PENANGGULANGAN KASUS GAWAT DARURAT PRA RUMAH SAKIT Tri Wahyu Murni Perhimpunan Kedokteran Gawat Darurat Indonesia
PENDAHULUAN (Introduction)
ISTILAH DARURAT (Emergency)
KASUS GAWAT DARURAT (Life threatening cases)
• 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
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– 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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IEMSS (Integrated Emergency Medical Services System) Environmental Demographic
Population
Prehospital Communication Transportation
Hospital Inter Emergency Dep Hospital. HCU, ICU, OR
EMS outcome
Resources : Prevention Programs febr2016
Personnel, Facilities, Equipment Organization Procedures TWMS
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Slide 7 TWM1
Tri Wahyu Murni, 7/6/2008
SPGDT / IEMSS Lingkup/ Scope
Kejadian / Event
1. Pra RS (Prehospital) 2. Di RS (in Hospital) 3. Antar RS (inter - Hospital)
• SPGDTS-sehari-hari
• Pencegahan (Care) • Penanganan (Cure)
• SPGDTB-saat Bencana
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(Daily emergency medical service system)
(Emergency medical service system on Disaster ) TWMS
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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 febr2016
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PRE HOSPITAL EMERGENCY CARE (PHEC) 1
Communication system incl. Emergency call number PERSONNEL a. Medical doctor b. Nurses c. Non medis profesional a. MFR (Medical First Responder) b. PHEC personnel
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Transportation: Ambulance service incl profesional crew
Ambulances Service center (ASC), Public safety center (PSC), Primary care/ Acute care TWMS
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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) febr2016
• Darurat bedah /kecelakaan (Surgical emergencies / accident) – Trauma – Luka bakar (Burn injury) – Cedera tulang belakang (Spinal cord injury)
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Sumber Daya Manusia (Daily medical emergencies personnel )
Medical profesional.
Pre Hospital Emergency care (PHEC) 1. First aid qualification 2. Advanced PHEC Ambulance crew Rescue personnel Public safety personnel
1. Medical doctor 2. Nurses
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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. 2. 3. 4. 5. 6.
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Revision first aid Anatomy& physiology Shock Resuscitation Oxygen therapy Trauma condition (treat use of traction splint, cervical collar, extrication devices, lifting and moving techniques with stretcher and position in transport) Emergency medical conditions ( focus on cardiac arrest and using AED)
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Patient assessment (incl diagnostic equipment., sphygmomsnometer, glucose monitor, pulse oximetry, Pupil tourch,chest percussion) 9. Introduction to drugs (aspirin, 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 CERTIFIED FIRST AIDERS (valid cerificate ).
Course : 1. immediate advanced first aid assistance any situation 2. Familiar with basic emergency equipment (airway care respiraory support) Penyelenggara St Jons utk sseluruh NZ diberikan untuk indivisual/ group
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Lama pelatihan 3 hari , Biaya $ 649.00
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Materi : 1. Scene assessment 2. Scene management 3. Patient assessment 4. Using adjunct airways 5. Bag/mask resucitation 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 TWMS
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PHEC PERSONNEL (New Zealand red cross standard) • Course 24 hours (3 x 8 jam) $.595 1. 2. 3. 4. 5.
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Extended first aid Basic life support Oxygen theraphy shock and defibrillation 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 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
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Materi pelatihan 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 febr2016
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OXIGEN THERAPY
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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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FASILITAS & PERALATAN KEDARURATAN FACILITY & EQUIPMENT ON EMERGENCY
SARANA & PRASARANA PADA SPGDT SEHARI HARI (Facilities on Daily medical emergencies system ) Need 1. 2. 3. 4. 5.
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Transportation (ambulance services) Public safety center / call center Communication system Medical equipment (Basic & advanced life support) 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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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 )
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Charity ambulance ambulans yg disiapkan khusus misal pd masa liburan anak2 atau orang usila
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Bariatric ambulance jenis khusus utk orang2 obese
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TYPE II -USA
TWM Ambulance service mei 2007
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AMBULANCE TYPE III USA
TWM Ambulance service mei 2007
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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.
5.
6. 7. 8.
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Emergency care assistan. Emergency care support workers (ECA/ECSW) : assist the clinician (drug, fluid, basic observation, 12 lead ECG). Emergency medical technician (EMT)/ Ambulance technician: wide emergency care skills : defibilation, immobilization, bleeding control, splinting, medication, O2 theraphy Emeregency nurse Emergency care practioner Doctors (most in air ambulance)
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STANDAR KELENGKAPAN AMBULANS 1. Two way radio, (UHF/VHF) komunikasi kru ambulans dan RS
3. CCTV dg video camera utk merekam kegiatan dan juga sound recording
2. Mobile data terminal (MDTs), wireless dan terhubung dg sentral komputer utk mengetahui detail kegiatan amblans, samapi lokasi, berangkat dari lokasi dan detail yg dilakukan krus
4. Tail lift / ramp (facilitate 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 febr2016
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Bagaimana jenis pelayanan pada Fasilitas Kesehatan
PRIMARY HEALTH CARE Primary care
Acute care
• Primary care is the day-today health care provided by and overseen by a health care provider
• Patient receives active but short-term treament for a severe injury or episode of ilness and urgent medical condition or during recovery from surgery.
• Tipycally this provider acts 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.
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• 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 dialami korban (jumlah korban, keparahan kasus).
1.
To control the problem of victim (number of victim, severity of cases)
2.
Melakukan pelayanan medis berdasarkan ketentuan praktik medik yg baik
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To treat patient based on the rules of good medical practise
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Ensure on going proper treatment for all patients
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To support the limited facility
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4.
Menjamin penanganan yg tepat bagi semua pasien 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 FEBR/2015
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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) febr2016
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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) febr2016
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SUGESTION
CRITICAL CARE WITHOUT WALL DEVELOPMENT FOR INDONESIA
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SPGDT PRA R.S.
Semoga bermanfaat FEBR/2015
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