INDONESIAN INTEGRATED EMERGENCY SYSTEM

Since 2000 the Ministry of Health has developed the concept of Integrated Emergency Management System (SPGDT) integrating emergency care from pre-hospital level to hospital level and referral between hospitals with cross-program and multisectoral approach. Emergency response emphasizes prompt and precise response to the principle of Time Saving is Life and Limb Saving. It is a system where coordination is a major element of a multi-sectoral nature and there must be support from various professions are multi-disciplinary and multi-profession to carry out and organize an integrated service form for emergency patients either in everyday situations or in disasters and outside events ordinary.

In providing SPGDT medical service is divided into 3 sub-systems, namely: pre-hospital service system, hospital service system and inter hospital service system. These three sub-systems cannot be separated from each other and are interrelated in the implementation of the system.

The principle of SPGDT is to provide fast, accurate, and precise services, where the purpose is to save lives and prevent disability (time saving is life and limb saving) especially this is done before being referred to the intended hospital.

MEDICAL SERVICE SYSTEM PRE-HOSPITAL

1. Public Safety Center

In the implementation of pre-hospital service system should establish or establish a service center that is general and emergency in which the form is a unit of work called Public Safety Center (PSC), this is a work unit that provides public services, especially the emergency can be UPT District Health Offices or Municipalities, whose day-to-day operations are headed by a director. In addition, pre-hospital services can also be done by forming a special unit that served in the handling of disasters where at this time often called the Disaster Prepared Brigade (BSB), ambulance services, and communication. In the implementation of the Public Service Center can be done by the community for the benefit of the community, where the organization under local government, while the human resources consist of various elements, such as health elements, firefighting elements, police elements, elements of community and community itself engaged in the field of relief first, so it has a fast response function in emergency response response.

2. Disaster Alert Brigade (BSB)

Is a special unit that is prepared in the pre-hospital handling, especially related to health service in disaster management. Organizing is formed by health personnel both at central and regional levels (depkes, dinkes, hospitals) medical officers both doctors and nurses as well as non-medical personnel both sanitarian nutrition, pharmacy and others. Financing is obtained from designated agencies and included in the regular budget of APBN and APBD.

3. Ambulance Service

Integrated service activities within a coordination that empowers ambulances belonging to puskesmas, private clinics, maternity houses, public and private hospitals, private and government health institutions (PT Jasa Marga, Jasa Raharja, Police, PMI, Foundation and others). Of all these components will be coordinated through a service center that is mutually agreed between the government and non-government in order to carry out ambulance mobilization especially in case of mass casualties.

4. Communication

In carrying out the daily emergency service activities require a communication system where the nature is the formation of network delivery of coordination network information as well as network of emergency services so that all activities can take place in a unified system coordinated into one unity of activities.

DISASTER MEDICAL SERVICES

Service in a state of disaster that causes mass casualties requires special things to do. The things that need to be done and organized are:

1. Coordination and Command

In the event of a disaster, a pattern of activities involving cross-sectoral activities is required which will be effective and efficient if it is within a commander and a coordination agreed upon by all the elements involved.

2. Escalation and Resource Mobilization

This activity is the handling of disasters that result in mass casualties that must carry out escalation or various upgrades. This can be done by mobilizing human resources, mobilizing facilities and facilities and mobilizing all supporters of health services for victims.

3. Simulation

Required provisions are mandatory (protap) procedures, operational guidelines (juklak) and technical guidelines (technical guidelines) that must be implemented by officers who are the standard of service. The provision needs to be assessed through a simulation in order to know whether all systems can be implemented in the reality of the field. 

4. Reporting, Monitoring and Evaluation

Disaster management needs to be done documentation activities, in the form of reporting both manual and digital and accumulated into one data used for monitoring and evaluation, whether the success or failure, so that the next activity will be better.

HOSPITAL MEDICAL SERVICE SYSTEM

Care should be given to the provision of suggestions, infrastructure that must exist in the ED, ICU, mortuary, investigation units, such as radiology, laboratories, clinics, pharmacy, nutrition, inpatient rooms, and others.

1. Hospital Disaster Plan

Hospitals should make a plan to deal with catastrophic events called Hospital Disaster Plan, either in the hospital or external hospital.

2. Emergency Unit (ER)

In the ER there must be a good and complete organization of financing, trained human resources, facilities with good standards, medical and non medical facilities and following medical services technology. The main principle of service in the ER is the response time of both national and international standards.

3. Disaster Preparedness Brigade RS (BSB RS)

In the hospital should also be in the form of Disaster Preparedness Brigade which is a special task force that has the duty to provide medical services during times of disaster both in hospital and outside the hospital, where the nature of this incident caused mass casualties.

4. High Care Unit (HCU)

A form of hospital service for stable patients with both hemodynamic respiration and consciousness levels, but still requires strict and continuous care and monitoring treatment, this HCU should be present in both type C and type B hospitals.

5. Intensive Care Unit (ICU)

It is a multi-disciplinary hospital service. It is special to avoid death threats and requires a variety of tools to improve vital functions and requires sophisticated technological means and considerable financing.

6. Chamber of the Bodies

Services for patients who have died, both dead in hospitals and outside hospitals, under normal circumstances or disasters. At the time of the mass occurrence in need of organizing a complex which will be done identifying the victims both known and unknown and special human resources specialize in addition to relating to matters of legality aspect.

MEDICAL SERVICE SYSTEMS TRANS HOSPITAL

A referral network is created based on the ability of the hospital to provide services both in terms of quality and quantity, to receive patients and this is closely related to the ability of human resources, the availability of medical facilities in the ambulance system.

1. Evacuation

Forms of transport services directed from command posts, field hospitals to referral hospitals or hospital transportation, both due to disasters occurring in hospitals, where patients must be evacuated to other hospitals. Implementation of evacuation must still use standardized means to meet the criteria that determined based on hospital service standards.

2. Terms - evacuation conditions

• The victim is in the most stable state possible to be evacuated • The victim has been prepared / given adequate equipment for transportation.
• Recipient health facilities are notified and ready to receive victims.
• The vehicles and escorts used are the most feasible.

3. Some forms of evacuation

Land evacuation, in which the victims must be rapidly displaced, because the harmful environment, life-threatening circumstances, require immediate relief, as well as if there are a number of patients with life threats requiring help.
Immediate evacuation, the victim must be handled immediately, because of the existence of a stroke for his soul and can not be done in the field, such as patients shock, stress patients environment events and others. Also dilaukan pad patients who are in the environment that resulted in the patient's condition quickly decreased due to rain, cold or hot temperatures.
The usual evacuation, in which the victim is usually not threatened, but still needs help at the hospital, where the patient will be evacuated when it is in good or stable condition and is possible to move, especially in fracture patients.

4. Control traffic

To facilitate the safeguarding of evacuations, traffic control should be carried out by the police, to ensure traffic between hospitals and medical posts and command post. The medical post may convey to the command post so that the patient can be evacuated if it is in a stable state. So the traffic control must be in line with the evacuation process itself.

Successful Emergency Handling Depends 4 Speed:

1. Speed found the presence of GD sufferers
2. Speed and Response Officer
3. Ability and Quality
4. Speed Ask for Help

The possibility that occurs if late resuscitation

0- 4 Minutes	Dead Clinical	Damage Brain cells are not expected
4-8  minutes		There may already be Damage to Brain Cells
8-10 minutes	Dead Biological	Already Begins Brain Damage
> 10 minutes		Almost certainly occurs Damage to brain cells

TRANSMISSION COORDINATION EMERGENCY RESPONSE UNIT