PENANGGULANGAN KASUS GAWAT

DARURAT PRA RUMAH SAKIT

Tri Wahyu Murni
Perhimpunan Kedokteran Gawat Darurat Indonesia
PENDAHULUAN
(Introduction)
 ISTILAH
DARURAT
(Emergency)
• Any condition that-in the
opinion of the patient, his
family, or whoever assumes
the responsibility of
bringing the patient to the
hospital-requires immediate
medical attention
KASUS GAWAT DARURAT
(Life threatening cases)
– Immediately life
threatening
(critically ill patients)
– 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
(Integrated Emergency Medical Service System)

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TWM1

IEMSS
(Integrated Emergency Medical Services System)

Environmental
Demographic

Prehospital Hospital Inter

Communication Emergency Dep Hospital. EMS
Population
Transportation HCU, ICU, OR outcome

Resources :
Prevention Personnel, Facilities, Equipment
Programs Organization
Procedures
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Slide 7

TWM1 Tri Wahyu Murni, 7/6/2008

 SPGDT / IEMSS
Lingkup/ Scope Kejadian / Event

1. Pra RS (Prehospital)
• SPGDTS-sehari-hari
2. Di RS (in Hospital)
(Daily emergency medical
3. Antar RS (inter - Hospital) service system)

• Pencegahan (Care) • SPGDTB-saat Bencana

• Penanganan (Cure) (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

Hospital readiness ? EU, HCU,ICU,OR ?

ANTAR RUMAH SAKIT
Hospital coordination, transpotation,
communication

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 PRE HOSPITAL EMERGENCY CARE (PHEC)

1 2 3

Communication system incl.

Transportation:
Emergency call number
Ambulance service
PERSONNEL incl profesional
a. Medical doctor crew
b. Nurses
c. Non medis profesional
4
a. MFR (Medical First
Responder)
b. PHEC personnel

Ambulances Service center (ASC), Public safety

center (PSC), Primary care/ Acute care
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 KASUS (CASES)
• Darurat medis
(Medical emergencies)
– Keracunan (poisoning)
– Serangan jantung (Heart
attack)
– Henti jantung mendadak
(Sdden cardiac arrest)
– Bayi berisiko tinggi (High
risk infant)
– Penyakit menular
(Communicable disease)
• Darurat bedah
/kecelakaan
(Surgical emergencies /
accident)
– Trauma
– Luka bakar (Burn injury)
– Cedera tulang belakang
(Spinal cord injury)

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1 Sumber Daya Manusia
(Daily medical emergencies personnel )

Pre Hospital Emergency

care (PHEC)
1. First aid qualification
Medical profesional. 2. Advanced PHEC

1. Medical doctor Ambulance crew

2. Nurses 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 8. Patient assessment (incl
2. Anatomy& physiology diagnostic equipment.,
sphygmomsnometer, glucose
3. Shock monitor, pulse oximetry, Pupil
4. Resuscitation tourch,chest percussion)
5. Oxygen therapy 9. Introduction to drugs (aspirin,
6. Trauma condition (treat use of GTN, adrenalin, glucagon,
traction splint, cervical collar, salbutamol, Entonox)
extrication devices, lifting and 10. Patient movement
moving techniques with 11. Scenarios (sed in medical and
stretcher and position in trauma patients)ultiple scenario
transport) to assist in developing
7. Emergency medical conditions ( confidence and competence is
focus on cardiac arrest and using assese
AED)
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 CERTIFIED Materi :
FIRST AIDERS (valid cerificate ). 1. Scene assessment
2. Scene management
Course : 3. Patient assessment
1. immediate advanced first aid 4. Using adjunct airways
assistance any situation 5. Bag/mask resucitation
2. Familiar with basic emergency 6. Defibrilation
equipment (airway care
respiraory support) 7. Trauma condition
8. Medical condition
Penyelenggara St Jons utk sseluruh NZ 9. Oxygen administration
diberikan untuk indivisual/ group 10. Neck and spinal injuries
11. Extrication / stretcher
12. Moving patients
• Lama pelatihan 3 hari , Biaya $ 13. Scenarios
649.00 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) certificate
UK qualification endorsed by the Royal college of surgeon of Edinburg

• Pelatihan ini setara dg 5 hr Materi pelatihan

PHEC course., ditujukan pd
personnel yang pada situasi
kritis harus memberikan
pertolongan karena tidak
adanya harapan adanya rescue
support.
• Misalnya untuk personnel SAR,
offshore, hostile environment
medics
• Waktu pelatihan 5 hari
1. Intermediate & advance
airway managemnt incl.
surgical airways
2. Management of injuries from
road trafific colition, ballistic,
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

MEDICAL EMERGENCY focus on

cardiac arrest & using AED)

MOVING
& LIFTING

Basic life support

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OXIGEN THERAPY
 Bagaimana pelatihan bagi masyarakat yang akan
memberikan pertolongan pertama ke gawat
daruratan medis

Bagaimana sertifikasi dan standard yang

ditetapkan pada kebijakan di Indonesia

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2 3

FASILITAS & PERALATAN

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
membawa pasient tdk urgen
tetapi memerlukan
pelayanan kesehatan
misalnya ke unit dialisis (
mobil van / mini bus)
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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 )
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

23
2007
AMBULANCE TYPE III USA

TWM Ambulance service mei

24
2007
 AMBULANCE CREWING
• Advanced life support ambulance
crew: one paramedic & one WMT
Basic
• Coomon ambulance crew
qualification :
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
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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 :
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) 3. CCTV dg video camera utk
komunikasi kru ambulans merekam kegiatan dan
dan RS juga sound recording

2. Mobile data terminal 4. Tail lift / ramp (facilitate

(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
protection association (NFPA
standard)
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UK
• England : NHS (National
Health Services) trust
• Scotland : St Andrews
ambulance association ->
Scottish ambulance services
(incl. air ambulance :
helicopter, fixed wing)
• Northern Ireland
Ambulance 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 Acute care
• Primary care is the day-to- • Patient receives active but
day health care provided by short-term treament for a
and overseen by a health severe injury or episode of
care provider ilness and urgent medical
condition or during recovery
• Tipycally this provider acts from surgery.
as the first contact and
coordinates other specialist
care that the patient need

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 The role of acute care in health system and
services (WHO)
• Peningkatan kebutuhan
acute curative services
responsive to life
threatening emergencies,
acute on chronic illnesses dll
yg perly tindakan segera.
Perlu kesepakatan
diperlukannya acute care
• Terjadinya fragmentasi
pelayanan kesehatan yang
tdk mengadopsi pelayanan
acute care.
• Terdapat potensi bahwa
acute care memiliki
kontribusi pd disain
integrated health system
utk me ngurangi moratlitas
dan morbiditas.
• 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 ?

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 1. To control the problem of victim
dialami korban (jumlah korban, (number of victim, severity of
keparahan kasus). cases)

2. Melakukan pelayanan medis 2. To treat patient based on the

berdasarkan ketentuan praktik rules of good medical practise
medik yg baik
3. Ensure on going proper
3. Menjamin penanganan yg tepat treatment for all patients
bagi semua pasien
4. To support the limited facility
4. Memberikan dukungan untuk
menunjang adanya
keterbatasan fasilitas

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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
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 2011

• Every ambulance provider : Best practice

guidance : Joint Royal colleges Ambulance
liasion commitee (JRCALC)

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 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

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 INDONESIA

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 SPGDT
PRA R.S.

Semoga bermanfaat
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