PENANGGUNGAN SUS GAWAT DARURAT PRA...
Transcript of PENANGGUNGAN SUS GAWAT DARURAT PRA...
PENANGGULANGAN KASUS GAWAT
DARURAT PRA RUMAH SAKITDARURAT PRA RUMAH SAKIT
Tri Wahyu Murni Perhimpunan Kedokteran Gawat Darurat Indonesia
ISTILAH
DARURAT
(Emergency)
• Any condition that-in the
opinion of the patient, his
family, or whoever assumes
KASUS GAWAT DARURATKASUS GAWAT DARURAT(Life threatening cases) (Life threatening cases)
– Immediately life threatening (critically ill patients)
family, or whoever assumes
the responsibility of
bringing the patient to the
hospital-requires immediate
medical attention
– Potentially life threatening (emergency patients)
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SPGDT(Sistem Penanggulangan Gawat darurat Terpadu)
IEMSS
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IEMSS(Integrated Emergency Medical Service System)
IEMSS(Integrated Emergency Medical Services System)
Environmental
Demographic
Prehospital Hospital Inter
Population
Prevention
Programs
EMS
outcome
Prehospital
Communication
Transportation
Hospital
Emergency Dep
HCU, ICU, OR
Resources :
Personnel, Facilities, Equipment
Organization
Procedures
Inter
Hospital.
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TWM1
SPGDT / IEMSS
Lingkup/ Scope
1. Pra RS (Prehospital)
2. Di RS (in Hospital)
Kejadian / Event
• SPGDTS-sehari-hari
(Daily emergency medical 2. Di RS (in Hospital)
3. Antar RS (inter - Hospital)
• Pencegahan (Care)
• Penanganan (Cure)
(Daily emergency medical
service system)
• SPGDTB-saat Bencana
(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
ANTAR RUMAH SAKIT
Hospital readiness ? EU, HCU,ICU,OR ?
Hospital coordination, transpotation,
communication
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PRE HOSPITAL EMERGENCY CARE (PHEC)
Communication system incl.
Emergency call numberTransportation:
1 2 3
Emergency call number
Ambulances Service center (ASC), Public safety
center (PSC), Primary care/ Acute care
PERSONNEL
a. Medical doctor
b. Nurses
c. Non medis profesional
a. MFR (Medical First
Responder)
b. PHEC personnel
Transportation:
Ambulance service
incl profesional
crew
4
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KASUS (CASES)
• Darurat medis
(Medical emergencies)
– Keracunan (poisoning)
– Serangan jantung (Heart
• Darurat bedah /kecelakaan
(Surgical emergencies / accident)
– Serangan jantung (Heart attack)
– Henti jantung mendadak (Sdden cardiac arrest)
– Bayi berisiko tinggi (Highrisk infant)
– Penyakit menular (Communicable disease)
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– Trauma
– Luka bakar (Burn injury)
– Cedera tulang belakang (Spinal cord injury)
Sumber Daya Manusia (Daily medical emergencies personnel )
Medical profesional.
Pre Hospital Emergency
care (PHEC)
1. First aid qualification
2. Advanced PHEC
1
Medical profesional.
1. Medical doctor
2. Nurses
2. Advanced PHEC
Ambulance crew
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
2. Anatomy& physiology
3. Shock
4. Resuscitation
5. Oxygen therapy
6. Trauma condition (treat use of
8. Patient assessment (incl diagnostic equipment., sphygmomsnometer, glucose monitor, pulse oximetry, Pupil tourch,chest percussion)
9. Introduction to drugs (aspirin, GTN, adrenalin, glucagon, 6. Trauma condition (treat use of
traction splint, cervical collar, extrication devices, lifting and moving techniques with stretcher and position in transport)
7. Emergency medical conditions ( focus on cardiac arrest and using AED)
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 CERTIFIEDFIRST AIDERS (valid cerificate ).
Course :
1. immediate advanced first aid assistance any situation
2. Familiar with basic emergency equipment (airway care
Materi :
1. Scene assessment
2. Scene management
3. Patient assessment
4. Using adjunct airways
5. Bag/mask resucitation
6. Defibrilationequipment (airway care respiraory support)
Penyelenggara St Jons utk sseluruh NZ diberikan untuk indivisual/ group
• Lama pelatihan 3 hari , Biaya $ 649.00
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
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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) certificateUK 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.
Materi pelatihan
1. Intermediate & advance airway managemnt incl. surgical airways
2. Management of injuries from road trafific colition, ballistic, violent assaults
support.
• Misalnya untuk personnel SAR, offshore, hostile environment medics
• Waktu pelatihan 5 hari
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
Basic life support
MEDICAL EMERGENCY focus on
cardiac arrest & using AED)
OXIGEN THERAPY
MOVING
& LIFTING
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Bagaimana pelatihan bagi masyarakat yang akan
memberikan pertolongan pertama ke gawat
daruratan medis
Bagaimana sertifikasi dan standard yang Bagaimana sertifikasi dan standard yang
ditetapkan pada kebijakan di Indonesia
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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
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 )
2. Patient transport ambulance membawa pasient tdk urgen tetapi memerlukan pelayanan kesehatan misalnya ke unit dialisis ( mobil van / mini bus)
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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AMBULANCE CREWING
• Advanced life support ambulance crew: one paramedic & one WMT Basic
• Coomon ambulance crew qualification :
1. First responder (a person who
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 :
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
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) komunikasi kru ambulans dan RS
2. Mobile data terminal (MDTs), wireless dan
3. CCTV dg video camera utk merekam kegiatan dan juga sound recording
4. Tail lift / ramp (facilitate loading patient)(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
UK
• England : NHS (National Health Services) trust
• Scotland : St Andrews ambulance association -> Scottish ambulance services • The National Fire
protection association (NFPA standard)
Scottish ambulance services (incl. air ambulance : helicopter, fixed wing)
• Northern IrelandAmbulance 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
• Primary care is the day-to-
day health care provided by
and overseen by a health
care provider
Acute care
• Patient receives active but
short-term treament for a
severe injury or episode of
ilness and urgent medical care provider
• Tipycally this provider acts
as the first contact and
coordinates other specialist
care that the patient need
ilness and urgent medical
condition or during recovery
from surgery.
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The role of acute care in health system and
services (WHO)
• Peningkatan kebutuhanacute curative services responsive to life threatening emergencies, acute on chronic illnesses dll yg perly tindakan segera. Perlu kesepakatan
• Terdapat potensi bahwa acute care memiliki kontribusi pd disain integrated health system utk me ngurangi moratlitas dan morbiditas.
Perlu kesepakatan diperlukannya acute care
• Terjadinya fragmentasipelayanan kesehatan yang tdk mengadopsi pelayanan acute care.
• 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 ?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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TUJUAN PERENCANAAN(THE GOALS OF EMERGENCY PLAN)
1. Mengendalikan masalah yg dialami korban (jumlah korban, keparahan kasus).
2. Melakukan pelayanan medis berdasarkan ketentuan praktik medik yg baik
1. To control the problem of victim (number of victim, severity of cases)
2. To treat patient based on the rules of good medical practiseberdasarkan ketentuan praktik
medik yg baik
3. Menjamin penanganan yg tepat bagi semua pasien
4. Memberikan dukungan untuk menunjang adanya keterbatasan fasilitas
3. Ensure on going proper treatment for all patients
4. To support the limited facility
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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
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 2011services 2011
• Every ambulance provider : Best practice
guidance : Joint Royal colleges Ambulance
liasion commitee (JRCALC)
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HEALTH CARE IN
PELAYANAN MEDIS pada
SPGDT- B (Bencana)
HEALTH CARE IN
IEMSS ON DISASTER
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Learn from the huge disaster
1. Mass casualties on he death victims
( in Tsunamies)
2. Mass casualties with dominant 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 INDONESIADEVELOPMENT FOR INDONESIA
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