EMERGENCY MEDICAL SYSTEM

SISTIM PELAYANAN
GAWAT DARURAT TERPADU

R. SUHARTONO
FKUI – RSCM JAKARTA
OBJECTIVES

1. Define the Components of EMS

system/SPGDT
2. Deferential the roles and responsibilities
of patient care out of hospital and in
hospital
3. Discuss the specific statutes and
regulations in the EMS system/SPGDT
THE NEED
Disaster and Mass Casualty Incident (MCI)
in Indonesia 1980 - 2007
1. Mt. Galunggung 1980
2. Food Poisening West Jakarta 1981
3. Harbor Fire Tg.Priok North Jakarta 1981
4. Gas Leak Tg. Priok Jakarta 1982
5. EQ West Java 1985
6. Hotel Fire Jakarta 1985
7. Plane Crash Karawang West Java 1985
8. Toll RD Crash 1985
9. Jakarta Atmajaya Hosp. Flood 1986
10.Jakarta Fatmawati Hosp.Evac
Munition Explosion 1987
11.Jakarta Bintaro Train Crash 1987
12.Jakarta Koja Hosp.Isolation
(Tg. Priok Riots) 1987
13.Food Poisening Jakarta Factory 1988
14.EQ Flores 1991
15.Jakarta Riots 1992
16. Jakarta Floods 1991-1992
17. Tsunami Lombok 1993
18. EQ Liwa 1993
19. Mt. Merapi Eruption Jogja 1995
20. EQ Kerinci 1995
21. Riots PDI-P Political Party
Jakarta 1996
22. EQ & Tsunami Biak 1997
23. EQ South Sulawesi 1997
24. Ethnic Riots Pontianak 1997
25. EQ Bengkulu 1997
26. Ethnic Riots Sampit 2001
27. Displaced Persons in Madura,
Poso, West & Easth Nusa Tenggara
Papua, West Java, Middle Java,
Molucus, North Molucus,
Nort Sulawesi 2001
28. Drought Sampang Borneo 2001
29. Mt. Papandayan Erruption 2002
30. Train Crash Brebes Middle Java 2002
31. Land Slide East Java 2002
32. Flood North Sumatera 2002
33. Floods Pekalongan & Semarang
Middle Java 2002
34. Religious Conflict/Riots Ambon 1999-2002
35. Religious Conflict/Riots Palu
South East Sulawesi 1999-2002
36. Papua Riots 1999-2002
37. Terorist Bombings (32x) Jakarta 1998-2002
38. Political Rios Jakarta 1998-2002
39. Jakarta 3 weeks Floodings 2002
40. Nunukan Displaced Migrant
Worker 2002
41. Bali Terrorist Bombing 2002
42. Htl Marriot Jakarta Terrorist
Bombing 2003
43. Gresik East Java Chemical Factory
Explosion 2004
44. Australian Emb.Jakarta Terrorist
Bombing 2004
45. EQ Karang Asem Bali 2004
46. EQ Nabire (2x) 2004
47. Aceh EQ & Tsunami 2004
48. EQ Palu SE Sulawesi 2004
49. Drought E. Nusa Tenggara 2005
50. EQ West Java 2005
51. Trash Dump Landslide
Bandung 2005
52. EQ Nias & Simulue 2005
53. Train Crash Tg.Barat Jakarta 2005
54. Mandala Air Crash Medan 2005
55. Bali Bomb II 2005
56. RS Budi Asih Jakarta 2005
57. Longsor/banjir Djember 2006
58. Longsor Banjarnegara 2006
59. Longsor Trenggalek 2006
60. Banjir Bima 2006
61. Merapi Erruption 2006
62. EQ & Tsunami Pangandaran 2006
64. Hot Mud Lapindo 2006
65. Jakarta Trash Dump Landslide 2007
66. Jakarta Flood & DHF – Diarhae 2007
67. Adam Air 2x, Senopati, Levina I
Garuda 2007
68. Gempa Padang 2007
Traffic Incident in Jakarta 1999 – Sept 2004
Kematian Data
Cedera Cedera Polda Kmr
Tahun KLL
Ringan Berat Metro Mayat
Jaya RSCM
1999 1003 340 599 403 1238
2000 871 306 634 324 1360
2001 674 260 408 261 1330
2002 689 180 496 262 1358
2003 1300 601 615 503 1492
s/d
Sept 107 - - - -
2004

JML 4644 1687 2752 1753 6778

Disaster & Mass Casualties Incident

• It is impossible to manage Disaster &

Mass Casualties properly if Our Day to Day
Emergency Care is Bad !!
• The Day to day Emergency Care in
Indonesia is Not Up To Standard !!!
EMS System – SPGDT
Basic  Safe Community

• To apply the EMS & Disaster management systems of

• developed countries to Aceh, Indonesia or other
• developing countries, will not work because we do not
• have the infrastructure.

Some conditions we must be aware of :

1. We will not be able to Manage Disasters properly if
we are not manage the day to day Trauma /
Emergencies cases properly.
2. Trauma / Emergency Care in Indonesia – Developing
Countries are of poor Quality / Standard.
3. In Indonesia / Developing Country there is no pre
hospital Emergency Medical Service (EMS).
4. We must develop the IEMSS, Networking between
Emergency Departments and improve the quality care .
The Committee On Trauma Indonesian Surgeons
Association (COT ISA) in November 2000 declared the
Safe Community Concept at the Makassar Declaration
2000 which is : we must be able to guarantee that any
Indonesian Citizen whether he is in the Urban or Rural
areas, he will be Healthy & Safe.

If these Medical Resourches are integrated with the

Post Graduate Courses like the ATLS, ACLS, ANLS,
APLS,MFR, CSSR, BTLS, BCLS, BNLS, BPLS, HOPE
and the Disaster Management,

we will have the SAFE COMMUNITTY.

Integrated Emergency Medical Service System (IEMSS)
(MFR, CSSR) (Paramedic , • HOPE
• “Emergency Nurse”
CSSR) (BTLS, BCLS, BNLS, BPLS)
Police • “Emergency physician”

(BLS) Fire Brigade 188 (ATLS, ACLS, ANLS, APLS)

• Surgeon
Security Guard Emergency (ATLS, BSS, DSTC, Peri OP CC)
Layman Civil Defense Ambulance • DISASTER MANAGEMENT
Scouts Service E.D. I.C.U Ward
Red Cross

Rehabilitation
Access
DISASTER Public
Emergency
Telephone Number Health
Center
110,113,118

Pre-Hospital Phase Hospital Phase

A. The Layman :
Any layman should be able to help anybody who is
injured or suffering from acute life threatening disease.
They should be able to recognize and able to free the
Airway, Support Breathing with the mouth to mouth
technique, Stop Bleeding and Splint & Bandage,
Transport Patient safely.

The COT has a course for layman which consist of :

1. How to Call For Help.
2. How to do Cardio Pulmonary Ressucitation whithout
equipment or drugs.
3. How to stop Bleeding.
4. How to Splint & Bandage.
5. How to transport patients safely.
B. The Emergency Telephone Number :
A National Emergency Telephone Number (Preferably a three
digit number) which is easy to remember and toll free is the most
important factor in this system. This the access of the people to the
system. However good the system is, if it is in accessible to the
people, it is of no good.

This number should be used not only for the IEMS, but also as an
access number for help in hotels,
public buildinsg like the airport, train station.
etc. Indonesia has three emergency telephone numbers :
􀂾 110 for the Police – Security.
􀂾 113 for the Fire Brigade – Rescue.
􀂾 118 for the 118 IEAS.
C. The Fire Brigade, Police, Security Guard, Red Cross
Volunteers, Scouts etc
They are people / personal who are on the streets / public
buildings. And they are people who are trained to protect and
help people.
They lack only in the training how to help people injured or
acutely ill. They are the best candidates to be trained in the
Medical First Responder (MFR) program. This is a program
from the Office For Foreign Disaster Assistance (OFDA) the
USA.
This is a two weeks course and is available in Nepal, India,
Philipine and Indonesia.

We also teach this course to our Paramedics -EMT Basic.

D. The Pre Hospital Ambulance Service :

The Fire Brigade, Police, Security Guards, Red Cross

Volunteers, Scouts etc.
Organized into an Integrated Emergency Medical Service
System – 118 IEAS.

Even Hospital ambulances (Hospital based, manned by the

nurses from the Emergency Dept and maintained by the
hospitals) and Public Health Center / Clinic ambulances can
be included and organized into an Emergency Medical Service
with a One System and One Command but different
ownerships.
E. We can use the existing post graduate courses like
the ATLS, ACLS, APLS and the ANLS to train the
doctors working in The Emergency Department of
Hospitals, Public Health Center & Clinics :
as “Emergency Physician”.
These “Emergency Physicians” will take care about
The Primary Survey (A, B, C & D) only and the
Specialist will handle the Secondary Survey –
Definitive Therapy.
Even the nurses can be trained as “Emergency
Nurses”.
If these nurses go with the hospital based ambulance,
then the ambulance is the same level as the Basic
Emergency Ambulance.
F. Disaster Planning and Training :
The Disaster Plan must be comprehensive and in
continuous with the National Disaster Plan. This is such
that the Disaster Plan of each province, city, Pre Hospital
Emergency Service and Hospitals is using the same format.
This can be done if each organization / agency sets up a
committee which is responsible to make the Disaster Plan.
These committees will identify and discuss all risk / type of
disaster faced by the hospital (In Aceh and Indonesia the
most common risk are Earthquake, Volcano, Flood, Fire,
Riots, Terrorist Attack etc), resources available, training &
exercises etc.
A Disaster can be an internal or external disaster. A
Disaster is internal if the hospital it self is involved in a
disaster or in a disaster area.
A disaster is external if the disaster is outside the hospital
and multiple casualties are taken to the hospital or the
hospital must dispatch a team (Mobile Medical Team) to
the disaster site / area.
Component/Fase of EMS System/SPGDT
1. Component/Fase  Detection
2. Component/Fase  Supersion
3. Component/Fase  Pre Hospital
4. Component/Fase  Hospital
5. Component/Fase  Rehabilitation
6. Component/Fase  Management Disaster
& MCI
7. Component/Fase  Evaluation/QC
8. Component/Fase  Budgeting
Classic Components of EMS
1. Regulation and policy
2. Resources Management
3. Human Resources and Training
4. Transportation
5. Facilities
6. Communications
7. Public Information and Education
8. Medical over sight
9. Trauma Systems
10.Evaluation