Messina &

Reggio,
1908

Tsunami
Anggaran
kematian ~
160000 org
‘Titanic’ karam – April, 1912
Kematian - 1403 orang
 Bangladesh.
Nov, 1970

Putting Beliung
(Cyclone)
Anggaran kematian ~
200 000 org
 Rusuhan
Orkney, South Africa – Jan, 1991
40 org mati, 50 org cedera
World Trade Center attack, NY – 9, Nov, 2001
Estimated death ~ 30 000
 Acheh
Gempa bumi & Tsunami, 26th Dec 2004
151 kematian 156 cedera Halloween Itaewon,
Seoul korea Selatan - 29/10/22
PENGENALAN
• Becana / Disaster – boleh berlaku bila-bila;

• Malaysia secara geografinya berada di ‘luar

lingkaran api Pacific’ (“Pacific Rim of Fire”)
dan adalah bebas dari ancaman bencana
yang teruk seperti gempa bumi, gunung
berapi dan taufan.

• Namun Malaysia sering terdedah kepada

kejadian seperti banjir, tanah runtuh dan
jerebu.
DEFINISI
Satu kejadian yang berlaku
dengan tiba-tiba menyebabkan
kemusnahan harta benda yang
besar, kehilangan nyawa yang
ramai dan gangguan
kehidupan seharian sesebuah
masyarakat.
 MAJOR INCIDENT MANAGEMENT

DEFINITION
(Referring Directive 20, N.S.C)
A REGIONAL EVENT THAT INVOLVES A
LARGE NUMBER OF CASUALTIES IN A
LARGE GEOGRAPHICAL AREA THAT
OVERWHELMS THE AVAILABLE LOCAL
RESOURCES & SERVICE.
MASS CASUALTY INCIDENT

• Urban orientated Incident

Civil emergencies occuring in urban
enviornment, producing many casualties
and destroying properties but not
necessarily affecting a large
geographical area
 TUJUAN / OBJEKTIF PELAN
PENGURUSAN BENCANA

• Memberi kefahaman apa itu bencana

• Memahami jenis-jenis bencana
• Pegawai yang terlibat memahami tugas dan
peranan masing-masing
• Memudahkan kerja-kerja menyelamat
mengikut konsep ‘Zoning’)
• Mengwujud satu sistem kerja pengendalian
bencana
 JENIS-JENIS BENCANA/
DISASTER /’MASS CASUALY
INCIDENT
1. BENCANA SEMULAJADI /
‘NATURAL DISASTERS’

- Gempa bumi
- Ribut Puting beliung
- Gunung berapi
- Banjir
- Dan lain-lain
 JENIS-JENIS BENCANA/
DISASTER /’MASS CASUALTY
INCIDENT
2. BENCANA AKIBAT TEKNOLOGI
DAN PERBUATAN MANUSIA
- Bangunan runtuh
- Kapal terbang terhempas
- Kemalangan kenderaan
- Perperangan
- Letupan/kebakaran kilang
- Dan lain-lain
 JENIS-JENIS BENCANA/
DISASTER /’MASS CASUALY
INCIDENT
3. BENCANA ‘HYBRID’ / BENCANA
AWAM (GABUNGAN 1 & 2 DI ATAS)

- Melibatkan bencana
semulajadi dan bencana
awam

- Contoh: Banjir dan bangunan

runtuh
KOMTAR
FIRE
22ND JANUARY
1983
PENANG FERRY TRAGEDY
31st JULY 1988
PENANG FERRY TRAGEDY
31ST JULY 1988
Bright Sparkles Factory explosion - 1991
22 dead; 103 injured
11 December 1993
–Highland tower collapsed, 48 died
 Genting Highlands Bus
Plunge 1996
17 dead; 20 injured
Mudslide in Orang Asli Settlement ( Pos Dipang) Kampar,
Perak, August 1996
Estimated dead ~ 44 and ~ 30 houses washed away
 Hurricane Greg in Sabah, December 1996
Estimated dead ~ 307 died and ~ 6,000 home ruined
Malaysia’s Worst Major Incident
 Enteroviral Outbreak in Sibu Sarawak 1-30.4.97
25 dead
 Country wide haze particularly in Sarawak Jul-Oct,1997
Environmental problem,health
hazard & economical losses.
 Fire & explosion @SMDS Bintulu Sarawak
2 injured
 Forest & peat fire throughout the country Feb-May 1988
3000 hectares of forest burnt
 Japanese Encephalitis Outbrek, Perak & N.Sembilan Oct,1998-Jun,1999
101 dead
 Ruan Changkul,Simunjan Sarawak. 28.01.2002
16 dead; 200 homeless
 SARS & Anthrax Scare, 2003
 Avian Flu, 2004
Covid-19 - 36.3k dead - 30/10/22
 PENGURUSAN
BENCANA

Hospital Activation Phase

On Site Management

Networking
ARAHAN 20,
MAJLIS
KESELAMATAN
NEGARA
( M.K.N.)
Majlis Keselamatan Negara-
Arahan No.20
• The disaster plan is
developed under the
following regulations &
guidelines:
• Arahan 20 MKN
• Policies of Department of
Civil Aviation
• Policies of Marine
Department
• 13 MEI 1969 MAGERAN,
1971 - MKN (JPM)
Agensi Pengurusan Bencana
Negara (NADMA)
• NADMA adalah agensi peneraju utama
pengurusan bencana negara.
• NADMA bertanggungjawab menyelaras
pengurusan bencana negara dan membentuk
serta memastikan segala dasar dan mekanisme
pengurusan bencana negara dipatuhi dan
dilaksanakan di setiap peringkat pengurusan
bencana.
• Tanggungjawab NADMA sebagai Agensi
Peneraju utama pengurusan Bencana Negara
digariskan di dalam Lampiran A: Arahan MKN No
 Directive 20 of the National
Security Council.
Disaster
• An event that occurs suddenly.
• Complex in nature.
• Loss of lives.
• Destruction of property and/or environment.

• Disruption of the community daily activities .

Divided into 3 main level of categories depending

on the management capability and capacity
 MKN ARAHAN 20
TAHAP-TAHAP BENCANA

 Bencana Tahap 1

 Bencana Tahap II.

 Bencana Tahap III.

 ARAHAN 20, MAJLIS
KESELAMATAN NEGARA (M.K.N.)
BENCANA TAHAP 1
Kejadian insiden major setempat
 dapat dikawal di peringkat tempatan
 tidak komplek
 bilangan mangsa dan kerosakkan harta
benda yang sedikit
 menjejaskan sedikit aktiviti harian
 Cth. Kemalangan bas, keretapi, tanah
runtuh.
Arahan 20
M.K.N.
BENCANA
TAHAP I
 ARAHAN
DIRECTIVE 20, MAJLIS
20 NATIONAL SECURITY
KESELAMATAN COUNCIL
NEGARA (M.K.N.)
BENCANA TAHAP 2
• Melibatkan kawasan yang agak luas
• Komplek dan sukar
• Bilangan mangsa yang ramai dan kemusnahan
harta benda yang besar
• Menjejas aktiviti kehidupan seharian
• Tidak dapat dikendalikan oleh pihak tempatan
• memerlukan bantuan dari pihak nasional atau
negeri sekitarnya
• Cth - Highland Towers runtuh
- Ribut Greg, Sabah,
- Letupan Bright Sparklers.
 ARAHAN
DIRECTIVE 20, MAJLIS
20 NATIONAL SECURITY
KESELAMATAN NEGARA (M.K.N.)
COUNCIL
BENCANA TAHAP 3
• Melibatkan kewasan yang sangat luas.
• Kehilangan banyak nyawa mansa yang banyak.
• Kerosakkan teruk ke atas infrastruktur dan
kemudahan awam.
• Amat komplek dan sulit.
• Risko yang tinggi kepada penyelamat.
• Aktiviti harian yang lumpuh sama sekali.
• Sumber tempatan musnah dan memerlukan bantuan
dari luar.
• Cth. Gempa bumi, Putting beliung, Gunung berapi,
Tsunami atau perperangan.
MEDICAL RESPONSE PLANNING

• Contingency Planning
• Emergency Response Plan
- Incident Site Management
- Hospital Activation Phase
• Recovery Phase
CONTINGENCY
PLANNING
Contingency Planning

• Forward Planning Process

• Process rather than
documentation
• Consensus building
• Defining actions
• Putting systems in place
• Prevent damage control and limit
consequences
Contingency Planning

• Risk analysis and assessment

• Resource matrix preparation
• Obligation of all
– Director, HOD, Community Leader
• Dynamic
• Inter agency and multi sectorial
• ERP and alert system
RISK ANALYSIS
• Lebuhraya
– MVA
• Kawasan Industri
– Kimia/Toksik, Kebakaran
• Lapangan Terbang - Antarabangsa,
TUDM
– Bencana Udara
• Pelabuhan
– Bencana Laut
• Kawasan Tadahan Air:
– Banjir Besar
• Bangunan Tinggi
DISASTER ON SITE
MANAGEMENT
INCIDENT SITE MANAGEMENT

1. Zoning and coding

2. Evacuation to reservoir area
3. Triage
- primary
- secondary
4. Onsite Management
5. Forensic activities
6. Public Health
7. Psychological Management
 ZONING CONCEPT AT THE INCIDENT SITE

Police Base Station

PRESS Medical Incident Area Fire Base

Base Station
High Risk Zone

Family & COMMAND CENTRE

Relative (TACTICS ZONE) Ambulance HQ
Transportation
STRATEGY ZONE

On Scene Commander On Site Medical Forward Field

Commander Commander
POLICE ( OSC )
( OMC ) BOMBA (FFC)
 KONSEP ‘ZONING’
Evacuation Zone Disaster Zone
(100-150mtr R) (50-100 mtr R)

Inner Disaster Command Post

Cordon
POLICE
Outer PKTK BOMBA
Cordon
SMART

MEDICAL

Safety Zone 991

Guard Post
(200mtr R) MRCS/SJA
Guard Post NGO & Other
Releif Agencies
ACCESS EXIT
Pengurusan pengangkutan yang teratur.
Ambulance
parking
point
IN

Medical Ambulance
Inner cordon base loading
station point Outer cordon

SITE

OUT
 MAJOR INCIDENT MANAGEMENT

Incident Site Management

Zoning

1. RED ZONE
 Inner Zone
 High Risk Zone
 Approx. - 50 to 100 m
 For Rescue workers, marshal, fire unit
 Rapid response team (Medical Team)
• 2. Yellow Zone
-Middle ring- supporting team
-Base station for Medical, Police and Fire
-Sorting out the Injured
-Command centre
• 3. GREEN ZONE
-Safe area
-Press
-Temporary Mortuary
-Transportation area
Incident Area: high risk zone
 On Scene
Commander

Scene
survey
 Medical Commander
• Command for medical &
paramedical teams
• Gather incident information
• Provide situational reports to base
• Establish initial medical control
points
• Establish liaison with other
emergency services
• Located @ strategic, secure, up-
wind from site
5S (Role of first medical team reach at disaster site)

1) Safety (staff and scene)

• Appropriate level of PPE

2) Scene size up (METHANE)

• Major incident - confirmed
• Exact location - grid reference
• Type - rail, chemical & road
• Hazard - present & potential
• Assess
• Number of casualties
• EMS
3) Send information to hospital (METHANE)
4) Set up medical base
• Inform the On Scene Commander (POLICE)
• Sent a liaison officer (MELO) to the control post
• Identify the codon
• Set up the medical base at yellow codon
• Set up the triage system
 Inner
INCIDENT AREA Wind
cordon direction

Decontamination
firemen team

Decontamination
Unit

Casualty clearing point

5) START triage (Remember : RPM)
Simple Triage And Rapid Treatment
• Treatment
- Open airway
- Circulation : control the bleeding
TRIAGE SYSTEM OF MAJOR
INCIDENT
• 1. Primary Triage/ Triage Sort
- At the Red zone

• 2. Secondary Triage/ Triage Sieve

- At the Yellow Zone

• 3. Definitive Triage
- At the Hospital
 Disaster Field Triage
• Basic Aim : To do the most good for the most
people
• Transport priority for the most salvageable with
the most urgent problems
• Transport those who are treatable in hospitals
but fatal in the field first
• “Sieve and Sort” using the START system
 Disaster Field Triage
• TRIAGE SIEVE • TRIAGE SORT
– ‘First look’ triage – ‘Retriage’ at Casualty
– Decision undertaken at
Clearing Station
Incident Site
– – Right patient to the
Rapid, simple, safe &
reproducible Right place at the
– Not perfect Right time
– Walking wounded to leave
danger area under their own
power
– Critical patients carried to
casualty clearing station
Casualty
Collecting
Point
How much treatment?

• Aim: to ensure patient stable enough to

endure journey to a facility where they
can be fully assessed & treated
– Most treatment will be directed towards
airway, breathing & circulation
• Amount of treatment delivered at the
scene corresponds to triage priority
REMEMBER Mnemonic

R 30
P 2
M Can do
 START Triage
RESPIRATIONS YES Under 30/min
PERFUSION
NO Over 30/min
Cap refill Cap refill
Position Airway Immediate > 2 sec < 2 sec.

Control
NO YES Bleeding MENTAL
STATUS
Dead or
Immediate Immediate
Expectant
Failure to follow Can follow
simple commands simple commands

Used with permission, Newport Beach Fire and Marine Dept.

Immediate Delayed
 Disaster Triage Tags
• Most effective
• Internationally recognized Color codes
• Defines severity of injury and also defines urgency of
transport
• Useful to incorporate ID codes here

• Red: critically injured (need immediate surgical/specialty

care)
• Yellow: less critically injured
• Green: no life/ limb threatening injury
• White/Black: fatal injuries or dead
Transportation:

• One of the prime task of command &

control structure is to ensure the
movement of patients is as smooth and
efficient as possible
• The structure of treatment and evacuation
areas is crucial
• Method of transport & order of evacuation
Transportation

Bring the
RIGHT patient
to the
RIGHT place
at the
RIGHT time
TRANSPORTER:
NON-CRITICAL VICTIMS
Perkhidmatan Forensik
• Personel
– Pakar Patologi
– Pakar Pergigian/Maxilofacial
– Anggota Sokongan
– Polis
• Kemudahan
– Mortuary
Recovery Phase
• Long term psychological &
emotional problems
• Psychiatrist
• Counselors
PELAN TINDAKAN
BENCANA

FASA ISHTIHAR SECARA

UMUM
(Hospital Activation Phase)
Hospital Activation Phase

• A Hospital Response NOT an ED Response

• A Hospital Strategy
• Handled by Hospital Authority
• A Mandotary requirement by the
MINISTRY OF HEALTH
• All Hospital personnel must be aware of
the Disaster Plan.
 DISASTER ACTIVATION
• BERMULA APABILA
PANGGILAN BENCANA
DI TERIMA

• MELALUI :-
• ORANG AWAM ( PERLU PENGESAHAN )
• Bilik MKDaerah / MKNegeri / MKNegara
• DCC (Polis/ Meritime)
• JBPM (Bomba)
• Bilik Kawalan Disaster (airport)
The First Person Receiving
Message
• Record time receiving
• repeat message to caller
• record message - what event, where,
when, how many victims
• get the caller’s - name, phone no.,
location, advise the caller if
necessary
• If it is disaster…. To follow plan of
action!
 Incident Hospital
Caller operator

Emergency
Hosp.Director Dept

Operator First Medical

Yellow Red alert team
alert

Activate Police
False alarm personnel confirmation

Stand Down Report to Take action card

operation room & go to
designated area
Aktivasi Yellow Alert
• Menerima maklumat kejadian bencana
• Membuat Pengesahan Bencana-Jika Terima Dari
Pemanggil Orang Awam.
• Call Centre Maklum kepada Jabatan Kecemasan
• Maklum Kepada Pengarah.
• Hantar ambulan ke lokasi untuk pengesahan jika
perlu ( Survey Team )
• Membuat persediaan penerimaan pesakit
• Jabatan Kecemasan
• Lain lain anggota – Turun Ke ED Tunggu arahan
& bersedia untuk arahan lanjut
 Red Alert
• Kejadian Bencana telah disahkan
• Aktivasi Plan Tindakan Bencana Hospital
• Pegawai – Pegawai dihubungi
• Bilik Gerakan di buka
• Ketua unit – Lapor diri ke Bilik Gerakan
• Menerima Taklimat
– Menjalankan tugas dan menerima arahan
• Petugas lain lain – Lapor diri di stesyen masing
masing
• Jika diarah – Lapor diri kepada Koordinator Klinikal
 PELAN TINDAKAN BENCANA
• Bencana telah berlaku
– Penolong Pegawai Perubatan terima
panggilan
– Maklumkan kepada Pengarah Hospital
– pasukan perubatan digerak ke tempat
kejadian
– Telefonis diberitahu -- menghubungi
staf lain
 PELAN TINDAKAN BENCANA HSJ
Directive by Establish MEDICAL
Pengarah FIRST RESPONSE TEAM Field Triage
BASE Hospital Triage
Hospital 1 MO (ED)
1 AMO (ED)
1 SN (ED) RED TEAM
1 PPK.(ED) 1 Consultant Surgeon/On-Call Red Tag Yellow Green
1 Ambulance driver 1 MO Anaes on duty/ On-Call Tag Tag
1 AMO (ED)
1 SR (ICU) on duty/on call
Activate All Pagers 2 SN (Wd.8 & 7) Red Yellow Green
( CODE - DISASTER) 1 PPK (Wd 5) Zone Zone Zone
Telephonist Inform by PA system 1 PPP U32 ED (document)
YELLOW TEAM
Clinical coordinator (EP)
1Ortho Surgeon on call
All Other Specialists •Ward
1MO Ortho on duty OT Team
1 MO Surgical on duty •OT
Emergency operative •Discharge
supervisor 1AMO Ortho on duty
Hospital Supervisor 1 SN (Wd.6) White Tag
Matron 1 PPK (Wd.2)
1 SN IC (document)
Mortuary
Contact Ward As Identified GREEN TEAM
1 Physician. On-Call
Hospital BM & Sg. Bakap 1 MO Paed On duty
Open Bilik Klinik Kesihatan SJ/ HKB 2 SN (Wd 1,SCN)
Gerakan 1 PPK (Wd 10) Forensic Team
D.O / Police / Security 1 PT (document)
SECOND RESPONSE TEAM
Admin Open up Disaster Ward REPLACEMENT TEAM
1 EP on duty.
Staff - Physician &Team 1 MO ED
1 MO Med on duty 1 AMO (ED)
2/shift
1 AMO (MOPD) on duty 1 SN (LR)
Clinical Support Services 1 PPK.(ED)
Revised Hospital Support Services 1 SN (WD 3)
1 PPK (SCN) 1 Ambulance driver
October 2012
1 Transport driver
Komponen Penting

• Tempat Menunggu
Waris/Keluarga:
– Kemudahan Asas
– Sistem perhubungan/informasi
– Kaunselor
• Kaunter Informasi
– Personel
 PELAN TINDAKAN BENCANA

• Sistem Komunikasi
– alat komunikasi yang disediakan
– ambulan dengan radio
– Walkie talkie
– GIRN (Government Integrated Radio
Network)
Bilik gerakan Alat radio Command
HSJ ED Post
HOSPITAL DIRECTOR
Hospital Coordinator
Declaration of alert phase
Activation of supporting hospital
Reporting to the State Health
Office and Ministry Of Health
Laise with relevant agencies
Public information and press
release
Officer-In-Charge Of
Operation
The Hospital Director will be in
charge of all aspects of operations. If
he/she is not available..
• Acting Hospital Director
• HOD E.D
• Hospital Supervisor
• ED Senior AMO
• ED AMO I/C Of Shift
Clinical Coordinator
• Overseeing the need for medical
personnel
• Ensuring the doctors will be called
back
• Preparation of ED for patient
reception
• Deploying medical team at the site
• Ensuring the preparedness of team
at various zones
Administrative Coordinator

The Timbalan Pengarah Pengurusan

will be the Administrative
Coordinator. The Administrative
Coordinator will be assisted by the
Hospital Supervisor and Hospital
Matron.
 The administrative coordinator will be
responsible for:
• The operation room.
• Waiting area for relative of the victims
• Identifying ward for accommodation of influx
of patients
• Information center
• Clinical, pharmacy, radio-imaging, blood bank,
forensic support service.
• Non clinical support service such as security,
Polis Transport and Faber Sdn. Bhd.
• Delegation of duties for clerks and driver.
Hospital Operation Room
• The hospital Operation Room will serve as:
– Nerve center where all decision and strategies
are discussed/issued
– Coordinate all activities.
– Act as main communication center and
sources of all information/ press statement.
• Personnel of this center comprised of hospital
directors, hospital supervisors, matron,
administrative officer and other members
identified by the hospital director.
Petugas Bilik Gerakan
• Memahami dengan mendalam akan tugas yang
dipertanggungjawabkan
• Rekod semua aktiviti dalam buku lapuran
• Melapurkan segala maklumat terkini kepada JKN
• Mengemaskini segala rekod tindakan, statistik
inventori dari masa ke semasa
• Memastikan setiap anggota yang hadir bertugas
di rekodkan
• Berhubung dengan pihak dapur untuk
penyediaan makanan
• Bersedia menerima arahan daripada pegawai
atasan dari masa kesemasa
Penolong Pegawai Perubatan bertugas

• Bersama telefonis hubungi:

– Pengarah Hospital
– Ketua Jabatan Kecemasan
– Penyelia Hospital
– Ketua Jururawat
• Aturkan pasukan penyelamat pertama
• Sediakan kawasan mengikut zon
• Triage semula kepada mangsa yang tiba
• Beri rawatan segera
• Aturkan urusan pendaftaran
• Memindahkan pesakit kecemasan lain ke
lokasi yang dikenalpasti
Pegawai Khidmat Pelanggan
• Hubungi semua pegawai-pegawai utama
– Pengarah Hospital
– Penyelia Hospital
– Penyelia Jururawat
– Ketua Jabatan Kecemasan , dll
• Pegawai Khidmat Pelanggan yang bertugas
hendaklah memastikan mana-mana panggilan
telefon yang bukan kecemasan dan utamakan
kegunaan talian bagi menghubungi pegawai
tang perlu dihubungi dengan segera.
Penyelia Hospital
• Buka Bilik Gerakan
• Membantu menggerakkan pasukan perubatan
kecemasan/penyelamat dengan seberapa segera
• Mengendalikan panggilan kakitangan tambahan
yang diperlukan
• Mengatur tugas kakitangan tambahan bersama-
sama dengan Penyelia Jururawat
Penyelia Jururawat

• Lapur diri di Bilik Gerakan

• Memanggil kakitangan bantuan
• Mengelola pengurusan kakitangan
• Menilai keadaan pesakit
• Pengasingan dan pengosongan wad dan
katil
• Mengurus lokasi pergerakan pesakit dan
kakitangan
Ketua Jabatan (Pakar-pakar di
hospital)
• Lapur diri di Bilik Gerakan
• Menentukan pemindahan pesakit
• Bertindak sebagai penyelaras dalam aspek
pengurusan klinikal.
RED/YELLOW/GREEN TEAM

• Lapur diri di pusat operasi kecemasan

• Bergerak terus ke zon masing-masing
• Bersiap sedia untuk menerima kes
• Ikut arahan Clinical Coordinator
Jaringan Antara Agensi
• Hospital Lain (Kerajaan/Swasta)
• Klinik Kesihatan
• NGO -
– PBSM
– St. John Ambulan
– JPAM
– Bomba sukarela
CABARAN PENGURUSAN BENCANA

1.Anggota mahir
2.Ambulans mencukupi
3.Peralatan dan kemudahan
4.Sistem komunikasi
5.Latihan / ‘Drill’
6.Belanjawan / Budget
7.Penyelidikan (R & D)
Terima kasih