PENANGGULANGAN KASUS GAWAT

DARURAT PRA RUMAH SAKITDARURAT PRA RUMAH SAKIT

Tri Wahyu Murni Perhimpunan Kedokteran Gawat Darurat Indonesia

PENDAHULUAN(Introduction)(Introduction)

ISTILAH

DARURAT

(Emergency)

• Any condition that-in the

opinion of the patient, his

family, or whoever assumes

KASUS GAWAT DARURATKASUS GAWAT DARURAT(Life threatening cases) (Life threatening cases)

– Immediately life threatening (critically ill patients)

family, or whoever assumes

the responsibility of

bringing the patient to the

hospital-requires immediate

medical attention

– Potentially life threatening (emergency patients)

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KEJADIAN DI PUSAT PERBELANJAAN

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KEJADIAN PADA PERTANDINGAN SEPAK BOLA

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SPGDT(Sistem Penanggulangan Gawat darurat Terpadu)

IEMSS

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IEMSS(Integrated Emergency Medical Service System)

IEMSS(Integrated Emergency Medical Services System)

Environmental

Demographic

Prehospital Hospital Inter

Population

Prevention

Programs

EMS

outcome

Prehospital

Communication

Transportation

Hospital

Emergency Dep

HCU, ICU, OR

Resources :

Personnel, Facilities, Equipment

Organization

Procedures

Inter

Hospital.

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TWM1

Slide 7

TWM1 Tri Wahyu Murni, 7/6/2008

SPGDT / IEMSS

Lingkup/ Scope

1. Pra RS (Prehospital)

2. Di RS (in Hospital)

Kejadian / Event

• SPGDTS-sehari-hari

(Daily emergency medical 2. Di RS (in Hospital)

3. Antar RS (inter - Hospital)

• Pencegahan (Care)

• Penanganan (Cure)

(Daily emergency medical

service system)

• SPGDTB-saat Bencana

(Emergency medical service

system on Disaster )

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SEHARI-HARI (DAILY EMERGENCIES))

PRA RUMAH SAKIT / PREHOSPITAL Personnel : Who is responsible ?

Communication : Emergency call ?

Transportation :Ambulance service?

Facilities & procedures: Primary care/

Acute care

DI RUMAH SAKIT / in HOSPITAL

ANTAR RUMAH SAKIT

Hospital readiness ? EU, HCU,ICU,OR ?

Hospital coordination, transpotation,

communication

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PRE HOSPITAL EMERGENCY CARE (PHEC)

Communication system incl.

Emergency call numberTransportation:

1 2 3

Emergency call number

Ambulances Service center (ASC), Public safety

center (PSC), Primary care/ Acute care

PERSONNEL

a. Medical doctor

b. Nurses

c. Non medis profesional

a. MFR (Medical First

Responder)

b. PHEC personnel

Transportation:

Ambulance service

incl profesional

crew

4

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KASUS (CASES)

• Darurat medis

(Medical emergencies)

– Keracunan (poisoning)

– Serangan jantung (Heart

• Darurat bedah /kecelakaan

(Surgical emergencies / accident)

– Serangan jantung (Heart attack)

– Henti jantung mendadak (Sdden cardiac arrest)

– Bayi berisiko tinggi (Highrisk infant)

– Penyakit menular (Communicable disease)

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– Trauma

– Luka bakar (Burn injury)

– Cedera tulang belakang (Spinal cord injury)

Sumber Daya Manusia (Daily medical emergencies personnel )

Medical profesional.

Pre Hospital Emergency

care (PHEC)

1. First aid qualification

2. Advanced PHEC

1

Medical profesional.

1. Medical doctor

2. Nurses

2. Advanced PHEC

Ambulance crew

Rescue personnel

Public safety personnel

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PREHOSPITAL EMERGENCY CARE (PHEC)

• Designing for people who are frequently called on to

provide first aid services to member of public who

live/ work in remote area, work in risky occupation

• Qualification ?

• Standard course/ training?

• Certification ?

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NEW ZEALAND STANDARD(First responder Qualification recognized under

NZ qualification Authority/ NZQA) 5 days course (40 hours) $950

• Course outline:1. Revision first aid

2. Anatomy& physiology

3. Shock

4. Resuscitation

5. Oxygen therapy

6. Trauma condition (treat use of

8. Patient assessment (incl diagnostic equipment., sphygmomsnometer, glucose monitor, pulse oximetry, Pupil tourch,chest percussion)

9. Introduction to drugs (aspirin, GTN, adrenalin, glucagon, 6. Trauma condition (treat use of

traction splint, cervical collar, extrication devices, lifting and moving techniques with stretcher and position in transport)

7. Emergency medical conditions ( focus on cardiac arrest and using AED)

GTN, adrenalin, glucagon, salbutamol, Entonox)

10. Patient movement

11. Scenarios (sed in medical and trauma patients)ultiple scenario to assist in developing confidence and competence is assese

Note: refresher course 2 days $400, units as above.

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PREHOSPITAL EMERGENCY CARE COURSE(New Zealand St John standard)

• Pelatihan/ kursus : utk CERTIFIEDFIRST AIDERS (valid cerificate ).

Course :

1. immediate advanced first aid assistance any situation

2. Familiar with basic emergency equipment (airway care

Materi :

1. Scene assessment

2. Scene management

3. Patient assessment

4. Using adjunct airways

5. Bag/mask resucitation

6. Defibrilationequipment (airway care respiraory support)

Penyelenggara St Jons utk sseluruh NZ diberikan untuk indivisual/ group

• Lama pelatihan 3 hari , Biaya $ 649.00

6. Defibrilation

7. Trauma condition

8. Medical condition

9. Oxygen administration

10. Neck and spinal injuries

11. Extrication / stretcher

12. Moving patients

13. Scenarios

14. Documentation

15. Managing deceased patients

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PHEC PERSONNEL(New Zealand red cross standard)

• Course 24 hours (3 x 8 jam) $.595

1. Extended first aid

2. Basic life support

3. Oxygen theraphy

4. shock and defibrillation

5. Move and position patients in preaparation for transport

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Medicine in Remote Area (MIRA) certificateUK qualification endorsed by the Royal college of surgeon of Edinburg

• Pelatihan ini setara dg 5 hr PHEC course., ditujukan pd personnel yang pada situasi kritis harus memberikan pertolongan karena tidak adanya harapan adanya rescue support.

Materi pelatihan

1. Intermediate & advance airway managemnt incl. surgical airways

2. Management of injuries from road trafific colition, ballistic, violent assaults

support.

• Misalnya untuk personnel SAR, offshore, hostile environment medics

• Waktu pelatihan 5 hari

violent assaults

3. Life threatening chest injuries & management incl. Needle decompression

4. Shock & fluid replacement (iv or io)

5. Environmental illnesses

6. ACLS

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SKILL

Patient assessment TRAUMA PATIENT

SPLINT

Basic life support

MEDICAL EMERGENCY focus on

cardiac arrest & using AED)

OXIGEN THERAPY

MOVING

& LIFTING

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Bagaimana pelatihan bagi masyarakat yang akan

memberikan pertolongan pertama ke gawat

daruratan medis

Bagaimana sertifikasi dan standard yang Bagaimana sertifikasi dan standard yang

ditetapkan pada kebijakan di Indonesia

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FASILITAS & PERALATAN

KEDARURATAN

32

KEDARURATAN

FACILITY & EQUIPMENT ON EMERGENCY

SARANA & PRASARANA PADA SPGDT SEHARI HARI

(Facilities on Daily medical emergencies system )

Need

1. Transportation (ambulance services)

2. Public safety center / call center

3. Communication system

4. Medical equipment (Basic & advanced life support)

5. Health facility (primary health care,)

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PELAYANAN AMBULANS

Berdasarkan fungsi:

1. Emergency ambulance utk acute care/ emergency care ( mobil, kapal, helikopter, pesawat terbang).

2. Patient transport ambulance

3. Response unit / Fly car/ Quick response vehicle memberikan respons cepat tetapi tdk bisa membawa pasien ,harus di back up dg pelayanan ambulans (mobil, sepeda motor )

2. Patient transport ambulance membawa pasient tdk urgen tetapi memerlukan pelayanan kesehatan misalnya ke unit dialisis ( mobil van / mini bus)

sepeda motor )

4. Charity ambulance ambulans yg disiapkan khusus misal pd masa liburan anak2 atau orang usila

5. Bariatric ambulance jenis khusus utk orang2 obese

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TYPE II -USA

TWM Ambulance service mei

200723

AMBULANCE TYPE III USA

TWM Ambulance service mei

200724

AMBULANCE CREWING

• Advanced life support ambulance crew: one paramedic & one WMT Basic

• Coomon ambulance crew qualification :

1. First responder (a person who

4. Emergency care assistan. Emergency care support workers (ECA/ECSW) : assist the clinician (drug, fluid, basic observation, 12 lead ECG).

5. Emergency medical technician (EMT)/ Ambulance technician: wide emergency care skills :

1. First responder (a person who arrives at the scene) : CPR & AED

2. Ambulance driver: first aid certificate

3. Ambulance care assistant : first aid , AED, O2 theraphy, other lifesaving/ palliative skill

wide emergency care skills : defibilation, immobilization, bleeding control, splinting, medication, O2 theraphy

6. Emeregency nurse

7. Emergency care practioner

8. Doctors (most in air ambulance)

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STANDAR KELENGKAPAN AMBULANS

1. Two way radio, (UHF/VHF) komunikasi kru ambulans dan RS

2. Mobile data terminal (MDTs), wireless dan

3. CCTV dg video camera utk merekam kegiatan dan juga sound recording

4. Tail lift / ramp (facilitate loading patient)(MDTs), wireless dan

terhubung dg sentral komputer utk mengetahui detail kegiatan amblans, samapi lokasi, berangkat dari lokasi dan detail yg dilakukan krus

loading patient)

5. Trauma lighting (sbg tambahan khusus utk ps dg fotosensitives

6. Air conditioning

7. Data recorder

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STANDAR PELAYANAN AMBULANS

USA, UK

USA

• Standard is published by the General services administration (A-F version).

• The National Fire

UK

• England : NHS (National Health Services) trust

• Scotland : St Andrews ambulance association -> Scottish ambulance services • The National Fire

protection association (NFPA standard)

Scottish ambulance services (incl. air ambulance : helicopter, fixed wing)

• Northern IrelandAmbulance service (NIAS) parliamentary order.

• Wales : The Wales ambulance Services- NHS trust

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AMBULANCE SERVICE

siapa pengelola pelayanan ambulans di Indonesia

adakah call center utk pelayanan ambulans

standar alat transportasi utk ambulans

PUBLIC SAFETY CENTER (PSC)

Sistem pelayanan terpadu untuk masyarakat berhubungan dengan keadaan kedaruratan (kepolisisn,

pemadam kebakaran , pelayanan ambulans) apakah diperlukan di Indonesia

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Bagaimana jenis pelayanan pada Fasilitas Kesehatan

PRIMARY HEALTH CARE

Primary care

• Primary care is the day-to-

day health care provided by

and overseen by a health

care provider

Acute care

• Patient receives active but

short-term treament for a

severe injury or episode of

ilness and urgent medical care provider

• Tipycally this provider acts

as the first contact and

coordinates other specialist

care that the patient need

ilness and urgent medical

condition or during recovery

from surgery.

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The role of acute care in health system and

services (WHO)

• Peningkatan kebutuhanacute curative services responsive to life threatening emergencies, acute on chronic illnesses dll yg perly tindakan segera. Perlu kesepakatan

• Terdapat potensi bahwa acute care memiliki kontribusi pd disain integrated health system utk me ngurangi moratlitas dan morbiditas.

Perlu kesepakatan diperlukannya acute care

• Terjadinya fragmentasipelayanan kesehatan yang tdk mengadopsi pelayanan acute care.

• WHO berharap dalam perkembangan mendatng akan muncul leaders, researchers , health workers yang responsible dalam National health system

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Bagaimana fasilitas pelayanan kesehatan Pra

Rumah sakit di Indonesia untuk pelayanan

kegawat daruratan / acute care

Peran PUSKESMAS ?Peran PUSKESMAS ?

Pelayanan kesehatan masyarakat (promotif, preventif, kuratif, rehabilitatif)

Pelayanan kesehatan individu (penanganan pertama/ primary care, penanganan kasus emergency / acute care)

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ORGANISASI & TATA KERJA

ORGANIZATION & PROCEDURE

TUJUAN PERENCANAAN(THE GOALS OF EMERGENCY PLAN)

1. Mengendalikan masalah yg dialami korban (jumlah korban, keparahan kasus).

2. Melakukan pelayanan medis berdasarkan ketentuan praktik medik yg baik

1. To control the problem of victim (number of victim, severity of cases)

2. To treat patient based on the rules of good medical practiseberdasarkan ketentuan praktik

medik yg baik

3. Menjamin penanganan yg tepat bagi semua pasien

4. Memberikan dukungan untuk menunjang adanya keterbatasan fasilitas

3. Ensure on going proper treatment for all patients

4. To support the limited facility

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DI INDONESIA

1. SK Menkes no 462 /2002 ttg SAFE COMMUNITY termasuk adanya SPGDT (Sistem Penanggulangan Gawat Darurat Terpadu)

2. SK DITJEN P2PL KEMKES NO KM 03.01/v/775/2012 dg rekomendasi ADINKES utk penenganan Henti

2. SK DITJEN P2PL KEMKES NO KM 03.01/v/775/2012 dg rekomendasi ADINKES utk penenganan Henti jantung mendadak di Fasilitas Umum.

3. Surat edaran DITJEN BUK KEMKES No BK 94.02/I/2698/ 12 utk Dinkes Prop/Kab/Kota ttg penanganan henti jantung mendadak di Fasilitas umum di Indonesia

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REGULATION

• Uk : Ambulance service & medical response

organization : regulated by CQC (Care Quality

Commision) 2008, replace NHS ambulance

services 2011services 2011

• Every ambulance provider : Best practice

guidance : Joint Royal colleges Ambulance

liasion commitee (JRCALC)

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HEALTH CARE IN

PELAYANAN MEDIS pada

SPGDT- B (Bencana)

HEALTH CARE IN

IEMSS ON DISASTER

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Fokus ; BENCANA DENGAN KORBAN MASAL

Focus on DISASTER WITH MASS-CASUALTIES

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Learn from the huge disaster

1. Mass casualties on he death victims

( in Tsunamies)

2. Mass casualties with dominant 2. Mass casualties with dominant

injury patients (in earthquake,

volcanous eruption, windstorm),

3. Mass casualties with dominant

victim are the refugees ( in flood)

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SUGESTION

CRITICAL CARE WITHOUT WALL

DEVELOPMENT FOR INDONESIADEVELOPMENT FOR INDONESIA

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FEBR/2015 TWMS BLS SCA

Semoga bermanfaat

SPGDT

PRA R.S.

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