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Intro to Disaster Nursing

Gilny Rantung, Ph.D.

Faculty of Nursing - Indonesia Adventist University
 DEFINITION

DISASTER :
• Any event that results in a precipitous or gradual decline in the overall
health status of a community with which it is unable to cope
adequately (WHO, 2005)
• A serious disruption of the functioning of a community or a society at
any scale due to hazardous events interacting with conditions of
exposure, vulnerability and capacity, leading to one or more of the
following: human, material, economic and environmental losses and
impacts (United Nations International Strategy for Disaster Reduction
[UNISDR], 2017).
 DEFINISI BENCANA di INDONESIA
UU. No.24 -2007
Tentang
PENANGGULANGAN BENCANA

BENCANA :
Peristiwa atau rangkaian peristiwa yang mengancam dan
menganggu kehidupan dan penghidupan masyarakat yg
disebabkan baik oleh alam dan/atau non alam maupun faktor
manusia sehingga mengakibatkan timbulnya korban jiwa manusia,
kerusakan lingkungan, kerugian harta benda dan dampak
psikologis.
KEBIJAKAN PENANGANAN BENCANA DI
INDONESIA

• UU no 23 Thn 1992 tentang Kesehatan

• Keppres no 3 thn 2001 tentang BAKORNAS PBP
• Keppres no 111 thn 2001 tentang perubahan
atas Keppres no 3 thn 2001

UU BENCANA No 24 -2007
BADAN NASIONAL PENANGGULANGAN BENCANA
BADAN PENNANGGULANGAN BENCANA DAERAH TK I/II
Bab XII ps 80. Pada saat berlakunya UU ini semua peraturan per UU
Yg berkaitan dg PB dinyatakan tetap berlaku sepanjang tdk bertentangan
Atau belum dikeluarkan peraturan pelaksanaan baru berdasarkan UU ini
Disasters can be divided into two categories:
natural and man-made
Natural Man-made (anthropogenic)
Hurricane Explosion
Earthquake Fire
Landslide Firearms
Ice storm/blizzard Stampede
Fire Structural collapse
Wildfire Hazardous material
Flood Power out
Tidal Wave Blocked communication
Tornado Transportation
Astroid collision • Airway (Plane)
Avalanche • Railway (Train)
Volcanic eruption • Waterway (Boat)
• Roadway (Car)
Weapons of mass destruction
• Biological
• Chemical
• Nuclear
BENCANA TIDAK TERJADWAL
TERJADI MENDADAK
SUMBER DAYA TERSEDIA JAUH
DIBAWAH KEBUTUHAN
MEMERLUKAAN KOORDINASI
MEMERLUKAN PERENCAAN

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 KOMANDO KOMANDO
PENGUASA SETEMPAT :
• Polisi
• TNI
• Kepala Pabrik
• Penanggung jawab lingkungan
• TIM MEDIS

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 UNSUR YANG TERLIBAT
UNSUR-UNSUR YANG TERLIBAT

• Keamanan : Polisi, SATPAM

• Rescue : Pemadam Kebakaran
• Kesehatan / Tim P3K
• Sukarelawan : PMI, Karyawan

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UNSUR YANG TERLIBAT
POS KOMANDO

Mengatur :
• Struktur Komando
• Operasional
• Logistik
• Perencanaan
• Keuangan

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 TIM KESEHATAN
Komponen
Terdiri dari komponen:
• Triage (Pemilahan penderita)
• Terapi Sementara
• Transportasi
Tindakan
• Penilaian Cepat
• Triase / pemilahan penderita
• Penanganan primer ( ABC )
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 AREA BENCANA
AREA 1
COLD • Daerah terlarang !!!
• Hanya petugas penyelamat (rescue), Petugas
/ tim P3K boleh masuk bila ada ijin.
WARM
AREA 2
HOT
• Daerah Terbatas
Hot • Untuk Petugas Khusus: Petugas kesehatan,
logistik, investigasi
• Pos komando

AREA 3
• Daerah Bebas
• Wartawan
• Masyarakat / Penonton
• Keluarga korban

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ALUR KERJA LAPANGAN

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 Korban datang ke
IGD - RS

SUMBER DAYA
• Jumlah?
• Kemampuan?
• Pembagian tugas?

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 TRIAGE
Gilny Aileen J. Rantung, PhD
Triage definition
• Triage (bahasa Prancis) : mengambil, memilah atau
menyaring
• Triage adalah proses pengelompokkan penderita-
penderita sakit atau cedera pada kejadian massal
• Adalah pemilahan penderita berdasarkan kegawatan
penderita

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Triage definition
• Tujuan : menolong korban sebanyak mungkin agar
mendapat kesempatan terbesar untuk tetap hidup
• Triage is the method used to assess patients' severity
of injury or illness within a short time after their
arrival, assign priorities, and transfer each patient to
the appropriate place for treatment (Fernandes et al.,
2005)

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• Triage has become something much
different than sorting in many
emergency departments worldwide.
• Over the course of time, triage
evolved into a place, an area of entry
for patients seeking emergency
services.
• In the ED setting triage is a verb, not
a noun; it is the process of quickly
assessing a patient and determining
whether he or she is sick or not sick.
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• Triage process requires the
skills of an experienced &
certified emergency nurse.
• Working as a triage nurse
can be mentally challenging
and sometimes exhausting.

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 TRIAGE QUALIFICATIONS
• Registered nurse
• Complete a standardized triage education
course
• Certified CPR and ACLS
• Effective communication skills and ability
to work collaboratively
• Ability to use the nursing process
effectively
• Flexible personality and adaptable to
change
• Role model and suitable hospital
representative
• Excellent decision-making skills

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• Recently, improving the flow
by streamlining the triage
process has been the focus of
many process improvement
efforts in emergency
departments.

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• Triage process requires the
skills of an experienced
emergency nurse.
• Recently, improving the flow
by streamlining the triage
process has been the focus of
many process improvement
efforts in emergency
departments.

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 Other reasons why
triage is important:
• The purpose of triage is to
put the right person in the
right place at the right
time for the right reason.
• The number of persons
seeking medical care in
EDs grew - Overcrowded
ED – Work overload

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Triage Categories in Indonesia:
Red Resuscitation/Most First Patients who come with life-threatening conditions. Life-
urgent priority threatening shock or hypoxia is present or imminent, but he
patient can likely be stabilized and if given immediate care, will
probably survive
Yellow Urgent Second Patients who come with very disturbing conditions and have
priority the potential to get worse if they do not get medical treatment
in the ER. Theyccan likely withstand a 30 to 60 minutes wait
without immediate risk
Green Non-urgent/ non- Third Patients who come because they have complaints that are not
immediate/ delayed priority potentially worsening, but require a medical assessment to
ensure their condition is safe to be discharged. These patients
generally are unlikely to deteriorate for several hours (>60
mnts).
Black Dead

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Assignment:
• Canadian Triage System (CTAS)
• Chinese Four-level and Three
district triage standard
• Manchester Triage System

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Comprehensive triage step by step:
• An experienced emergency nurse greets the patient.
• Patients in need of immediate care are identified quickly.
• A knowledgeable professional performs an assessment.
• Immediate reassurance is provided to the patient and the family.
• First aid and comfort measures are initiated as needed.
• The patient, family, and visitors can be informed about emergency department processes.
• During the assessment, the emergency nurse has an opportunity for patient teaching.
• The triage emergency nurse decides which area of the emergency department is most suitable
for the patient.
• If protocols are in place, medications for fever, pain relief, and tetanus prophylaxis may be
administered.
• Triage emergency nurses may initiate laboratory work and order radiographs based on triage
guidelines.
• Waiting patients are reassessed regularly according to departmental policy.
• A strong communication link is maintained between the triage area and the treatment area.

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Elements of a comprehensive triage
documentation
• Date and time of arrival at the emergency • Reassessments
department • Assessment of pain
• Patient age • History of current complaint
• Chief complaint • Subjective and objective assessment
• Significant medical history
• Triage interview time
• Last menstrual period
• Allergies (medications, food, latex)
• Last tetanus immunization
• Current medications (prescription, over-the- • Diagnostic procedures initiated
counter, supplements)
• Medications administered at triage
• Triage severity rating • Signature of registered nurse
• Vital signs • Consider including the following:
• Mode of arrival
• First aid measures • Use of an interpreter

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START Triage system - Methods of
Disaster Triage
• START (Simple Triage and Rapid Treatment)
• START is a triage method used by first responders to quickly classify
victims during a mass casualty incident based on the severity of their
injury
• This algorithm is utilized for patients above the age of 8 years
• START triage status is intended to be calculated in less than 60
seconds (1 minute).
• Goal: To help as many victims as possible in order to have the greatest
opportunity to stay alive [Do the greatest good for the greatest
number]

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The START triage system involves:
• START Triage method is based on the principle of ABC
• Making a rapid assessment (<1 minute) of every casualty
• Determining which of four categories the casualty should be
assigned
• Visually identifying the categories by color coding
• No therapy – Just identifying and color coding (using triage
tags)

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4 categories in START triage
1st Priority – RED 2nd Priority – YELLOW
IMMEDIATE CARE (Gawat Darurat) DELAYED (Gawat tidak darurat)
• Airway, breathing, circulation problems • Burns without any airway problems
• Uncontrollable bleeding • Excruciating pain in some parts of the body
• Neck or head injury • Swelling and shape change, especially in the
• Abdominal open wound extremities
• Hiper/hypothermia • Back injury
• Severe burns

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4 categories in START triage
3rd Priority – GREEN 4th Priority – BLACK
MINOR DECEASED
• Victims who did not experience serious injury, • Died victim
require little care and can wait for treatment
without getting worse
• Mild pain
• Minor burns
• Swelling

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General procedures:
• Stop, look, listen and think
• Conduct voice triage after identifying yourself: “if you can walk, come
to the sound of my voice”.
• Assign a location for those who can walk.
• Start to assess victims from where you stand.

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• Fernandes CM, Tanabe P, Gilboy N, et al. Five-level triage: a report
from the ACEP/ENA Five-level Triage Task Force. J Emerg
Nurs. 2005;31:39–50.
• Scrofine S, Fitzsimons V. Triage: the sorting of patients. J Emerg Nurs.
2014 May;40(3):289-90. doi: 10.1016/j.jen.2014.03.004. PMID:
24810510.

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