Medical Response Managementin Disaster
Handoyo Pramusinto
Emergency Dept. Sardjito HospitalSDG’s & Disasters

Katrina survivor , 2005 (?)

18.000 in Houston Astrodome

January, 2013

311 case
Friday, March 11 , 2011, 8,9 Magnitude
the most powerful ever earthquake in Japan andresulting tsunami devastated parts of northern Japan( coastal area Tohoku and southern Hokkaido )22.000 death & missingIn fact three distinct disasters
Massive scale earthquake with major urban destruction,
disruption of residential and industrial structure,
loss over 4.000 lives and many traumatic injuries

A series of tsunami ( material loss, loss of lives )Major disruption several nuclear power plants
resulting radiation emergency

Disaster Management Cycle

4 Elements of Medical Response
1. Search & rescue
2. Triage & initial stabilization
3. Definitive care
4. Medical Evacuation

Important Aspects of Medical Response
1. Response time is critical
2. Rapid assesment
3. Need most attention and resources
4. Rapid and effective action
5. Save lives, protect health and stabilize situation
6. Avoid making the emergency worse

85-95 % survivor extricated within 24 hours

Prehospital Response:
organizational structure• Incident Command System:– Incident Command• Overall responsibility of event– Operations Section• Manages all tactical activities (police, fire, medical)– Planning Section• Collect and analyze data of event, develop plans– Logistics Section• Provide equipment for operations– Finance Section

Phases of Response• Activation:– event is first discovered– Scene assessed– Command established• Implementation:– Search and rescue– Triage– Stabilization– Transport– Definitive management of patients and scenePhases of Response• Recovery– Withdrawal from scene– Resume normal operations– Debriefing– Analysis of event

The Disaster Site – How is itorganized?
• Scene secured• Command Post
• Staging area for incoming personnel andsupplies• Landing Zone
• Casualty collection point• Morgue

Veterinary services

Triaging Patients• Basic goal is to do the most good for the mostpeople• Priority is given to the most salvageable
patients with the most urgent problems• Transport patients first who have problems
treatable in hospital but fatal in the field

START protocol (Simple Triage andRapid Treatment)• Based on the respirations, radial pulse, and mental status

PATIENTBLACK

GREEN: “walking wounded”

RED
YELLOW

Able to walk away from the scene
Reassessed after critical patientsare triaged

START TRIAGE
Respirations?
NO

YES

Position airway

> 30

<30

No

Yes

RED

RadialPulse?

BLACKREDSTART TRIAGE
Radial Pulse?
No

Yes

Control Bleeding
RED

Follows commands?
NoRED

Yes
YELLOW

SAVE TRIAGE• Used when treating multiple patients andthere is a delay in accessing definitivemanagement• 3 categories of patients:– Will die regardless of how much care is received– Will live whether or not they receive care
– Will benefit from field interventions

Patient triage• Only 70 % sensitive• Casualties require frequent reassessment andretriaging as appropriate

First steps in the ED after disaster
notification• Discharge as many patients from the ED as
possible• Quick inventory of existing supplies• Stock extra supplies needed for patient
treatment and to restock ambulances that will
return to the disaster scene

Role of the ED during disaster• Receiving area for patients• Decontamination• Triage• Stabilization• Initial treatment

Role of the physician in a disaster• Medics are best trained for initial triage, stabilizationand transport• Only physicians trained to work in the field should
do so• Physicians should be sent to the field only if there isa surplus in the hospital• Provide definitive care in the hospital setting

How to optimize disaster care
• Have a pre-made plan
• Have clear role definitions• Have a clear chain of command• Clear communication• PracticeFactors that negatively impact ofeffectiveness of disaster response :1. Poor coordination and lack of warning system
2. Very slow response time
3. Limited number of trained and dedicated clinicians
4. Lack of SAR system and equipment
5. Poor community empowerment and participation

Criteria to evaluate healthcare facility’s
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Current disaster planning strategy
Bed capacity
Surgical capacity
Blood transfusion resources
Supplies of medicine and equipment
Staff availability
Staff training
Communication facility
Transport availability
Disease surveillance and control

KEY ELEMENTS OF INTELLIGENT
EMERGENCY RESPONSE• Communication• Evacuation• Mass Care• Search and Rescue

KEY ELEMENTS OF INTELLIGENT
EMERGENCY RESPONSE• Emergency Medical• Emergency Transportation• Local, Regional, and InternationalAssistanceThank Youfor your attention