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TTSH Charity Ride

Bintan 2013
A Journey of Hope

KM Breakdown 30KM

KM Breakdown 60KM

KM Breakdown 145KM

KM Breakdown 145KM

CONTINGENCY PLAN
CONTINGENCIES:
1. Inclement Weather
2. Unsafe road conditions
3. Fatal accident
1. INCLEMENT WEATHER
Inclement weather, like lightning, heavy rain or wind gusts, is a potential danger to safety of the participants. In the event of lightning or stormy weather, the start will
be delayed until weather conditions have improved. The event organizer may decide to shorten the distances or delay the event till weather improved. In the
event of lightning or stormy weather, the organizer may decide to stop the ride if the conditions are considered dangerous to the participants.
Precautionary measures:
Weather conditions will be monitored from one hour before event start.
Contingency Plan:
TTSH 30km, 60 & 145km Start: 07:30hrs)
Start may be delayed by up to 1 hour. The route keeps its original format.
Start may be delayed by 1 to 2 hours. The 145km route will be reduced by 50km. (Sekerah Loop is removed).
Start may be delayed by 2 to 3 hours. The 145km will be reduced by 75km. (use 60km route)
Start after 3 hours, all use 30km route.
2. UNSAFE ROAD CONDITIONS
In the event the roads are considered unsafe due to the police not being able to secure the route, bad road surface or other hazards on the course, the organizer
may decide to amend the route or introduce neutral zones with speed limits at hazardous sections.
Precautionary Measures:
The organizer works closely together with the Bintan Traffic Police and other relevant authorities to ensure that the course is secure and safe. The organizer will
perform numerous road inspections by the Course Manager & team.
3. FATAL ACCIDENT
In the event of a fatal accident during the event, the organizer reserves the right to stop event depending on the conditions of the accident. (E.g. organizer cannot
guarantee the safety of the participant any longer. The accident involves several deaths.)
Precautionary Measures:
See our medical safety plan.

HEALTH/MEDICAL SUPPORT FOR TAN TOCK SENG HOSPITAL CHARITY CYCLE


2013

GENERAL

1. The 2013 Tan Tock Seng Charity Cycle will be held on 22 June 2013. It will
comprise of 3 cycling stages over one day with up to 100 participants of varying
degrees of cycling fitness and experience. In order to optimize the health and
safety of the participants, the following health & medical support plan covers the
resources, disposition, and operational plan to manage illness and injuries that may
occur during the day of cycling. This plan meets or exceeds guidelines established
by the Singapore National Sports Safety Committee based on their 2007 report.

HEALTH & MEDICAL RESOURCES

2. The manpower, facilities and related resources to provide health/medical support


for the event are as follows:

a. Manpower
- Medical Director/Mobile medical element (name Dr. Said Reza)
- 2 x mobile medical teams, each team comprising a doctor, nurse, and ambulance
driver
- Fixed medical facilities, including the Klinik Pariwisata Lagoi at BRC and 3 x Bintan
hospitals

Health Facilities & Medical Teams


Name
Klinik Pariwisata Lagoi at BRC

Staff
2 x doctors
1 x Senior Manager, Environmental Health
(Ranan)
Nurses
Ambulance drivers

Capabilities
- 24-hour clinic with basic emergency capabilities &
ambulances (1 x complete, 1 x 4WD utility vehicle) near
ferry terminal
- new defibrillators but limited emergency drugs; no pediatric
emergency equipment
- limited current experience with cardiac arrest or
emergencies
- evacuation plan to Singapore integrated with Bintan Resort
Crisis Centre (under Mohammad Anuar)
- capable of basic management of heat stress
= evacuation end point on Bintan

Nirwana Garden Hotel clinic

1 x doctor
1 x nurse

- house clinic handling staff and non- cycle guest illnesses


- no experience with collapse and heat injuries
- no emergency equipment
- good English language skills
- able to provide post- cycle treatment support

Mediyanto

TNI navy managed general hospital


All key basic specialties

Rumah Sakit Umum Propinsi

2-year old general hospital


all key basic specialties
- 24-hour A&E

- A&E dept + 3-bed ICU


- X-rays
- Ortho, cardiac, internal medicine care
- English-speaking doctors
- good hospital to cover Stage 1
- Able to provide ICU and immediate emergency care
- A&E dept + 5-bed ICU
- modern equipment including defibrillation (yet unused)
- X-rays, general medicine
- able to provide ICU and immediate emergency care
- best coverage for Stage 2 and Stage 3 events

Mobile medical teams (total of 2


teams)

Dr Said Reza is key medical


representative of the Bintan Health
Division
Each team to comprise:
1 x doctor
1 x nurse
1 x ambulance driver

- Dr Said Reza is experienced at supporting sports events in


Bintan (eg. 6 years of Bintan Triathlon, Tour de Bintan, and
MetaMan Bintan)
- based out of ambulance
- 2 x ambulance team covering the 3 cycle categories
- 1 x medical team at start/finish line by TTSH
doctor/paramedic.
- first aid supplies including wound dressings, fracture
splints, basic IV infusion fluids
- Doctor must be speak English or have translator present

Medical Vehicles
VEHICLE

LOCATION

ACTIVATION

2 x ambulance

Klinik Pariwisata Lagoi at BRC

On call by Dr. Said Reza

2 x Medical Team ambulances

2 x ambulance in vehicle convoy


supporting the cycle categories

Course Director communicate to Dr.


Said Reza on sighted injury or
activation within convoy control.

1 x utility vehicle

Start and finish roaming all categories


in cycle

Medical Director/TTSH Doctor

MEDICAL SUPPORT IN PHASES

3. Medical treatment policy. The medical teams will provide support for cycle event-related injuries or illnesses only. All noncycle event illnesses or injuries will be the responsibility of the individual, and will make use of the available medical care at the
resorts and on the island.

4. Medical conditions. From past experience with cycling events in Singapore, the following medical conditions may be
anticipated:
- Heat injuries
- Fall- or crash-related: skin abrasions, fractures
- Head injuries
- Cardiac conditions

5. Medical response sequence.


(1) The Medical Director or medical team will be alerted to the occurrence of an injury by marshals, participants or spectators.
Should on-site assessment be necessary, a mobile medical element will be activated or the category medical team.
(2) The responding medical team will assess the casualty condition and decide if evacuation to a clinic or hospital facility is required.
(3) If the injury is minor, first aid may be provided on the spot (eg. wound dressing, bandaging) and if the casualty is well, he or she
may be permitted to continue the event.
(4) If the injury requires further attention at a clinic or hospital, the Medical Director will be informed and a decision made as to
which facility to evacuate the casualty to. Casualty evacuation will be by ambulance, while the casualtys bike will be handled by
the sweeping truck.
(5) Serious medical cases will be evacuated to the nearest capable hospital and then the Klinik Pariwisata Lagoi for stabilization prior
to onward evacuation to Singapore. Such evacuation to Singapore will be managed by the Bintan Resorts Crisis Centre according
to the established medical evacuation procedures in existence.
(6) Details of serious casualties must be informed to the Medical Director/TTSH doctor, who will then inform the Course Director.
(7) Clinical records should be kept for all casualties including:
- Name
- cycle number
- Medical condition
- Diagnosis
- Treatment given
- Hospital facilities casualty is sent to

6. The medical support in phases is as follows:


Phase
Pre-event

Event

Medical Support
Individual medical clearance & disclaimer

Responsibility
Individuals (all staff & participants)

Health & medical advice (cycle booklet, website)

Medical Director/TTSH Doctor

Medical support plan


Pre- cycle recce, equipment collection, briefings to Bintan
medical elements, ambulance recce, comms check

Medical Director/TTSH Doctor


Medical Director/TTSH Team

Pre-event medical briefings & familiarization

Medical Director/TTSH Team

Operations of medical support plan

Medical Director/TTSH Doctor


Local Medical Teams/Dr. Said Reza
Medical Director
Medical Teams

Cyclist reporting:
- Medical capability to be ready half an hour before cycle
start
- Medical teams to line up in convoy sequence
- 1 x medical team to deploy at the medical room or
medical tent
Cycle underway
- 1 x medical team static at start + finish line area (may be
activated for emergencies
- Medical teams to remain in convoy order during the cycle
- When medical treatment needs to be provided, the
ambulance and team will stop by the road side and treat
the injured cyclist
- If the cyclist can continue, the medical team will then
move ahead and re-join the convoy in its convoy position
- Should the ambulance need to evacuate the casualty, the
Medical Director will provide medical support to the
category convoy in the absence of the ambulance medical
team
- Upon return from casualty evacuation, the ambulance
medical team will rejoin its assigned category convoy

Medical Director
Medical Teams
Medical Director will roam the course and respond to
injury requirements as needed.

Mass Crash
- In the event of mass crash, ambulances from other Activation will be directed by Medical Director after
convoys may be activated to assist in response even while review of the situation
the cycle is underway
Other Contingencies
The Medical Director will decide on response to any other
contingencies in discussion with the Course Director

Post-event

- Post-cycle medical management co-ordination


- Post-cycle treatment of minor injuries by hotel clinic or
Klinik Pariwisata Lagoi

Medical Director

7. Scope of medical responsibilitiesThe respective medical resources will carry out the following
treatment:EQUESTS
Resource
Ambulance Medical Teams

Hospitals

Klinik Pariwisata Lagoi at


BRC

Manpower & Responsibilities


1 x doctor, 1 x nurse, 1 x ambulance driver in ambulance
First aid supplies, AED, IV fluids
Provision of on-site assessment of casualty severity leading to
decision on level of care needed, evacuation location & priority
Provision of first level response (first aid), life-saving treatment
(CPR), and stabilization for evacuation if required
Fixed medical team to have IV infusion stands and oxygen
mask/cylinders
Doctors, specialists and nurses
24 hour emergency department
Emergency medical treatment: Defibrillator, drugs, IV
X-rays
Stabilisation for evacuation to BRC klinik
Doctors and nurses
General clinic set-up
Emergency medical treatment: Defibrillator, drugs, IV
Stabilisation for evacuation to

8. Levels of responsibility. In order to ensure efficient and effective use of all resources, the Medical Director
will have overall authority on:

- Individual participation in the event (fit or not fit)


- Re-deployment of ambulance medical teams to meet situational requirements
- Advice on use of evacuation assets in the event of injury during the event
- Advice on evacuation to Singapore
Final approval authority for all health/medical decisions will be given by the Medical Director.

HEALTH + MEDICAL SCENARIOS


9. Lightning. In the event of environmental lightning, adequate covered shelter must be
provided for participants. All spectators will be advised to move indoors. Information on
lightning threat and shelter plans will be given during the pre-cycle briefing. Delay or
alteration of the conduct of cycle events will be the sole discretion of the Course
Director, advised by Bintan Operations Room (contact: Mohammad Anuar).
10. Unusually hot weather. In the event of unusually hot weather, extra emphasis will be
provided to participants regarding lowering physical exercise intensity. Adequate
hydration, and vigilence for signs of heat injury. All cycle officials must have adequate
personal protection and fluid availability, in addition to shelter where available.
Marshalls must be on the increased alert for signs of heat injury amongst participants.
11. Mass crash. In the event of a serious mass crash, the Mobile Medical Element will
respond to provide assessment and immediate medical attention. Additional medical
personnel may be called upon from the Medical Room/Tent should the need arise.
Priority for treatment and evacuation will be determined by the Medical Director.
12. Multiple medical incidents. Should more than one medical incident arise at any one
time that requires assessment or treatment, the Medical Director may activate the
various convoy ambulance medical teams to assist in mobile incident response.

COMMUNICATIONS

13. Communications means by mobile phone to:

Medical Director (1)


Doctor of each ambulance medical team/local interpreter (2)

14. The Medical elements will be part of the main operations communications net run by the
Course Director. Mobile phones will be used for all communications needs during the event.

CLINICAL MANAGEMENT NOTES

A. HEAT DISORDERS / INJURIES

15. In order to ensure consistency of management of heat disorders/injuries, the following


treatment protocol will be used by all health/medical personnel.

a. Causes of heat injuries. Heat injuries represent a continuum of states arising from an
imbalance between heat gained/produced/retained and heat lost from the body. The main
underlying factors that lead to heat injuries are:

- high environmental temperatures


- high humidity
- solar radiation
- poor conditioning
- insufficient acclimatisation
- over-exertion
- insufficient hydration.

b. Classification of heat disorders. The main heat injuries are:


Heat cramps/syncope

Muscle cramps (especially calf and abdominal muscles)


Feeling lightheaded

Heat exhaustion

Fatigue
Headache
Nausea
Excessive sweating
Thirst

Heat stroke

Irritable
Mental confusion
Bizarre behavior
Loss of consciousness & coma
Core temperature of > 40 deg C

c. Treatment steps.
Reduce current heat load

Stop the exercise


Move the person to a cool, shaded area
Remove as much clothing as possible

Start cooling the person (until core temperature reaches 38.5 deg C)

Actively fan the person or turn on a fan


Apply cool or cold water using cloth over all surfaces
Ideally, provide a fine spray of water under a fan

Actively rehydrate the person

Encourage drinking of cool fluids


Establish wide bore IV + administer cooled IV Dextrose Saline

Monitor the person

Vital signs (heart rate, Blood pressure)


ABC
Core temperature

Treat collapse if necessary

Carry out CPR


Carry out emergency procedures for shock & collapse
Evacuate to hospital if patient does not respond well

B. Skin Abrasions.

Arising from crashes, these superficial injuries can be very painful and lead to long-term scarring. The preferred
treatment is as follows:
a. Clean the wound site gently with sterile solution or surgical wash
b. Apply a non-stick dressing (eg. Tulle Gras, parrifin layer, etc)
c. Apply a gauze absorption layer
d. Cover with a dressing layer (eg. tape, Op Site)
e. Review dressing daily

C. Fracture of Clavicle

This is the most common fracture arising from a fall from a bike. When assessing a cyclist who has fallen, always
examine for pain in the clavicle. If any is found, suspect and treat as for a fractured clavicle. The treatment steps are
as follows:

a. Examine site of pain on the clavicle. If this is tender and shoulder movements are painful, suspect a fractured
clavicle
b. Place the affected arm and shoulder in a simple sling to immobilize the joint and bone
c. Send for X-rays to confirm the fracture
d. If fracture is shown, use a figure-of-8 bandage or an arm sling to immobilize the shoulder
e. Evacuate the patient for hospital review and care (eg. Singapore).

REQUIREMENTS & REQUESTS


1

Medical Director Vehicle

Ambulance Medical Teams

NRH clinic

Driver (speaks English and Bahasa)


By mobile phone
Boxes of water and sports drinks
Interpreter
Doctor to speak English confidently, or a translator present
Boxes of water and sports drinks
Plastic container with ice, water, and towels (for casualty cooling)
Medical items for first aid: bandages, splints, dressings, neck
stabilization, stretcher, and if possible, oxygen and AED

IV fluids, IV infusion sets, with IV fluids stand


Oxygen with mask

Hospital Address

LANDMARKS PHOTOS

Resort Centre

Resort Centre Start & Finish Arch

Beware of hump
before security
post (1.7km)

Water dam/
reservoir on
each side

Drink Station for


30, 60, and 145
km

Monkey Statue
(end of
reservoir)

Ria Bintan
Entrance Gate
(13km) - turn
left

Run about @
Ria Bintan
(14.6km) U
turn

Exit Gate @ Ria


Bintan (16.1km)
turn right

Simpang Lagoi (22.4km)


30km straight on (back to
NG)
60 & 145km turn left

60 & 145km turn


left

30km straight
on

Drink Station for


60 and 145 km
Simpang Lagoi
(30.1km)

Simpang Sei
Kecil (34.3km)

145 km straight
on

Telecom Tower T
Junction (37.8km)
145 km straight
on

60km turn left

60 km turn right

145km straight on

60 km

145
km

Route for 60km (internal


road)
Road hole & Sandy turn
right (38.6km)

Drink Station for


145 km
Drinks Station
(40km)

Simpang Jago
(48.6km) turn
left

T-junction (a
yellow house on
the right).
Turn left here.
(photo not
required)

Melayu bedendang
(swimming pool)
(51km)-Turn left

Yamaha shop
(landmark)

Lobam T
junction
(52.9km)

Busong bridge
up ahead
(66km)

Numbered
brown pillars
Turn right.
(Simpang
Penaga
opposite road)

Sebung Road
hole (91.6km)

Dahope
minimart-turn
left (101.3km)

Drink Station layout

RESORT CENTRE ARCH

ROUTE SIGNAGE

WATER

SLOW
DOWN!

DRINK
STATION
100m

PLAZA VENUE LAYOUT PLAN