You are on page 1of 64

Training for Better

Disaster Preparedness,
the Tailor Made Approach

Emergency Medicine and


Disaster Management Working Group
eddy.rahardjo@yahoo.com
Thank you the organizing committee,
Dr Triwahju, Dr Chris Johannes
Thank you Mr Chairman, Co-chairman
Thank you ladies and gentlemen.
Id like to apologize that I will present in English,
not because my English is good.
I believe it is far from that. The reason is simply
because the Committee required me to do so
Personally I am not too happy to speak English
to my Indonesian Colleagues because
I will find restrictions on communicating difficult issues
and this may make it fail in creating maximal
understandings
It is not quite often that one could take part and got
involved in disaster-rescue several times.
But most of the staff members of Dr Sutomo Team
for Disaster Assistance have considerable
cummulative experiences since 1986

Tampomas ship fire-disaster in 1986


Flores Tsunami 1992
Aceh Tsunami 2004
Petrowidada Chemical Factory Blast 2005
Yogyakarta Earthquake 2006
Jember Landslide 2007.
This paper intends to forward several ideas to work out
further-on in countries like Indonesia

where potentials of many types of natural


disasters exist
where disasters may recur repeatedly
where rescue and help may be slow due to
geographical obstacles
distance, separated by seas or mountains
where resources are limited
rare transportation
lack of fund
slow government response
Archipelago resting on unstable tectonic plates
and dozens of active volcanoes

volcanoes
epicenter of
big quakes
one month registry of earthquakes in the world
(various Magnitude scale)
If this 10 meter-above-sea-level island is struck by tsunami
would rescue and aid be available?
80% of Indonesian population live in rural area,
many in places unreachable by normal transportation

TANIMBAR
No land transportation.
Only boats on rough seas.
For 5 months in a year
the waves are too high and
Saumlaki the wind to strong to sail
Doctors and
a simple hospital is here
rivers without bridges can only be crossed
only when the water is low
So, as a rule for survival, a region is
supposed to rely more on what remains
after disaster strikes rather than waiting
for outside help to come
require specific training for doctors
Unfortunately, what still available after
disaster struck were usually negligible
training simple basic techniques to utilize the
least resources still available
up to June 2009 : 85 courses throughout Indonesia
2508 alumni

more than 1x

Primary Trauma Care Courses trained doctors working in


remote areas to be self-sufficient and able to command in
event of disaster
A look to facilities in a simple hospital
Electricity might be insufficient and
sterilization relies on gas burner
stock of oxygen quickly runs out
so, to run the anesthesia machine
one can not rely on compressed gas
Disaster Preparedness could not be generic
because every disaster is unique.

Situation faced after an earthquake is different to


massive landslide following flash flood caused
by heavy downpour tropical rain
Textbooks dictate that for a region, a disaster
mapping can be generated, based on historical
events and recent analysis to existing risk
factors.
In real life, in tropical country like Indonesia, one
region may have potentials for 3 or 4 different
disasters.
Even disasters similar in name, earthquakes, will
show differences that make standard preparedness
become un-effective

Two giant earthquakes, in Aceh 2004 and in


Yogyakarta 2006, were totally different :
regarding physical damages,
situations that hampered rescue,
social values,
tradition,
communication language and
local mindsets.
Lets take a quick look to past experiences,
and gather some fresh ideas
Flash flood in Jember
Petro-chemicals blast in Gresik
Earthquake, 6 Richter scale in Yogyakarta
Flash flood following continuous downpour rain of just 2 days
The 5m-wide stream became 50m in a sudden
swelling, destroying the villages
The deads, the woundeds had to be evacuated by air
The petrochemical factory blast
The fire, the smoke, the polution
Burned casualties ranged from 30%-40% BSA .
to 90% BSA with smoke inhalation injuries
Lapindo LNG explosion, Sidoarjo
90% BSA burn was admitted
the overcrowded Emergency Room after
earthquake of 6 Richter Scale
From the type of structural damages one can
predict what casualties to deal with
Fractures, internal bleedings, spine and head injuries
with the high number of casualties, surgery should move fast
and do only the minimally necessary things
WHO concept of disaster management cycle

1. Impact,
2. Acute Response,
3. Recovery, IARD-PMP
4. Development,
5. Prevention,
6. Mitigation
7. Preparedness.
Now, what to train for
Disaster Preparedness

1. Awareness of disaster risk(s)


2. System Building and Communication /
Coordination Rehearsals
3. Early warning system
4. Coordinated evacuation / protection
5. Coordinated Find, Collect, Sort victims
Sistim Penanggulangan Gawat Darurat Terpadu
Integrated Emergency Care Response System

Field Front Command


Post Post HQ

Lay-people Ambulance Doctors Spec-Doctors


Spec-Lay-people personnels Nurses Spec-Nurses

Communication

TRANSPORTATION

+
Ambulance Primary HC C-hosp B & A-hosp
Casualties
early warning
system:
indigenous
alert response
in
Java Island

The voice of this


hollow log when
struck
can send messages
miles away
MERAPI VOLCANO: hot smoke and ash 300-4000 Celcius
ran down the slopes
Plantation was burned down to ashes
along the route of lava and hot air flush
So, preparedness means preparing safe evacuation
sites and put clear signs to show
the quickest escape route
In the event of disaster,
coordination and coperation
are the keywords
Dangerous area Safe area
TRIAGE

HOT ZONE
Treat
or send

Collect
and sort

Evacuate away

Zoning in the perimeter of disaster area


Quickly train survivors to collect the
injured, sort, (stabilize) and transport

collected and sorted


victims
Scattered victims
Sistim Penanggulangan Gawat Darurat Terpadu
Integrated Emergency Care Response System

Field Front Command


Post Post HQ

Lay-people Ambulance Doctors Spec-Doctors


Spec-Lay-people personnels Nurses Spec-Nurses

Communication

TRANSPORTATION

+
Ambulance Primary HC C-hosp B & A-hosp
Casualties
Training for preparedness includes

Who must be trained as shown in the SPGDT


scheme
What materials is to lay people
be trained special lay people
red cross volunteers
senior high school students
policemen
Nurses
GP
Specialist Doctors
so they can function in the job-
slot effectively
Now, what to be trained for
Disaster Preparedness

Basic and Advanced Life Support


Primary Trauma Care for GP and nurses
ATLS and Damage Control Techniques for
Surgeons and GP licensed to do surgery
train them to work to save lives with
whatever available resources, facilities
and manpower
Remember lessons learned in Aceh

Million dollar worth sophisticated modern medical


equipments were brought in
Sad to say, not many really operated to save patients
problem with electricity
black-outs
brown-outs
no supply at all
problem with medical gas PROBLEMS UNKNOWN
impurities TO DONOR COUNTRIES
water contents
problem with supporting equipments
un-trainable human resources
Anesthesia machine

you can ask 100 Anesthesiologists in Indonesia


who can use this copper-kettle machine;
and even more, without oxygen tubing supplied
Many electronic equipments
ended in warehouses, never
being used.
Train them with minimal basic items,
NOT advanced-state-of-the-art items

Wound cleaning
filtered boiled water
not necessarily sterile Normal Saline because sterile
Normal Saline is used for infusion to treat bleeding
and shock
Closed fractures
immobilize, cast and traction
not necessary to do external fixation nor open
reduction + implant
do not make new wounds and waste antibiotics
obviously this state-of-the-art external fixation will waste OR time
and reduce the number of patients that can be treated
this cast immobilisation and traction would
be more rational to do as the first line
treatment
Train to use existing resources

Convince that by being creative they can


contribute a lot to save lives
Bury any dream about an ideal condition

And that is why, advanced trauma courses


constructed in first world countries might
trap the users in helplessness state
Find used plastic
infusion bottles to
make oxygen mask
This combination
suffices to immobilize
the neck.
sand-filled plastic bag
Waiting for evidence
base in this case
is futile!

carton box
1.

2.
90% of patients
can be saved
by using these
simple methods
3.
3

we are not supposed


to save them all
Gold standard
Utilize the available manpower to achieve best possible result
stay on training basic simple techniques

it is always better to light a candle


than cursing the darkness
but lighting too many candles, despite
more lights, they produce more CO2
more doesnt always mean better
These big-trucks arrived at Lhok Seumawe and meant
to be driven to Meulaboh 500 km away
probably, if they chose smaller delivery vans,
life would be easier
They have neglected to consider the totally
damaged roads connecting the cities
not to mention dozens of damaged
and washed away bridges
a disaster preparedness for a region
can be constructed to include:
1. Generating people awareness to disaster and
disaster potentials
2. System setup to limit the damage, i.e:
early warning system,
structured and systematic evacuation to
predetermined sites etc
3. System setup to maximize life saving
stock of medications,
spare hospital facilities,
stock of food
survival amenities
4. Training for communicating the type and extent
of damage effectively and specify the amount
of help and time frame required
5. Training for working together in coordination
with any incoming relief teams.
Coordinating team work, discussion and joint decision making
are soft-skills we did not learn in formal classes
Wassalamualaikum

For further enquiries: Eddy Rahardjo


HP : 081 650 6752
eddy.rahardjo@yahoo.com

Emergency Medicine and Disaster


Management Working Group

You might also like