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Preparedness Emergency Management System among Nurses on Disaster in Banda Aceh

PREPAREDNESS EMERGENCY MANAGEMENT SYSTEM AMONG


NURSES ON DISASTER IN BANDA ACEH

Cut Husna1,2*, Teuku Tahlil3, Hajjul Kamil4, Mustanir5, Rizka Hayaturrahmi6


1
Medical and Surgical Nursing Department, Faculty of Nursing, Syiah Kuala University,
Darussalam-Banda Aceh, Indonesia
2
Mathematic and Applied Science Department, Postgraduate Program, Syiah Kuala University,
Darussalam-Banda Aceh, Indonesia
3
Community Nursing Department, Faculty of Nursing, Syiah Kuala University
Darussalam-Banda Aceh, Indonesia
4
Management of Nursing Department, Faculty of Nursing, Syiah Kuala University Darussalam-Banda
Aceh, Indonesia
5
Chemistry Department, Faculty of Science, Syiah Kuala University, Darussalam-Banda Aceh,
Indonesia
6
Faculty of Nursing, Syiah Kuala University, Darussalam-Banda Aceh, Indonesia
*Corresponding author e-mail: cuthusna@unsyiah.ac.id

ABSTRACT
Nurses are leading professionals as providers of care in emergency or disasters. The health care system
in the emergency response situation will succeed in preventing and reducing the mortality rate of the victims by
implementing emergency response system at the health care facilities. The study aimed to identify nurses’
preparedness in emergency response systems on disaster management at Maternal and Child Hospital Banda Aceh.
The variables of research are disaster response system, communication network, and ambulance transportation
system. The research of study is descriptive quantitative with cross sectional study design. The sample of the study
was total sampling of 103 nurses in Maternal and Child Hospital Banda Aceh. Data was collected by questionnaires
in dichotomous scale consisted of 33 questions developed by the researcher. The questionnaires consisted of
disaster emergency response system, communications network, the ambulance transport system tested validity and
reliability with scored 0.611, 0.698, 0.621, and 0.962 respectively. The results of the study showed that nurses’
preparedness in emergency respond system in disaster management was well prepared (73.8%). The variables of
the study showed that for disaster emergency response system (53.4%) was unprepared, communications network
(64.1%) and the ambulance transport system (77.7%) of respondents were well prepared respectively. The nurses
preparedness in emergency response system on disaster management in the hospital was well prepared, particularly
on communications network and the ambulance transport system. The hospital could effectively conduct to disaster
management, disaster simulation exercises, and develop standard operating procedures related of disaster
management systems in the future.

Keywords: disaster, emergency, hospital, nurse, preparedness.

INTRODUCTION
Indonesia is a vulnerable country and has a high risk of disaster. Disaster is a series of
events that threaten and disrupt the life caused by both natural factors, non-natural factors and
human factors resulting in the occurrence of human casualties, environmental damage, property
loss and psychological impact (Undang-Undang No.24, 2007). Disasters can also cause damage
to the social life of the community and have significant effects on the physical, emotional and
psychological health of the community (Thobaity, Plummer, & Williams, 2017; Park & Kim,
2017). Disaster is a disturbance that involves a community or society causing harm in material
and environment (Hammad, Arbon, Gebbie, & Hutton, 2012). Disasters are a serious disruption

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Preparedness Emergency Management System among Nurses on Disaster in Banda Aceh
that affects the people, causing harm to human, material and environmental life that exceeds
the community's ability to cope (Al Khalaileh, Bond, Beckstrand, & Al-Talafha, 2010).
Disaster preparedness should be a priority especially in areas at risk of disaster. The
tsunami disaster and earthquake on 26 December 2004 with involving 13 countries reached
127,672 people, while data on the number of casualties in the province of Nanggroe Aceh
Darussalam and North Sumatra around 110,229 people died, 12,132 people disappeared,
703,748 people displaced and 925 people in hospital (Baghdady, 2005). Due to efforts to reduce
the impact of the disaster, the need for quick response and preparedness from health workers,
especially nurses who have a critical role in every phase of disaster management (Thobaity,
Plummer, & Copnell, 2016). Disaster does not only require the provision of necessary resources
and requests but also it is necessary to anticipate through effective collaboration with other
professionals including nurses (Park & Kim, 2017).
The hospital is one of the most urgent public health center which deal some events when
disaster occured. Hospital preparedness in responding and delivering emergency is critical to
the overall success of health care services. Nurses are the largest population in hospitals that
have a major roles in the disaster response phase in providing health care services efficiently.
Hospitals should be able to prepare the availability of resources, equipments, places and spaces,
medical and non-medical personnels through emergency and hospital disaster preparedness,
disaster plan, disaster drill, and assessment of hospital disaster plan (Kaji, Langford, & Lewis,
2008).
Maternal and Child Hospital is the referral hospital in emergency cases speciallly care of
mothers and children, hence it requires good emergency preparedness (Rencana Pembangunan
Jangka Menengah Daerah Aceh, 2017). Based on data obtained from medical records Maternal
and Child Hospital mentioned that the hospital already has disaster management team and
available 110 nurses. The hospital also has emergency respond system, policies and procedures
to respon fires disasters. The hospital had available information boards which is responsible for
the evacuation patients to every ward. The hospital had conducted trainings for nurses with
emergencies such as triage training for emergency nurses, code red and code blue training for
emergency cases and APAR training (fire disaster management), and simulation to evacuation
of earthquake and fire victims. Those are part of the hospital preparedness in anticipation
emergency case and disaster (RSIA, 2018). According to interview found that the mechanism
of communication networks in RSIA using Hospital Management Information System (SIM
RS), LAN and internet, and telephone between wards up to emergency services. Another
preparedness is the provision of emergency and disaster emergency ambulances and available

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Preparedness Emergency Management System among Nurses on Disaster in Banda Aceh
equipment such as infusion sets, oxygen, nasal cannulas, beds, first-aid kits and certain
medications.
Nurses as health workers should be ready to handle the emergency situation include
disaster. Nursing preparedness is one of the keys to success in preventing, reducing the impact
of disasters, and decreasing mortality rate of victims. The objective in preparedness is to have
the ability to carry out emergency response activities before disaster will happened (LIPI &
UNESCO/ISDR, 2006). The results of a study conducted on three hospitals related to disaster
preparedness reported 474 respondents with characteristics of nurses found that disaster
preparedness in the weak level. The assessments of nurse preparedness showed only 11% have
ever participated in the real drill disaster (Al Khalaileh et al., 2010).
Based on the Regulation of the Minister of Health of the Republic of Indonesia No. 19,
2016 on Emergency Management System aimed to strengthen preparedness in emergency
management. So, need some important component there are development of implementation of
emergency response system, communication network, and ambulance transportation system
(Kemenkes RI, 2016). Implementation of disaster emergency response system will reduce and
save disaster victims through the improvement of health care quality related to disaster
preparedness and handling (Kemenkes RI, 2011).
Communication during disasters is an important component of disaster respon, to know
about emergencies response, and improve inter-sectoral coordination related emergency
planning processes (National Emergency Communications Plan, 2014). The ambulance
transport service system is part of the first series in health care in the event of a disaster and can
contribute significantly in programs treating and transferring patients to health care facilities
(Heide & Scanlon, 2007).The research objective was to identify the nurse' preparedness in
emergency management system on disaster consisted of emergency response system,
communication network, and ambulance transportation system.

MATERIALS AND METHODS


The study used descriptive quantitative with cross sectional study design. Data collection
techniques used questionnaires of 33 items in dichotomous scales. The questionnaires passed
the validity and relibiality testing. The study was conducted in April, 2018 at Maternal and
Child Hospital of Aceh Province, Banda Aceh, Indonesia. The sampling method using total
sampling of 110 nurses who worked at Maternal and Child Hospital of Banda Aceh. However,
the sample met criteria is 103 respondents. Data analysis used univariate: frequency,
percentage, mean, mode, and standard deviation. This study passed the ethical test of the ethics

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Preparedness Emergency Management System among Nurses on Disaster in Banda Aceh
committee team from Faculty of Nursing Syiah Kuala University Banda Aceh with
No.111072260318.

RESULTS AND DISCUSSION


Demographic Data
Demographic data collected at Maternal and Child Hospital of Banda Aceh consisted of
age, sex, duration of work, educational level, workplace/ward, employment status, and
attending emergency/disaster training.

Table 1. Demographic Data Respondents in Hospital Maternal and Child Hospital Banda Aceh
(n = 103)
N Data Frequency Percentage
1 Age (year)
25-35 72 69.9
36-45 26 25.2
46-55 5 4.9
Mean (33.3)
2 Gender
Male 10 9.7
Female 93 90.3
3 Length of working (year)
1-5 38 36.9
6-10 40 38.8
>10 25 24.3
Mean (8.5)
4 Educational level
Diploma III 63 61.2
Diploma IV 6 5.8
Bachelor 34 33.0
5 Place of work
Pediatric ward 18 17.5
Adult ward 11 10.7
PICU 10 9.7
NICU 19 18.4
ICU 11 10.7
EDs 22 21.4
VIP ward 12 11.7
6 Employee status
Gov. employee 62 60.2
Non-Gov. employee 41 39.8
7 Attending emergency training
Yes 68 66.0
No 35 34.0

Nurse’ Preparedness in Emergency Management System on Disaster


Based on the results of the study, nurse’ preparedness in emergency management system
on disaster is ready with the value ≥17 and not ready with the value <17 as showed in the Figure
1. The result of study showed that nurse’ preparedness in emergency management system on
disaster is ready with 76 respondent (73.8%). According to Pourvakhshoori, Norouzi, Ahmadi,
Hosseini, and Khankeh (2017) nurse preparedness is defined as the preparatory actions

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Preparedness Emergency Management System among Nurses on Disaster in Banda Aceh
undertaken focusing in the context of disaster management. The result is supported with the
research from Rifai and Harnanto (2016) on the nurse and midwife preparedness in carrying
out the Preparedness for Emergency and Disaster Hospital management in Surakarta hospital
with cross sectional study design. The sample in the study were nurses and midwives for 30
respondents. The results showed that the majority of nurses and midwives had good prepare for
disaster preparedness with the majority of respondents answered ready (86.7%) and not ready
(13.3%). According to the study, the nurse is the first professional care and has a very important
role when disaster occurs.

73.8
Percentage of Respondent

Ready
(%)

26.2 Not ready

Figure 1. Nurse’ preparedness in emergency management system on disaster at Maternal and Child Hospital
Banda Aceh

The results of the studies are supported by Geum (2017) mentioned that the
nurse’perception and competency of disaster nursing in South Korea with a sample of 163
nurses who worked in tertiary hospitals in Seoul, Korea.The results showed that core
competency in disaster nursing regarding nurse’ perception and competency on education and
disaster preparedness is good with score 3.14, SD (± 0.79). It is found that awareness and
disaster preparedness is influenced by education of disaster nursing. Thus, ongoing training to
improve core competencies and understanding of disaster nursing should be developed.
Based on the result of the study, showed that nurse’ preparedness in emergency
management system on disaster management at Maternal and Child Hospital Banda Aceh, in
terms of ready (73.8%). This can be supported by the majority of respondents with 6-10 years
working experiened (38.8%), the majority of nurses are in emergency department (EDs) of 22
respondents hence all of the EDs nurses are always ready in case of emergency, and the majority
of nurses have attended in emergency/disaster trainings of 68 respondents (66%). This indicates
that most of nurses in the EDs, intensive care unit, neonatal intensive care unit, perinatal

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Preparedness Emergency Management System among Nurses on Disaster in Banda Aceh
intensive care unit, and inpatient wards are ready to deal with unpredictable catastrophic events
suh as a disaster.
According to observations and interviews conducted by researchers, indicate that all the
care and intensive unit or emergency department at Maternal and Child Hospital already have
good preparedness in respon to disaster. For example, emergency response system has been
available hospital disaster plan and has a disaster management team, nursing support tools and
adequately human resources. In addition, communication networks have been available
optimally such as communication system code red (fire emergency) and code blue (medical
emergency), and the chain of command on disaster response. Furthermore, ambulance
transportation as well as ambulance officers have been stand by if emergency and disaster
struck. The hospital also have worked with several organizations such as government and
local, national dan internatioanl non government organization (NGO) to respon to disaster.

Disaster emergency response in emergency management system on disaster


Based on the results of the study, emergency response system is s ready with the value ≥
4 and not ready with the value <4 as showed in the Figure 2. Based on the results of the study
showed that 55 respondents (53.4%) considered that nurse preparedness in terms of emergency
response system is not ready. The results are supported by a study conducted by Tzeng et al
(2016) mentioned that nurse’ preparedness in disaster response system in Taiwan with 311
respondents found that the majority of respondents are not ready in the disaster response system
(21.38%) including the training aspect related disaster, experience in disaster response and
experience of emergency/intensive care.

53.4
Percentage of Respondent

Ready
(%)

46.6
Not ready

Figure 2. Disaster Emergency Response System in Emergency Management System on Disaster.

The results study by Oztekin, Larson, Akahoshi, and Oztekin (2016) studied about nurse’
perceptions of knowledge, skills, and preparedness in disaster with 902 respondents found that
nurses unable to respond in unpredictable situations and disaster. In disaster, The nurses had

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Preparedness Emergency Management System among Nurses on Disaster in Banda Aceh
attending a disaster emergency plan but they are not able to perform according to the the real
procedures. It proved that nurses need to know about information in preparation of emergency
disaster, so that they have readiness to respon disaster in the future.
Furthermore, the results of study by Labrague et al (2018) said that nurses is not ready to
response disaster. Exposured to disaster events and provision of disaster-related training and
simulations is an effective way to prepare nurses for disaster management and adequate
response systems. The findings of this review can be informed to nurse educators, hospital
administrators in supporting nurses to have preparedness in emergency response.
Based on interviews and observations conducted by the researchers at Maternal and Child
Hospitals of Banda Aceh, the disaster emergency response system has been set up according to
the hospital disaster plan, in which disaster management team that will provide command
during the disaster through the information center, and evacuation handling procedures are well
managed. The hospital also available standard operating procedure (SOP) for emergency
response and disaster in the hospital but not yet inform optimally to service units such as
inpatient ward, EDs, ICU, PICU, and NICU.
In terms of training, emergency response training has the principles of emergency
handling, bleeding and shock management, cardiopulmonary resuscitation, airway breathing
problem and management. Some of nurses have been trained such as Basic Trauma Life
Support (BTCLS), Hospital Preparednes for Emergencies and Disaster, and Hospital and
Advanced Cardiac Life Support (ACLS). Emergency training such as BTCLS has been trained
annually for all nurses with 73.8%. According to study mentioned that the frequent of training
and disaster simulation will support in the coordination and handling disaster management
effectively so that the impact of disasater can be reduced.
The results of this study is accordance with Kasmawati and Dirhamsyah (2016) on the
analysis of hospital disaster plan policy implementation in the Maternal and Child Hospital
Banda Aceh in respon to earthquake and tsunami disaster. The results obtained are the policies
that have been developed by the hospital still not fully meet the principle of hospital disaster
plan. Maternal and Child Hospital Banda Aceh in implementing disaster preparedness is far
from perfect. The policies that must be considered by the the hospital by making Standard
Operational Procedures (SOP) disaster management team and specify the fuction and tasks of
team.

Communications network in emergency management system on disaster


Based on the results, the communication network is ready with the value ≥ 4 and not
ready with the value <4 as showed in the Figure 3. The results showed that the number of 66

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Preparedness Emergency Management System among Nurses on Disaster in Banda Aceh
respondents (64.1%) indicates that communication networks that support nurse’ preparedness
is ready in the hospital. Based on Emergency Response System, communications network used
is guided by the rapid response that emphasizes “time saving is life saving” and is managed by
national command center with has function to providing information in a disaster event and
handling emergency cases as well as should be integrated with PSC 119 P2KK (crisis
management health center) Aceh.

64.1
Respondent (%)
Percentage of

35.9 Ready
Not ready

Figure 3. Communication Networks in Emergency Management System on Disaster.

The result of this research supported by Hidayati (2008) about the knowledge of nurses
of the Emergency Department at dr. Sardjito Hospital in disaster preparedness of 45 respondents
using cross sectional study design. Based on the study showed that the communication networks
for knowledge disaster preparedness is good (82%). Furthermore, the study by Simatupang
(2017) on the preparedness of RSPAD Gatot Soebroto Hospital in disaster mitigation to
anticipate the threat of bioterrorism showed that the hospital’ preparedness is good in
communication system (76.90%). The conclusion that the communication should be set
effectively to respon the disaster, hence every health worker have to understand with clear
information and communication.
Based on the study by Budi (2012) on disaster communication: The system coordination,
information and cooperation explained that disaster preparedness, the communication aspect
include by accurate information, coordination and cooperation aspects of disaster events. At the
disaster event, the four aspects of communication, information, cooperation and coordination
are the keys to success of disaster management, especially for the handling of the victims. This
finding can be concluded that an effective communication system can prevent or reduce
mortality and morbidity rate of the victims and disaster response time in emergency response
is to be a first priority.
Based on the results of interviews and observations by researchers found that the
communication network conducted by internal and external organization using the telephone

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Preparedness Emergency Management System among Nurses on Disaster in Banda Aceh
network. Hand talky (HT) is not yet available in the service unit of Maternal and Child Hospital.
Emergency communication still use the coordination of the information center which will notify
the actions or procedures to be performed when emergency service occurs in every ward using
the telephone. In accordance with the research by Anjarsari et al., (2014) explained that
communication planning in disaster preparedness in information delivery, coordination and
control because it is needed communication tools other than telephone and mobile phone, such
as HT to anticipate when disaster occurs when telephone network is disconnected causing
phone off and no signal. This can make it difficult to communication or coordination in the
hospital.
Preparedness in communications network used to by Maternal and Child Hospital based
on “time saving is life saving”, in which every service unit always communication before
transfer patient to the treatment unit. In terms of external hospitals, the hospital is ready to
communication with the Public Safety Center (PSC) 119 Center for Crisis Response of Health
Banda Aceh if has medical emergency cases. The communication network carried out by
Maternal and Child Hospital with other external organization such as with other hospitals is
well established which involves transferring patients to other hospitals using referral letters and
telephone. However, for the communication system for the code blue (medical emergency) is
available in all service units by using telephone communication to EDs.The Maternal and Child
Hospital also available for the code red communication system (fire emergency) in all health
care units with the ready team.

An ambulance transport system in emergency management system on disaster


Based on the results, the ambulance transport system is ready with the value ≥ 3 and not
ready with the value <3 as showed in the Figure 4. The results of the study in Table 5.4, the
majority of respondents (77.7%) indicated is ready in the ambulance transport system.The result
is accordance with study by Soemarko (2004) on evaluation of effectiveness of training and
pre-hospital management education referred to Saiful Anwar Hospital with observational
research method. The results showed that the emergency ambulance transport system was
changed of ± 250% from 1999 to 2003 by operating several new ambulances with trained
personnel in ready preparation. The results of this study found that in case of emergency, the
ambulance transport system has the principle of timeliness such as, when the travel time
increased, the possibility of safety decreased.

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Preparedness Emergency Management System among Nurses on Disaster in Banda Aceh

77.7

Respondent (%)
Percentage of
Ready

22.3 Not ready

Figure 4. Ambulance Transportation System in Emergency Management System on Disaster.

According to research by Montjai, Mulyadi, and Jill (2017) studied about the description
of the accuracy ambulance personnel used in referring emergency patients at Prof. Dr. R. D.
Kandou Manado hospital, showed that the use of emergency ambulance in referring to
emergency patients is good (86.25%), the patients referred by using emergency ambulances
available with medical emergency equipments. The result of services analysis of emergency
ambulance showed that the operational of service system is good.
According to the clinical policy review literature: non-emergency ambulance transport
showed that the effectiveness of an emergency ambulance transport system is directly related
to the accuracy of medical care needed for patients. The quality of emergency care performed
by health workers and the patient reaches the health care center influence patients survival to
the response time when health workers receive ambulance calls (Clinical Policy: Ambulance
Transportation Non Emergency, 2017).
The interviewed with ambulance officers and observation of facilities and infrastructure
in ambulances conducted by researchers showed that ambulance transportation at Maternal and
Child Hospital is always stand-by in case of emergency medical and emergency disaster. In
March 2018, the hospital received a complete ambulance unit of emergency from non-
government organization (NGO) with complete facilities in handling medical emergency. This
condition was strengtheness the hospital ambulance transport is ready. Furthermore, the hosptal
already had 2 emergency ambulances transport units which consisted of emergency kit, shock
management equipment such as infusion set, infusion liquid, tourniquet, ECG monitor and
cardiopulmonary resuscitation equipments such as bag valve mask, oxygen and nasal cannula
and well-functioning ambulance unit.
According to the researcher, the ambulance readiness with the support of the emergency
set facilities can assist the victim in obtaining the emergency services, hence find quick and
precise handling according to the principle of integrated emergency management system that is
“time saving is life saving”.

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Preparedness Emergency Management System among Nurses on Disaster in Banda Aceh

CONCLUSIONS
The conclusions about the preparedness in emergency management system among nurses
on disaster at Maternal and Child Hospital Banda Aceh are as follows: 1) Nurse preparedness
in emergency management system on disaster in ready (73.8%); 2) Disaster response system
based on nurse’ preparedness in emergency management system on disaster in not ready
(53.4%); 3) Communication network based on nurse’ preparedness in emergency management
system on disaster in ready (64.1%); and 4) An ambulance transport system based on nurse’
preparedness in emergency management system on disaster in ready (77.7%).

ACKNOWLEGEMENTS
The authors would like to thank all the respondents at Maternal and Child Hospital of
Banda Aceh for their full participation in the research, as well as to chief of training and
research of the hospital for their assistance in this research.

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