem of disaster response was not“ The problem of disaster response was not•• “ The problem of disaster response was not “ The problem of disaster response was not lack of any single resources but inadequate lack of any single resources but inadequate management “.management “.

Regional Management !

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Disaster Response TeamDisaster Response Team

•• SARS, 2003 SARS, 2003

•• Bali Bombing I, 2003Bali Bombing I, 2003

•• Tsunami, Aceh, 2004Tsunami, Aceh, 2004

•• Landslide, Banjarnegara, 2005Landslide, Banjarnegara, 2005

•• Earthquake, Bantul, 2006Earthquake, Bantul, 2006

•• Tsunami, West Java, 2006Tsunami, West Java, 2006

E th k B k l 2007E th k B k l 2007•• Earthquake, Bengkulu, 2007Earthquake, Bengkulu, 2007

2003 - 2007

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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 20

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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 NorthAmerica, June 2006,vol 86, No 3Guest ed.: LTC Robert M Rush, Jr, MD

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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 surgedthe hospital within 10 hours transfer of victims and pilethe hospital within 10 hours, transfer of victims and pileof 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:– CoordinationCoordination– 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 CourseManagement Course

N DN D•• Non DegreeNon Degree•• S1S1•• S2, S3S2, S3

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SummarySummary

1.1. Disaster Responses must be relied on Local capacities.Disaster Responses must be relied on Local capacities.p pp pLocal networking is mandatory.Local networking is mandatory.

2.2. All aids activities should be conducted to support the All aids activities should be conducted to support the local capacities, not to replaced it.local capacities, not to replaced it.

3.3. Volunteers have a special place in Volunteers have a special place in disaster responsedisaster response44 Evaluation and Development of the National conceptEvaluation and Development of the National concept4.4. Evaluation and Development of the National concept Evaluation and Development of the National concept

and guideline on DRR must be performed and guideline on DRR must be performed systematically .systematically .

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Thank YouThank You

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