SAFE COMMUNITY

The Silent Disasters,

&
Disasters - Mass Casualties
The Indonesian Experience

Aryono D.Pusponegoro
118 EAS
SAFE COMMUNITY :

Develop the Pre Hospital 118

Emergency Ambulance Service (118EAS)
in 33 Provinces
Train The Laymen,
Police, Fire Brigade, Security, Red
Cross, Scouts, High School Students,
Paramedics,
Emergency Nurses,
Emergency Physicians,
Hospital Managers
in Emergency Care & Disaster
Management
Heart Disease & Stroke Cause of Death
in Jakarta 1993 Sept 2008
(THE SILENT DISASTER)
Year Cardiac Stroke

2001 2961 1027

2002 3255 1138

2003 1475 1151

2004 1003 1400

2005 1419 1133

2006 1114 1101

2007 1450 1118

s/d Sept 2008 524 619

JML 13201 8687

Traffic Accident Mortality in
Jakarta 1999 2008
(THE SILENT DISASTER)

Tahun KLL Cedera Cedera Kemati DATA Multiple

Ringan Berat an Kmr Trauma
Polda Mayat IGD
RSUPNCM RSCM
Metro
Jaya
2003 1300 601 615 503 1320 208

2004 4065 1827 2441 1010 1270

2005 4060 3236 3124 526 1230

2006 4395 2799 2814 1089 1170 252

2007 4754 3302 2211 960 1200 105

2008 6393 4317 2597 1169 1350 96

JML 24967 16082 13802 4731 7540 606

2009 Ramadhan Hollidays
780 Traffic Accident / 14 Days
(The Silent Disaster)
Desember 2006 :
AGD 118 DKK DKI
KLL Kmr Mayat :
2006 1170
2007 1200
2008 1350
Trauma Multiple IGD RSUPNCM :
2002 208
2006 252
2007 105
2008 96
RS di JKT :
2002 109
2009 139
2009 Situ Gintung
Bom Htl Marriott & Ritz Carlton ???
.
 Angka Kematian Bayi &
Angka Kematian Ibu (SDKI 2003)
(The Silent Disaster)

307 Ibu / 100 rb 34 Bayi / 1000

15000 Ibu / Th Kelahiran Hidup
1279 Ibu / Bln 2007
43 Ibu / Hr 35 Bayi / 1000
2 Ibu / Jam Kelahiran Hidup
Perdarahan 42% 2003
Eklampsi 11% 531 Bayi / Hr
Infeksi 10%
Partus lama 9%
Since 1980 up to Now
The 118 EAS was involved in the
Management of 81 Disasters &
Mass Casualties

10 Dogmas in Disaster
Management
 10 Dogmas in
Disaster Management :
1. It Is Impossible To Manage
Disasters & Mass Casualties
Properly If Your Day To Day
Emergency Care Is Bad.
2. Do Not Move The Disaster / Mass
Casualties To The Hospital
Triage & Dispatch
3. The Right Patient To The Right
Hospital By The Right Ambulance
At The Right Time
4. Triage & Damage Control Surgery
Only No Definitive Surgery
 10 Dogmas in
Disaster Management :
5. Triage & Local Rapid Assessment
(Health & Needs)
6. Risk / Hazard Assesment
Management
7. Single Disaster Plan Multy Hazard
For The Pre Hospital 118 EAS,
Hospital, City, District, Province &
National with The Security &
Rescue
8. The Right Team In The Right Place
At The Right Time With The Right
Knowledge, Right Skill & The Right
Logistics
 10 Dogmas In
Disaster Management
9. In Disasters with Displaced People,
the most important is How To Stay
Healthy in the Camps For Special
Needs People (Newborn Babies,
Mothers in Labour, Pregnant
Mothers, Toddlers, Old Peoples /
Geriatrics, Hypertension, Cardiac
Deseases, Stroke, PTSD & Public
Health)
10. Local Capacity Building
YO YO 24 48 Hrs
(1st & 2nd Bali Bombing)
Dogma N0 1 :
ORDER
It Is Impossible To
Manage Disasters KFC, PIZZA HUT,
& Mass MC DONALD
Casualties
Properly If Your
Day To Day
Emergency Care
Is Bad. 10' - 15'
(Cook First)

AMBULANCE ???
Dogma N0 1 :
(MFR, HOPE
CSSR) Emergency Nurse
(BTLS, BCLS, BNLS, BPLS)
Police (Paramedic Emergency Physician
Fire Brigade , CSSR) (ATLS, ACLS, ANLS, APLS)
Surgeon / Trauma
Security 118 (ATLS, BSS, DSTC, Peri OP CC)
(BLS /
Guard Emergency DISASTER MANAGEMENT
CADRE)
Civil Ambulance
Layman Defense Service
Scouts E.D. I.C.U Ward
Red Cross

Rehabilitation
Access
DISASTER Public
/ CRISIS CENTER
Emergency Health
Telephone Number Center

110,113,118

Pre-Hospital Phase Hospital Phase

 Dogma N0 2 :
Do Not Move The Disaster / Dr.Aryonos Presentation
Mass Casualties To The
Hospital Triage &
Dispatch
Medical
DISASTER

Support 30 50 meter
Management >< wind
Support Extrication, Triage &
Command & Control
* Security
Stabilisation Medical
* Rescue Support
*AGD 118
black red yellow green

DISPATCH
Mobile Med.
Team ?

helipad
Dogma N0 3 :
The Right Patient
To The Right
Hospital By The
Right Ambulance
At The Right Time
 125 118 EAS Concept
1 Motor Cycle, 2 Helmets &
5 Passengers
1. The Motor Cycle in Indonesia = The
Family Car (1st Child, 2nd Child,
Father, 3rd Child & The Mother)
5 Patients
2. Low Roof Can pass under Portals
(IV Fluid Free Flow / Straps ),
3. Small Can go to the Villages
4. Floods +/- 60 Cm
5. Can be Decontaminated &
Desinfected
6. Ergonomic
7. Cheap (+/- $ 17 17.500 Incl A,B,C,D
& E Equipment)
Dogma No 4 :
Triage & Local The Local
Rapid Team decides
Assessment What Kind of
(Health & Needs) Help is Needed
Criteria Of
Dispatch
 HAZARD Dogma No 6 :
Risk / Hazard
Assessment
MODIFICATION RISK PREVENTION Management

EVENT

IMPACT
Vulnerability
(provided by nature
+ augmented by
man)

DAMAGE
(The destruction
and Injuries Absorbing
resulting from
The event Capacity

Buffering RESILIENCE
Capacity
Response
DISASTER
Dogma No 7 :
HAZARD
Single Disaster Hospitals in Indonesia :
Plan Multi 1. EQ & Tsunami.
2. Volcano.
Hazard For Pre
3. Floods & Hurricane.
Hosp 118 EAS & 4. Landslides.
Hospital, City, 5. Fires.
District & 6. Transportation (Air, Sea
Province / Water & Land)
7. Riots (Demo, Labor,
Collaboration Ethnic, Religion,
with Security & Politics)
Rescue 8. Terrorism & War,
Industrial Accidents
HAZMAT
9. Infectious Diseases &
Epidemics (DHF,
Bird Flu).
Dogma No 8 :
(The Right Team In The Right Place At The Right Time
With The Right Knowledge, Skill & The Right Logistics)
1st Team (1st Week) :
Rescue / Collapse
Structure Search &
Rescue (CSSR)
Surgery dll
Water
2nd Team (2nd Week & Etc :
How To Stay
Healthy in Camps
(Special Needs People)
3rd Team Reconstruction
Micro Economy
Rescue Team from Outside
24 Hrs ?
We Are Always Too Late
Airway
Breathing
Circulation
Disability Fraktur - Fraktur
Dogma No 9 :
In Disasters with Displaced People,
the most important is How To Stay
Healthy in the Camps
For Special Needs People
(Newborn Babies, Mothers in
Labour, Pregnant Mothers,
Toddlers, Old Peoples / Geriatrics,
Hypertension, Cardiac Deseases,
Stroke, PTSD & Public Health)
Dogma No 10 :

Local Capacity Building

YO YO 24 48 Hrs
(1st, 2nd Bali Bombing &
Karang Asem EQ)
YO YO 24 48 Hrs
Medical Resourches
&
Geo Mapping
2002 Jakarta : 2005 Denpasar :
331 Public health 18 Hospitals
Center.
18 ER.
45 Ambulance.
18 118 EAS Basic
591 GP Public
Health Center. Hospital based.
109 Hospitals. 2005 Banda Aceh :
2005 8 Hospital / 500.000
40 118 EAS& 1 Hosp. Destroyed
10 118 Motorcycles Sigli, Bireun,
Lhoksmawe.
YO YO 24 48 Hrs
Post Graduate Courses in
Emergency Care :
ATLS (1995) Comm. Collapsed Structure
On Trauma Ind. Surg. Search & Rescue (CSSR)
Ass. PHTLS, BTLS USAID / OFDA / ADPC
(2002) 118 EAS.
ACLS (1996) PHCLS,
BCLS. BSS, PERI OP CC, TNT,
DSTC -> KOLEGIUM ILMU
APRC / APLS (1999)
BEDAH INDONESIA
PET / NET, BPLS.
Hospital Preparedness
ANLS (2002) PHNLS,
For Emergencies &
BNLS.
Disasters (HOPE)
BLS -> (1980) 118 EAS USAID / OFDA (2003)
CADRE (2010) USAID / 118 EAS
OFDA/ ADPC -> 118 EAS MANAJEMEN BENCANA
Medical First Responder (utk Incident
(MFR) USAID / OFDA / Commander 118 EAS
ADPC (2000) -> 118 EAS. (2006)
YO YO 24 48 Hrs
ROAD MAP
Safe community (IKABI)
Indonesia Healthy 2010

HOPE (MOH, ISA & IHA)

IEMSS / 118 EAS

Governor, Municipal Health Office,
MOH, ISA & IHA
Police
Fire Brigade, Scouts, Red Cross
Askes, Jamsostek, Jasa Raharja,
Jamkesmas, PrivateInsurance
Companies.
 Post Graduate Courses In
Emergency Care
&
Medical Resourches


IEMSS / 118 EAS & Safe Community
No Patient Without Optimal
Medical Care
Thank You