Pengalaman menghadapi Kejadian Bencana
di Rumah Sakit
Kasus : Penanganan Korban Gempa Jateng – DIY th 2006
di RS Sardjito Yogyakarta
Hendro Wartatmo
Pusat Kebijakan Menejemen Kesehatan
FKKMK - UGM
Pusat Kebijakan Menejemen
Kesehatan
bencana-kesehatan.net/
• Pusat di FKKMK ( Fakultas Kedokteran
Kedokteran-Gigi …. Dan Keperawatan )
• Kelompok Kerja Bencana
• Divisi Menejemen Bencana
• Universitas: Disaster Emergency Respon Unit
EMERGENCY RESPONSES
OF SARDJITO GENERAL HOSPITAL
DURING EARTHQUAKE IN BANTUL,
INDONESIA, ON MAY 2006.
Hendro Wartatmo
Sardjito General Hospital
Yogyakarta, Indonesia
9th Asia-Pasific Conference on Disaster and Emergency Medicine,
Seoul 2 – 4 Novemebr 2008.
Capacity
Problems Capacity Notes
Beds :
Wards 650 - 700
ICU- ICCU 22
PICU–NICU 10
Stroke Unit 10
Burn Unit 6
Operating Room :
Central Operating Theatre 12
On Day Care Surgery 2
Infertility Surgery 2
Emergency Department 3
Medical Personnel
Staff Number
General practitioners 24
Specialist :
- Anaesthetist 11
- Surgeon 14
- Orthopedics 5
- Neurosurgeon 4
- Urologist 5
- Internist 28
- Cardiologist 8
- Others 163
Nurses 846
Registrar / resident 700
Student 600
Victims
Case Number
Vulnus/Skin Injury >4.000
Fracture: 1230
Shoulder&Ext.Sup 360
Pelvis & Extr.Inf. 870
Multiple Injury:
Head Injury 395
Spine Injury 365
Abdominal Injury 102
Thorax Injury 98
Response
( 27 May – 25 June, 2008 )
Activity Workload Note
Triage 6.891 victims 2000 victims arrived during
the first 12 hours
Minor Injury 4.861 Ambulatory treated
Major injury 2.030 Admitted
Surgery 1.368 240 were performed in the
first 24 hours
DOA 146 84 were arrived in the first
10 hours
Hospital Death 96 6 deaths were due to
tetanus
Surgical Treatment
Procedure Number %
Debridemen dengan GA 98 7.16%
ORIF+OREF 649 47.44%
Closed Reduction 245 17.91%
Laminektomi-stabilisasi 195 14.25%
Laparotomi 59 4.31%
WSD 57 4.17%
Rekonstruksi Maksilofasial 24 1.75%
Kraniotomi 15 1.10%
Sistostomi 14 1.02%
Skin Graft 12 0.88%
Total 1.368 100%
Surgical Complications
Complication Number
Sepsis 131
Urinary Tract Infection 50
Wound Infection 50
Decubitus 45
Pneumonia 25
Tetanus 22
Notes : 16 from 22 Tetanus patients were referred cases.
6 From the 16 patients died .
Total mortality rate among tetanus patient was 75% ( 27 from 36 )
The Problems
What was prepared Actual fact
Event Volcanic eruption Earthquake
Scale of the event Localized Widespread
Estimated no of victims Maximum no = 200 192.534
Estimated major case Burn Trauma ( fracture )
Triage SIT / One triage officer “SAVE” / In-coordinated
Expanding treatment zone Minimum plan Enlarged
Management of External Unplanned Obligated
support
Local networking Limited plan Un-operational
Problems and Solutions
Problems Support / Solution
Insufficient Command System - Self Coordination of each Operational Units
- Coordination Meeting
Insufficient number of Hospital Large number of volunteers
Staff
Limited Logistic Mobilization from PHO and MOH
Less space for treatment Expand the treatment area
Evacuate or Not Evacuate …… debated ….
All Hazard Emergency Operation Plan
1. Command
2. Safety Management Support
3. Communication
4. Assessment
5. Triage
6. Treatment Medical Support
7. Transfer
1. Command
• Job description …… ada ( tidak lengkap )
• Komunikasi antar unit kerja …… sangat
terbatas
• What if / How if … tidak ada
INCIDENT COMMANDER
Di
HOSPITAL COMMAND CENTER
- Rompi IC, ID Direksi, Real-time
data
Instinctive Response
Hospital Incident
Command System
( HICS )
Project Sponsor: CALIFORNIA EMERGENCY
MEDICAL SERVICES AUTHORITY
Copyright © 2014 by California Emergency
Medical Services Authority (EMSA). EMSA
grants permission for these materials to
be reproduced or utilized in whole or in
part
ISBN: 978-0-692-02997.
- Implementasi dari ICS ( Incident
Command System ) di Rumah
Sakit
- Sistim Komando, di adop oleh
BNPB ( Perka no 10 - 2008 )
Padang, 2009
Disaster Task Force’s
Management Support at
Emergency Response Phase
after Merapi Eruption,
October 2010
Hendro Wartatmo, Laksono Trisnantoro
Center of Health Service Management, Faculty of Medicine,
Gadjah Mada University, Yogyakarta - INDONESIA
17th World Congress of Disaster and Emergency Medicine, May 30 – June 4, 2011, Beijing, China
2. Safety
• Staf …… belum mencukupi
• Situation ….. Minimal, belum ada penilai
keamanan bangunan
• Survivors ……. Maksimal
Bengkulu, 2007
RSU Pidie Jaya
Pasca gempa
3. Communication
• Sistim komunikasi umum …… baik
• Komunkasi khusus antar petugas …… belum
diatur
• Komunikasi dg pihak luar ……… belum diatur
• Komunikasi dengan korban / keluarganya ………
terbatas
Hospital Information Center
Public Information
Komunikasi kurang optimal
4. Assessement
• Belum ada pihak / tim yang ditunjuk
• Prosedur tetap belum ada
• Assessement untuk evvakuasi atau tidak
evakuasi melalui diskusi
5. Triase
• Sistem yg dipersiapkan : Single Triase (!)
• Area yg disediakan kurang
• Akses sulit
• Pemilihan lokasi incident command post tidak
tepat
Single Triase - RS
6. Treatment
• Penanganan medis sudah dilakukan secara
maksimal oleh tenaga medis yang ada
bersama relawan
• Belum ada koordinasi yang baik
7. Transfer
• Belum menguasai Hospital Evacuation
Ringkasan
• Untuk dapat menangangani korban bencana secara
optimal, diperlukan persiapan di rumah sakit secara
maksimal: berkesinambungan – sistematis-
terstruktur
• Rencana persiapan RS diwujudkan dalam Hospital
Disaster Plan / Persiapan RS menghadapi Bencana
• Tujuan utama mempersingkat chaos supaya
mortalitas - morbiditas minimal
Terima Kasih
