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BRAINS Bundle Regular of AMSA-Indonesia National Competition

PCC EAMSC 2013

SCIENTIFIC PAPER

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SCIENTIFIC POSTER

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FILM

PUBLIC POSTER

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Month Day Year

Table of Content Introduction

RHiTME-D System (Recruiting, Healing, Training, Monitoring, Evaluating – Developing) for Emergency and Long Term Medical Care System Based on the Flash Flood in Padang. Anggoro S., Chrisandi Y., Elmi A., Puspita W. Khrisna R. AMSA-UB, Faculty of Medicine Universitas Brawijaya Indonesia ABSTRACT Introduction : Long term health care management post disaster in indonesia hasn`t been established yet. Though the government both in central and local has efforted to give health service, but it hasn`t still done by clear guideline yet. This study purpose to create new system for long term health care management post disater. The researchers take flash flood as a theme for this study, Methode : This research used prospective comparation which aimed to plan a new system of long-term by comparing systems that has been used for today. Variable that used in this research is including the type of incoming variable. Variables which involved include Padang flash flood, the strategic plan of the BNPB. However, there are some data that was not available so the researchers took data from online print media that came from reliable and formal sourcess. Result : Indonesia is still need more organizable system for preventing tremendous health occurance in future post disaster in long term health care management. So the researchers proposed the system : RHiTME-D (Recruiting, Healing, Training, Monitoring, Evaluating – Developing.) Discussion : For strengthening community empowerment, the system that planned by VOAD (Voluntary Oraganization Active in Disaster) as NGO in America such as LTGR (Long Term Group Recovery) and health warehousing are better to apply in this country. An easiness access, more organizable system in human resourcess multi sectorial part are expected in order to help the governement for manage the disaster recovery in a future. The successful of long term relief must be measurable from any point include medical service. Thus, for integrating cooperation in multiagencies to take a role in improving health quality, it is needed to formed a group to serve community needs in health field. Conclusion : RHiTME –D is expected to be effective and applicable in Indonesia in order to integrate previous system made by BNPB specifically in medical field and to increase survivors health status with maximizing community act and multi sectorial health agencies practitioners Keyword : Long- term health care management, BNPB, RHiTME-D. INTRODUCTION Indonesia as an archipelago country which consised by 17,500 islands.It is a land with 189 million square meters. Both in demography and hidrology codition are positioning Indonesia as a country which has a much risk for facing disaster such as floods, landslides, droughts, tsunamis,

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and the others. It can threaten and disrupt the lives and livelihoods societies that caused by natural or non natural factor and resulting human casualities,environment damage, loss of property and psycological impact (Law Number 24 year 2007). In this recent decade, floods is the most common and frequent disasters.(1)

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Chart 1. Table frequenty of disaster in Indonesia. (http://dibi.bnpb.go.id/DesInventar/dashboard.jsp?countrycode=id&continue=y&lang=ID) Padang flash flood disaster management is to understand how Indonesia's organization coordinated by Padang Disaster Mitigation involve and response in disaster medicine, to Agency (BPBD) as the province disaster agency know the role of foreign organizations, to which stand under BNPB (National Disaster identify the problems with the supporting Management Agency) has declared an organization and systems for disaster medicine, emergency status and warned other residents who and to create improved strategies and live near the rivers(4). management for strengthening or enhancing Lastly, based on the bill number 58 from law medical support to disaster survivors when a number 24 year 2007 ,one of activities in the disaster happens. rehabilitation phase is health service. That is why we need to integrate and reorganize the new METHOD health care system to monitore and evaluate The information from data obtained from the health condition of the survivor also as the effort database of us is made by BNPB,BPBD for reducing more complicable health problem (Regional Disaster Management Agency), the among survivor. The problem is a lot of human Ministry of Health, Indonesian Rescuing Team resources emergency medical care when a (SAR), Health – social organization (PMI), and disaster occurs haven`t adequate capacity to carry the Ministry of Social Affairs. This research is out rescue actions(10)..Flash flood Padang variable prospective comparation which aimed to plan a is a subject that will be subjected to be new system of long-term by comparing systems monitoring and implementing in the context of that has been used for today. This research is emergency medical care and long term medical observed in terms of cross-sectional approach. care. BNPB strategic plans and actions which By approachment of cross sectional data, the taken by the department and the related gathering of data can be done at one time, but stakeholders will be used as a comparison for includes all data or the needed aspect. Variable new system which proposed by the researcher. that used in this research including the type of Specific purpose of this paper is to explain the incoming variable. However, there are some data current situation following disaster in Indonesia, that was not available so we took data from

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online print media that came from reliable and formal sources. Flash flood Padang variable is a subject that will be subjected to be monitoring and implementing in the context of emergency medical care and long term medical care. BNPB strategic plans and actions which taken by the department and the related stakeholders will be used as a comparison for new system which proposed by the researcher. The corelative analysis is done in BNPB`s action and aid from another country also the result which appear by those action . At the end, this paper is include the type of library research and if we classified from the purpose of this research paper, it will influence the future policy that the researcher hope for this nation`s better in disaster management which focusing in all disaster phase. RESULT A. Current Situation On July 24th, 2012 flash flood hit Padang, West Sumatra, Indonesia. The flash flood that hit the capital city of West Sumatra late on Tuesday afternoon (July 24th, 2012) has inundated homes in five sub districts, forcing hundreds of people

evacuate and seek refuge on higher ground. The flood struck Padang at about 6:30 p.m. Water rushed out of the swollen Lubuk Kilangan, Kurao Pagang and Batang Kuranji rivers, destroying the houses and other buildings in its path. The flood also destroyed several bridges and cut off electricity, isolating several homes.(2) Flash flood occurred 4 sub districts, Those are Sub district Nanggalo, hits 4 Villages (Tabing Banda, Laweh Gurun, Surau Gadang, and Kurao Pagang), Sub district Kuranji hits Kalumbuk Vllages, Sub district Pauh hits 2 Villages (Batu Busuk and Limau Manis), and Sub district Lubuk Begalung hits 2 Villages (Baringin and Banuaran), Padang Sumatera Barat Province. This Flash floods also caused the displacement of 344 families to neighbors/relatives who are not affected by the incident, with details 138 families from Tabing Gadang Village, Sub district Nanggalo, 62 families from Gurun Laweh Village, Sub district Nanggalo, 22 families from Surau Gadang Village, Sub district Nanggalo, 20 families from Kurao Pagang Village, Sub district Nanggalo, 50 families from Kalumbuk Village, Sub district Kuranji, and 52 families from Banuaran Village, (3) Sub district Lubuk Begalung.

Figure 2: Maps of Padang Flash Flood Disaster (http://geospasial.bnpb.go.id/wp-content/uploads/2012/07/2012-07-30_banjir_padang.pdf)

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B. Government Association for Disaster Management and Disaster Management System in Indonesia Padang flash flood disaster management is coordinated by National Disaster Management Organization which The Padang Disaster Mitigation Agency (BPBD) as the province disaster agency which stand under BNPB has declared an emergency status and warned other residents who live near the rivers. BNPB is a national disaster management organization which formed by Indonesian government in 2008 (4). As the instruction of bill number ten on law number 24 year 2007, government as intended on bill number five forms disaster management agency. BNPB which referred in previous paragraph is government agency on non departementel ministerial level. Law number 24 year 2007 is the answer of diaster management paradigm transformation. On a global level, it is accordance with effort of the world contained in the Agreement Framework Hyogo (Hyogo Framework for Action/HFA) 2005-2015 which makes Indonesia commits to international disaster risk management. It is also expected occur the sinergism of defense capacity and reduction for decreasing the risk of disaster in central government, district until in society. By the lead of president regulation number 5 years 2010 about The National Middle Scale Plan years 2010-2014 (RPJMN), 20th of february 2010, BNPB created strategic plan (RENSTRA) refer to these law(9). The Joint Search and Rescue Team has been working since Tuesday (July 24th, 2012) night to evacuate residents still trapped in the flooded areas in Padang(2). The emergency act from Indonesia Rescueing Team (SAR) is deserve for being proud due to their effort for saving the survivor . The aid that provide by Padang City

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Health Office and West Sumatra Provincial Health Office are : 1. Development of Surveillance Team and Rapid Health Assessment Team that will complement the Rapid Response Team of West Sumatra Provincial Health Office and Padang City Health Office that already in the location to anticipate the flash flood disaster impact. 2. To monitor public health conditions, especially to anticipe of the outbreak. 3. To streamline the health care units such as Puskesmas (Public Health Centers), Pustu (sub Public Health Centers), and health post that is not affected by flooding. 4. To provide 2 units of operational cars and 2 units of ambulances from West Sumatra Provincial Health Office, all of the ambulances from Padang City Health Office, and ambulances. 5. To distribute 52 boxes of (MP-ASI) breast-fed complementary foods for infats/toddles at IDP’slocation. Although the flash floods gradually subsidized, but monitoring still underway by the Padang City Health Office, West Sumatra Provincial Health Office, and West Sumatra of Sub regional Center for Health Crisis(3). On BNPB`s Contigency Plan for Facing Disaster 2nd edition , contigency is a future planning process in uncertain condition, whereas the scenario and aim are agreeable, technical act and managerial are firmable, reaction system and potency conscription is agreed together to prevent, or manage it better in emergency situation or crisis. Disaster management phase is consisted by 4 phase : • Prevention and Mitigation • Preparedness • Emergency (17) • Recovery

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Figure1. Contigency Procedure`s Chart BNPB`s contigency plan 2nd editioN coordination, information and policies between On scenario developing point, it has been the various sectors. With this mission, MPBI considerated by BNPB that there`ll be 5 term determined to do disaster risk reduction activities affected by disaster and one of them is by using the Hyogo Action Framework(6). MPBI demography/life aspect such as pain, and committed to the transformation of the New refuuges. It has been well known issue for Testament which is realized in a variety of continuing disaster management includes medical programs, such as: care which serves as important point for 1. Initiating the preparation of Disaster demography sector.(17). The executor of Management Bill (enacted on 26 April 2007 contigency plan inconsolidated in a team from into Law. 24 Year 2007 on Disaster multi sectoral such as management and Management - Law 24/2007). coordination, food and nonfood agencies, health, 2. Encourage drafting rules derived from the evacuation,transportation and infrastructure. By Law 24/2007 both at national and local levels. seeing those teoritical desicion, it can be possibly 3. Creating a framework for Community-Based appearing a risk of lack coordination between Disaster Risk Reduction (PRBBK) or one sector to another and threat data`s validity for community-based disaster risk reduction medical supplies, medical aids, etc. Proper data management (CBDRM) based on field managements ensure that priorities are set and experience CBDRM offender. enforced 4. Promote and disseminate humanitarian C. Non Government Association for standards (Sphere Project) for offenders Disaster Management disaster management in Indonesia. Indonesian Society for Disaster Management 5. Conduct disaster assessment issues. (MPBI) is a nonprofit organization established on 6. Conduct training DM. March 3, 2003 (03/03/2003) in Jakarta. MPBI MPBI hope that the work of PB in the future created because of an awareness that Indonesia is can be done by people of all backgrounds.This located in disaster prone areas which have not also encourages the PB is not only focused on been maintained properly, causing gaps emergency response, but a good thorough

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handling of pre-disaster, during disaster and after the disaster. (6) D. Organizations From Other Chapter Indonesian disaster also raise reaction from another country to give assistances. In August 9th 2012, moslem organization from USA and Sydney gave food staples through National Humanitarian Agencies (LKN/PKPU). They know about Padang Flash Flood from the media and soon they collect many donation from their civilian As NGO, LKN is trusted by those two organization to distribute their donation.As one of LKN mission to develope partnerships with community, corporate, government, and nongovernmental organizations at home and abroad(19). E. Improved Strategies In order to integrate the previous system that has been made by BNPB as Indonesian governmental organization and accordance to Indonesian disaster experience , we intend to give solution by inventing a new system for long-term disaster management with RHiTME-D (Recruiting, Healing, Training, Monitoring, Evaluating – Developing.) system which generally contain by integrating human resourcess, enhancing the preparedness, restructuring evaluating and monitoring system.For long term management, Indonesia is still need more organizable system for medical care in long term managament. RECRUITING BNPB along with local and province health departement will hold open and close recruitement of health workers (doctor, nurse, midwifery, dentist, pharmacist, nutritionist etc) . It is done immediately after acute phase while several of them has been involved there. Then, the local health agencies will determine the needed health workers based on valid data collected of disaster`s survivors. Each health institution in those district must submits their employees list that will be tested by local health departement. Test schedule will be divided into two phase. Teoritical and practical test. Allowed participant are they who fulfill the qualification that is required by local health departement based on International Red Cross Curriculum, Medical First Responder, and (AHA) American Heart Association for CPR(15) : 1. Prespective of first aid and its law aspect.

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2. 3. 4. 5. 6. 7. 8. 9. 10. 11.

Safety and continuing threat. Anatomy-Phisiology. CAB-PF. Medical Case. Triage. Incident Command System. Operational Standart Arrangement. Resourcess Mobilitation. Table Top Exercise. Simulation. The tested health workers also have to show their registration license (STR-Surat Tanda Registrasi) as another qualification. Allowed health workers will be continue to next step. HEALING Minimal energy needs for each team, among others: Rapid Response Team, the team that is expected to be immediately move up time 0-24 hours after a catastrophic event information(14). Quick movement team consists of: • General practitioner : 1 people. • Physician Surgeon : 1 people. • Anesthesia Specialists : 1 people. • Proficient nurses (surgical nurses, emergency room): 2 people. • DVI Practitioner : 1 people. • Pharmacist / Assistant Pharmacist : 1 people. • Ambulance Driver : 1 people. • Surveillance: an expert of epidemiology • Sanitarian : 1 people. • Communications Officer: 1 people. Practitioners above should be provided with a minimum of general knowledge about disasters associated with their respective work`s area. TRAINING Many humanitarian workers assigned in disaster prone areas and remote areas, where the access to emergency care is very limited. Injury or medical problem can override humanitarian worker, anywhere and anytime. Modest efforts undertaken in the first aid humanitarian workers can save lives and prevent disability, whether it is for business partners, beneficiaries and the aid workers themselves. And not only that, also need community participation in disaster. So that humanitarian workers have the First Aid`s skills and it has been certified. Therefore, the need for training that is not only made unilaterally, but also all people involved in training.

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Material 1) First Aid Kit (12) Content : • 1 Clinical Thermometer • 1 Penlight • 1 Patient Blanket ( as necessaries ) • 2 Triangular Bandage • 1 Cotton 25 grams 10 Roll Gauze 5 cm • 5 Roll Gauze 10 cm • 1 box Gauze Pads • 1 Elastic Bandage 3” • 5 Diposable Masks • 5 pairs Gloves • 1 Adhesive Tape 1/2” • 10 Adhesive Bandage • 1 Safety Pin • 1 Cotton Buds (100/pack) • 1 Rub Ointment/Oil • 1 Antiseptic Hand Sanitary • 1 Alcohol 70% • 1 Iodine Povidone • 1 Bandage Scissors • 1 Dressing Forceps • 1 Note Book + Pen • 1 Pentamed First Aid Case 2) Community empowerment (13) Community empowerment is a process to facilitate and encourage the community to be able to put theirself in the proportional standart and act as the main actor in utilizing strategy environment to achieve a long-term sustainability. There are some principles in this phase : a) Community Leader. b) Community Fund. c) Community Facilities. d) Community Knowledge. e) Community Decision. f) Community Technology. By the community preparedness. It is expected to : a) Ease the public information. b) Certainty about the roles and responsibilities of the community. c) Ease and certainty for the community for getting medical care. It is also needed an education and training for community such as develop standarization training modules for community disaster

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management.,cnduct training and technical management for disaster management by BPBD and local government for community,an understanding of local hazard and risk of disaster also the technology advanced.,preparedness of food crisis and emergency aid. MONITORING Monitoring done shortly after the emergency medical care have been implemented. So that we can make sure the extent to which improvements that has been made possible after the disaster occurred(13). a) Monitoring survivors physical and psycological healthness progress in refugees. b) Monitoring both physical and psycological in refugees and home residents. c) Supplying food and water by the government until the local community can back into normal life and increase their life`s quality. EVALUATING Evaluation made after monitoring done but there are still many things that have not neatly arranged so needed actions again. If monitoring only for emergency medical care, the evaluation is done to see the impact of the disaster as a whole and the overall impact of rescue(13). Evaluate all of activity and applied system RHiTME-D when monitoring insist. Any agency that handles given evaluation sheets will be reported to the BNPB. The evaluation sheet was given according to the format of the BNPB. DEVELOPMENT a) Form RHT (Rapid HealthTeam) based on local health agency`s recruiting. b) Assess society`s health condition to prevent tremendous occurance (KLB’Kejadian Luar Biasa’) with determined questionare by selected health workers.. c) Checking the last development of health by giving health service in refugees routinely in 2 times a week. d) Prepare some units of HSC (Health Service Car) for providing health service in field operational as necessaries. (7) e) Take cooperation between Disaster Management Departement in Ikatan Dokter Indonesia’IDI’ and BNPB as continuing step for monitoring survivors in health term by :

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• Providing health water and health service by cooperate with local/district health agencies . • Mapping some point which possible as disaster risk area as prevention effort. • Cooperate with multi health proffesion agencies such as PDGI, PPNI, ISMKI, etc. (8)

The reconstruction phase in disaster recovery is absolutely needed. At the end, reconstruction phase post disaster must be better than before those disaster occured. Based on Padang flash flood,so Dr. Faisal Fathani and his researcher team state that the mitigation activity which could be done by the government along with society are : 1. Watercourses restructuring 2. Upstream structuring 3. Early warning system practice. Monitoring tool that can be used is ARR (Automatic Rainfall Recorder) and AWLR (Automatic Water Level Recorder) such as ultrasonic sensors and pendulum system placed upstream (11).

Figure 5: RHiTEM-D System Before the disaster occur, thus the recruitment done in each regency and city. This recruiting is done and standarized by BPBD. Each person can follow this recruitement if they fullfill as needed qualification. Each district must submit the list of representation who will follow this recruitement.Then, they will be divided into two team (permanent and secondary team). Permanent team will work when the disaster hits current regency or district and they`ll be also sent

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if another regencies who face the other disaster are lack of personnels. While secondary team will work if amount of permanent team still less in current regency or district . the member of this team can be a medical students, college students, or employee. Healing is a phase when the permanent team divided into smaller team. The member of it is the people who has capability specialization in their each field. Training is a phase when all of member can involved in it by an expectation to get the similarity of capabilities and understanding about disaster management. When the disaster hits, permanent team works firstly. Unless they aren`t enough in amount context, secondary team will be down through. But both of the team should be ready for work although the training process yet done by expectation that they are ready in recruitement and they can work as needed. Monitoring will be immadiately done after medical aids down through. If there are any matter in medical assistance, it will be done soon the exact step by smaller team who has their on specialization. Then, they will be continue by evaluation with checking all of aspect in the medical term for assist the survivor needs or rebuild the health infrastucture. This evaluation will be underlie a development program that should be done in the district which got a disaster. This cycle will be continuing relating with regeneration both in personnel or its programs. DISCUSSION Disaster relief is really crucial things to plan by government and citizens itself. The community based on organization introduced as citizens empowering implementation both in Indonesia also another country such as VOAD (Voluntary Oraganization Active in Disaster). This organization consisted of the most reputable NGO`s organization in the 55 states in America. Long Term recovery as VOAD written on its guideline are : Transition occurs between the presence of national organizations and the local community, implementation begins for disaster case management and recovery initiatives administered by the local community. construction activities to include repairing, rebuilding and/or relocation of homes proceeds

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during this phase. resumption of the routines of daily life characterizes this phase. LTGR (Long Term Group Recovery) In the VOAD guideline chapter 2 it is said that LTGR (Long Term Group Recovery) can be formed as a community stakeholders strengthness.11 Indonesia can adopt this system by identifying agencies that provide disaster services such as mental health community, community health groups,etc. Partner agencies can act like identify the unmeet needs from the survivor related to disaster and monitor ongoing training. The successful of LTRG will be determined by how well it located resources (money, facilities, volunteers, personnel, in-kind donations), and how well it served the community (survivors helped, homes repaired and rebuilt, measurable impacts, etc).11 Health Warehousing Health Warehouse is a center to receive a bulk items and may become the place to sort and re packaging health aid supplies for survivors. It isn`t opened for public. Consider fist about location/access. Beside those parts, long term care can be successfull if societies sustain physical, economic, and social life.Thus, long term medical care must be appliable in order to implement one of the point above, physical. CONCLUSION The term of long term medical service`s system in disaster is still like being mazed till this time. Flood as the most frequent disaster in this country also needed immadiately remembering that Indonesia has high rain fall. By reviewing BNPB`s system, the researchers want to integrate previous system created by BNPB into the new system which focused on health care management in long term. As our review from BNPB`s guideline for disaster 2007 and Rencana Strategis BNPB for 2010-2014, BNPB has been establish and clearly explain about long term health care. That is why it should be planned wisely prevent tremendous occurance in health field in worse context after disaster. So we propose RHYTME-D (Recruiting, Healing, Yet, Training, Monitoring, Evaluating – Developing.) system to integrate BNPB`s previous system and specify in long term health

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care management by maximizing community act and multi sectorial health agencies practitioners. REFERENCES 1. ADRC, (2012), Information on Disaster Risk Reduction of the Member Countries. Available at http://www.adrc.asia/nationinformation.php ?NationCode=360&Lang=en&NationNum= 03. 2. Jakarta Globe, (2012), Padang Flash Flood Destroys Bridges, Inundates 5 Subdistricts. Available at http://www.thejakartaglobe.com/home/pada ng-flash-flood-destroys-bridges-inundates-5subdistricts/532551. 3. Zulkarnain, (2012) Flash Flood Hits 4 Subdistricts in Padang. Available at http://penanggulangankrisis.depkes.go.id/art icle/view/12/1673/FLASH-FLOOD-HITS4-S.htm. 4. International Federation of Red Cross and Red Crescent Societies (IFRC), From crisis to recovery, Switzerland. Available at http://www.ifrc.org/en/what-we-do/disastermanagement/from-crisis-to-recovery/ 5. Badan Nasional Penanggulangan Bencana (BNPB), (2007), UNDANG-UNDANG REPUBLIK INDONESIA NOMOR 24 TAHUN 2007 TENTANG PENANGGULANGAN BENCANA. Available at www.bnpb.go.id/website/file/publikasi/41.p df 6. Masyarakat Penanggulangan Bencana Indonesia (MPBI), (2009), Masyarakat Penanggulangan Bencana Indonesia (MPBI). Available at http://www.mpbi.org/content/tentang-kami 7. Zulkarnain, (2012), Banjir Bandang Menerjang 4 Kecamatan di Kota Padang. Available at http://penanggulangankrisis.depkes.go.id/art icle/view/6/1675/Banjir-BandangMener.htm 8. IDI, (2008), Waspadai Penyakit Pasca Banjir – PR PB IDI. Available at http://www.idionline.org/ 9. Badan Nasional Penanggulangan Bencana (BNPB), (2010), National Action Plan for Disaster Risk Reduction 2010 – 2012.

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Available at http://www.bnpb.go.id/website/file/pubnew/ 99.pdf Danismaya. Irawan, (2012), Carut Marut Pelayanan Gawat Darurat di Indonesia. Available at http://ml.scribd.com/doc/96811703/PELAY ANAN-GAWAT-DARURAT Grehenson. Gusti, (2012), Peneliti UGM Temukan Banjir Purba Pasca Banjir Bandang Kota Padang. Available at http://www.ugm.ac.id/index.php?page=rilis &artikel=4854 St. John Ambulance, (2012), First Aid Training Guide. Available at http://www.sja.ca/BCYukon/Training/Docu ments/FINALweb_SJA%20Training%20Gu ide-Jul-Dec%202012.pdf. Sabine Garbarino and Jeremy Holland, (2009), Quantitative and Qualitative Methods in Impact Evaluation and Measuring Results. Available at http://www.gsdrc.org/docs/open/EIRS4.pdf National Wildvire Coordinating Group, (2010), Interim NWCG Minimum Standards for Medical Units Managed By NWCG Member Agencies. Available at http://www.fs.fed.us/logistics/logistics/medi cal/documents/NWCG0152010attachmenta minimumstandardsmedicalunits012010.pdf International Federation of Red Cross and Red Crescent Societies (IFRC), Vulnerability and Capacity Assesment (VCA), Switzerland. Available at http://www.ifrc.org/en/what-we-do/disastermanagement/from-crisis-to-recovery/ International Federation of Red Cross and Red Crescent Societies (IFRC), From crisis to recovery, Switzerland. Available at http://www.ifrc.org/en/what-we-do/disastermanagement/from-crisis-to-recovery/ Badan Nasional Penanggulangan Bencana (BNPB), (2012), Panduan Perencanaan

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Kontinjensi Menghadapi Bencana (edisi 2). Available at http://www.scribd.com/doc/87612222/BNP B-2011-Panduan-Perencanaan-Kontijensi 18. Detasemen Siaga Bencana I Resimen Mahasiswa Jayakarta, (2012), Update Dampak Banjir Bandang dan Gempa 6,2 SR. Ayailable at http://den-gana1jaya.nblink.web.id/v1/2012/08/update-dampakbanjir-bandang-dan-gempa-62-sr/ 19. Padang Today, (2012), Korban Banjir Bandang Terima Bantuan Muslim Amerika. Available at http://padangtoday.com/?mod=berita&today=detil&id=37 906 20. NVOAD. 2012. Long Term Recovery Guide. http://www.nvoad.org/

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Leaf-Masking, One Second Action For Preventing Acute Respiratory Infection In Highly Erupted Volcanic Areas Enggar Sari K. W., Elisha Rosalyn Rosdah, Kunni Mardhiyah, and Agus Mahendra Medical Faculty of Sriwijaya University ABSTRACT Introduction: Mount Merapi as an active volcano, recently made world in tumult because of its eruption in 25 October 2010. Merapi's eruption was said by authorities to be the largest since the 1870s. Many people die because of volcanic ash. Volcanic ash contains some toxic gaseous, such as CO2, CO, and silica that can distract respiration. Its structure is very sharp and danger to respiratory tract. When enter the lung, it can make people stop breathing, and cause die. Nowadays, people in volcanic areas save their lungs by using mask. Unfortunately, the mask which used by them is only could filtered dust and not protect from chemical agents such as CO and silica. Hundreds years ago, researchers found about the structure of the leaf with its difference functions. By it’s physiologically function through photosynthesis, some part of leaf seemed to be effective for preventing those pollutants. Because of that, we elaborate to find the effectiveness of leaf to filter CO and silica, and also become mask in emergency situation. Beside of that, leaf can find everywhere, mainly in volcanic area that has flourishing land. Method: We use experimental study due to investigate the effect of using leaf mask in pollutant area. This experiment were studied in 20 healthy volunteers, all were no respiratory problem. The subjects wear surgical mask banded with leaf on the outer side when the pollutant exposure given. The source of pollutant is from vehicle emission which has the same characteristic of toxic gaseous from volcanic eruption. Vital, inflammation and subjective sign is measured 6 times with or without pollutants exposure. Identifying the leaf aroma was taken from previous study. Twenty subjects inhalant the fragrance contains (-)-limonene. ANS parameters recorded were skin temperature, skin conductance, breathing rate, pulse rate, blood oxygen saturation and systolic as well as diastolic blood pressure. Subjective experience was assessed in terms of mood, calmness and alertness on visual analog scales13. Result The most similar data was found between control (subjects inhalant ambient air) and compared with consuming ambient air, wearing leaf mask while CO exposure give most similar data. OR=0.95 Reliability interval (RI) = 95%. Increasing of heart rate, respiratory rate, blood pressure are physiological when a protected respiratory is given. 95% subjects feel comfort because of leaf aroma that contains (-)-limonene. Inhalation of (–)-limonene caused an increase in systolic blood pressure but had no effects on psychological parameters13. Discussion We report that leaf mask showed satisfying effect to prevent toxic gaseous exposure due to acute respiratory infection and toxicity. Three mechanisms involved: (1) Physiological. Leaf mask protects pollutant by stomata trapping, excitated chlorophyll’s bond with CO, and reactions between CO and O2 produces CO2. (2) Structural, protect respiratory system from silica (SiO2) of ash fall by the strong barrier of peptic polysaccharides of the cell wall. (3) Pharmacological, (-)-Limonene excite autonomic nervous system to reduce stress. In conclusion, leaf mask is effective for biofiltering pollutant through eruption. Further research could be on experimental study for threshold of the leaf protecting from pollutants and application for traffic use. Key words: volcanoes, eruption, acute respiratory infection, CO, SiO2, stomata, chlorophyll, limonene Introduction The geography of Indonesia is dominated by volcanoes that are formed due to subduction zones between the Eurasian plate and the IndoAustralian plate. Indonesia has some 155 centres of active volcanism.

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The most active volcanoes are Kelut and Merapi on Java island which have been responsible for thousands of deaths in the region. Since AD 1000, Kelut has erupted more than 30 times, of which the largest eruption was at scale 5 on the Volcanic Explosivity Index (VEI) while Merapi has erupted more than 80 times.

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Merapi recently erupt again, on 25 October 2010 the Indonesian government raised the alert for Mount Merapi to its highest level (4). Merapi erupted three times on Monday afternoon spewing lava down its southern and south-eastern slopes.1 Instead the Crisis Center MOH (Ministry of Health) reported the numbers of casualties are 168 people died, 552 inpatients, and 17,770 outpatients with Acute Respiratory Infection as the leading cause of visit.3 The following are number of health problems among IDPs in Yogyakarta Province (up to 8 November 2010): N Disease Number o 1 Acute 1,396 Respiratory Infection 2 Hypertension 609 3 Eyes 586 Problems 4 Gastritis 547 5 Headache 544 6 Muscle and 478 Joint Problems 7 Skin 222 Problems 8 Diarrhea 149 9 Others 89 1 TOTAL 5,423 0 Source: Crisis Center, Ministry of Health, as per 8 November 2010 Table 1. Number of health problems among IDPs in Yogyakarta Province (up to 8 November 2010) Why the highest number of health problems is acute respiratory infection? When erupted, volcano spurt mostly hydrogen (H2O), carbon dioxide (CO2), sulfur dioxide (SO2), hydrochloric acid (HCl), hydrofluoric acid (HF), and volcanic ash into the atmosphere. Volcanic ash contains silica (SiO2), minerals, and rocks. The most common element is the sulfate, chloride, sodium, calcium, potassium, magnesium, and fluoride. There are also other elements, such as zinc, cadmium, and lead, but in lower concentrations.

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(http://ramlannarie.blogspot.com/2010/11/abuvulkanik-lebih-berbahaya-dari-debu.html) Figure 1. Volcanic as very sharp and danger to respiratory tract Mt Merapi volcanic ash which had a silica (SiO2) content of 56 percent was during the past two weeks mostly blown by winds in westerly and south-westerly direction. Silica will damage the respiratory tract by entering through the nose. So, it is vital that the population exposed protects themselves by wearing masks. The type of mask which most distributes in the society is dust mask. It is a flexible pad held over the nose and mouth by elastic or rubber straps to protect against dusts encountered during construction or cleaning activities, such as dusts from drywall, concrete, wood, fiberglass, silica (from ceramic or glass production), or sweeping. Dust masks are manufactured to protect against only certain dangers, and do not protect against chemicals such as vapors, mists, CO, and SO2. Dust masks are a cheaper, lighter, and possibly more comfortable alternative to respirators, but may not provide as much protection. Plant has a capability to absorb some pollutants effectively and has a role to “clean up” the pollutant in the atmosphere. The absorbance pollutant will bound in the metabolism process8. Leaf mask is the offered solution. It has highly temperature resistance4. The chlorophyll structure also resemble with heme of human’s red blood cell (figure 2). The stomata and guard cell has similarity action as human’s respiratory system5. Leaf produces O2 (oxygen) during photosynthetic pathway that essential for human and trapped CO2 (carbon dioxide). Because of the similarities and advantages, it is suggested that leaf can substitute human respiratory system to “inhalant” undesirable particles during eruption

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of volcanoes. The substitute action could prevent human from acute respiratory infection which caused by CO and SiO2.

Figure 2. Comparison between (A) chlorophyll c2 and (B) heme B 4

Method Anually we performed 10 both male and female healthy-randomized volunteers aged between 6 and 50 years took a part in the experiments. All were no respiratory problem, i.e. asbestosis, coal worker’s pneumoconiosis, berylliosis, pneumonitis hipersensitif, bagassosis, bronkiektasis, hemoptisis, dispnea, etc (Zul Dahlan, 2009) included in the study. Besides, factory worker, smoker, obese, gardener, and farmers are excluded. Per-Subject comparisons vital and inflamation sign after several physical activity were examined first with the result. The experiment will treat while using the emmission of vehicle indeed as the pollutant source. Vehicle emission contains many pollutants (table 2).

Table 2. The composition of vehicle emission. (Source: Suharsono, 1996) We defined subjects using the mask of chlorophill substance and growing out physical action on 2-3 minutes distance up with 5-25 minutes time interval The mechanisms are shown below.

Figure 3. Vital and Inflammation Sign Measurement obtained the same vital sign when the subjects Bold line shows the presence of mask were being breath ambien air. The data is to chlorophyll. On the figure was approved by the indicate the subjects who were not hypoxia measurement which was done 6 times at the same exposure. For further need to clarify for time for getting precise accuration to asses the inflammation sign related the other pollutant that impact of pollutant and overcome with the having inhalation on the experiment. accurate result. The study is expected which

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The baseline characteristic of the 2 groups were similar. In this result outcome the subjects treated with the mask of chlorophill substance compared with those not treated. Secondary outcome included the primary prevention happened on our society problem especiall in our country that take on troubled of disasters. The research for finding the correlation between leaf aroma and autonomic nervous system was done on the previous study by Heuberger et al (2000). Individuals were tested in four separate sessions; in one session one fragrance was administered. The fragrances are: (+)-limonene, (-)-limonene, (+)-carvone and (-)carvone. ANS (Autonomic Nervous System) parameters recorded were skin temperature, skin conductance, breathing rate, pulse rate, blood oxygen saturation and systolic as well as diastolic blood pressure. Subjective experience was assessed in terms of mood, calmness and alertness on visual analog scales. In addition, fragrances were rated in terms of pleasantness, intensity and stimulating property13. SC (skin conductance was recorded using a GSR100B amplifier and Ag/AgCl finger electrodes (Biopac TSD103A) by the constant voltage (0.5 V) technique. Electrodes were filled with conductive gel and placed on the first phalanx of the middle and the index finger of the non-dominant hand with non-caustic adhesive tape13. ST (skin temperature) was measured with a SKT100B amplifier and a fast response thermistor (Biopac TSD102A). The sensor was placed on the middle of the back of the nondominant hand with non-caustic adhesive tape13. Measu Variable re 1 (control) BP <120 65% mmHg 20% 120/80 15% mmHg <120mm Hg Heart >100 Rate 60-100 100% <60 Respirato >24 5% ry Rate 16-24 95% <16

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PR (pulse rate) and BOS (blood oxygen saturation) were assessed using a Pulse Oximeter Module (OXY100A) and a photoelectrical transducer (Biopac TSD123B). The non-invasive transducer was placed on the first phalanx of the ring finger of the non-dominant hand with noncaustic adhesive tape13. BR (breathing rate) was measured using a SKT100B amplifier and a TSD102D surface temperature thermistor probe which registers breathing cycles on the basis of the difference in temperature between inhaled and exhaled air. The probe was placed at the entrance of the left nostril with non-caustic adhesive tape13. SBP (systolic blood pressure) and DBP (diastolic blood pressure) were measured in the left arm by sphygmomanometry using an automated system (Hartmann Digital HG160; Paul Hartmann AG, Heidenheim, Germany)13. VASs were used to assess subjective mental and emotional conditions. They consisted of 100 mm lines for three items: ‘mood’, ‘calmness’ and ‘alertness’. Each subject was asked to mark his or her feeling for each item between the two possible extremes: alert (on the left) and tired (on the right) for the item ‘alertness’, calm (on the left) and restless (on the right) for the item ‘calmness’ and cheerful (on the left) and bad tempered (on the right) for the item ‘mood’13. Result The primary analysis was the subjective sign based on anamnesis and vital sign. As shown on the table, the insignificant increasing between control and interventional subject. All subjects reported in compos mentis. 2

3 (control)

70% 20% 10%

95% 5%

10% 90%

100%

20% 80%

100%

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4

5

100 %

100 %

100 %

100 %

100 %

100 %

6

100 %

100 %

100 %

15


Temperat

>37.2 36.5-37.2 37.2

ure Consciousness Subjectiv e sign

100%

100

55% 45%

65% 35%

60% 40%

63% 37%

Com pos mentis 5%

Com pos mentis 5%

Com pos mentis 5%

% Compo s mentis

Nausea Anorexia Dispneu Inflammat

Com pos mentis 5%

Compo s mentis

5%

5%

ion Else Table 3. Comparison of the experiments The incidence of nausea and dispneu (5%) happened with or without intervention, so that it can’t be considered. The increasement or heart rate, respiratory rate, blood pressure little to normal were physiological situation when there was protected air. 95% fells charm and reducing subjective effect because of leaf aroma. Inflammation sites are not found. RO = 0.95 Reliability interval = RI = 95%

Normal vital sign and no subjective sign Leaf mask and pollutant exposure

Yes No Value

Yes 95 0 95

No 5 100 105

Value 100 100 100

Figure 3. [third trial in a (–)-limonene session]. ST, skin temperature; SC, skin conductance; BR, breathing rate; BOS, blood oxygen saturation; PR, pulse rate. (Source: Heuberger et al, 2000)

Table 4. Table of odd ratio leaf-masking

Table 5.Correlation analysis for (+)-limonene, (-)-limonene, (+)-carvone, and (-)- carvone (source: Heuberger et al, 2000)

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In order that leaf which is the object we are focused contains (-)-limonene, hereby in the result of (-)-limonene. In the (–)-limonene session a correlation between subjective ratings of pleasantness and effect of the odor was found: the more pleasant the fragrance was rated the more stimulating it was judged (ρ = +0.466). Ratings of the fragrance’s pleasantness and effect were correlated with changes in subjective calmness and alertness: the more pleasant the odor was judged the less calm subjects felt (ρ = +0.495); the more stimulating the fragrance was rated the more alert subjects felt (ρ = –0.484). Subjective evaluation of the fragrance’s effect and intensity interacted with changes of ST and PR: the more stimulating (–)-limonene was rated the more ST decreased in the third trial (ρ = – 0.518); the more intense the substance was rated the greater was the change in PR (increase or decrease) (U-shaped, r = 0.653, P = 0.001)13. Discussion This study shows that by using the mask of cholorophill substance brought out the benefit in order for protecting forward air exposure. For the effects of leaf mask as written before, three mechanisms are involved: physiological, structural, and pharmacological20. 1. Physiological: Protects Pollutants before and after eruption First. the structure of the lower epidermis of the leaf have many stomata. Stomata are pores in the epidermis through which diffusion of gasses occurs. Each stoma is bounded by two sausageshaped guard cell5. Throughout the entire process of leaf aging, stoma responds in such a way that intercellular leaf CO2 concentrations remain constant7. Stomata respond to intercellular CO2 concentration and are insensitive to the CO2 concentration at the surface of the leaf and in the stomatal pore8. When stomata opened, not only CO2 get into the leaf but also other particle. In the case of eruption, toxic gaseous can get and trapped into the leaf. The pollutant’s particles enter into the leaf by passive diffusion9. The mechanisms of particles stick with epidermis are: (1) Sedimentation cause of gravity (2) bumped by wind turbulence (3) precipitate due to rain12. Stomata’s cleft is 10 µm in width and 2 –7 µm in length. The particle enters the

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leaf are settled and pail in the air space between palisade and spongy tissue10 (figure 4).

Figure 4. The accumulation of pollutant’s particle (Pb) through leaf (source: Widagdo, 2005) Second. Light energy is trapped by photosynthetic pigments. In the process of photosynthesis, the light energy absorbed by the chlorophylls, is converted to chemical energy while the chlorophyll’s electrons were excitated4. Excitated electron on chlorophyll supposed to be bond with toxic gaseous i.e. CO with the same mechanism. But, nowadays there is no research for the effectiveness of chlorophyll-CO bonding18. Third. In the presence of Platina (Pt) and Padmium (Pd) on eruption place, possibly there is a reaction shown below: CO(g) + 1/2 O2(g) ! CO2(g)

Pollutant

Product of photosynthesis done by its leaf

Figure 5. Reaction between CO (Carbon Monoxide) and O2 (Oxygen) in the presence of catalysts and certain environment SnO2-Pd and SnO2-Pt catalysts recombine CO and O2 at low concentrations in a basic gas mixture of CO2, N2 and He at a total pressure of one atmosphere. Significant rates were measured over the whole temperature range of the investigation (-27 degrees C to 44 degrees C)17

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Then CO2 produced by the reaction can across into stomata and perform photosynthetic pathway, produces O2.

Figure 6. Photosynthetic pathway The oxygen (O2) produces by the photosynthetic pathway above then used as reactan combined with CO. The reaction is same as the first reaction. 2. Structural: Protect Respiratory System from Silikan (SiO2) of Ashfall Plants are organism with a cell wall surrounding its cell. Intercellular transport was done by apoplast and simplast pathway.

Figure 7. Ultraviolet photomicrograph, taken at 240 nm, of the cell walls of black spruce earlywood tracheids. The densitometer tracing was taken along the dotted line. (source: Fergus et al, 1969) This is make it up for avoiding unexpected ions so that they can enter filling through. Besides the solid structure in which diameter cleavage narrow, and certainly it can’t through diffuse mechanism (shown below) made it become a barrier which can’t be throught by sillican (SiO2). The accumulator of silica can be affected silicosis causing the obstruction of the lung16.

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Figure 8. Two kinds of flowering plant and its cell wall 3. Pharmacological: Giving the neurotherapy effect Some leaf contains aromatherapy. Jeruk purut leaf (Citrus Hystrix) contains citral and limonene. Jintan (Ningella Sativa) contains carvacrol, carvol dan carvene that relaxed the neuromuscular15. Inhalation of (–)-limonene caused an increase in systolic blood pressure but had no effects on psychological parameters. Correlation analyses revealed that changes in both ANS parameters and self-evaluation were in part related to subjective evaluation of the odor and suggest that both pharmacological and psychological mechanisms are involved in the observed effects. Inhalation of (–)-limonene led to a significant increase in SBP. Also, subjects reported feeling significantly more alert after the third trial, reach statistical significance13. Dochinger (1980) told the leaf can decrease the concentration of Pb in atmosphere by increasing the airway turbulence. Leaf can survive 50 minutes after get loose from its branch11. Further research could concentrate on the application of leaf as traffic-mask and synthesize the mask which has the same effect as leaf mask. In conclusion, we report that leaf mask is effective as biofilter for preventing human from acute respiratory disease in highly-eruptedvolcanoes area. The effects of using chlorophyll masks are neutralizing toxic gaseous from ash fall and first barrier of SiO2 inhalation. Some evidence was found that leaf contain (-)-limonene is not over-excitated autonomic nervous system activity. We suggest to use leaf mask from wide leaf to cover mouth, nose, and chin22.

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References 1

"Merapi spews lava". Jakarta Post. 2010-10-25. Retrieved 2010-10-27 2 Riyadi, Slamet (11 November 2010). "Flights resume to Indonesia as volcano spews ash". AP Wire News-Associated Press. Retrieved 11 November 2010.) 3 http://www.searo.who.int/LinkFiles/Indonesia_MME CJ-ESR_06.pdf 4 Adiputro, B.S., N.S.W. Karliansyah, dan H.D.W. Wardana. 1995. Klorofil Tumbuhan sebagai Bioindikator Pencemaran Udara. Lingkungan dan Pembangunan 15(2): 233-248. 5 Jones et al. 2007. Biology: AS Level and A Level. Chambridge University Press. Oxford 6 Nobel, et al. 1998. Temperature influences on leaf CO2 exchange, cell viability and cultivation range for Agave tequilana. Journal of Arid Environments (1998) 39: 1–9. Article No. ae980374 7 Azuna et al. 1985. Analysis of Guard Cell Viability and Action in Senescing Leaves of Nicotiana glauca (Graham), Tree Tobacco. Plant Physiol. 79, 7- 100032-0889/85/79/0007/04/$0 1.00/0 8 Widagdyo, Setyo. 2005. Tanaman Elemen Lanskap sebagai Biofilter untuk Mereduksi Polusi Tmbal (Pb) di Udara. Makalah Pribadi Falsafah Sains (PPS 702) Sekolah Pasca Sarjana / S3. Institut Pertanian Bogor 9 Smith, J. 1981. Air Pollution and Plant Life. John Willey & Sons Ltd. Chichester, New York. 10 Chen, M.; Schliep, M.; Willows, R. D.; Cai, Z. -L.; Neilan, B. A.; Scheer, H. (2010). "A Red-Shifted Chlorophyll". Science 329 (5997): 1318-1319. doi:10.1126/science.1191127. PMID 20724585 11 Buckley, Robert. 2007. Inducing Adventitious Rooting in Cycad Leaves.32005 Pleasant Glen Road, Trabuco Canyon, California, U.S.A. 926793228 12 Joseph Pelletier and Joseph Caventou. September 1951. Journal of Chemical Education 28 (9): 454. doi:10.1021/ed028p454. ISSN 0021-9584. 13 Heuberger, et al. 2000. Effects of Chiral Fragrances on Human Autonomic Nervous System Parameters and Self-evaluation. Institute of Pharmaceutical Chemistry, Center of Pharmacy, University of Vienna, Althanstrasse 14, A-1090 Vienna, Austria 14 Manahan, S.E. 1977. Environmental Chemistry. Longman Chesire, London. 15 Marker, A. F. H. (1972). "The use of acetone and methanol in the estimation of chlorophyll in the presence of phaeophytin". Freshwater Biology 2: 361. doi:10.1111/j.1365-2427.1972.tb00377. 16 Robert Burns Woodward, et al. (1990). "The total synthesis of chlorophyll a" (PDF, 0.5 MB).

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Tetrahedron 46 (22): 7599–7659. doi:10.1016/0040-4020(90)80003-Z. 17 Sastroasmoro, Sudigdo dan Sofyan Ismael. 2010. Dasar-dasar Metodologi Penelitian Klinis. Sagung Seto:Bandung 18 Stark, D.S and Harris, M.R. (1983) Journal of Physics E: Scientific Instruments Create an alert RSS this journal Volume 16, Number 6 . Royal Signals & Radar Establ., Min. of Defence, Great Malvern, UK. doi: 10.1088/0022-3735/16/6/012 19 Setiawati, K. 2000. Studi Toleransi Jenis Pohon Tepi jalan terhadap Pencemaran Udara Emisi kendaraan Bermotor. Tesis Pascasarjana. IPB. Bogor. 20 Wardana, W.A. 1995. Dampak Pencemaran Lingkungan. Andi Offset.Yogyakarta. 21 Fergus, B. J., and Goring, D. A. L. (1970a). . 90l: forschung 24, 118-124 22 Iswanto, Apri Heri. 2008. Keberadaan Lignin dalam Sel Kayu. Fakultas Pertanian. Universitas Sumatera Utara 23

http://www.scientificamerican.com/article.cfm?i d=new-form-chlorophyll 24

http://www.newscientist.com/article/dn19338infrared-chlorophyll-could-boost-solar-cells.html

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The Misses Review: New Concept Field Hospital for Disaster Management System in Indonesia Cendikiawan Felix, Dewantara Angga, Rahma Annisa, Renna Yunneke 7th semester medical students, Brawiajaya University, Indonesia ABSTRACT Aims: Propose new concept of field hospital in order to achieve the goal, minimize the number of disaster victims in Indonesia. Introduction: Indonesia is a country with a high level of disaster that so-called as hypermarket of disaster, one of them is the earthquake. Earthquake threat worthy of attention especially high scale and level of earthquake victims. One of the current issues in disatser management is that perfomance in disaster management is still not optimal. Unoptimal perfomance can also be seen in poor coordination and cooperation in emergancy response. Methods: The method of this paper relies on literature review. This literature includes central government regulations and reports as well as some research papers. Moreover, this paper only focuses on the natural disaster management system, because the management system for technological disasters is traditionally different from the one for natural disasters. Results: Disaster management in Indonesia is still less than the maximum. This is because due to the lack of an integrated design that SOP in all areas especially related to medical problems. It also occurs in the local medical personnel who are available, often do not meet the terms of quality and quantity. Equipment support and the medical professionals are good combination to achieve new concept field hospital goal, which reduce the number of victims after a disaster. Conclusion: New field hospital would have to have medical standard equipment and also supported by adequate facilities for the medical team and patients. There is still no standard system of standard hospital field in Indonesia in terms of disaster management. Therefore, the authors tried to propose a new system of field hospitals are expected to reduce mortality and to support victims of existing systems. Key words: New concept hospital field, Indonesia disaster management system. INTRODUCTION Natural disasters and their mitigation are global issues, especially in Asian countries, which have suffered from such geohazards as earthquakes, tsunamis, and volcanic eruptions and such hydrometeorological hazards as typhoons, cyclones, storm surges, and floods. Indonesia is a country with a high level of

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disaster that so-called as hypermarket of disaster, one of them is the earthquake. Earthquake threat worthy of attention especially high scale and level of earthquake victims. Geologically, the area of Indonesia is at the confluence of three active tectonic plates, namely the Indo-Australian Plate to the south, in the northern part of the Eurasian Plate and the Pacific Plate in the East 1.

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Picture 1. The map of plates arround Indonesia Considered geologically, the Indonesian earthquake frequency must increase the number archipelago is the second meeting of seismic of victims of the incident. lines, namely lines circum Pacific earthquake and seismic lines Alpide Transasiatic. In addition, Indonesia also has 129 active volcanoes, 80 of them harmless. Therefore, Indonesian archipelago is located in areas that have a high earthquake activity 1. With such geological conditions, the threat of disaster in the region of Indonesia seems a matter of time. Moreover, coupled with environmental degradation and natural resource use that are not controlled. The frequency and severity of catastrophic events or fatalities increased in Indonesia. Governments have an important role in the Table 1. List earthquake in Indonesia response to the disaster in the archipelago. One of the current issues in disaster Government awareness and disaster mitigation management is that perfomance in disaster efforts in Indonesia have existed since management is still not optimal. In general it independence was declared 2. The times and the could be said that the goverment, the community needs of the disaster and helped change and all relevant disaster management perceptions contribute to the formation of the stakeholders in indonesia have not been prepared National Agency for Disaster Management. The to deal with disaster so that the number of disaster management system is also involved in disaster victims every year is still high and the health, especially in all aspects of emergency material losses caused by disaster are also still menacing. Therefore formed disaster medicine is sizeable 3. Unoptimal perfomance can also be a combination of emergency medicine and seen in poor coordination and cooperation in disaster management. Disaster management emergancy response. During emergency response system is important based on the frequency of ineffectiveness can still be seen in the earthquakes in Indonesia. High level of mobilization of the search and rescue teams and

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in the collection and distributin of aid goods for disaster survivors. Post-disaster recovery has also not been optimal, data concerning the number of people died and injured, and data about houses totally destroyed, heavily damaged and lightly damaged are seldom consistent and sometimes there are several versions of data that do not agree with each other. Difference of data in terms of survivors that are injured and the types of injury the suffer will make it difficult to allocate medical personnel and equipments, including medicine needed to treat disaster survivors 3. Likewise, difference in data concerning damaged houses, and public facilities and infrastrucutres will hamper the calculation of the needs for rehabilitation and reconstruction, which will further slow down the overall recovery of the disaster-affected communities. The other issues that also needs to be dealt with immediately is the institutional orientation of disaster management in indonesia that still tends to emphasize more emergency response rather than disaster prevention and risk reduction. It seems that the understanding and realization that disaster risks may be reduced throug development interventions are still very limited. Law number 24 year 2008 on Disaster Management has shifted disaster management paradigm from a responsive orientation (focused on emergency response and recovery) to a preventive one (risk reduction and preparedness), but in implementation there are still few disaster risk reduction programs that are planned and programmed 4. Disaster risks can be reduced through development programs that employ a risk reduction perspective and spatial planning that is based on disaster risk mapping and analysis 2. METHODS The method of this paper relies on literature review. This literature includes central

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government regulations and reports as well as some research papers. Moreover, this paper only focuses on the natural disaster management system, because the management system for technological disasters is traditionally different from the one for natural disasters. Katz and Kahn (1978) suggested an ideal integrated system means a well-defined and clearly differentiated structure of components with mutually agreed upon roles interacting over time in a coordinated manner to achieve common goals 5. “Well-defined and clearly differentiated structure of components” refers to the organizations in the system and “mutually agreed upon roles interacting over time in a coordinated manner” means operation functions over a long period of time with different contexts (focus issues) at different times in the system 5. To apply Katz’s and Kahn’s opinion to the state mechanism in Indonesia, the ordinances and regulations promulgated by the state apparatus have to be discussed. Therefore, this study describes the natural disaster management system from three approaches: organizations, operations, and focus issues by having new concept field hospital. RESULTS I. National Agency for Disaster Management Government has an important rule in handling national disaster management. Creating specific department who responsible in national disaster management become the best solution for indoensian government. BNPB (in Indonesian language) is the Indonesia National Agency for Disaster Management. It was established in 2008 to replace the National Disaster Management Coordinating Board that was established in 1979. BNPB is directly responsible to the President of Indonesia and the chairman is directly appointed by The President 1.

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Chief of  BNPB  

Deputy for   Preven3on  and   Preparedness  

Chief Auditor  

Prime Secretary  

Centre of  Data   Informa3on  and  PR  

Centre of   Educa3on  and   Training  

Deputy for   Emergency   Management  

Deputy for   Rehabilita3on  and   Reconstruc3on  

Deputy for  Logis3c   and  Equipment  

Directore

Directore

Directore

Directore

Directore

Directore

Directore

Directore

Directore

Directore

Directore

Picture 2. Organization structure The current disaster management system involved in an integrated countermeasure based on National Agency for Disaster system when a major disaster takes place 6. Management can be categorized into the • Disaster Management Plans following three sections. The duty agencies are required by the • Disaster Management Organizations and DPRA to draw up three statutory disaster Their Functions management plans. These three plans have to Disaster Prevention & Response Council be periodically reviewed or revised every (DPRC), should be made in one specific three to five years due to social and Department in the Indonesia provincial environmental changes. These plans were: government was the major organization to Disaster Prevention and Response Basic Plan take this responsibility. The current disaster (DPRBP), the Disaster Prevention and management system consists of three Response Operational Plans (DPROPs), and governmental levels. Every level of the Local Disaster Prevention and Response government is required to establish a DPRC. Plans (LDPRPs). In this period, disaster Since the DPRC itself is a task force style management emphasized disaster response, organization, it doesn’t take responsibility for early recovery and pre-disaster Preparedness. policies implementation. The specific agency, These plans should be developed at the central Disaster Prevention & Response Committees government level by duty ministries and (DPRCM) under the DPRC, takes charge of public utility companies; and LDPRPs, which overseeing and implementing disaster related should be developed at local government policies and plans. At the central government level. These plans must be based on the level, five duty ministries are designated to environmental characteristics, hazard respond to one or more types of mass vulnerability, and social and economic disasters and implement related affairs. conditions within each local jurisdiction. The Moreover, militia corps and armed forces as LDPRP is a comprehensive plan, which well as non-government organizations covers all six phases of disaster management 5 (NGOs) and community organizations are all . • Operation System

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The operation of disaster management is not only based on the disaster management plans described above, but also many supporting ordinances, regulations, standard operation procedures (SOPs) and guidelines at different government levels. The SOPs and guidelines have to clarify the details of what needs to be done or planned 5.

Picture 3. Disaster cycle Mitigation means attempt to prevent hazards from developing into disasters, reduce effects of disasters, rocuses on long-term measures for reducing and eliminating risks, structural measures – drainage for flood water, bomb shelters, earthquake resistant buildings, non-structural measures – laws, insurance, must first identify risks and evaluate hazards. Afetr focusing in mitigation we go to preparedness. Preparedness refers to disaster and communication plans with easily understandable terminology, maintenance and training of emergency services such as emergency response teams. development of emergency population warning methods and shelters, evacuation plans, disaster supplies and equipment; survival kit, develop trained volunteers e.g. Red Crescent/Cross Society. After that we focused on response, mobilization of emergency services and first responders – fire fighters, police and ambulance crews, supported by secondary emergency services e.g. specialist rescue teams, search and rescue attempts, majority of disaster victims die within 72 hours, based on government response plan and Incident Command System (ICS) 7. There are some steps that have been made by the Indonesian 8

1. Response: Life (property saving), Information dissemination, Communication 2. Rehabilitation: Temporary rehabilitation, Reestablishing Transport systems, Reestablishing, communication routes 3. Reconstruction: Permanent rehabilitation, Infrastructures reconstruction, Building Reconstruction 4. Prevention and Mitigation: Risk assessment, 5. Preparedness: Risk forecasting, Organization, Planning of resources, Emergency Planning Training, Public awareness 6. Alert : Alarm Triage system is the process of determining the priority of patients' treatments based on the severity of their condition. This rations patient treatment efficiently when resources are insufficient for all to be treated immediately. Triage may also be used for patients arriving at the emergency department, or to telephone medical advice system. Simple triage is usually used in a scene of an accident or "mass-casualty incident" (MCI), in order to sort patients into those who need critical attention and immediate transport to the hospital and those with less serious injuries. This step can be started before transportation becomes available. The categorization of patients based on the severity of their injuries can be aided with the use of printed triage tags or coloured flagging. Indonesia special agency for disaster management defined triage system in three categories : P1, P2 and P3 9.

P1 Procedure RESUSCITATION TEAM

CALL DOCTOR

P1

NURSE

FURTHER PLAN

DECIDE

WHAT INVESTIGATION NEED FBC, CARDIAC ENZYME ECG, X-RAY ETC

OBSERVATION ROOM

ADMIT

OT

ICU

WARD

Picture 4. P1 Procedure

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P2 Procedure EXAMINE DECIDE

WHAT INVESTIGATED NEED FBC, CARDIAC ENZYME ECG, X-RAY ETC

CALL DOCTOR

FURTHER PLAN NURSE

P2

PASIEN

ADMIT

OBSERVATION ROOM

OT

ICU

DISCHARGE BE INTERACTION WITH

ARRANGE FOR FOLLOW UP

RELATIVES

MEDICAL ADVICE

WARD

Picture 5. P2 Procedure Standard Operating  Procedure  Of  P3  Pts NURSE

CHIEF COMPLAIN CALL DOCTOR

P3

DECIDE

WHAT INVESTIGATION NEED, IF ANY (FBC, CXR, ECG, ETC).

FURTHER PLAN

CARE OF MINOR TRAUMA

DISCHARGE INTERACTION WITH

OBSERVATION WARD PATIENT

RELATIVES

MEDICAL ADVICE

ARRANGE FOR FOLLOW UP

Picture 6. P3 procedure

Picture 7. Triage Tag

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With all the existing procedural, disaster management in Indonesia is still less than the maximum. This is because due to the lack of an integrated design that SOP in all areas especially related to medical problems. Another issue that is not less important is the lack of readiness of local medical services to cope with disaster happened either from issues of quantity and quality problems that place 10. It also occurs in the local medical personnel who are available, often do not meet the terms of quality and quantity. Often the damage where medical services are also caused due to lack of construction that is ready to face an earthquake in the region - an area prone to natural disasters. Besides the help that comes too often become a problem as the lack of medical personnel are able to engage in the handling of disaster medicine as aid worker. According to this situation- it becomes a separate concern for the writer to assist in the medical field, especially as a medical student. II. ISSUES FACING NATURAL DISASTER MANAGEMENT TODAY Even though the Disaster Prevention & Response Committee (DPRCM) was established as a specific agency in the central government level based on DPRA, it didn’t have a full time staff. The current DPRCM staff members are part-time personnel from National Fire Administration under Ministry of Interior. Due to the staffs’ background, current disaster management still focuses on hazard preparedness and response, with very little emphasis on mitigation and recovery. The local Disaster Prevention & Response Committees (DPRCMs) have the same problem as the central government. This phenomenon is very similar to the findings of Lindell et al. and Lindell and Perry that lacking full time staff support had significant impact on the effectiveness of the Local Emergency Planning committees in the US 5 . Traditionally, local governments didn’t think they had the capacity for disaster management. Instead, they relied heavily on support from the central government 11. Moreover, since Indonesia has huge islands, even a local disaster becomes a mass media headline. This sometimes has forced the central government to take responsibility for local disasters.

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Indonesia is a kind of developing country who still has unstable economic condition, so few local governments even have enough tax income for their own staffs’ salaries. Thus, local government relied heavily on budget support from the central government. Since local governments didn’t have large enough budgets and mayors don’t think the implementation of all six phases of disaster management a high enough priority to request funds from the central government, the local governments lacked the capacity to implement all six phases of disaster management, while we need money to response natural disaster. One of the most important facilities to build and spent a lot of money is field hospital. Actually disaster management system in Indonesia already has a concept of its hospital but unfortunately the system implemented is less maximum. This can be seen with the advent of several problems such as overlapping leadership in a field hospital so that the instructions are unclear. Besides receiving line - the handling of patients is still not settled. This is because the number of patients coming in does not match with the number of health care workers. On the other hand, many of volunteers, who took over the handling of the victim in the field hospital, but unfortunately the volunteers do not have enough medical skill to help so that makes the crowded situation 12. DISCUSSION Due to the lack of SOP, the authors propose a new, more efficient SOP. This is because the first system less effective, thus increasing the number of victims of any disaster. Many volunteers are confused in dealing with emergency situations. In this paper author would like to porpose new SOP based on field hospital concept. Basic concept of health management in disaster area are : tag treat -> transfer. Tag here based on triage system. hopefully every single person who involved in disaster management team has the same concept of triage system. we can devide triage system into three categories P1,P2, and P3. Treat is a procedure when patiens come to hospital then doctor examined them and decide wheter the patients need more general check up, surgery or just take some medicines. If doctor found any complications that could not be handled by field

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hospital, patien would be send to central hospital, the bigger one. This procedure is in transfer phase 9. We as medical students focusing more on treat phase. We propose new schematic procedure in handling patiens based on field hospital concept. A field hospital is a medical staff with a mobile medical kit and, often, a wide tent-like shelter (at times an inflatable structure in modern usage) so that it can be readily set up near the source of the casualties. In an urban environment, the field hospital is often established in an easily accessible and highly visible building In case of an airborne structure, the mobile medical kit is often placed in normalized container; the container it self is then used as shelter. When a natural disaster destroys a city's medical facilities, victims rely on field hospitals to function in their place. Setting up a self-sustaining hospital, however, requires a massive logistical effort that must be performed on a tight deadline. Setting up a field hospital, staff must first consider where to place it and decide on its layout 13. Security concerns and accessibility are two major criteria in a perilous location. Field hospital is designed to set a maximum of 3 days after the disaster in the central area where the disaster which is predicted by the number of victims that much. Field hospital concept should have standards of facilities and equipment in the field of emergency medicine. Some of equipments are Monitor Vital Sign, ECG monitor & Defibrilation, ECG Machine & ECG Paper, Emergency Drugs, Portable Pulse Oxymeter, Label Triase (P1-P2-P2, different colors), Pts Observation Charts, Bedside Glucose Stick, Non-Rebreathing Masks (adults & Paeds), nasal canules (adults & Paeds), Nebulizer Masks (adults & Paeds), Portable Ventilator, Airway Management Set, Jackson Reese, Oxygen Regulator, Name tag with logo for team personnel, TED Vest, Plastick Bags (Yellow), Sterile Gel, ECG Gel, Laboratory Labels, Sticky Labels, Disposal Bags (Yellow), Queu Card for P3 (thick paper), Trays for paperworks flow 9. In addition to medical equipment, other things can not be forgotten is the human resources or a medical worker consisting of a nurse, pharmacy, and several specialist doctors: Obstetric gynecology, surgery, orthopedics, emergency

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medicine, psychiatric, radiologist, medical rehabilitation and pediatric. Field hospital prepare 100-bed facility, there will be 30 doctors and medical personnel working on every 8 shift. In other words, during a 24-hour period, 80 to 100 medical personnel will be available to see hundreds of patients. If the number of patients increases beyond the capacity of the current hospital, additional tents can be set up. Equipment support and the medical professionals are good combination to achieve new concept field hospital goal, which reduce the number of victims after a disaster. Health services for disaster victims would have to include many things, such as mental health recovery. High stress levels will make the victim feel pressured and threatened and if this condition not considered as separate issue in the area of disaster, it will become seriouse problem. That is why we provide mental health recovery room to handle this. Field hospital should be set up in the affected areas in an effort to provide fast relief for disaster victims. To achieve this target, it seems right to preside over the system is local government, because local government is the most out of its territory, including topography, land area, population distribution and the quality of human resources that can be assigned in terms of disaster management in their region 14. Field director of the hospital should be led by a doctor from the area, because the doctor felt the need to know more about the hospital than when bringing doctors from other areas. Local government should have authority for establishing policies related to disaster management in the region, but still did not forget to coordinate with the central government because of the disaster could become a national issue 15. Whatever the policies adopted by the local government must keep reporting to the central government.

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Picture 8. New field hospital layout R : Registration Room PR : Public relation C : Clinic room AMB : Ambassador. TR: Training Room. RC : Indonesia Red Cross Ped : pediatric

NS: Nurse station

DrugsR : Drugs room.

AB : Ambulance bay PHA : Pharmacy MR : Meeting room RR : Rest room

Psyc : psychiatri post

CS : Cleaning service RecoR Recovery

Triage Tent ICU : intensive care unit SR : surgical room Steril : sterilization room : RM : rehabilitation

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department Water water suply

room MW : medical waste Supply : Cemetery food and drink : Obg : W : ward obtetric gynecology Pr : Praying Room :

medic T : Toilet BR : bath room Elec : electricity

New patients could come through the Ambulance Bay or through Registration. Patients placed in registration room then doctors or medical student screen them based on triage system who trained before in the training room. After that, the patient will be directed in accordance with the results of the triage. They wait in their tents - each in accordance with the color code triage. Patients with a green and yellow triage will be directed to the Clinic. In the Clinic doctors or a students who are trained to do the history and examination - further investigation. Patients with red triage will be taken to ICU to get Basic Life Support by a doctor, nurse, or medical student who are prepared. Aftter that patient goes to spesific department that has been prepared and will certainly be taken care of by specialists and nurese. Patients from surgical room will be taken to the recovery room and the monitored by nurses. If patients condition improved, patiens will have therapy and strengthening exercises in the department of rehabilitation medicine room. Nurses who can stand by in nurse station and may help in the form of preparing equipments sterilization so ready to use or can also assist in the Pharmacist to provide medication - drugs for each department or for patients in ward and for patients in the Clinic. Moreover, it can also help do the reloading of Drugs Room. The benefits that have come up, either in the form of food, medicine or volunteers from other countries, it should be registared first in the the Ambassador Room. In this room, all came to be recorded in order to set up and planned a few days in preparation for the future. The volunteers who came being recorded and will be distributed

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according to ability in each post. For those volunteers who have a medical background will be developed in the training room that can be distributed on the post that requires medical assistance. Moreover, the authors plan to prepared meeting room as the coordinating center. Resting room for medical personnel there. Supply as a place to process food aid coming in and manage to survive for a few days. Cleaning service team is also working to collect waste - medical waste . killed people should be established a proper cemetery for the victims . On the other hand, will put up the toilet, bathroom, and a praying room. In a field hospital suggested by the authors, the system under the form of shifting duration every 8 hours. We provide psychiatric department is to maintain and stabilize the mental state of the members of the medical team. Cemetery also formed with the appropriate service to honor the victims who have died. CONCLUSION Indonesia disaster management system still has some weaknesses, which are still not yet implemented the appropriate sop to the needs in the area of disasters, so it is not effective and efficient, it is necessary to systematically soup a new, more effective and efficient, with the establishment of new hospital concept consisting of field some specialists such as emergency medicine, orthopedic, surgical, psychiatric, obstetric, pediatrics, anesthesia, radiology, and rehabilitation medic. New field hospital would have to have medical standard equipment and also supported by adequate facilities for the medical team and patients. There is still no standard system of standard hospital field in Indonesia in terms of disaster management. Therefore, the authors tried to propose a new system of field hospitals are expected to reduce mortality and to support victims of existing systems. Local government should have authority for establishing policies related to disaster management in the region, but still did not forget to coordinate with the central government because of the disaster could become a national issue.

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REFERENCES 1. BNPB. (2011). Indeks Rawan Bencana Indonesia. 2 : 9 - 16 2. BNPB. (2010). Rencana Strategis Badan Nasional Penanggulangan Bencana. 12 – 13 3. BNPB. (2010). National Disaster Management Plan. 4(3): 80-85 4. Warnars, Spirs. (2009). Indonesian Earthquake Decision Support System, Jakarta. Indonesia 5. Chen, Liang-Chung et all. (2006).The Evolution of The Natural Disaster Management System in Taiwan. Journal of the Chinese Institute of Engineers, Vol. 29, No. 4, pp. 633-638 . 6. BNPB. (2011). Panduan Perencanaan Kontinjeni Menghadapi Bencana. 2(1) : 6 – 10 7. Haedar, Ali. (2009) A Lesson Learned from West Smatra Earthquake. Team of Eergency and Disaster. 8. BNPB. (2010). National Action Plan for Disaster Risk Reduction 2010 – 2012. 2(5) : 2 – 22 9. Haedar, Ali. (2012). Disaster & Role of Health Service. National Instructor for Hospital Disaster Plan Indonesian Department of Health. 10. Sinapoy M. Ohoe. (2011). Gema BNPB. 2 : 11-13 11. Kumorotomo, Wahyudi. Penganggaran Untuk Penanggulangan Bencana. Gajah Mada University. 2009 12. BNPB (2010). Pedoman Peran Serta Internasional Pada Saat Tanggap Darurat. 10 – 21 13. A Loghmani, N Jafari, M Memarzadeh. (2008). Determining The Field Hospital Setting in Earthquake : Using RAND/UCLA Appropriateness Method. 10 (3) : 181 - 189. 14. United Nation Development Programme Indonesia (2007). Projectfacts, The Emergency Response and The Transitional Recovery Programme (ERTR). 1 – 2 15. BNPB (2012). Rencana Aksi Rehabilitasi dan Rekonstruksi. 5(5) : 9

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Electrocardiogram Abnormalities As The Cheap And Fast Way To Screen The Victims With Subdural Hemmorage In Disaster Condition Kartika Afrida Fauzia, Duhita Pramesti Hayuningtyas Students of Medical School of Airlangga University Background:In the disasters situation, medical proffesionals need a fast and effective way to triage the victims. Head injury is one of the most possible cases that happen during natural disaster. CT scan of the head is needed to find out abnormality but not all the hospital in Indonesia has the CT-scan. The aim of this study is to investigate the use electrocardiogram abnormalities as the cheap and fast way to screen the victims with subdural hemmorage in disaster condition. Method:This is a review study which analyze 27 journals to support the main idea to use ECG as a diagnostic and Prognostic in the disaster management and was carried out at the Universitas Airlangga in 2012. Result: Arrhythmias were found in 96 of 107 patients (90%). From the 90% patient, 49% have ventricular premature complexes, 29% have supraventricular premature complexes,29 % have sinoatrial block and arrest, 9% have paroxysmal supraventricular tachycardia or atrial fibrillation, 1 % have second-degree atrioventricular block, and 2% have atrioventricular dissociation in 4 and idioventricular rhythm. The morphological change of the ECG found in the ECG are T-wave changes (39%) and the presence of U waves (26%). Conclusion:The change of ECG can be used as a tool to diagnose the Subarachnoid haemorrhage and can be measured best in 48-72 hours after SAH. Keyword: Electrocardiogram,Subdural Haemorrhage, Disaster BACKGROUND Nowadays, natural disasters is becoming the world's biggest fear. Because most of the natural disasters is unpredictable even with the high technology. With the approximately 13.487 islands and 1.910.931 km2wide, Indonesia becomes one of the most possible place for natural disasters occured. In the chaos situation caused by the disasters, medical proffesionals need a fast and effective way to triage te victims, so the number of death victims won't increases. Head injury is one of the most possible cases that happen during natural disaster. Head injury is any trauma that injures the scalp, skull, or brain. The injury may be only a minor bump on the skull or a serious brain injury (1). Traumatic Brain Injury (TBI) is a head injury that happens to brain. TBI costs the country more than $56 billion a year, and more than 5 million Americans alive today have had a TBI resulting in a permanent need for help in performing daily activities. Survivors of TBI are often left with significant cognitive, behavioral, and communicative disabilities, and some patients develop long-term medical complications, such

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as epilepsy (2). Because of that, a person with head injury need to be treated as fast as possible. CT scan of the head is needed to find out any blood clot or bleeding in the brain or if there is any fracture of the skull bone. But not all the hospital in Indonesia has the CT-scan. Only a big hospital in big city has it. And of course, in the middle of disasters situation, there will be a lot of victims that need to examine with the CTscan as soon as posibble to check is there any brain hemmorage or not. Because of the limited number and the expensive cost of the CT scan, many head injury cases not treated well. So, in the emergency situation, the health proffesionals need to to triage, if the suspect of head injury need to examine with CT scan or not. Examine the head injury suspects with Electrocardiogram is the cheap and fast way to triage them. The electrocardiogram can predict the Severity of Blood Volume Loss using ECG Features Based on P, QRS, and T Waves (3). So after the examination using the electrocardiogram, the medical doctors can triage, who is the victims that need to examine with CT-scan and who don't. This way will make the triage faster, cheaper and more effective. So the head injury victmis can be

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treated as fast as possible and get the next/long term medication quicker. This study aimed to METHODS This is a review study which analyze 25 journals to support the main idea to use ECG as a diagnostic and Prognostic in the disaster management. and was carried out at the Universitas Airlangga in 2012. RESULTS A controlled study is held to see the prevalence of cardiac arrhythmia which is detected in the ECG. This paper reviewed some studies which are aimed to determine the frequency and severity of cardiac arrhythmias in intracranial subarachnoid hemorrhage. In a study,120 nonselected patients were prospectively studied by 24-hour Holter ECG monitoring. Arrhythmias were found in 96 of 107 patients (90%) with adequate Holter recording (18). The arrythmia are listed as below. N Arryhtmia % o. 1. ventricular premature 49 complexes 2. supraventricular premature 29 complexes 3. paroxysmal 9 supraventricular tachycardia or atrial fibrillation 4. sinoatrial block and arrest 29 5. second-degree 1 atrioventricular block 6. atrioventricular 2 dissociation in 4 and idioventricular rhythm Other study shows the morphological changes in ECG in SAH(8): 1. T-wave changes (39%) and the presence of U waves (26%). 2. Deep, symmetric inverted T waves, usually without much ST-segment elevation or depression, are the typical abnormality 3. .Left bundle branch block, which is sometimes considered a marker of acute,

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large-vessel ischemia, was present in only 2% of patients. Another study give the results below (16): Morphological changes in ECG in SAH ECG changes High R waves ST depression T-wave abnormalities Large U waves Prolonged QTc

Percentages (%) 19 15 32 47 23

Figure 1. ECG result in a Subarachnoid Haemorrhage patient (16) DISCUSSION Cervical angina and ECG changes can be induced by anteflexion of the head. This case is focused on the change of ECG in subarachnoid Haemorrhage Trauma and spontaneous SAH are sometimes difficult to disentangle. Patients may be found alone after having been beaten in a brawl or hit by a drunken driver who made away, without external wounds to indicate an accident, with a decreased level of consciousness or with retrograde amnesia, making it impossible to obtain a history and with neck stiffness, causing the patient to be worked up for SAH(26). Conversely, patients may cause an accident whilst riding a bicycle or driving a car at time of the aneurysmal rupture. The diagnostic conundrum is particularly difficult when patients sustain a skull fracture having fallen after aneurysm rupture (24) or when head trauma causes an aneurysm to burst (25). Meticulous reconstruction of traffic or sports accidents may

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therefore be rewarding, especially in patients with disproportionate headache or neck stiffness. There are two cases of acute cervical angina and ECG changes induced by anteflexion of the head. This case is focused on the change of ECG in subarachnoid Haemorrhage. ECG Abnormaliti as a prognosis in the Subarachnoid haemorrhage Subarachnoid haemorrhage is one of barachnoid hemorrhage (SAH) involves the rupture of an aneurysm in the deep part of the brain, around the circle of Willis, which disperses blood not within the parenchyma but around the brain.(4) There is a close relationship between the subarachnoid haemorrhage and the heart Observations suggest that cadaveric kidneys from donors dying of subarachnoid haemorrhage may induce or sustain hypertension after transplantation.(5) The abnormality found in the Subarachnoid haemorrhage are shown in the ECG. Sakr and colleagues found rhythm abnormalities in 30.2% of 106 patients with SAH and an abnormal ECG; the most commonrhythm abnormality was 1.sinus bradycardia (16%), 2. sinus tachycardia (8.5%) 3. arrhythmias (5.7%), which included ventricular pre- mature contraction, ventricular bigeminy, and atrial fibrillation(8). Premature atrial, junctional and ventricular complexes, ventricular tachycardia and atrioventricular block have also been detected occasionally (15) The worst risk in subarachnoid haemorrhage is torsade de point. Multifocal ventricular tachycardia (torsades de pointes) is associated with a high mortality rate and is a feared complication of SAH, but its importance has been called into question recently (4). Torsades de pointes occurred in 5 of 1,139 patients with SAH (0.4%), they were unable to rule out confounding factors (ie, hypokalemia and hypo- magnesemia) as the cause of the arrhythmia(9). In a supportive finding, van den Bergh et al reported that QT intervals in patients with SAH are actually shorter when serum magnesium levels are lower (prolonged intervals are thought to indicate elevated risk for multifocal ventricular tachycardia).(10)Although it is clear that patients with SAH frequently have

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a prolonged QT interval (discussed later), which is thought to be a risk factor for torsades de pointes, the electrolyte abnormalities seen in patients with SAH make it hard to definitively attribute the arrhythmia to the direct action of the brain. Cardiac Ischemia Certain ECG changes seen in patients with SAH are referred to as ischemic changes because of theirresemblance to ECG changes seen in acute coronary artery occlusion. In SAH, there is evidence that acute coronary artery occlusion is not present. The myocardial changes are assumed to be due to subendocardial ischemia. ECG abnormalities usually disappear with in a few days or without resolution of the neurologic or cardiac condition. They are considered markers of the severity of SAH but not predictors for potentially serious cardiac complications or clinical outcomes.(10) Repolarization abnormalities , also commonly seen in coronary artery ischemic disease, is found in 83% of SAH patients,. It can be seen from the ECG results. The most common ECG abnormality was Twave inversions; the next most common abnormalities were ST depression, ST elevation, and Q waves of unknown duration. The most common pattern for ECG abnormalities suggests abnormalities in the anterior descending artery territory or in multiple vascular territories. The most common pattern for ECG abnormalities suggests abnormalities in the anterior descending artery territory or in multiple vascular territories. Follow-up tracings demonstrating reversal of the abnormalities were available for 23 of the 58 patients (40%). There was no significant association between any specific ECG abnormality and mortality.(4)

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Mechanism

acute activation could potentially contribute to ECG abnormalities and cardiac injury. In addition, the parasympathetic response may also affect the inflammatory response.(14)

Brain Injury

Figure 2. chematic diagram of the possible mechanism of myocardial injury after acute brain injury.

ECG as Diagnostic Value In addition to the classic clinical signs and symptoms of SAH, which include abrupt onset of severe headache, nuchal rigidity, nausea, vomiting, and alteration in consciousness, electrocardiographic (ECG) abnormalities often occur. These abnormalities include both morphological waveform changes in the 12-lead ECG and arrhythmias (23). Sudden, explosive headache is a cardinal but non-specific feature in the diagnosis of SAH: in general practice, the cause is innocuous in nine out of 10 patients in whom this is the only symptom. CT scanning is mandatory in all, to be followed by (delayed) lumbar puncture if CT is negative. This procedure is only available in the big city hospital. Unfortunately, most disaster happen in the remote area which is too far from a hospital.

Twenty-nine consecutive patients with SAH and no record of preexisting coronary artery disease were enrolled in a study of ECG abnormalities in SAH at Alexandria University Hospitals in Egypt. Each patient had ECGs during the preoperative period, during surgery, and during the first 3 days of post-operative treatment. We found that patients who had ECG abnormalities that fluctuated over the course of their early treatment had worse outcomes. This findingsuggests that part of the mechanism of cardiac damage may occur later than the initial ictus. (5) Parasympatic Pathway Fibers from the vagus nerve are now known to innervate the myocardium and therefore may play a role in the cardiac damage in SAH. The “neuorinflammatory reflex” is a vagally mediated phenomenon that may relate to parasympathetic nervous system activation that suppresses inflammation. (13) Evidence of parasympathetic dysfunction in SAH is becoming more abundant. Kawahara et al measured heart rate variability in patients with acute SAH and determined that enhanced parasympathetic activity occurs acutely. This

ECG as Prognostic value The reported prevalence of ECG changes in patients with SAH ranges from 27% to 100% (13-17). Brouwers et al. (17) found that during the first 72 h after SAH, ECG changes were the most pronounced. Di Pasquale et al. (18) found that 90% of patients had ECG abnormalities within the first 48 h following SAH, In earlier studies of the prognostic importance of ECG changes, sample sizes were small and the results were equivocal. Zaroff et al (27) examined mortality due to cardiac abnormalities and to all causes in 58 patients with SAH who had ECG changes consistent with myocardial ischemia or infarction. The results indicated that ECG abnormalities were not a significant predictor of mortality. However, 20% of patients in the source SAH database were excluded from the study because their medical records did not include ECG findings, perhaps leading to selection bias. This study was further limited by its small sample size and inclusion of only 3 “snapshot” ECG recordings per subject. To date, patients’ outcomes have not been studied in a prospective investigation that included a large sample size.

Insular Cortex Arrythmia

Hypothalami c Pressure Cathecilamin e Release ATP Depletion

Commited step to Cell Death

MPT activation

Myocardial Cell Death

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Measurement of Electrocardiogram Abnormalities As The Cheap and Fast Way to Screen The Victims With Subdural Hemmorage In Disaster Condition Timing of ECG data collection may influence conclusions about the prevalence of abnormalities. In a 12-lead ECG investigation, Brouwers et al (17) found that the most pronounced ECG changes occurred during the first 72 hours after SAH. Di Pasquale et al (18) found that 90% of patients had ECG abnormalities in the first 48 hours, suggesting that studies in which surveillance is started later in the course of illness may miss significant data. CONCLUSION The change of ECG can be used as a tool to diagnose the Subarachnoid haemorrhage and can be measured best in 48-72 hours afterSAH. This can be an easy way to give the triage and diagnose in the disaster condition in a low availability of CT scan. 1.

REFERENCES Heegaard WG,

Biros

MH.2009.

Rosen’s

Emergency Medicine: Concepts and Clinical Practice. 7th ed. St. Louis, Mo: Mosby; 2009:chap. 38. 2. NINDS ,2012. Traumatic Brain Injury: Hope Through Research. National Institute of Neurological Disorders and Stroke 3. Bsoul et al, 2009. Prediction of Severity of Blood Volume Loss Using ECG Features Based on P, QRS, and T Waves. 120:S1466. 2009 American Heart Association, Inc. 4.Marshally and Proventio, Inflammation as a link between brain injury and heart damage, The model of subarachnoid hemorrhage*CLEVELAND CLINIC JOURNAL OF MEDICINE VOLUME 75 • SUPPLEMENT 2 MARCH 2008 5. Hypertension in renal allograft recipients may be conveyed bycadaveric kidneys from donors with subarachnoid haemorrhageS STRANDGAARD, U HANSEN 6. Lanzino G, Kongable GL, Kassell NF. Electrocardiographic abnormalities after nontraumatic subarachnoid hemorrhage. J Neurosurg Anesthesiol 1994; 6:156–162. 7. Tung P, Kopelnik A, Banki N, et al. Predictors of neurocardiogenicinjury after subarachnoid hemorrhage. Stroke 2004; 35:548–551.

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8. Sakr YL, Lim N, Amaral AC, et al. Relation of ECG changes toneurological outcome in patients with aneurysmal subarachnoidhemorrhage. Int J Cardiol 2004; 96:369–373. 9. Machado C, Baga JJ, Kawasaki R, Reinoehl J, Steinman RT, Leh-mann MH. Torsade de pointes as a complication of subarachnoidhemorrhage: a critical reappraisal. J Electrocardiol 1997; 30:31–37. 10. van den Bergh WM, Algra A, Rinkel GJ. Electrocardiographicabnormalities and serum magnesium in patients with subarachnoidhemorrhage. Stroke 2004; 35:644–648 11. Provencio JJ, Bleck TP. Cardiovascular disorders related to neuro-logical and neurosurgical emergencies. In: Cruz J, ed. Neurologicaland Neurosurgical Emergencies. Philadelphia, PA: WB SaundersCo; 1998:39–50. 12. Elsharkawy HA, El Hadi SM, Tetzlaff JE, Provencio JJ. Dynamicchanges in ECG predict poor outcome after aneurysmal subarach-noid hemorrhage (aSAH). Neurocrit Care (Supplement). In press. 13. Tracey KJ. The inflammatory reflex. Nature 2002; 430:853–859. 14. Kawahara E, Ikeda S, Miyahara Y, Kohno S. Role of autonomicnervous dysfunction in electrocardiographic abnormalities and cardiac injury in patients with acute subarachnoid hemorrhage. Circ J2003; 67:753–756 15. Estañol BV, Badui ED, Cesarman E, et al. Cardiac arrhythmias associated with subarachnoid hemorrhage: prospective study. Neurosurgery. 1979;5:675–680. 16. Sommargren CE. Electrocardiographic abnormalities in patients with subarachnoid hemorrhage. Am J Critical Care. 2002;11:48–56. 17. Brouwers PJ, Wijdicks EF, Hasan D, et al. Serial electrocardiographic recording in aneurysmal subarachnoid hemorrhage. Stroke. 1989;20:1162– 1167. 18. Pasquale G, Pinelli G, Andreoli A, Manini G, Grazi P, Tognetti F. Holter detection of cardiac arrhythmias in intracranial subarachnoid hemorrhage. Am J Cardiol. 1987;59:596–600. 19 Kreus KE, Kamila SJ, Takala JR. Electrocardiographic changes in cerebrovascular accidents. Acta Med Scand. 1969;185:327–334 20. Solenski NJ, Haley EC, Jr, Kassell NF, et al. Medical complications of aneurysmal subarachnoid hemorrhage: a report of the multicenter, cooperative aneurysm study. Crit Care Med. 1995;23:1007–1017. 21. Arruda WO, Lacerda FS., Jr Electrocardiographic findings in acute cerebrovascular hemorrhage: a prospective study of 70 patients. Arq Neuropsiquiatr. 1992;50:269–274. 22. Rudehill A, Olsson GL, Sundqvist K, Gordon E. ECG abnormalities in patients with subarachnoid

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haemorrhage and intracranial tumours. J Neurol Neurosurg Psychiatry. 1987;50:1375–1381. 23. Yamour BJ, Sridharan MR, Rice JF, Flowers NC. Electrocardiographic changes in cerebrovascular hemorrhage. Am Heart J. 1980; 99: 294–300.\ 24. Sakas DE, Dias LS, Beale D. Subarachnoid haemorrhage presenting as head injury. BMJ 1995; 310: 1186–7. 25. Sahjpaul RL, Abdulhak MM, Drake CG, Hammond RR. Fatal traumatic vertebral artery aneurysm rupture. Case report. J Neurosurg1998; 89: 822–4.. 26. Van Gijn and Rinkel, 2001, Subarachnoid Haemorrhage: Diagnosis, causes and management, Brain (2001) 124 (2): 249-278. 27. Zaroff JG, Rordorf GA, Newell JB, Ogilvy CS, Levinson JR.1999, Cardiac Outcome In Patients With Subarachnoid Hemorrhage And Electrocardiographic Abnormalities, Neurosurgery.Jan;44(1):34-9; Discussion 39-40.

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Prevalence Study of Health Problems in Wasior Flashflood Disaster : Secondary Data Analysis Nina Belinda, Ayu Pramitha, Ananda Rizky, Camoya Gersom University of Brawijaya, Indonesia ABSTRACT Introduction : Indonesia has a big potency to get disaster in any time. On 4 October 2010, at 08.30 local time, flash flood occurred in Wasior sub-district, Teluk Wondama District, West Papua Province, Indonesia. There are 29 dead, 60 majorly injured, 103 missing, and thousands are trapped by the flood. Many kind of disease occured in this emgergency situation. The present study aimed to get the prevalence of health problems that occured the most in Wasior flashflood. Methodology : We conduct secondary data analysis from population of the Wasior flashflood victims, who came to the health center that built by the emergency team, involving 45 victims age distribution of victims in the original surveys varied from 2 months until 61 years old. Results : Our study shows a high prevalence of upper respiratory infection among all of the health problems that occured in Wasior flashflood. Upper respiratory infection is the most common health problem suffered by the victims with 42,2% (n= 45) and occured most below 5 years old and 26 until 35 years old (n= 45). Conclusion : In view of the high prevalence of of upper respiratory infection among all of the health problems that ccured in Wasior flashflood, knowledge on emergency medicine in in general and specific for this case is important and crucial not only to the government and health proffesionals, but also medical students. When emergency medicine becoming important study to be developed in nowadays. Introduction Geographically, Indonesia is a huge archipelagic country located between two continents, Asia and Australia. Indonesia also located between two oceans, the Indian Ocean and the Pacific ocean. It also passed through by equator line. Geographical position of Indonesia causes most of Indonesia area have tropical climate. With a tropical climate, Indonesia is often subjected to massive amounts of rain within a short time. There are over 5000 rivers throughout Indonesia, of which at least 30% pass through major population centres. Therefore, when a disaster like flood occured, there must be hit hundred or thousand people and properties.Indonesia is very susceptible to various natural disaster such as floods,droughts,landslides,volcanoes eruptions, earthquake, tsunami,forest fire, etc. But, among the natural disasters mentioned, flood is the one that most frequently occured every year. The western areas of Indonesia are particularly susceptible to flood. But, there is one big flood

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occured in Indonesia, instead of tsunami Aceh. It occured in West Papua Province.1 On 4 October 2010, at 08.30 local time, flash flood occurred in Wasior sub-district, Teluk Wondama District, West Papua Province, Indonesia. Flash flood was triggered by heavy rainfall that caused overflow of Sanduai, Anggris and Manggurai rivers and broke the dam which is located in the high area above the Wasior. Figure 1. shows the floods and mudslides that hit Wasior in West Papua.

Figure 1. Based on the report of Crisis Center, Ministry of Health, there are 29 dead, 60 majorly injured, 103 missing, and thousands are trapped by the flood. The number is increased day by day.

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Injured patients referred to Manokwari District Hospital and Nabire District Hospital by helicopter. However, due to limited numbers of helicopter, many injured patients still have to wait in Wasior airport. The emergency team built ruined health center which the previous one had been destroyed by the flashflood. The team are facing problems of poor sanitation, lack of clean water and threat of diarrhea outbreak in the next 3 â&#x20AC;&#x201C; 4 days.2,3 Inevitably with this situation, medical team have to face many health problems and diseases from the victims. In every disaster there will be many of health problems we should solve as medical practitioner. We should aware to possibilitity of various health problem. It is important to know what kind of helath problems that commonly appear to prepare.

This paper summarizes of Wasior flashflood disaster victims, with 4 main goals: 1. to examine the prevalence of health problems in Wasior flashflood disaster victims, 2. to find the most common health problem in Wasior flashflood disaster victims 3. to analyze the most common health problem and to propose recommendations treatment for future research in emergency disaster. Method Study design, setting and population We performed secondary data analysis from population of the Wasior flashflood victims, who came to the health center that built by the emergency team. We selected data consisting of name, age,address, gender, triage and diagnosis of health problems. We collected data from 45 victims with age distribution of victims in the original surveys varied from 2 months until 61 years old. Table 1 : Demographic characteristic of study population (n=45) N % Age Group

Gender

<5

7

15,55

5-15 16-25

5 7

11,1 15,55

26-35

11

24,4

36-45

7

15,6

46-55

4

8,9

56-65

4

8,9

>65

0

0

Male

28

62,2

Female

17

37,8

Data analysis Age, gender, triage and diagnosis of health problems were calculated from 4 months until 61 years old. Descriptive analysis was used to analyze demographical data and prevalence of health problems during Wasior flashflood disaster

Results A demographic characteristic of all participants are presented in Table 1. The range of age from 2 months until 61 years old in which majority of the victims (24,4%) are from 26-35 years of age group and out of this 24,4%, 62,2% are male.

Table 2 shows the prevalence of health problems occured in Wasior flashflood. Upper respiratory infection is the most common health problem suffered by the victims with 42,2% Health Problem Triage Female Male n %

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Vomiting&dehidration

2

1

0

1

2,22

Acute GI

1

0

1

1

2,22

Upper respiratory infection

1

8

11

19

42,2

1

2

1

3

6,7

AMS

3

0

1

1

2,22

Wound infection

1

2

4

6

13,3

Pterygium

1

0

1

1

2,22

Contusio musculorum

1

1

0

1

2,22

Mialgia

1

1

2

3

6,7

Headache

1

2

2

4

8,9

Fever

2

0

1

1

2,22

Fever malaria

1

0

2

2

4,44

Methanol intoxication

3

0

1

1

2,22

Dyspepsia

1

0

1

1

2,22

Dermatitis atopi and contac allergi

Table 2 : Distribution of health problems among Wasior flashflood victims 45 40   35   30   25   20   15   10   5   0  

%

Chart 1 : Distribution of health problems in Wasior flashflood Table 3 showed the distribution of each health problem with age group. We can see upper respiratory infection happened the most below 5 years old and 26 until 35 years old. N Health problems < 5 1 2 3 4 5 > To o. 5 until 6-25 6-35 6-45 6-55 6-65 65 tal

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15 1 2 3 4 5 6 7 8 9 1

Vomiting&dehidrat ion Acute GI Upper respiratory infection Dermatitis atopi dan contac allergi AMS Wound infection Pterygium Contusio musculorum Mialgia Headache

1 6

1 1

3

6

1

2

1 19

3

1 1

1

1

1 1

1

1 1 1

1 1

1 1

1

1 1

3 1 6 1 1 3 4

0 1

Fever

1

Fever malaria

1

1

1 1

1

2

1

1

2 1 3 1

Methanol intoxication Dyspepsia

1

1

4 Table 3. Distribution o health problem according to age group Discussion most below 5 years old and 26 until 35 years The purpose of performed secondary data old. analysis from population of the Wasior Infections of the upper respiratory tract flashflood victims is to examine health problems presenting as the common cold, rhinosinusitis, suffered by Wasior flashflood victims. After the tonsillopharyngitis or otitis media are highly data collected, we got that there are many health prevalent among young children.4-6 These problems suffered by victims as shown in Table infections not only have an impact on childrenâ&#x20AC;&#x2122;s 2. health and well-being, but also generate high The data we were collected consisting of medical costs and indirect costs for the family name, age,address, gender, triage and diagnosis and the society.8,9 When they grow older,the of health problems. We collected it in order to incidence of these infections decreases, probably identify what is the most common disease from asa result of a more mature immune defence many health problems found in the victims. andimproved anatomical conditions, for From the examination and identification we instance, of the Eustachian tube. A subgroup of found that upper respiratory infection is the most children, however,will develop persistent upper disease among health problems with 42.2%. respiratory tract. Population studies have Wound Infection at second place with 13.3%. provided important information on the Hence, we can make decision for the best epidemiology of upper respiratory infection in treatment to take care of it. The purpose is to children. Little is known, however, about its make an emergency rescue in order to give a fast persistence through adolescence since most of and precise treatment for patients with upper these studies have focused on the period respiratory infection. Its purpose to prevent between 0 and 6 years of life and follow-up patients in bad circumstance. wasrestricted to a few years.4,6 For example, it is And we can also see that in Wasior unknown whether recurrent URTIs (rURTIs) flashflood, upper respiratory infection occured experienced in early life tend to persist through

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adolescence and whether rURTIs in adulthood are related to recurrent infections earlier in life. Although high prevalences of URTIs during early childhood have been reported before 4-10, no one has followed its natural course into adulthood. But in this case, not only in children upper respiratory infection, this health problem occured in adult too with 6 cases between 26 until 35 years old. This is different with the prevalence in common which upper respiratoy infection mainly occured in children. Because of this is an emergency case, there will be many possibilites to get this disease. This information might also give clues for developing more effective therapeutic and preventive strategies in emergency cases. This research also can help us to sort out which are an emergency patients that should give an emergency medicine first and which are not. It can reduce mortality or morbidity rate. There should be any further research about the treatment and strategy to treat upper respiratory infection in emergency case. In order to realize it, there should be a collaboration of government, health proffesionals and also medical students. Study Limitations and Recommendation: We acknowledged the following limitations of our study because of limited data. It needed to collected more complete data from Wasior flashflood victims. Conclusion This research has provided us with the information about the distribution of health problems and also which the most health problem that happened in Wasior is. Upper respiratory infection is the most disease among health problems with 42.2%. And it is occured most below 5 years old and 26 until 35 years old, which is this health problem occured in chidren in common. The challenge therefore is to develop therapeutic and preventive strategies

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that will prevent upper respiratory infection in emergency case References 1. Indonesia: A Country Study. Available at : http://countrystudies.us/indonesia/, last accessed 7 September 2012 2. Papua land of peace. Available at : http://www.faithbasednetworkonwestpapua.org/n ews_release/west_papua_diocese_aids_disaster_v ictims, last accessed 7 September 2012 3. Flash Flood in Teluk Wondama District, West Papua Province, Republic of Indonesia. Available at : http://www.searo.who.int/LinkFiles/Indonesia_ES R-1FF-Papua-05-10-2010.pdf, , last accessed 7 September 2012 4. Wald ER, Guerra N, Byers C. Upper respiratory tract infections in young children: duration of and frequency of complications. Pediatrics 1991; 87: 129–133. 5. Harsten G, Prellner K, Heldrup J, Kalm O, Kornfalt R. Acute respiratory-tract infections in children. A 3-year follow-up from birth. Acta Paediatr Scand 1990; 79: 402–409. 6. Benediktsdottir B. Upper airway infections in preschool children—frequency and risk factors. Scand J Prim Health Care 1993; 11:197–201. 7. Carabin H, Gyorkos TW, Soto JC, Penrod J, Joseph L, Collet J-P. Estimation of direct and indirect costs because of common infections in toddlers attending day care centers. Pediatrics 1999; 103: 556–564. 8. Dixon RE. Economic costs of respiratory tract infections in the United States. Am J Med. 1985; 78: 45–51. 9. Kvaerner KJ, Nafstad P, Jaakkola JJ. Upper respiratory morbidity in preschool children: a cross-sectional study. Arch Otolaryngol Head Neck Surg 2000; 126: 1201–1206. 10. Forssell G, Hakansson A, Mansson NO. Risk factors for respiratory tract infections in children aged 2–5 years. Scand J Prim Health Care 2001; 19: 122–125.

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The Transition of Emergency Care to Long-Term Medical Care of The Merapi Eruption Refugees on 2010 – 2011 Period Afria Beny Safitri, Rifa Roazah, Siti Alfiana Pembangunan Nasional University,Jakarta ABSTRACT Background: Community life consist of the individual’s emotional, physical, environmental, and social support system can be disrupted when a major disaster occur. The Merapi Eruption on 2010 was erupted twice causing a big volcanic blast, widespread damage and considerable loss in four districts with 350,000 refugees. Situation and condition that experienced by refugees while in evacuation obviously affect their physical and psychological condition. Objectives: This paper describe and discuss the transition of emergency care to routine/ long-term medical care of the Merapi eruption refugees on 2010 – 2011 period including the role of UPN "Veteran" Jakarta as academic institution, government, and NGO in it. Methods: Merapi eruption’s emergency care data were collected by primary and secondary source. The primary data source were collected from UPN "Veteran" Yogyakarta Healthcare Shelter on November 9th – 14th, 2010. The secondary data source were collected from the center for health crisis control ministry of health report 2010 period. The Merapi eruption’s routine / long term medical care data were also collected from secondary data consist of health ministry reports, earlier research literature, other online and print media information. Results: Merapi Eruption Refugees’s Emergency Care. UPN "Veteran" Jakarta’s medical team treated 498 people with five common obtained cases consist of upper respiratory tract infection (44%), common cold (18%), cephalgia (14%), pharyngitis (13%) and hypertension (11%). The counseling sessions had positive effect to refugees’s behavior. Ministry of Health had made various efforts to overcome the health crisis not only medical services but also nutrition services, mental health, reproductive health, environmental health, and recovery efforts. Merapi Eruption Refugees’s Routine / Long Term Medical Care, the government and NGO involved in this. Physicological disorder can appeared in long term phase. There was variety of government and NGOs’ programs to provide long term care. Conclusion: Long term care after disaster is really important. The programs of government and NGOs can prevent the refugees from suffering depression and other psychological disorder in long term phase. Keywords : Merapi eruption, emergency care, long-term medical care, refugee INTRODUCTION Ring of Fire in Pacific (Figure 1) is an arc of intense seismic (earthquake) and volcanic activity stretching from New Zealand, along the eastern edge of Asia, north across the Aleutian Islands of Alaska, and south along the coast of North and South America. It is composed over 75% of the world's active and dormant volcanoes. The final section of the Ring of Fire exists where the Indo-Australian plate subducts under the Pacific plate and has created volcanoes in the New Guinea and Micronesian areas (Figure 2). Near New Zealand, the Pacific Plate slides under the Indo-Australian plate (Rosenberg, 2010). Based natural disasters risk index 2010 (Figure 3 and 4), Indonesia occupies

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the second rank as “extreme risk” on the world after Bangladesh (Maplecroft, 2010). Mount Merapi (Figure 5 and 6) is an active stratovolcano located on the border between Central Java and Yogyakarta, Indonesia with elevation 2998 m above sea level. It is the most active volcano over the world and has erupted regularly since 1548 (Lan et al, 2011) with the peak coordinate of 7.542°S / 110.442°E (Surjono and Yufianto, 2011). Administratively, Merapi Mountain is located in four districts (Figure 7), Sleman District (DI Yogyakarta Province) in the southern downhill, Magelang District in the western downhill, Klaten District in the southeastern downhill, also Boyolali District (Central Java Province) in the northern and eastern downhill (BMKG, 2011).

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In 2010, Merapi was erupted twice causing a big volcanic blast, widespread damage and considerable loss in four districts. On 26 October 2010, Mount Merapi began its eruption phase indicated by heat clouds and explosive eruptions with lava flow. Based on the recommendation of The Center of Volcanology and Disaster Management, 7 villages within 10 km radius from the summit are to be cleared, especially areas along the river banks. According to the Crisis Center, Ministry of Health, 28 people died, 91 people have been admitted to Sardjito Hospital with respiratory difficulties and burn injuries, and 18,197 have been evacuated to 13 IDP sites (WHOa, 2010). The second-most significant eruption came on 5 November 2010 cause 386 people died, 2,856 houses damaged, thousands hectares of forest and farm business heavily damaged and tens of sub villages destroyed. The affected area located at four districts Magelang, Boyolali, Klaten and Sleman with 350,000 refugees (Wayan, 2012). Indonesian National Body for Disaster Management or BNPB reported (2011) Government has measured any damage and loss from five aspects : shelter, social, economic, infrastructure, inter-sectoral (government, finance, and environment). The worst causalities mostly caused by people low awareness, who lived in the danger zone. Total value of damage and losses are Rp. 4,227 Trillions, in all sectors including housing, infrastructures, productive livelihood etc. The most affected damage and losses was Sleman district (65%) followed by Magelang district (15%), Klaten district (6%), Boyolali district (6%), Yogya and other district (8%) (Figure 8). The most losses is on agriculture sector with Rp 1,326 Trillions (31.4% from total value of damage and losses). Horticulture and crops subsector livelihood (67%) are the largest Merapi eruption’s percentage in four district (Figure 9). Wayan (2012) reported the damage incurred not only physical damage but also mental and emotional downturn. According to Sudarma (2008), post disaster community is the community that get life pounding in forced. Their soul did not well prepared to face disaster. Although modern society have had early detection system or early warning detection that ready for all of disaster

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possibility, they don’t have perfect preparation in facing disaster. Zhaobao et al (2010) reported when a major disaster occur, every aspect of community life is disrupted, causing breach in the individual’s emotional, physical, environmental, and social support system. Brown (2008) reported the immediate consequences of disaster produce a series of powerful reaction in adults of all ages : feeling of shock, horror or disbelief; concern about personal safety; and intense personal emotions, such as anxiety, apprehension, fear and anger. Beside that, situation and condition that experienced by refugees while in evacuation obviously affect their physical and psychological condition. Government agencies and civil society organizations reacted more quickly to provide relief, partly because the affected areas were much more accessible and partly because effective local governments were able to respond. Domestic health staff from around the country were mobilized overnight to provide emergency relief, while field hospitals and orthopedic help were provided quickly by international assistance (Leitmann, 2007). Many parties of government, NGO (NonGovernmental Organization) and academic institution including University of Pembangunan National Veteran Jakarta (UPN "Veteran" Jakarta) helped the Merapi eruption victims. In order to take care of the humanitarian natural disasters caused by Merapi eruption, UPN "Veteran" Jakarta sent 37 people of medical student, doctors, nurses and public health personnel as healthcare team which was led by dr. Miftahuddin. Administratively, UPN "Veteran" has three campuses, which located in Jakarta, Yogyakarta, and Surabaya. On November 2010, UPN "Veteran" Yogyakarta had been used as one of healthcare shelter post Merapi eruption. It was the application of community service as one of the university vision and field medicine curriculum. Field medicine itself is health effort that implemeted in order to improve physical and mental capability for environment fluctuate adaptation properly in land, air, water, and space (UUD 23, 1992). Medical Faculty of UPN "Veteran" Jakarta is the only medical faculty in Indonesia that has field medicine curriculum. So that upon

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graduation, the students are ready for disaster management. The objection in this paper was to describe and discuss the transition of emergency care to routine/ long-term medical care of the Merapi eruption refugees on 2010 – 2011 period including the role of UPN "Veteran" Jakarta as academic institution, government, and NGO in it. METHODS Merapi eruption’s emergency care data were collected by primary and secondary source. The primary data source were collected from UPN Veteran Yogyakarta Healthcare Shelter on November 9th – 14th, 2010. We arrived at UPN Veteran Yogyakarta Healthcare Shelter on 9th and divided into two team. First team as medical treatment team and second team as counseling team. In the medical treatment team, the refugees were asked about their identity (name, age, and complaints) and the health team also observed their facial expression, words and body language then identified whether the complaint related to physiological or psychological disorders then gave them therapy. In the counseling team divided again into 3 groups : group for children along with theirs mother, adults and elderly. The counseling team then did some counselings sessions consist of group counseling and interpersonal counseling. On the first day, the health team did environment health survey around refugees area. In the second day, the team prepared tools and materials appropriate with dominant problem of refugees. On the third day, group counseling was held. On the fourth day, interpersonal counseling was held. On fifth day, the team evaluated refugee’s environment health problem. The Merapi eruption’s emergency care secondary data source were collected from the center for health crisis control ministry of health report 2010 period. The Merapi eruption’s routine / longterm medical care data were also collected from secondary data consist of health ministry reports, earlier research literature, other online and print media information. RESULT 1. Merapi Eruption Refugees’ Emergency Care

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a. UPN "Veteran" Jakarta’s Medical Team Prevalence of obtained refugees reported at UPN " Veteran" Yogyakarta on November 9th, 2010 was 1,556 people (Figure 10). The most number refugees based on age was 26-45 year old (38.94%) followed by 46-60 year old (18.05%), 6-14 year old (15.29%), more than 60 year old (11.63%), 15-25 year old (7.45%), 1-5 year old (6.94%) and less than 1 year old (1.67%). Prevalence of refugees who received treatment from UPN "Veteran" Jakarta’s medical team (Figure 11 and Figure 12) on november 9th -14th , 2010 was 498 people with the most number were women (55%). The most number refugees based on age (Figure 13) was 26-45 year old (32.12%) followed by 15-25 year old (15.86%), 46-60 year old (13.45%), 6-14 year old (12.85%), more than 60 year old (11.04%), 1-5 year old (9.23%) and less than 1 year old (5.42%). Prevelence of the obtained cases could be divided into subgroups (Figure 14) according to differing health problem into respiratory tract disorder (50%), digestive track disorder (13.65%), skin disorder (9.83%), neuro disorder (9.83%), cardiovascular disorder (6.62%), inflammation disorder (5.22%), other case (2.40%), other infection case (2%) and psychiatry disorder (0.40%). The respiratory tract disorder consist of upper respiratory tract infection (23.7%), common cold (9.6%), acute pharyngitis (6.8%), cough observation (3.8%), influenza (3.6%), asthma (1.2%), tuberculosis (0.2%) and suspect pneumonia (0.2%). The digestive tract disorder consist of diarrhea (2.8%), gasthritis (2.8%), caries (2.2%), stomatitis (1.6%), vomitus observation (1.6%), gastroentheritis (1.2%), dyspepsia (0.6%), constipation (0.4%) and abdominal colic (0.4%). The skin disorder consist of pruritus (3%), tinea (2%), dermatitis (1.6%), miliaria (1.4%), scabies (0.4%), carbuncle (0.4%), urticaria (0.4%), herpes (0.4%) and impetigo vaskulosa (0.2%). The neuro disorder consist of cephalgia (7.4%), neuralgia (1.4%), migraine (0.6%), neuropathy (0.2%) and neurodermatitis (0.2%). The cardiovascular disorder consist of hypertension (5.8%), hypotension (0.6%) and angina pectoris (0.2%). The inflammation disorder consist of febris observation (4.4%), gout (0.2%), limphadenophaty (0.2%), buccal edema mucous

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(0.2%), and prop cerumen (0.2%). The psychiatry disorder consist of sleep disorder (0,2) and anorexia (0.2%). The other infection cases consist of conjunctivitis (0.6%), hordeolum (0.4%), acute tonsilitis (0.4%), typhoid suspect (0.2%), urinary tract infection (0.2%) and ototis (0.2%). The other cases consist of myalgia (0.8%), laseration (0.4) , burn injury (0.4%), hemathome (0.2%), diabetes mellitus (0.2%) and fracture (0.2%). Over all, five common obtained cases (Figure 15) consist of upper respiratory tract infection (44%), common cold (18%), cephalgia (14%), pharyngitis (13%) and hypertension (11%). In first day, UPNVJ’s health team came in to the refuge and observed the condition. The health team founded that level of hygiene there was poor. The environment was not clean enough and there were lot of rubbish around the refuge. In first day, the team also founded that Upper Respiratory Tract Infection was the most common disease that suffered by the refugees. Therefore, Upper Respiratory Tract Infection was used as the counseling theme in third day. The results of health counseling by the health team of UPN “Veteran” Jakarta on the third day are : 1. The opening of the counseling was represented by the responsible committee for the refugees in the mosque. 2. The counseling material (about ISPA) was delivered by the students of UPN Veteran Jakarta. 3. Refugees were enthusiastic and very interested in attending counseling and they were given the opportunity to ask the doctor. 4. There were door prizes for the refugees who could share their experiences about cough disease and participated actively during the counseling. The results of interpersonal counseling (in fourth day) to refugees about the placement of items and how to reduce the humidity to avoid disease are : 1. Refugees drained towel outdoors after taking a bath 2. There were still some refugees who drained their towels in the room for fear of disappear 3. In the morning the window opened with the aim of getting better air circulation

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4. Parents who felt ill and have a toddler used masks (Ministry of Health, 2010) b. Government of Indonesia Ministry of Health reported one of the efforts that has implemented in order to control the health crisis caused by the disaster is the effort for medical services. Ministry of Health has made various efforts to overcome the health crisis caused by the disaster. Medical service efforts that have been made include : mobilizing health personnel to assist medical services among multiple disaster sites, distributing a variety of medical tools to support health care, setting up static and mobile shelters to serve the victims of the disasters. Beside that, there were efforts for nutrition services, mental health, reproductive health, environmental health, and recovery efforts. The efforts for nutrition services were the implementation of promotive and curative activities in order to overcome health crisis caused by disaster. The promotive nutrition activities include the implementation of nutrition education and breastfeeding counseling. Curative activities nutrition that conducted in emergency response is the distribution and allocation of feeding complementary food, especially in children under 2 years old. Efforts for mental health in Mount Merapi eruption area were early detection of mental health disorder with symptom checklist, case finding through group activities, relaxation exercises together, play therapy for children by psychologist, and referring to a psychiatrist if there was any indication of psychopathology; conduct PFA (Psychological First Aid) debrieving to 200 health workers; and implementation of PFA to refugee communities. Reproductive health efforts aimed to prevent the morbidity and mortality of maternal and newborn, reduce the transmission of sexually transmitted infections including HIV / AIDS, prevent and overcome gender-based violence and sexual violence, and to ensure safe blood transfusion. Environmental sanitation efforts were established to control environmental risk factor to protect the communities from possible transmission of environment-based disease around the disaster site. The government also

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provided logistical assistance in the field of environmental health. Merapi Eruption Refugees’ Long-term Care a. Government of Indonesia The government also took part in implementation of refugee’s long-term care (recovery efforts). One of them that were conducted at the Center for Crisis Ministry of Health was coordinating with relevant units in the early recovery phase. Form of early recovery may be physical or non-physical. At the beginning of the recovery in the form of physical recovery is the functioning of health facilities damaged submarine emergency response to disasters such as the establishment of tent Mount Merapi health services to the local health center that did not work because it was in disaster-prone areas. Non-physical recovery among others, the risk factors and vector control tools needed, repairment of contaminated water quality, establish Post Traumatic Center at shelters, mentoring and networking soul case. In the post disaster rehabilitation and reconstruction of both physical and non-physical was coordinated by the Bureau of Planning and Budget in the budgetary allocation to the rehabilitation and reconstruction of related units of the program. b. Non-Governmental Organizations In order to long-term recovery of Mount Merapi eruption refugees, there were several non-governmental organizations that participated, such as : 1. Atturots Al Islamic Assembly Foundation reported that Islamic Center Bin Baz and Islamic Al Education Foundation of Al Atsari Yogyakarta held a series of activities of preaching and counseling with the submission aid for the victims of Mount Merapi eruption. 2. Tribunnews reported in 2010 that Nanda Dian Nusantara Foundation in cooperation with Alchemy held charity event “Mother Love For Indonesia”. Besides material and moral support, the foundation established “House Cheer’s” as trauma center dedicated to the victims for 4 months post-emergency conditions.

3.

2.

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4.

5.

6.

7.

8.

The refugees were trained to make handycrafts by the volunteers from the Central for Social Rehabilitation Development Grahita (BBRSBG) Kartini, Temanggung. The refugees were given training to make patchwork doormats and also make handicrafts from old newspapers and plastic. SALIMAH DIY in Hifzul Bi’ah Tower Hall Foundation, Kedung Sriti, Gondang, Umbulharjo, Cangkringan reported about its activities : skill training for the mothers and elderly to make handycrafts so they could forget their physicological trauma. Public relation division of BSMI reported that BSMI (Bulan Sabit Merah Indonesia) and BTN (Bank Tabungan Negara) provided help to accelerate recovery of the Mount Merapi eruption victims. BSMI with BTN provide school kits to 225 junior high and elementary school in the village of Kepuharjo, Cangkringan. In addition, it was also filled with gymnastics with refugees in Barak Kepuharjo, mini out bond, and nutritional supplementation. The event was followed by a gym with 300 people displaced refugees and 225 junior high and elementary school students. Other activities were also carried out simultaneously is free health care and checks blood sugar levels for 100 people displaced. Islamic Relief, one of the international NGOs are also active in helping the community when Merapi Eruption 2010 happens. This foundation reported about they activities : supporting communities in socio-economic development, water and sanitation, education, orphan, disaster preparedness and emergency response. European Commision Humanitarian Aid funded activities : emergency shelter, water and sanitation, access to primary health care and disease control, distribution of food and non-food items, emergency communications, psychological support and logistics. All actions possible will mainstream disaster preparedness activities. Wayan Suriastini (2011) reported that in time of disaster elderly is one of the vulnerable groups which need special attention. She and her partners did research about Anand

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Ashram Foundation (Affiliated with United Nations) and its programs. This foundation conducted an intensive trauma and stress healing program (PPSTK) at a sub village which only 7 km from the Merapi. The Therapy program conducted for 10 weeks, with 5 times group therapy sessions, every two weeks. The therapy offer is Self Empowerment Technique created by Anand Krishna. Self Empowerment Technique has positive effect on elderly mental health recovery post 2010 Merapi eruption. In both areas, treatment and control, expose of the elderly to the stressor is high, over than 90 percent of the elderly reported that hear thundering sound, feel sand, ash rain and sulfur smell during the Merapi eruption. About 74% of the elderly participate in PPSTK trauma healing. The difference of difference of the change in treatment and control area indicated that the intensive PPSTK trauma healing program has good influence on reducing : (1) Feeling as future is short, (2) too cautious, worry; (3) Feeling uneasy; The program have been significantly increased the self confidence including : (1) felt as good as other people, (2) hopeful about the future, (3) enjoyed life. DISCUSSION According to treatment performed by UPNVJ we can see that the most common diseases suffered by patients during acute or emergency phase is Upper Respiratory Tract Infection and common cold. This could be caused by constant exposure of volcanic ash that cause irritation. Irritation of the upper respiratory tract attacked the bottom, causing the victim cough or sneeze. This irritation can cause further respiratory infection. Physiological disorder more dominating than psychological disorder. This could occur because the psychological symptoms appeared slowly and also the lack of public attention to psychological disorder. (dppm.uii.ac.id) Beside establishing treatment shelter, there was also counseling for the refugees. Counseling done as preventive and promotive measures to reduce morbidity in refugees, especially in women and children under 2 years old. Counseling was conducted because it can

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directly touch the refugees so that effective communication can occur between instructor with attendees and participants with other participants. It can also reduce post-traumatic stress experienced by refugees and avoid boredom in the shelter. Beside overcoming emergency phase, longterm care was also implemented. The most common disorder in long term phase was psychological disorder. The government also provides long-term recovery efforts coupled with a number of NGO. NGO have a role in the emergency phase care and the long term, but most in long term care. Some NGOs provided the refugees with religious (spiritual) and skills training. These programs could prevent refugees from feeling bored and improve their skills so their level of depression decreased. In the long term phase, psychic condition of the refugees need to be considered and the government itself has made various attempts, one of them is PFA (Psychological First Aid) where health workers were given a briefing on how to overcome mental disorder early. PFA run well but the government should also consider health problems in the long term phase. As medical students and future doctors, we can actively participate as volunteers in the long term care. We can also encourage the government to pay more attention to long-term care and also socialize matra curriculum as a required curriculum in other medical faculty. It is intended that students and physicians are better prepared for future disasters in Indonesia that has high risk for disaster possibility. CONCLUSION In conclusion, this research shows that long term care after disaster is really important. Psycological disorder can appeared in long term phase. Forms of long-term care itself can be spiritual or religious activities, skill training, counseling, and others. These programs can prevent the refugees from suffering depression and other psychological disorder. References 1.

United Nations, Department of Economic and Social Affairs, Population Division. (2011). World Population Prospects: The 2010 Revision. Retrieved September 5, 2012 from

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http://esa.un.org/unpd/wpp/JS-Charts/poptot_0.htm 2. Rosenberg Matt. (2010). Pacific Ring of Fire: Ring of Fire - Home to Earthquakes and Volcanoes of the Earth. Retrieved September 5, 2012 from http://geography.about.com/cs/earthquakes/a/rin goffire.htm 3. http://www.maplecroft.com?about/news/natural _disasters.html 4. Badan Meteorologi, Klimatologi, dan Geofisika. (2010). Informasi Trayektori dan Sebaran Debu Gunung Merapi. Retrieved September 8, 2012 from http://www.bmkg.go.id/bmkg_pusat/klimatologi /InformasiGnMerapi.bmkg 5. BNPB. (2011). Gema BNPB Ketangguhan Bangsa Dalam Mengalami Bencana (Vol. 2). Jakarta 6. Eriyanti, Dewi. Purwatresna, Eka Agustina, Rofiqoh Inayati. (2011). Upaya Pemulihan Kondisi Psikologis Korban Bencana Alam Melalui Pendekatan Spiritual. Unpublished bachelorâ&#x20AC;&#x2122;s essay, Bogor Institute of Agriculture. 7. Brown, Lisa M. (2007). Issues in Mentalhealth Care for Older Adults After Disasters. Disasters and Other Adults, Winter 2007/2008, 21. 8. Lan, Qiongqion. Wu, Taixia. Zhang, Xia. (2011). Satellite Hyperspectral Remote Sensing Data Monitoring the Temporal-spatial Distribution of Erupted CO2 from Gunung Merapi. Proc. of SPIE Vol. 8006 80061M-2. 9. Surjono, Sugen Sapto. Yufianto, Andreas. (2011). Geo-Disaster Laharic Flow Along Putih River, Central Java, Indonesia. Vol 3 (2), 103110. 10. Suriastini, Wayan. Sikoki, Bondan. Arnashanti, Nur Suci. Mulia, Muhammad. Stress and Trauma Recovery of Elderly Post 2010 Merapi Eruption: a Case Study. (2011). 11. Yayasan Majelis At-Turots Al-Islamy. (2010). Bantuan dan Bimbingan Rohani Korban

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12.

13.

14.

15.

16. 17.

18.

Merapi. Retrieved September 8, 2012 from http://atturots.or.id/index.php?option=com_cont ent&view=article&id=2354:bantuan-danbimbingan-rohani-bagi-korbanmerapi&catid=49:informasi&Itemid=130 Wardhani, Anita K. (2010). Rumah Ceria Untuk Senyum Korban Merapi. Retrieved September 9, 2012 from http://m.tribunnews.com/2010/11/19/rumahceria-untuk-senyum-korban-merapi Al Husen, Panji. (2011). Relawan Latih Pengungsi Korban Merapi Buat Kerajinan Tangan. Retrieved September 11, 2012 from http://sigapbencana-bansos.info/berita/13322relawan-latih-pengungsi-korban-merapi-buatkerajinan-tangan.html Persaudaraan Muslimah (SALIMAH DIY). (2011). Berbagi Kebahagiaan Bersama Merapi. Retrieved September 13, 2012 from http://salimahdiy.multiply.com/journal?&show_ interstitial=1&u=%2Fjournal BSMI Yogyakarta. (2011). BSMI dan BTN Bagikan Paket Sekolah Untuk Anak-anak Pengungsi. Retrieved September 15, 2012 from http://bsmiyogyakarta.wordpress.com/category/ bidang-humas/ http://www.islamic-relief.com/wherewework/9ID-indonesia.aspx European Comission Humanitarian Aid, European Civil Protection. (2010). Factsheet Indonesia Merapi Eruption. Retrieved September 22, 2012 from http://ec.europa.eu/echo/files/aid/countries/indo nesia-volcano-factsheet-101110.pdf Wijayanti, Mumpuni Punik. Suryaningsih, Betty Ekawati. Tiniko. (2011). Analisis Situasi Kesehatan Pasca Bencana Erupsi Gunung Merapi di Kecamatan Srumbung, Magelang, Jawa Tengah. Retrieved September 25, 2012 from http://dppm.uii.ac.id/dokumen/prosiding/2e_Art ikel_punik.pdf.dppm.uii.ac.id.pdf

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Civilian Empowerment of Non Medical Practitioner Base on Knowledge, Belief, and Willingness in Helping Natural Disaster Victims In Order to Get Long Term Medical Services Sawitri Satwikajati , Prilly Priskylia AMSA-Brawijaya, Faculty of Medicine, Brawijaya University ABSTRACT Background and Aims: Indonesia has a big potential of natural disaster. In the last 10 years the number of natural disaster and victims were increase. In Indonesia, BNPB regulates the national disaster. There were no valid data about the ratio of victims and emergency teams. We suggested that the number of emergency teams were not enough to help the victims. We wanted to get the information how exactly the non medical practitioner’s participation in helping the victims, hands this paper is aimed to survey the knowledge, belief, and willingness of them in helping natural disaster victim’s and correlate these finding with their demographic characteristics. We used the result to make the decision in order to decrease the number of mortality and injury. Method: A questioner based cross-sectional survey was carried out among civilian (non medical practitioner) in Ponorogo, Kediri, and Malang East Java in 30th October - 6th November 2012. Consenting individual were requested to complete questioners distributed to them. Results: The respondent from 3 different sampling areas showed similarity. 50% of all respondents in three different areas had good knowledge (experience) in confronting natural disaster. Moreover, 97% respondents believed that disaster had big potential in mortality and injury. They believed that health is the most focus problem among disaster and need longer medical treatment. 76.5% respondent showed their enthusiasms in helping the victims; join to the emergency disaster team and training. The experience about natural disaster (knowledge) (χ2= 0.773, p= 0.379) and demographic factor; education level (χ2= 0.102, p= 0.799), sex (χ2= 0.912, p= 0.339) weren’t influence their belief and willingness in helping natural disaster victims. Conclusion: We got no correlation among knowledge, belief, and willingness; suggest that basically person has self consciousness to save theirselves and other. This is the reason why mostly respondent had big enthusiasm to study about helping natural disaster’s victims in the best way to reduce mortality and injury. It can be good suggestion for the government to make medical emergency disaster training program to empower the civilian especially non medical practitioner. Participations from medical practitioner need to train civilian how to execute victim evacuation in the best way. Furthermore, the number of mortality and injury could be decreased. Key word: Knowledge, Belief, Willingness, Non Medical Practitioner, Helping Natural Disaster’s Victims. INTRODUCTION National Data about Natural Disasters, Victims, and Regulation Nowadays natural disaster becomes a serious problem in Indonesia. In last 10 years BNPB notices 187.071 cases of dead, 397.860 cases of injury, and 9.101 cases of human lost1. Flood is the highest case of natural disaster (4000 case), followed by landslide 2000 cases, puting beliung 2000 cases, and dryness 1500 cases2. In Indonesia, the government regulates the all disaster through BNPB (Badan Penanggulangan Bencana). This

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regulation including; pre-disaster management (mitigation, alert, preparedness, and early detection), disaster management (response), and post disaster management (restoration and rehabilitation)7. National Problem about Natural Disaster Victims One of the disaster management concerns is direct emergency medical treatment to decrease the number of mortality and injury3&9. We have no valid data about the ratio of victims and emergency teams. We suggests that the number of emergency

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teams are not enough to help victims of natural disaster. Indonesia has very large area with different topographic, hands most emergency teams come late to the location. In addition, the patient with airway, breathing, and circulation problem can be dead before the emergency team come3. Every district should be able to treat the victims in the first 24-48 hours before the proper help come3. It is impossible to move all the victims to the hospital due to capacity. We never be able to treat the victims in the best way if we do not use the standard operating procedure about helping natural disaster victims. Moreover, we need to empower the civilians to help the victims, hands we can help the right patient to the right hospital by the right ambulance in the right time3. In order to get the information how exactly the civilian participation in helping the victims, this paper is aimed to survey the knowledge, belief, and willingness of non medical practitioner in helping natural disaster victimâ&#x20AC;&#x2122;s and make the further decision depend on it. METHOD Study Design and Study Site We did a cross sectional study, using close question questionnaire in three different cities in East Java; Ponorogo, Kediri, and Malang. East Java is 2rd highest number of natural disaster. Ponorogo represent rural area with high number of natural disaster, Kediri represent rural area with middle number of disaster, and Malang represent urban area with low number of natural disaster. The questionnaire was made by literature review and used dichotomous choice. Inclusion Criteria The participants were local civilian who know about natural disaster and not medical practitioner such as doctor, specialist, professor, midwife, nurse, nutritionist, and pharmacist. The respondent can speak in Indonesian and Javanese language. The total of eligible participants at the time data collection was estimated to be 500. Exclusion Criteria The exclusion criteria were medical practitioner such as doctor, specialist, professor, midwife, nurse, nutritionist, and pharmacist. Study Sample and Data Collection Consecutive sampling was used to draw the sample size. The investigators visited the eligible participants in the office, house, and the places

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where the local event are held. The data was collected during 30th August 2012 - 6th September 2012. The eligible participation were explained about the objectives of this survey and each of them was given a subject information sheet containing the particular of the study. All consenting participants were given a questioner. The questioner used close question and dichotomous choice. Moreover, there is no information about national management disaster victim and the important of transition medical assessment from emergency to long term medical services whichnwas divulged. They were requested to fulfill the questioner. The complete questioners were collected from participant in the same day (55%) and in the next day (45%). 500 eligible participants, 400 could be approached at home, office, and place of the local event are held and 150 of them are refused to participate in the study. 250 questioners were given but 46 participants were incomplete answer. Consenting individual who did not complete the questioner or who could be contacted after two days were considered as non respondents. Questioner Development The questioner was developed based on review literature, guide, and peers. The questioner prepared and then pre-tested on 20 respondents and necessary changes were made in the questioner based on this pre-testing. Section The questioner was divided into 4 sections. Apart from demographic question, it consists of 23 questions used dichotomous choice which related to knowledge, belief, and willingness of helping natural disaster victimâ&#x20AC;&#x2122;s in order to get long term medical services among non medical practitioner. Section 1 The first section comprised of demographic information essential for data stratification during data analysis. The data include age, gender, occupation, and education. Section 2 Section 2 assessed the knowledge (8 questions) of respondents regarding the experience about natural disaster, socialization of important medication among natural disaster victims, BNPB, and risk of natural disaster. Good knowledge if the score was 16-10 point and bad knowledge if the score was <10.

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Section 3 Section 3 assessed the belief (9 questions) of respondents regarding needs medical emergency team, hospital referral, government help, socialization of important continue emergency medical services, and the pretension to be emergency team. Good belief if the score was 1810 point and bad belief if the score was <10. Section 4 Section 4 assessed the willingness (6 questions) of respondents regarding face the natural disaster and willingness to join the training and take a part as additional medical emergency disaster team. Good willingness if the score was 12-8 point and bad willingness if the score was <8. Statistical Analysis The data were collected and analyzed using SPSS (version 17.0). Results were expressed in percentage and frequency using appropriate tables. Comparison groups were formulated on the basis of age, gender, education, and natural disaster experience. The experiences could be as a victim or family story related to natural disaster victim. Differences in terms of demographic, knowledge, belief, and willingness concerning help natural disaster victims in order to get long term medical services were tested using the χ2-test of significance. Level of significance was set at 0.05. The analysis consist of univariant analysis; normality mean, deviation standard, frequency and percentage, and bivariant analysis to find the relation between knowledge, belief, and willingness of respondents in help natural disaster victim’s in order to get long term medical services among non medical practitioner. RESULT Demographic Characteristic The 204 respondents have completed the questionnaire. According to age, most of respondents are 16-20 years old (35%), female (56.4%), student (37.7%) and graduated from high school (61.3%). Ponorogo The Ponorogo respondents mostly female (55.8%), <20 year (42.3%), graduated from high school (75%), and non civilian workers (38.4%). Many natural disasters happened in the last 5 years; flooding, dryness, land slope, and puting beliung. The data collected from 52 respondents. 61.6% of respondents were good knowledge about natural

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disaster, (98%) were good belief and (80.8%) were good willingness to join the additional emergency disaster aid and training. Female had better belief (96.5%) and willingness to join additional medical emergency disaster team (79.3%) than male. 38% respondents had bad knowledge in natural disaster, in the other hand 95% of them had good belief that good quality of first aid could decrease the number of dead and injury. Furthermore, knowledge had no correlation with belief (χ2= 0.117, p= 0.732) and self willingness (χ2= 0.03, p= 0.87). In addition, belief that health is one of vital thing and need good quality of first aid among disaster victims had no correlation with self consciousness to take a part as emergency team and join to additional medical emergency team (χ2= 0.558, p= 0.455). We concluded that natural disaster promoted people to rescue other and theirselves first although they didn’t have any knowledge and belief that natural disaster is potentially hazardous. Education level (χ2= 1.071, p= 0.301), age (χ2= 23.20, p= 0.767), and sex 2= 0.008, p= 0.927) did not influenced their willingness to join the additional medical emergency team and training. Kediri Kediri has middle number of natural disaster. We collected questioner from 90 respondents. 63.3% female, 31-40 year, 43 % non civilian worker, 30% graduated from high school. 50% respondents had good knowledge about natural disaster, 97.8% of all respondents believed that to decrease the number of dead and injury need good quality of first aid. 96.7% respondents had good willingness to join the additional medical emergency team and training. 81.8% male assumed that they were already to become an additional medical emergency team of natural disaster. Both male and female believed that natural disaster was potentially hazardous. They considered that health was one of crucial things; hands need good basic life support, structured referral and longer medication. 50% respondents had bad knowledge about natural disaster but 95% of them believed that health was the solution to decrease the number of dead and injury; hands need good basic life support, structured referral and longer medication. They believe that natural disaster is potentially hazardous. Both experience and inexperience respondents had good belief (χ2= 0.167, p= 0.683) and willingness to join additional medical

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emergency disaster team (χ2= 1.029, p= 0.31). willingness was lower than other sampling area due Education level (χ2= 1.071, p= 0.301), age (χ2= to lack of experience confronting the natural 27.28, p= 0.747), and sex 2= 0.492, p= 0.483) did disaster; for instance 72% respondent had bad not influenced their willingness to join the willingness and 70.6% of them were inexperienced about natural disaster. Experience in confronting additional medical emergency team and training. natural disaster is the main issue in self Malang Malang is an urban area (heterogeneous consciousness that natural disaster is potentially residence) with low number of natural disaster. We hazardous and need good quality of victim first aid. collected data from 62 respondents. 59.7% male, It was confirmed through the correlation between 16-20 years (72.6%), student (82.2%). 63% knowledge and belief were not significantly 2 respondents had bad knowledge about natural correlate (χ = 0.167, p= 0.68). Male (78.4%) disaster. All of respondent (100%) believed that respondent had better willingness than female (χ2= natural disaster is potentially hazardous; moreover, 1.550, p= 0.213). 27.4% of them had bad willingness to join additional medical emergency disaster team and Combine Data training. Furthermore, the statistical analysis Data from three sampling areas were combined. couldn’t be done because the number of belief was The correlation between each variable showed in 100% among the respondent. We assumed that the the table bellow; number of belief was higher and the number of Table 1: Recapitulation Data from Sampling Areas Good Bad Good Bad Good Bad Knowledge Knowledge Belief Belief Willingnes Willingnes s s Age n % n % N % n % n % n % 16-20 30 4 42 5 7 1 0 0 5 7 2 29. 1.7 8.3 2 00 1 0.8 1 2 21-30 22 5 17 4 3 8 3 1 3 7 9 25 5 5 6 8 2 0 5 31-40 26 6 14 3 4 9 1 2 3 7 8 22 3.4 6.6 0 7.6 .4 2 8 41-50 22 5 15 4 3 8 5 1 2 7 9 24. 9.4 0.6 2 6.5 3.5 8 5.7 3 51-60 6 5 5 4 1 9 1 1 1 9 1 10 4.5 5.5 0 0 0 0 0 >60 2 4 3 6 3 6 2 4 2 4 3 60 0 0 0 0 0 Gender Male 42 4 47 5 8 8 9 1 6 7 2 27 7.2 2.8 0 9.9 0.1 5 3 4 Female 53 4 62 5 1 9 1 1 8 7 2 22. 6.1 3.9 14 9 9 7.4 6 6 Occupational Student 36 4 41 5 7 1 0 0 6 7 1 20. 6.7 3.3 7 00 1 9.2 6 8 Civilian Worker 9 5 7 4 1 1 0 0 1 1 0 0 6.2 3.8 6 00 6 00 Non Civilian 39 5 32 4 7 9 1 1 5 7 1 21. Worker 4.9 5.1 0 8.6 .4 6 8.9 5 1 Unemployed 20 5 20 5 3 7 2 2 3 7 1 25 0 0 8 6 4 0 5 0

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Education Elementary

13

1st middle school

12

High school S1

Knowle dge

middle

62 14

4 1.9 4 2.8 4 9.6 7 0

18 16 63 6

5 8.1 5 7.2 5 0.4 3 0

2 8 2 7 1 23 2 0

9 0.3 9 6.4 9 8.4 1 00

3

9 .7

1

4 3

.6 2

2 0

1 .6

0

2

9 3

0

1 9

7 7.4 7 1.4 7 4.4 9 5

Table 2. Correlation between Knowledge, Belief, and Willingness Belief Willingness G Ba p Good Bad ood d 0.1 N % n % 67 n % n % 2 G 9 48 2 0. 74 36 26 12 χ ood 8 98 .3 .7 = B 1 49 3 1. 0.167 82 40 22 10 ad 01 .5 5 .2 .8 1 5 156 48 99

Table 3. Correlation between Belief and Willingness Willingness G Ba p ood d 0.3 n % n % 79 Belief G 1 75 46 2 χ2 ood 53 2.5 = B 3 1. 2 0. 0.773 ad 5 98 1 48 56 Table 4. Correlation between Education Level, Belief, and Willingness Belief Willingness G Ba p Good Bad ood d 0.5 n % n % 99 n % n % 2 Educati H 1 69 3 1. 111 54 33 16 χ on igh 41 .1 5 .4 .2 = L 5 28 2 0. 0.277 45 22 15 7. ow 8 .4 9 4 1 5 99 Table 5. Correlation between Gender, Belief, and Willingness Belief Willingness G Ba p Good Bad ood d 0.7 n % n % 99 n % n % Sex Male 9 44 2 0. 74 3 1 9.

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6 8 3 2 1

P 0. 415 χ2 = 0.665

P 0. 102

P 0. 339

53

22. 6 28. 6 25. 6 5


1 Femal

.6 53

1 3 e 08 1 5 99 The respondent from 3 different sampling areas showed similarity. Most of them considered that helping natural disaster victims need to be done in the best way. The trend showed that they already join to additional medical emergency disaster team and training. 50% of all respondents in 3 different areas had good knowledge in confronting natural disaster. In addition, 97% respondents believe that disaster has big potential in mortality and injury. They also believed that health is one of the most focuses among disaster and need longer medical treatment. 76.5% respondent showed their enthusiasms in helping of the victims; including to join the emergency disaster team training. The education level (χ2= 0.102, p= 0.799), sex (χ2= 0.912, p= 0.339), and experience (χ2= 0.773, p= 0.379) about natural disaster (knowledge) weren’t influence their belief and willingness in helping natural disaster victims. DISCUSSION In the last 5 years, natural disaster and the victims becomes a national high light. The number of natural disaster, mortality, and injury rate were elevating. We have no valid data about the number of victims and emergency disaster teams. Civilian contribution, specially the victims who not seriously injured is needed to help the victims which is has airway, breathing, circulation problem and injured. This contribution aimed to work together with emergency disaster team to decline the number of mortality and injury. We recommended to the victims whose not seriously injured and not injured because they know the condition along and after disaster, not far away, and require short time. 85.3% respondents assumed need continuously medical services among victims, 84% wanted to take a part as an emergency disaster team; moreover 74% respondent supposed they would join to emergency disaster training. They believed that helping the victims in best way, the mortality and injury rate would be decline. Rely on interview we got the information that 54.9% respondent had socialization about the essential of helping the

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χ2 = 0.065

98 1. 5

82 156

6.3 4 0.2

9

3 2

9

1 4.2

χ2 = 0.912

4

8 natural disaster victims, but common they did not know the technique of helping the natural disaster victims. This is an opportunity for government to recruit the civilian in turn to involve their self in helping natural disaster victims as additional medical emergency disaster team. Solution for Government’s Program Government is supposed to make a natural disaster’s victim first aid and management training. This program is aimed to educate and empower the civilians regarding to help the victims in the best way. Moreover, to maintain the outcome whether that program is successfully held or not, government should make a simulation about the aid of natural disaster’s victim. Training Material The material should be focused in post disaster medical emergency treatment such as basic life support, triage and stretcher system. The basic life support material are air way, breathing, and circulating evaluation, carotis and radialis artery evaluation, simple palpation, emergency injury treatment, Glasgow Coma Scale (GCS), and stretcher system. Furthermore, the theory about kind of the most save place related to each natural disaster should be given too. Role of the Program to Succeed Disaster Management Circle Recruitment Recruitment should be done by government. Every civilian could join this program. This program would be held in area where natural disasters often happen. Mitigation Mitigation aimed to educate the civilian. Every participant will get knowledge about basic medical emergency such as characteristic of every natural disaster which is often happens, everything they can do when natural disaster happens, how to rescue themselves, and first aid. Focus material about Basic Life Support (BLS), stretcher system, and Search and Rescue (SAR). Participation from medical practitioners, medical students, and SAR

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team as mentor absolutely need to maximize the impact and outcome. The mitigation program should be held until civilian had good understanding about medical emergency disaster and they know everything that should be done while confronting natural disaster. Preparedness The emergency training as continue program of mitigation. This is aimed to make sure that participants had good understanding about material which had been given and to facilitate them to practice it. Medical practitioners, medical students, and SAR team whose involve in simulation should train the civilian how to rescue themselves and other, found a save place, and gave a first aid.

From this training we do hope they can do the right action while confronting post natural disaster so the number of mortality and injury could be decreased. Response Empower the civilian through participation in medical emergency disaster as additional SAR team and medical team. Medical Students and Medical Practitioner Participation Medical students, general practitioner, specialist of emergency, professor should have good knowledge and skill in Basic Life Support (BLS). Especially specialist of emergency should be expert skill in Basic Trauma Life Support (BTLS). Their participation is absolutely needed to train the civilian how to execute good evacuation.

Emergency Training

Preparedness Medical students and medical practitioner participation

Public Education

Mi3ga3on

Response

Empower Civilian to do Emergency Medical Treatment

Medical students and medical practitioner participation

Recovery CONCLUSION Knowledge (χ2= 0.773, p= 0.379) or experience about natural disaster, and demographic factor (education level (χ2= 0.102, p= 0.799) and sex (χ2= 0.912, p= 0.339)) were not influence respondent’s belief and willingness to join additional medical emergency team and training. They had self consciousness to find the save place, save their self, contact the emergency disaster team, and helping the victim in best way. They had big enthusiasm to learn

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helping natural disaster victims in the best way. This reason must be good suggestion for the government to make emergency disaster training programme and involve the civilian as additional medical emergency team. Participations from medical practitioner need to educate civilian how to do victim’s evacuation in the best way. This programme is aimed to decrease the number of mortality and injury caused by natural disaster.

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8.

REFERENCE 1. 2. 3. 4. 5. 6.

7.

Badan Nasional Penanggulangan Bencana, 2012, http://dibi.bnpb.go.id/DesInventar/dashboard.jsp ?countrycode=id&continue=y&lang=ID Badan Nasional Penanggulangan Bencana, 2012, http://dibi.bnpb.go.id/DesInventar/profiletab.jsp D, Aryono, 2011, The Silent Disaster Bencana dan Korban Masal, Jakarta: Sagung Seto Dahlan, Sopiyudin, 2010, Statistik Untuk Kedokteran dan Kesehatan, Jakarta: Salemba Medika. Dinas Komunikasi dan Informatika, 2012, Tanggulangi Bencana dengan Konsep Preventif, Kalimantan Timur Environmental Study Web Blog, 2009, Lempeng Indonesia, http://udhnr.blogspot.com/2009/02/lempengindonesia.html Haryo, Agung, 2010, Wilayah Perairan Indonesia, http://hankam.kompasiana.com/2010/09/04/wila yah-perairan-indonesia/

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9.

10. 11. 12. 13.

Hazrumy, Andika, Manajemen Penanganan Bencana Berbasis Masyarakat, Serang-Banten: Pusat Kendali Operasi (PUSDALOPS). Hee, Fong, et al, 2011, Knowledge, Attitude, and Practice of Complementary and Alternatif Medicine (CAM) among Medical Practitioner: A Survey in an Academic Medical Centre in India, Hongkong: Academic Booklet Join Conference 2011. Indah, Rosari, et al, 2011, KAP Study on Dengue Prevention in Aceh, Banda Aceh: TDMRCUnsyiah. Inpres No 4, 2012, Tentang Penanggulangan Bencana Banjir dan Tanah Longsor, Preside Republik Indonesia. Sri,Heru, Konsep Dasar Kebencanaan dan Penanggulangan Bencana abstrak, Sistem Reduksi Resiko Multi Bencana Susetyo, Heru, Menuju Kebijakan Penanggulanga Bencana yang Integratif, bacatanda.wordpress.com/menuju-kebijakanpenanggulangan-bencana-yang-integratif/

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INDONESIAN DISASTER AWARENESS VILLAGE (IDAV) AND SURVIVAL BAG PROJECT: A Better Management to Prevent Hidden Hunger (A Community Based Approach Innovation of Refugee and Nutrition Disaster Management) Sofi Nur Fitria, Ilmania Norma Aini, Yesita Rizky F.P. Faculty of Medicine, Brawijaya University

ABSTRACT Introduction: Geographically, Indonesia is placed in between three tectonic plates, there are IndoAustralia plate, Eurasia plate, and Pacific plate. In these plates meet point, lots of friction energies are accumulated. The energy explosion will make a lot of damage such as seismic wave acceleration, tsunami, landslide, and liquefaction. Indonesia is vulnerable country, most of its citizen have known about it, but they aren’t aware yet. As the policies being discussed, there are also more problems left behind. Methods : Survey and study literature. A literature review was conducted by searching databases such as in PubMed, Highwire, social department of Indonesian Government and mostly Indonesian Journals. By reviewing the literatures, we introduce an innovation for management, nutrition and health problems when disaster occurs. Interviews to Indonesia Red Crescent as Non-Government Organization are performed in order to make sure that our system can be applied in disaster area. Result : NGO (non-Government Organization) and GO (Government Organization) have the authorization to manage the disaster effect. They already established some policies, and we want to accomplish them. Actually, the problems are: 1. There is no control of the system; 2. Lack of human resources, 3. Some policies are not specific enough, especially in technical problems. Discussion : Beside the management system, nutrition is an important problem. Unfortunately, it got less attention. Nutrition problem is like iceberg phenomena, it looks simple, but it caused a lot of diseases to the refugees. We also offer innovation to resolve the initial days when disaster occurs. There are already a lot of management disaster policies, but it’s not specific yet, so it caused less effective in application sucha as nutrition management for refugee. Our main focus is nutrition and health management, so we offer the idea to make the project to overcome the problem. Conclusion : Our Project title INDONESIAN DISASTER AWARENESS VILLAGE (IDAV) AND SURVIVAL BAG PROJECT and our tagline is “Better Management To Prevent Hidden Hunger”. Our Project has 3 part of action that are before, local management when disaster happened, and post disaster. Our project is a community based approach program that empowerment is the main concern. Keyword: Indonesian Disaster Awareness Village (IDAV), Survival Bag, Community Based Approach Innovation, Nutrition Disaster Management INTRODUCTION Indonesia is the largest archipelago in the world to form a single state; it consists of five main islands and 30 smaller archipelagoes, totaling about 17,508 islands and islets, of which about 6,000 are inhabited. Geographically, Indonesia is placed in between three tectonic plates, there are Indo-Australia plate, Eurasia plate, and Pacific plate. In these plates meet point, lots of friction energies are accumulated. The energy explosion will make a

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lot of damage such as seismic wave acceleration, tsunami, landslide, and liquefaction. Indonesia is vulnerable country, most of its citizen have known about it, but they aren’t aware yet. As the policies being discussed, there are also more problems left behind. So, we are as medical students and young generation of Indonesia would like to offer our idea. NGO (non-Government Organization) and GO (Government Organization) have the authorization to manage the disaster effect. They

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already established some policies, and we want to accomplish them. Actually, the problems are: 1. There is no control of the system; 2. Lack of human resources, 3. Some policies are not specific enough, especially in technical problems. Beside the management system, nutrition is an important problem. Unfortunately, it got less attention. Nutrition problem is like iceberg phenomena, it looks simple, but it caused a lot of diseases to the refugees. We also offer innovation to resolve the initial days when disaster occurs. METHODS Survey and study literature A literature review was conducted by searching databases such as in PubMed, Highwire, social department of Indonesian Government and mostly Indonesian Journals. By reviewing the literatures, we introduce an innovation for management, nutrition and health problems when disaster occurs. Interviews to Indonesia Red Crescent as Non-Government Organization are performed in order to make sure that our system can be applied in disaster area. RESULTS 1. Coordination System of Government Organization Every country has their own management system to overcome disasters. In Indonesia the management is regulated by BNPB. BNPB is the Indonesia National Agency for Disaster Management. It was established in 2008 to replace the National Disaster Management Coordinating Board which was established in 1979. BNPB is directly responsible to the President of Indonesia and the chairman is directly appointed by the President (See Picture 1). The BNPB Chairman is Mr. Dr. Syamsul Maarif.

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Picture 1. BNPB Structural Organization (source: http://www.bnpb.go.id/) One of the duties of BNPB is establish policies for disaster management. The goals of the policies are (1) Strengthen national capability in disaster management, especially in prevention, mitigation, and preparedness; (2) Manage and mobilize all potential resources (infrastructure and manpower) in disaster preparedness, response and recovery; (3) Empower local authorities in anticipating and responding to disasters in their regions; (4) Coordinate all stakeholders and activities in disaster management; (5) Incorporate Disaster Risk Reduction in the framework of National Development Plan. BNPB also arranges strategies to reach the goals, those are (1) Disseminate DRR and strengthen capacity through Training and Education; (2) Develop Guidelines and SOP in responding to any type of disaster;(3) Develop a Disaster Management Information System (DMIS); (4) Develope Hazard Mapping and Risk Mapping for Disaster prone areas; (5) Develop Disaster Management & Contingency Plan for National-Provincial-District levels; (6) Strengthen National/Provincial/District Emergency Operation Centers and Rapid Response Teams; (7) Strengthen local capacity in disaster recovery. When the disaster come BNPB are responsible for regulating the coordination, commanding, and executing the disaster mitigation. Coordinating disaster mitigation done through cooperation with central and local government agencies, business agencies, international agencies, and / or other parties deemed necessary at pre-disaster and postdisaster stage. In the emergency state, BNPB plays the command role in order to handling

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emergency in the affected areas through the deployment of human resources, equipment, and logistics of BNPB and related agencies, the Indonesian National Army and Police of the Republic of Indonesia. The last function is being the executor of disaster mitigation. At the postdisaster conditions this function implemented in a coordinated and integrated with government agencies at the central and local levels, taking into account policy disaster management; national development policies, as well as aligned with the provisions of the legislation. Those three functions of BNPB in disaster mitigation are translated into strategic activities in disaster (See picture 2 below).

Picture 2. National Center Disaster Mitigation Regulated by BNPB Nationally, as well as development, disaster mitigation efforts have to be comprehensive and systematic, but it is still constrained by the two main issues, such as: (1) There are insufficient personnel and institutional performance disaster management, (2) The low awareness of disaster risks and understanding of preparedness in the face of disaster. Those issues are affecting the preparation for the disaster mitigation effort. At the emergency and post disaster state, coordination between the parties that take a part in disaster mitigation becomes the biggest problem. If the coordination fails it could further adversely affect the handling of the disaster victims. Nutrition problem in the refuge is one of the main issues at the disaster state. 2. Coordination System of NonGovernment Organization

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In Tsunami Aceh in 2006, there were reports at one area, there were more international NGOs than national and local NGOs involved in the response operations in the tsunami-affected areas. While this may certainly have been the case, NGOs in Indonesia are very active and operate across the country on various issues such human rights, the environment, and development. There were already a handful of NGOs involved in disaster management prior to the tsunami, and now there are many more newcomers in the priority area. Based on the fact, to gather more information, we did a survey to a NonGovernment Organization called Indonesian Red Crescent (IRC). Just like Red Cross, this organization orientation is in human welfare, especially in disaster medicine. To join the disaster medicine team in disasterâ&#x20AC;&#x2122;s spot (cooperate with government team), IRC need to accomplish the administration rules as NGO which written in Government Policy of Indonesia Republic Number 23 Year 2008. The Government Policy consists of policies about the role of international organizations and foreign non-government organizations in overcome disasters. There are 18 points of Indonesia constitution law explain about the role of NGO or other International Organizations to give help in Indonesia when a disaster attacks. Based on the Republic of Indonesia Government Policy Number 23 Year 2008, there are some steps that must be accomplished by NGOs. First of all, the NGO must make a proposal, memorandum of understanding, and work plan. These three requirements must be coordinated with BNPB, an independent government organization which has the right to regulate disaster management in Indonesia, before being written. Those three requirements must be given to BNPB. BNPB must oversee the NGO which has been approved, and the NGO itself must give reports to BNPB about all information that BNPB are asking. Indonesia Red Crescent is one of lots NGO in Indonesia that has been approved to help out the government in disaster medicine. In our survey, we met Ns.Heri, he is a nurse who already has experiences in IRC team disaster medicine. Based on his experiences, one or two persons from the team will go to the disaster spot first.

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They will do some survey to get permission from the locals (government) and to gather information about what kind of help that the victims probably need. One or two days after, the other team’s members are coming with bring the stuffs or equipment based on the surveyors reports. Of course, they must report their equipment and members list to BNPB’s responsible person there. 3. Nutrition and Health Problem in AffectedArea and Refugees Itself Ns. Heri also said that the nutrition problem were urgent matters but it got less attention. In the first five days after disaster, the food available is only instant noodle. It made the victims need more nutrition for their bodies. To overcome the nutrition problem, we need to be aware and prepare for the disasters that will come without notice. The solution we have is by creating a Disaster Awareness Village and also the Survival Bag. DISCUSSION Food shortage is a frequent problem in refugee or population displaced (e.g. caused by natural disaster). It led to high prevalence of malnutrition and hidden hunger. There are two major causes; the first one is the sudden and massive reduction of food availability and food accessibility. The second one is impairment of health quality. The other reason is food has caused conflict in refugee, because the distribution is not equal in one area to other area. For infant, they rely on breast milk substition, but most cases said that clean and appropriate water is unavailable. And the last one, natural disaster caused by climate changes (El-Nino, flood, etc.) always cause drought in affected area. Base on the reasons, it’s extremely important to start paying attention in disaster management and also the nutrition management of disaster. Our main focus in this paper is to make empowerment program (community-based approach). The people to help their self-survive during the disaster. So, we have some ideas to help the management before, on the day of disaster, and after the disaster. 1. Before disaster (preparation) 1.1 Empowerment

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Every area in Indonesia is vulnerable to disaster. When disaster occurs, the access to the area is very limited. So, we want the people to save their self, by giving them some training and preparation. The project include (1) Training about BLS and disaster evacuation; (2) Training and Preparation about the Nutrition, (3) Choose Volunteers to Train the Other Citizen, and (4) Choose the Nutrition and Health Surveillance. Volunteer must come from the each area citizen because their role is very important. First to educate others and second, this volunteer will be the chief of disaster management if there is no help yet from NGO or GO. We will educate the volunteer and citizens, but the volunteer have more responsibility to educate, spread the information, and also warn the others. But, because our main focus is in nutrition management, so we’ll discuss more about it. 1.2 Choose The Nutrition and Health Surveillance Do some preparation training for disaster and nutrition management. The nutrition surveillance is one of our volunteer. Their duties are: a. assess the health, include the nutrition status of refugees (by doing some simple test), b. they have to manage the distribution of food to the most proper categories of vulnerable refugees, c. After the help from NGO or GO comes, they have to report it. Then, pra-disaster, the surveillance has to survey the nutritional and health status. 1.3 Survival Backpack and Its Management Structure We call it “Survival Backpack”, inside this backpack, there is not only first aid, but also food and clothes. Because, as our surveys prove that in the firs-two days of disaster, the access to the area is extremely difficult. At least, this backpack will be able to fulfill one family of four members until two days. First, we will explain the system of this backpack. This backpack must be ready in every home, especially in vulnerable area. In some strategic and highly possibility places to be refugee camp (such as public facilities: praying building, mosque, church, etc.) and healthcare center, it should be prepared for 5 until 7 backpacks (minimal number). The contains of this backpack must be updated according to the expired date. The responsibility to update this

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backpack is mostly given to social department of government (government public facilities). Also, the backpack must be placed in easy and reachable area (living room, or close to exit doors). Beside empowerment, the system that we’re going to use is cross subsidy. So the medium to high economy status will have all items needed in their backpack, while the poor one will only have only selected items. So, the rich one will help the life of the poor one.

Below is the minimal number of food intake as calculated for one family with four members. Table 1. Three Main Important Nutrition (adapted for disaster condition)

Below is the list of items inside of the backpack. In public facilities backpack, all of the must be available. For each-home backpack, the optional item is recommended. Especially for medium to high econimy family, so it can subsidy the low economy family.

Picture 3. Coordination and Management System of IDAV and Survival Bag The structure above shows us the system of managerial of Survival Backpack. Government always has the main role, but the NGO and GO has to help it. They have to work together to approach the individual. 1.3 Inside the Survival Backpack The picture below of good balance of daily food intake. But in refugee it’s almost impossible to fulfill them all, so we have selected several main items.

Table 2. The Survival Backpack Items

Picture 4. Good Balance of Nutrients

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2. Local Management when Disaster Happened The local management here is the implementation of our empowerment system. One of the idea is the nutrition assessment for refugees. To apply this program maximally, the refugees need to be separated into several categories.

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Then, our volunteer has responsibilities to build community-based approach. They have to rise up their spirit after disaster. Psychological events will be very good for all stages of age. Such as singing competition, dancing, drawing, and having some physical activities.

Picture 5. Vulnerable Categories Our projects for the volunteer, on the first week of disaster (according to our management system) are: 1. Identified the region which is potential to be hidden-hunger region 2. Survey the population condition and food supplies. 3. As supervisor of health and nutrition intervention. 4. As information distributor (especially about health care and food distribution). 5. As distribution manager of food, according to the categories (pregnant woman, children under 3 years old, geriatric, and other categories). 6. Calculating the daily food rations and needs for large scale population. 3. Post Disaster The volunteer needs to keep in touch with others. They have to survey about the health and nutrition condition of population. In some cases, they can also do routine test such as weight scale, mid-upper arm circumstance, or other simple health tests. This act is one of our controls to prevent hidden-hunger.

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CONCLUSION There are already a lot of management disaster policies, but it’s not specific yet, so it caused less effective in application sucha as nutrition management for refugee. Our main focus is nutrition and health management, so we offer the idea to make the project to overcome the problem. Our Project title INDONESIAN DISASTER AWARENESS VILLAGE (IDAV) AND SURVIVAL BAG PROJECT and our tagline is “Better Management To Prevent Hidden Hunger”. Our Project has 3 part of action that are before, local management when disaster happened, and post disaster. Our project is a community based approach program that empowerment is the main concern. REFERENCES Ruswandi, Dody. The Roles of Satellite Data for Disaster Management in Indonesia. ICG -GNSS Seminar. Tokyo, September 5 2011. BNPB (2014). Rencana Strategis Badan Nasional Penanggulangan Bencana Tahun 2010-2014. Jakarta 2010 (Strategical Plan of Management Disaster Year 2010-1014). (Online, http://www.bnpb.go.id/website/asp/content.asp?id =1) Indra et al (2011). Strategi Pemberdayaan Masyarakat Survival Pasca Bencana (Community Empowering as Survival Strategies of Management Disaster). 13.04.2011 Consulate General of the Republic of Indonesia. Indonesia at a Glance http://www.deplu.go.id/vancouver/Pages/Country Profile.aspx?IDP=2&l=en Social Government of Indonesian Republic (2008). Kajian Staf Ahli Mentri Sosial Dalam Penanggulangan Bencana Alam (Minister of Social Studies in Natural Disaster Management) BNPB (2011). Indeks Rawan Bencana Indonesia (Index of Disaster Vulnerable Area in Indonesia). October 2011 Minister of Social (2011). Pedoman Teknis Penanggulan Krisis Kesehatan Akibat Bencana (Technical Guidelines to Ovrcome Health Problem Caused By Disaster). 5.12.2011

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David H. Simajuntak (2005). Waspadai Hidden Hunger Pada Pengungi (Hiden Hunger in Refugees Caution). Page 117-120 Social Minister (2010). Pedoman Pelaksanaan Penanganan Gizi dalam Situasi Darurat

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(Technical Guidelines of Nutrition Emergency Condition). October 2010 Pocket Guide First Aid Project (Online: http://www.icbse.com/projects/first-aid-pocketguide )

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Revitalization of a Comprehensive and Integrated Approach in Reducing the Incidence and Impact of Fire Disasters in Makassar Taufiq Akbar, Jean Vibertyn, Achmad Randi Hasanuddin University, Makassar, South Sulawesi Introduction: sea level. Makassar City residents in 2000 was There is no single measure of a disaster that 1,130,384 people, made up of 557,050 men, can capture the full scope of a disaster. A 573,334 women's lives and souls with an common example is the number of people killed average growth of 1.65%. Makassar overall or affected. The individual will consider the density of 6330 people / km2, but the impact on his or her family and livelihood. concentration of the densest populated area Disaster managers will assess the speed and located in five districts called Tallo, Bontoala, success of the disaster response. The word Makassar, and Mariso Mamajang, the population disaster implies a sudden overwhelming and density is above 20,000 people / km2. unforeseen event. At the household level, a disaster could result in a major illness, death, a substantial economic or social misfortune. At the community level, it could be flood, fire, the collapse of buildings in an earthquake, the This table refers to the Full Paper text in other destruction of livelihoods, an epidemic or document. This table show us clearly about the displacement through conflict. When occurring different of amount of fire insideces in Makassar at district or provincial level, a large number of from 2007 till 2011. people can be affected. Most disasters result in Fire danger is not just a technical issue, but the inability of those affected to cope with furthermore is caused by non-technical elements outside assistance. of the issue of culture. People who are lazy and there are several types of disasters : unwilling to prepare for something that can 1. Disasters from forces in nature happen in the future. Cultural unpreparedness is a. Tropical storms also one of the factor that makes people neglect b. Floods and increases the odds of the likelihood of c. Droughts disaster. The data of the fire cases in period d. Extreme hot or cold 1984-1989 were the result of Research and e. Volcanoes Development Center (Center for) Settlement f. Earthquakes Public Works Department in 1830, showed that g. Landslides there were fires (32.6% of the total fires), due to h. Tsunamis the human carelessness. Given the potential 2. Disasters from humans factor cause of the fire is increasing significantly, a. Mudslides from deforestation these hazards must be anticipated and dealt with b. Famine a variety of prevention efforts are c. Desertification comprehensive, systematic, effective and 3. Disasters directly caused by people sustainable. a. Conflict based on the observation by one of the b. Industrial events medical team, there are three issues that c. Transportation events experiencedbymost the victims of the fire, the d. Wildfire first is burns, post-traumatic stress syndrome, and dislocation / fracture. One of the Makassar is the fourth largest city in organization that works to handle fire is Indonesia, and the largest in eastern Indonesia. It Makassar City fire department. However, has a total area of 175.79 km2 with a population because the number of fires in Makassar doesnot of 1,112,688. In the administration of the city shown to be decrease, it certainly needs a consists of 14 districts and 143 villages. The city thorough treatment, either from the fire is located on the height between 0-25 m above

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department, Medical Assistance Team, doctors, National Disaster Management Agency (BNPB), local governments, and communities to prevent fires in the future. Methodology: This study used a qualitative research method, using a variant of case study research. Qualitative methodology is a research that produces descriptive data in the form of words written or spoken of the people and behaviors that can be observed. This approach is directed at the background and the individual holistically. Thus, this case should not isolate the individual / person into a variable or a hypothesis, but needs to be looked at as a part of or a whole thing. This type of research is descriptive and subjective approach (interpretive). Researchers would like to know something about how and what circumstances, how much, how far, and so on. Descriptive studies describe or explain the events or the cases. Furthermore, a variant of case study research is an attempt in this research strategy. Case studies can provide added value to our knowledge of the phenomenon that is unique individually, organizational, social and political. There are four types of case study designs, the design of a single case holistic, single-stranded, multi case holistic, and multi cases intertwined. This study used a single case study design because it examines a holistic unit of analysis (fire) and reviewing general properties of an object such as research (process control and prevention). Data Collection Techniques: Data collected in this study is divided into two, primary and secondary data. - Primary data a. Observation Researchers conducted observations for several fires that occurred, and then merge the existing data related to this study. b. interview Researchers obtain primary data through interview techniques. The interview is the process of obtaining information for the purpose of research by questioning face to face between the interviewer or interviewers with the respondents answering or using a tool called an interview guide.

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- Secondary data a. Literature Studies This is the part that contains the theories that support the research. Literature commonly referred as the study of literature or theoretical basis. Result: From the findings of the data obtained and the results of interviews with firefighters. Fire information systems are fine, although there were some complaints from the medical team when there is no Satkorlak fire. However, from the data it was found that most of the fires occurred at homes. This indicates that the omission is a major factor in the cause of the fire Makassar city. Object of Fires in Makassar (2011) Ho

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Object of Fires in Makassar (2010) Ho

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Object of Fires in Makassar (2009) Ho

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Object of Fires in Makassar (2008) Ho

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181

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This table refers to the Full Paper text in other document. This table show us about several object numbers of fires incidences in Makassar from 2008 till 2011 that was shown on the table. From the table we can found that most of fire in Makassar occured at home.

Although the fire victims never exceed 10 per case of fire. However, the role of health personnel required to perform preventative actions for things that are not predictable. The participation of the Indonesian Red Cross (PMI), the SAR team, and Medical Assistance team is very helpful in the rehabilitation of the victims of the fire.

The lack of good coordination workflow, sometimes causing the confusion about the handling of the fire. The lack of clarity regarding the Coordination and Implementation Task Force (Satkorlak) sometimes becomes an obstacle for information about the fire. So that the information about the fire is only received by a few agencies, such as the Fire Department, the Indonesian Red Cross, and the National Disaster Management Agency (BNPB). The rescue teams and medical teams sometimes do not get the information. So does the lacking of fire-fighting role of students in Makassar. Discussion:

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This process is a process of fire complex involving fire, fuel, climate factors including elevation and meteorology. Combustion of organic materials oxidation is a process that produces water vapor and carbon dioxide (CO2) thus forming compounds that are not oxidized perfectly (e.g. carbon monoxide) or a compound formed is reduced (e.g. methane and ammonia). These compounds are found in smoke consists of particles of respirative irritant gases and in some case may be carcinogenic. The smoke itself is a complex mixture of the components that depends on the type of material fuel, water content, such as fuel additives pesticides sprayed on foliage or trees. There were no system or the source of information of the reported fires in the city of Makassar. If there is any event of fire, the Fire Department contacts the call center and then reconfirmed by theFire Department that the information obtained is valid, thus the Fire Brigade willimmediatelydrive to the fire location. The next information system is the entire city of Makassar apparatus using the same radio frequency in a variety of information. So that if any information is received, the entire radio frequency receiver are on the same frequency would have been informed about the events that occurred. Handling fires must be done by the Fire Department, assisted by the Indonesian Red Cross (PMI). PMI functioned as a medical team for the fire event. Once the fire has been extinguished, BNPB duty is to mitigate the impact of the fire. Both in terms of financial, rehabilitation of theburnt buildings, or the evacuation of victims and residents that live by the fire.For the part of the victim's kitchen's fires conducted by the Department of Social Makassar. There are several obstacles encountered by the Fire department in charge. First, sometimes the information obtained is less valid, thereby it disrupting the duty. Second, sometimes the difficulty of access to the location of the fire, fires often occur in residential hallways, making it difficult to get the fire truck into fire location. Third, difficult access to water sources, so that firefighters sometimes use a water pickup. Based on the data obtained from the Fire Department, the loss of material obtained from

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the fire reaching hundreds of millions of dollars. It can certainly be reduced if prevention can be conducted. Fires usually occur at night, so for the market area and the building needed to have Spirinkeler Automatic, which can reduce or even prevent the occurrence of fires. If you focus on fire prevention, of course, the amount of loss can be reduced or even non-existent. For installation on a single fire hydrant only cost one hundred million rupiahs. It means nothing if compared with the amount of losses that could reach billions of rupiahs.

economic and psychological range of people who experience a disaster, such asa prolonged shock. Instead, because this coming catastrophic fires are not yet common, and not the main routine hazards, preparedness of the public interest to obtain information about the fire was minimal. Consequently, when the danger occurs, worse losses could be experienced.

This table refers to the Full Paper Text in other document. in this table we can found the loss of material obtained from the fire reaching hundreds of millions of dollars (from 2009 till 2011)

The most common cause of fire was electrical and that most occurred in a residential area, indicating that the housing society do not alert to the electrical equipment or electrical installation at home, so the possibility of a short circuit. One of the effects of the population density in the city of Makassar affectsthe spreading of the fire. The distance between a housethat located close to one another is one of the factors that lead to the easily spreading of fire in Makassar. based on data obtained from Makassar city fire department, from 2007 to 2011, the number of fires in Makassar indicates abundance. Fires often cause a variety of undesirable consequences both concerning losses (material, stagnation of business, environmental damage, or pose a threat to the safety of human lives). There is also the danger of catastrophic fires that have a very broad impact that includes social and economic life of the experience. Fires that occur in densely populated or centers of economic activity in urban areas could lead to social consequences,

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This table refers to the Full Paper Text in other document. On this table we can see the distribution and population density in Makassar on 2011. The most common cause of fire was electrical and that most occurred in a residential area (the area with higher population density) indicating that the housing society do not alert to the electrical equipment or electrical installation at home, so the possibility of a short circuit.

There are three diseases suffered by the victims of the fire, such as burnts, Post-traumatic Stress Syndrome, and dislocation / fracture. Usually for these victims handled by PMI, or sometimes rescue teams and medical teams. If the victim is seriously injured, he will be send to the closest hospital.The effects of burns can not be ignored because this burns could have so much unpredictable effects. Burns are one of the most common and devastating forms of trauma. Patients with serious thermal injury require immediate specialized care in order to minimize morbidity and mortality. Significant thermal injuries

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induce a state of immunosuppression that predisposes burn patients to infectious Complications. A current summary of the Classifications of burn wound infections, Including their diagnosis, treatment, and prevention is given. Early excision of the eschar has substantially Decreased the incidence of invasive burn wound infection and secondary sepsis, but most of Deaths in Severe burninjured Patients are still due to burn wound sepsis or Complications due to inhalation injury. Burn Patients are also at risk for developing sepsis secondary to pneumonia, catheter-related infections, and suppurative thrombophlebitis. Prior to the widespread use of early surgical excision of burn Wounds, conservative management was practiced. Colonization of the burn wound was permitted to break down the burn eschar so that it separated spontaneously. Daily cleansing and immersion hydrotherapy were used to debride necrotic eschar surface. Skin grafting occurred only after the development of granulation tissue on the burn wound's surface. It is important to understandabout the timeframe of edema development and resolution. The ability of the tissues to receive oxygen and Nutrients is reduced during this time, while susceptibility to infection is increased. The impact of this on clinical management is that strategies to aid recovery of the zone of stasis edema must extend until resolution has occurred. Inflammation becomes prominent at 7-10 days post-injury. It is at this time that blood flow in the burn wound is at its maximum level. Surgery therefore, may be hazardous due to an increased risk of blood loss. Post-traumatic stress disorder (PTSD) is a psychiatric disorder recognized well that can be followed with a major traumatic event. Characteristic symptoms include re-experiencing phenomena such as nightmares and recurrent distressing thoughts of the event, avoidance and numbing of general responsiveness, such as trying not to talk about or be reminded of the traumatic event, experiencing detachment and estrangement from other people and hyper arousal symptoms including sleep disturbance, irritability and hyper vigilance Increased. PTSD is a relatively common condition

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Based on the above, it can be said that the health effects on victims also need to be aware of. Although the victim did not die, but the negative effects must be avoided. So the function of physicians and medical students in the fire disaster is very useful in post-fire rehabilitation Solution and Conclusion: From the description above it can be concluded that the fire prevention, handling of fire, even fires can occur due to several factors and also require the assistance of numbersof somedifferent factors. In this case there are four aspects that are responsible for preventing and mitigating the effects of the fire. The first is the government, of course, the government should provide funds for disaster relief to BNPB so the response can be givenas quickly as possible and the victims can live their life back to normal as soon as possible. Government also needs to improve the density of people living in the city of Makassar so it can speed up the handling of fires and reducing risk. Governments can also improve firefighting facilities, such as multiply the water sources. The second one is that the fire department needs to have an integrated information system and effective coordination between organizations in the handling of fire suchas BNPB, PMI, The Search and Rescue team and medical relief team. Third, a society that needs to be more aware and installation of electrical equipment need to do routine checks on their equipments and electrical installations at home. And finally remember that fire also has a lot of health effects, so it needs to be made in a district of fire management team, physician have to coordinate with health centers in that region, so that the victim can be handled quickly and based on procedure. And finally as a student, a major role in the handling of fire is to have a need for the curriculum of the fire disaster and to be active in campus activities of a medical relief team. With this solution and conclusion, expectation that the rate of the fire case in the city of Makassar can be reduced and the quality of the fire accidents treatmentscan be increased, both from the infrastructure and the victims themselves.

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References: 1. R. Vicky, 2004, Kebakaran, BahayaUnpredictible,Upaya Dan KendalaPenaggulangannya, repository.usu.ac.id/bitstream/123456789/12 81/1/arsitektur-vinky8.pdf 2. Faisal. F, yunus. F , 2012, DampakeAsapKebakaranHutanPadaPernapas anwww.kalbemed.com/Portals/6/10_189Dam pak%2520Asap%2520Kebakaran%2520Huta n%2520pada%2520Pernapasan.pdf 3. JurnalPenanggulanganBencana Volume 3 Nomor 1, 2012, BadanPenanggulanganBencanaNasional 4. JurnalPenanggulanganBencana Volume 2 Nomor 1, 2011, BadanPenanggulanganBencanaNasional 5. JurnalPenanggulanganBencana Volume 2 Nomor 2, 2011, BadanPenanggulanganBencanaNasional 6. PedomanPenanggulanganBencana, 2005, bnpb.go.id 7. ProfilKabupaten Kota Makassar, 2004,ciptakarya.pu.go.id/profil/profil/timur/s ulsel/makassar.pdf

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8. KebakaranPasarSentral Makassar KerugianDitaksirMencapai Rp1 Triliun, 2011, http://www.seputarindonesia.com/edisicetak/index2.php?option =com_content&task=view&id=409264&pop =1&page=0 9. Fire and Disaster Management Agency, 2012, http://www.fdma.go.jp/en/ 10. K. Sheila, Burn Wound Infections, www.worldburn.org/documents/hospitalburn care.pdf 11. C. Deirdre, E. Sameer, O. Reid, 2006, Burn Wound Infection, http://www.ncbi.nlm.nih.gov/pmc/articles/P MC1471990/ 12. Bisson J, Andrew M, 2009, Psychological treatment of post-traumatic stress disorder (PTSD) 13. P. Christopher , L.Cynthia, G.Gia, S.Besa, 2010, Risk Factors for Posttraumatic Stress Disorder Among Deployed US Male Marines 14. Bisson J, Andrew M, 2009, Psychological treatment of post-traumatic stress disorder (PTSD) 15. DinasPemadamKebakaran Kota Makassar

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Comparison of Indonesia’s National Guideline and IASC Guideline in Psychosocial Management Post Disaster : A Scientific Review Abinisa I. Taim, Adhitya S. Ramadianto, Eka S. Nugraha, Gladys, Marco C. Michael, Yasser Jayawinata AMSA-UI Introduction Indonesia is an archipelago country of 17.504 islands and it sits in the volcanological hotspot called the Ring of Fire. Its population are spread from the westernmost island of Weh to the wilderness of Papua in its easternmost border. Approximately 240 million people calls the archipelago home; however, its population is not evenly spread among the islands. In 2011, Indonesia experienced 1598 natural disasters, dominated by hydrometeorology disasters such as flood. The disasters caused numerous deaths and forced people out of their homes: not less than 50 thousand houses were damaged.(1) The drastic increase of disaster frequency and its growing impact necessitates the Indonesian government to establish Badan Nasional Penanggulangan Bencana (BNPB) or National Disaster Management Agency in 2008. The agency cooperates with Ministry of Health and Ministry of Social Affairs to enact policies and take actions regarding disasters. As disasters affects many aspects of a victim’s life, the term ‘disaster’ can be defined in various ways. It is generally agreed that a disaster is “any community emergency that seriously affects people’s lives and property and exceeds the capacity of the community to respond effectively to the emergency”. (3) In the US alone, 15% of females and 19% of males are exposed to any disaster at least once in their lifetime. Consequently, the effect of disasters on the health of its victims and the community is never to be underestimated. (2) Post-traumatic stress disorder (PTSD) is one of the health consequences of disasters. Accordingly, it is the most studied psychiatric disorder in the aftermath of a disaster, although other psychopathologies do exist and not to mention the functional impairment that follows. (2,4) With the frequent disasters hitting Indonesia, PTSD is a major problem and being a psychiatric disorder, it can go undocumented and underappreciated.

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Thus, we conducted a review of policies regarding disaster management with a focus in mental health, especially in preventing and managing post-traumatic stress disorder. We explored the implementation of policies established by the Indonesian government and assessed whether those policies are in line with international guidelines in managing PTSD or psychiatric disorders in general. Through this study, we aim to formulate suggestions in preventing PTSD in future disasters. Methods To fulfill our aim, we conducted a review of policies enacted by the Indonesian government. The policies come from the BNPB and the Ministry of Health through its Minimum Standards of Health Problem Management in Disasters and Refugee Management. To put those policies in a global perspective, we also reviewed international standards made by InterAgency Standing Committee (IASC), the coordination for humanitarion efforts by UN and non-UN bodies. We compared the views reflected in those policies on mental health, including definitions used, the indicators set to assess the policies, and the implementation of policies in real situations. The review was conducted in September 2012. Results In this paper, we use the data collected from governmental organization, such as the Ministry of Health and also Badan Nasional Penanggulangan Bencana (BNPB). These data will be compared to the data from WHO in dealing with mental health and psychosocial support in emergency settings under the InterAgency Standing Committee (IASC). According to the 1357 / Menkes /SK / XII / 2001 Ministry of Health’s Minimum Standard of Health and Refugees Management due to Disaster, the definition of the psychosocial management is post-traumatic stress

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management through various forms of counseling in the field. Currently there is no indicator of this program. However, the Ministry of Health stresses the point of education, guidance, and counseling after the disaster. These will be done by authorities or trained field agents. Counseling will be done in big groups consisting of more than 20 people each. Experts in psychology are needed to guide the victims. Further management of post –traumatic stress patients can be done or can be referred to local health center, psychology clinic, hospital, and asylum.(5) Other policy made by one of the Indonesia’s leading field agent, BNPB defines post disaster psychosocial management as aid given to the people with the aftermath so that they can function normally. In the year of 2008, BNPB made standard guideline of the management. There are two indicators of this program, which are functional and psychological indicators. Functional indicator stresses out the normal function as it is hoped that people may perform normal family function, perform normal community function, and perform the activities as it was before the disaster happened. Psychological indicators include acceptance of the disaster, managing emotion and psychological wounds due to the disaster, feeling free from anxiety and stress, managing the psychological burden so that it does not interfere the mental health. The activities done to fulfill these are individual or group counseling, psychosocial activities, training, psychological education, and it is needed to consider the characteristics of the community, local culture, and local beliefs. In the field, not only BNPB will work by themselves, but they will be helped by other related organizations. Coordination will be done in national scale and also with the local community leaders. This can be done in various settings, including school, hospital, etc. (6) According to Inter-Agency Standing Committee (IASC) by World Health Organization (WHO), holistic health is one of the most important thing in handling an emergency settings like in a post-disaster condition. Holistic health here means that we also have to think about psychosocial health instead of physical health and based on these

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reasons, IASC make a guideline on mental health and psychosocial support in emergency settings. (7) In this paper, we have a comparative study between what Indonesian government has done and IASC Guideline in handling a psychosocial trauma post-disaster. In this IASC Guideline, we can see that the main indicator is how to make a holistic function of disaster victim is going well as before that got the disaster part in their life and press the point of core mental health more as a supportive help for the holistic function itself. Based on comparation in principle of doing a post-disaster management, IASC has emphasized some principles of procedures, such as human rights and justice, participations from affiliated parties, a do no harm concept, developing on the available resources and capacity, building in an integrated support system and a layered-system support. Meanwhile, in reality, there are several principles that we can’t or never do in managing a post-disaster condition. For example, sometimes, BNPB or another national disaster management organization can’t have a great integrated support system with another parties or organizations, such as fire brigades, police, etc. IASC Guideline also have some point of activities in managing a psychosocial trauma post-disaster, such as great coordination; an integrated system of examination, monitoring and evaluation; tight protection of human rights; using resources around the affected areas effectively; doing a sustainable mobilization and community support; cooperating with medical staffs for a great medical services; giving education for sustainable mental health and holistic function and also spreading information to all over the affected areas or even all over the world. Nevertheless, in Indonesia, there are some activities that maybe missed from a postdisaster management because of several reasons, such as lack of specialized staff or even lack of transportation modals. Discussion In this paper, we compared available guidelines on the management of psychological aspects after emergency situations or disasters. Data collected from governmental organization, such as the Ministry of Health and also Badan

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Nasional Penanggulangan Bencana (BNPB) that works directly under the president’s command, along with non-governmental organization (NGO) from WHO. WHO itself has published one of the most comprehensive guideline in dealing with mental health and psychosocial support in emergency settings under the Inter-Agency Standing Committee (IASC). Thus, we will identify the guidelines from IASC and whether these guidelines are implemented in the makings of guidelines from BNPB and the Ministry of Health. All three guidelines includes the provision for mental health support in the face of recent disaster; they do offer different perspectives for such psychosocial management for posttraumatic condition. IASC uses the composite term “mental health and psychosocial support” in its guidelines. The term clearly describes that the support can come from local sources or from outside as long as it is aimed “to protect or promote psychosocial well-being and/or prevent or treat mental disorder. which is done by local sector or outside in promotion of psychosocial welfare and prevent and manage the mental disturbances”. The aims of the guideline as a whole also explicitly states its goals in preventing and managing mental disorders. In BNPB policy, psychological recovery is part of a post-disaster rehabilitation program which encompasses all aspects of public service in the vicinity of disaster. Its main goal is to achieve an adequately functioning government and public life. The policy does not explicitly demand preventive measures for psychosocial disturbances; rather, it calls for support only when problem actually arises. In a similar note, the Ministry of Health Guideline describes psychosocial management as post-traumatic stress management through different types of counseling on the site of disaster. This narrow definition excluds other interventions such as pharmacological therapy. This guideline runs the risk of not providing complete management for victims who cannot be managed by counseling only. Differences can also be found in the indicators used to evaluate the management. In IASC, the indicators are quite generalized. It is understandable because IASC is a coordinating body for various agencies in and out of the

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United Nations and thus, its guideline must allow for flexibility to adapt to local conditions. Its two main indicators are core mental health, and psychosocial support and common function across domains. In contrast, the BNPB indicators are more elaborate, and categorizes the indicators into two major groups: functional and psychological indicators. Consequently, the BNPB guideline are more practical to use in times after a certain disaster as it clearly states what needs to be assessed, such as normal family and community function, and acceptance of the disaster while being free from anxiety and stress. The guideline from Ministry of Health lacks any indicators, thus making it impossible to objectively assess whether the policies in psychosocial management actually reach its intended goals. Nevertheless, it should be noted that even without indicators, the guidelines may still prove effective. In the procedure criterion, the IASC has several principles in performing its humanitarian duties. Those principles are to be followed in conducting activities, which spans the range from coordination and education, to providing medical service. The activities itself includes multi-platform management, which includes examination, monitoring and evaluation, community support, resource utilization, medical service, education, spread of information, and coordination with human rights protection. As a result, the healthcare workers can disperse in these fields and ensure a holistic approach in dealing with post-traumatic victims. In contrast, both procedures from BNPB and Ministry of Health only demands counseling and psychoeducational activities for the management of psychopathology. Again, the heavy emphasis on psychoeducation comes at the expense of other types of treatment, especially pharmacological. PTSD patients may actually need psychiatric drugs to control their symptoms and to function normally. Providing only counseling may result in the incomplete treatment of PTSD patients. While BNPB branches out the counseling activity into individual or group counseling, training, psychosocial activities and education, the guideline from Ministry of Health only listed education, guidance, and counseling by authorities, trained volunteers or government

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agents as their activity for psychosocial management. These approaches that only emphasize on the education and counseling of the victims might be ineffective for those who are suffering from post-traumatic stress disorder (PTSD) that require pharmacological support, and other medical services. IASC guidelines possesses an extra aspect in designing its activities, which the BNPB and Ministry of Health guidelines lack: genderaware post-disaster assessment. In IASC, the key of recovery process lies in whether the healthcare workers recognize the distinct needs of both men and women in their priorities and interests. There is also widespread belief that women play pivotal roles in the recovery process after a disaster event. Adequate psychosocial support can reduce the risk of women from having resort to survival strategies that include prostitution, which expose them more to human rights violation. Finally, assessment on the implementation of the guidelines was done. The IASC guideline can be used by all humanitarian actors, community-based organizations, UN organizations, NGOs, and government authorities that operate in emergency settings at local, national and international levels. As the IASC guideline is intended for all countries worldwide, certainly with local adaptations, it can be used as a reference for governmental organizations in Indonesia in formulating local guidelines. Therefore, implementation of the IASC guideline can be reflected on whether other guidelines abide to IASC guidelines. BNPB guideline implementation is through psychosocial recovery program that is carried out by its provincial branches (BPBD), or by the regional governments themselves if needed. Coordination is done in the national scale, and community leaders are invited to help. The settings vary from school, hospital, and other relevant community centers. In the Ministry of Health guideline, implementation is through education, guidance, and counseling in a bigger scale and by psychologists. As it is published by the body that regulates the national healthcare system, the guideline also provides the referral of PTSD patients to primary health centers, psychology clinic, general hospital, and mental

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hospital. The implementation from Ministry of Health guideline is the most practical compared to other guidelines, and it clearly states the referral of PTSD patients that other guidelines lack to mention. Clearly, both BPNB and Ministry of health guidelines lack some aspects, but if combined they will complete each other. Conclusion Indonesianâ&#x20AC;&#x2122;s policies regarding mental health management post disaster have similar purposes and implementations as the international policy ( IASC ). However, some indicators need to be further explained. We also suggest that preventive methods as stated in IASC should be done to prevent any Post Traumatic Stress Disorder to the victims of disasters. Not only that, gender â&#x20AC;&#x201C; based psychological management needs to be developed in Indonesia because each gender has different psychological needs. Further management other than education and counseling should also be done. Follow up to the victims after the disaster should always be done to prevent further complications. The volunteers or the workers in the field should always be briefed about these standards and how important it is the psychosocial management and to prevent Post Traumatic Stress Disorder. These are done to provide more holistic management for the victims As medical students who have more medical knowledge compared to others, it is our job to give back to the society. We are often asked to be first responders on site of the disaster. Here, we must understand the importance of psychosocial management. We should always conduct physical examination related to mental health of the victims so that we may monitor the occurrence of depression, PTSD, or other mental health disturbances on the victims. As for the standards of management, medical students should always help the government in understanding what should be done on site. We should always inform the authorities when the standard is lacking or when it is not enough in managing the victims or when it is not feasible. References 1. BNPB. (2011). Statistik Bencana. Retrieved from http://www.bnpb.go.id/website/asp/berita_list.asp ?id=704

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2. Neria Y, Nandi A, Galea S. (2007). Post-traumatic stress disorder following disasters: a systematic review.. Journal of Psychological Medicine, 1-14 3. Kano M, Wood MW, Siegel JM, Bourque LB. 2010. Disaster Research and Epidemiology. In: Koenig KL, Schultz CH. Koenig and Schultz’s Disaster Medicine: Comprehensive Principles and Practice. 1st ed. Cambridge University Press,. 4.Hussain A, Weisaeth L, Heir T. 2011. Psychiatric disorders and functional impairment among disaster victims after exposure to a natural

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disaster: a population based study. Journal of Affective Disorders, 128:135-141. 5. Departemen Kesehatan. 2001. Standar Minimal Penanggulangan Masalah Kesehatan Akibat Bencana dan Penanganan Pengungsi. 14 6. Badan Nasional Penanggulangan Bencana. 2008. Peraturan Kepala Badan Nasional Penanggulangan Bencana Nomor 11 Tahun 2008. 7. Inter-Agency Standing Committee. 2007. IASC Guidelines on Mental Health and Psychosocial Support in Emergency Settings

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Scientific Poster

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FILM Think Faster than Tsunami Anggadha Saputra, Yurike Mandrasari, Amanda Andhika, Dea Nathania Indonesia is a country that prone to natural disasters. In 2004, Indonesia stroke by the giant wave, Tsunami. According to the U.S. Geological Survey reaches 283,100 dead, 14,000 missing, and 1,126,900 people homeless. According to the UN, 229,826 victims missing and 186,983 people were killed. This made the Indian Ocean Tsunami to be the worst earthquake and tsunami in the last 10 years. Arise from the problem faced by Indonesia, we, medical students; try to generate some ideas to raise people awareness of Tsunami. We made a short movie to help people recognize the signs of tsunami. By knowing the signs, we hope, people will understand what they are supposed to prepare before Tsunami happens.The signs are: 1. Animal sensitivity: which shown by bird migration 2. The receding sea 3. The tsunami siren

Plan|Essential Aji. R.P., Arifiani, K., Marsudi. B.A., Wikantyasa. A.

Events leading to disaster might strike anywhere, anytime. Over the past years, many events have occurred around the world leading to disaster at various severity and devastation. That includes our country Indonesia, which lies in the Pacific Ring of Fire, making it very prone to natural phenomenon of earthquake and volcano eruption, which leads to many disasters over the years. As Indonesia and the world moves towards future, the rate and severity of disasters will only continue to worsen. If nothing is done to better prepare society for future disasters, the world will continue to encounter an equal or greater devastation from disaster. Much effort and money has been spent in actions and programs that focus on the response capacity of disaster. Through the development of social media, a paradigm developed that voluntary action after disaster occurred to be something everyone should do, without any kind of training, nor continued by a recovery plan and evaluation. Where in fact, the most effective way to minimize damage and impact is through planning effective prevention, preparedness and understanding the basic framework of disaster. Which is why our video aims to raise public awareness about the steps of actions that can be taken to prevent unnecessary losses and unnecessary help. Our video’s information content is taken form the Oxford Text Book of Public Health. The book collaborates with WHO guidelines and simplifies the framework through 4 major categories namely: capacity building, assesment, coordination and filling in the gaps. Our video “Plan|Essential” brought 2 main concerns: “Awareness” and “Plan”. In order to design and execute an effective disaster prevention plan; all layers of society must be actively involved. This is depicted by the 4 distinguishable characters namely a businessman, an artist, a religious

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figure and finally a medical student. All these 4 characters upon hearing the news of disaster, showed no hesistance in taking action, this represents the need for “Awareness” and action. On “Plan”, we want to show the fact that merely the willingness to help is not enough. In fact, to bring the biggest benefit we need to design a plan through the framework, which is something simple, and everybody within the layer of society, could and should participate to uphold it. In conclusion we hope the ideas in the video can be embeded within each and every viewer to give a wider scope of knowledge and a bigger sense of responsibility in planning for future disasters. Learning From The Past, Give The Best Future Chrisandi Yusuf, Anggoro Satrio, Khrisna R.P, Puspita W, Elmi Alfia M. Universitas Brawijaya Malang This movie is starring a boy named Sandi, he is a victim of an earthquake disaster 4 years ago. One day when he was doing his homework, he found a photo of his family, it makes him remember how his parents and beloved sister died. Back then, BNPB officers came to his house to offer a traning and socialization about how to stay safe when earthquake comes, but unfortunately their parents refuse their offers, and drive away the officers. Suddenly, and earthquake came, and Sandi couldn’t open his room door, and he hide under his desks while holding his head, after the earthquake stopped, he found his parents and beloved sister dead, that made him mentally down for a few months. After that, he was adopted by his uncle, and he started to share how he survived the disaster, it named “ drop, cover and hold on + stay calm “, he made seminars in order to tell people to make sure that they didn’t have the same incident like him. MERAPI’S ERUPTION MANAGEMENTS Felix Evanda , Andre Stefanus Are you ready for something big? A breathtaking natural beauty. An awesome scenery ever. It's Merapi. Mount Merapi, the life core for our people. Feeding the population by giving its best volcanic land, and also the sand for the miners. Who knows, it can also kill people and destroy whatever is built in its surroundings. The eruption happens every 3-5 years, spitting out the hot lava and cloud heat which result in ash rain. The biggest eruption happened in 2010 and the impact was not small. Acute respiratory infection attacks the population, but the saddest thing is the many death and the pain that remains in everyone' heart. So... should we just stay in silent? NO ! We can work it out and give a helping hand How? Disaster management is the answer. BRAINs |

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Disaster management for civilians near the Merapi location consists of THREE things to consider in THREE different times. 1. Pre-disaster management which includes prevention and time estimation of the disaster. In this step, volcanic activities is always being monitored so that time estimation will be accurate and also the disaster awareness training routinely done by SAR's team before the disaster happen. 2. During the disaster management is more to the emergency things, it includes victim rescue, triage, and victim evacuation. The medical team has to be well-equipped with health care service to prevent the disease. 3. Post-disaster management has 2 components, which are the rehabilitation of the victims and the environment. Rehabilitation is curing psychological and physical trauma of the victims. While, environment rehabilitation can be done by cleaning the houses, translocate the victim of cloud heat, and also planting trees. Is that all ? Absolutely.... NOT ! Society awareness is the key of everything... So, keep aware and always remember, Prevention is better than cure :) Film 005 Disaster is something people want to avoid. Vulcanoes, earthquakes, tsunami, or even flood and fire. It is someting people would choose not to experience. But we know we can’t do that. But at least we can prevent it. Or when it happens, we can heal. Heal those who experienced. Who need to be healed. Both physics and soul. Just like the last fire catching out at Karet Tengsin. Hundreds of houses were burnt, hundreds of people were suffered and homeless. Many sleep on the nearby local apartment, but most sleep on the graves. The victims are not just adults. There were kids too, which is heartbreaking. Because they lost their home, and their playing field. They were hurt, they might need all those stuff that can be bought by money, but what about their feelings? But still.... There are still people who care. The people of tomorrow. Film 006 Ajeng Dias Puspitasari, Dea Nathania, Ni Made Maya Purnama Wulandari Tsunami is one of the natural disaster that cause a very huge damage. Most tsunamis, about 80 percent, happen within the Pacific Ocean’s “Ring of Fire,” a geologically active area where tectonic shifts make volcanoes and earthquakes common. In Indonesia, tsunami happened in Aceh in 2004 and was the biggest tsunami along the history. That tsunami destroyed almost all the buildings and caused 105.252 deaths of people. This video shows a replication of how a tsunami can destroy a beautiful town in just a few minutes, how is the condition of the victims when tsunami happens, how it affects the victims, how the helps come after the disaster, and the phenomena that the helps always disappear gradually a few months later, whereas the victims

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usually still have trauma that needs to be taken care, and their houses, the buildings, and the facilites hasn’t been fixed completely. The helps are usually getting less and less as the time goes by. In fact, what the victims need is not just an emergency care, but also a longterm and routine care. This video was made in order to make us, as a health provider, realize that we must not only give an emergency care, but also a longterm/routine care to the victims of disaster, because they are humans that need to be treated as a whole ,their suffering, especially the post-disaster trauma, not only happen for a while, but it can be happen for the rest of their life. SNOOZED Reno Prananditya Ashaf & Aditiawan Indrawanto Natural disasters are qualified as one of the main common threats to our daily life. It causes huge damage to infrastructures, lives, and mental health. But as the earth grows, technology has made it possible for us to dig deeper. It is not impossible for us now to study and roughly predict on when it will hit, how big it would be, and measure the impact. Although it is uncontrollable, researchers had found ways to not to avoid it one hundred percent, but to suppress the damage that they cause. The detailed studies on these disasters are not kept secret. It has been provided and could easily be accessed by everyone, worldwide. Yet, the problem is that there are still huge numbers of populations in this world that does not have the proper knowledge on natural disasters, while knowing how information could easily be accessed on this era where internet is one of the simplest source for example. This video was not intended to provide solutions to a specific natural disaster management. The main objective is to remind the audience that the informations are always there, on standby, continuously expanding and it’s waiting to be read. Of course, before its too late. Nutrition Consideration for Disaster’s Long Term Medical Care Anneke Wulansari, Karina Muthia Shanti, Rizti Medisa Aqsari Faculty of Medicine, University of Brawijaya Indonesia is the biggest archipelago which resides in all along ‘Ring of Fire’ area. Because of this geographical condition, Indonesia often experiences volcano eruption. The Krakatoa eruption in 1883 gave massive impact to universe. In 2010, Indonesia was shaken by the eruption of Mount Merapi that took about 170 tolls and there were more than 305.000 refugees. Despite of medical treatment, food service and nutrition consideration are the prominent things that cannot be aside of. Emergency feeding is given in order not only to satisfy the hunger, but also fulfill the nutrition needs. Emergency feeding with nutrition consideration is needed by refugees to sustain their life-span and maintain good health for a long time during and after the recovery phase. Due to Indonesian Health Department Guidance, rescuing stage in disaster management divided into 2 phase. First phase takes place maximum until 5 days, it refers when the disaster recently happens. The evacuation mostly aimed to survey the vulnerable group, such as infant, children BRAINs |

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below five years old, pregnant and lactating women, also the elderly. Emergency feeding plan does not made specifically, so all the age groups get the same type of food, then the infant still fed up with breastfeeding or complementary feeding. The establishing of public emergency kitchen done with minimal standard according to Social Department. When the evacuation has been completed, it meddles in second phase. The emergency feeding plan has became more detail and the supply of food has available. The next phase is the recovery emergency phase, started at least 20 days from the refugees’ first came. This phase’s made up to solve malnutrition through intervention by the medical workers. Intervention is done due to emergency rate of malnutrition. The stagees are assessment; diagnosis; intervention; then monitoring and evaluation. So, the victims of disaster should be rescued not only at that time but also as time passes. Monitoring and evaluating the nutritional status of the victims is needed, in order to prolong their life. KNOW DISASTER, NO DISASTER Schoollaus Daleru, Yunia Anggun Kumaladewi Faculty of Medicine Tarumanagara University Over the past decade, about 258 million people have been affected by natural disasters worldwide every year, and the deadliest disaster in history was caused by an undersea earthquake in the Indian Ocean on 2004 followed by 100 foot tsunami waves. More than 225.000 people were killed in 11 countries. There also other kind of major disaster, such as volcano eruption, typhoon, flood, and fire. The movie begins with philosophical sceneries which represents daily common life activity along with the writer’s voice as the narration that tells audience about their actual condition in every single non-disaster day. This first part leads the audience to the second part which shows what disaster really looks like, in order to make them realize the difference between the daily ideal conditions with when the disaster happened. The third part of the movie shows the after effect of the disasters. This part contains the information about what should audience do right before and while disaster happens, or what we called as “response phase”, which are: recognize the hazard sign, aware the disaster warning, go to evacuation area, and follow the safety instruction. The fourth part begins with some motivational scenes to encourage audience, continued with information about what should they prepared before disaster happened (preparedness phase) and what should they do after disaster happened (recovery phase). Preparedness phase includes: have a place to escape, develop emergency plans, secure their home, and know the emergency numbers. While recovery phase includes: rebuilt homes, business, & infrastructure, and makes sure that they prepare for the next disaster. In the end of the movie, audience is reminded that disaster may strikes without warning. If they know how to deal with disaster, they will be spared from it. The movie includes some of major disasters instead of focus only on one specific disaster, due to effectiveness of the movie. It explains what they should do in the face of any kind of disaster. Presented with the splendid and clear visual effect, with clear and effective messages, and enormous back sounds, the movie is worthy to be presented to the public as a campaign disaster movie, as the movie would bring a great impact to audience, and risen their awareness on

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disaster, whether to help them preparing for the disaster in future, or providing better support for disaster survivor return to activity daily living as soon as possible. PLAN FOR THE INEVITABLE FUTURE Nuralisa Safitri Indonesia is a disaster prone country due to its unique geographic position, where four global tectonic plates i.e. the Eurasian, Indo-Australian, Pacific and the Philippines plates meet each others, resulting in high seismic and volcanic activities in many parts of the country. The deadliest disaster occurred in early XXI Century also happened in Indonesia. On 26 December 2004, a big earthquake struck in the sea near Simeuleu Island, west of Sumatra Island. The earthquake triggered a tsunami that later killed more than 225,000 people in eleven countries and devastated coastal areas in the countries it affected. During the XX Century there were only few disasters with massive victims like the 2004 tsunami. In Indonesia alone the earthquake and tsunami killed around 165,708 people and affected a loss of over Rp 48 trillion. This tsunami has ended, but we can’t guarantee that it won’t happen again. Tsunami is only one of natural phenomena that have been turned into disaster which might occur in the next day because we can’t tell when the disaster happens. There are many kinds of natural phenomena in Indonesia beside Tsunami, Indonesia has land-slides, volcanic eruption, earthquake, flood, tropical storm, small tornadoes etc. All these are natural phenomena that have occurred throughout the history of humankind. However, rapid population growth, environmental pollution and degradation, and increased poverty, have all contributed to turning these natural phenomena into disasters that cause enormous losses in human lives, infrastructure, and material belongings. All these devastation should be prevented. Disasters are inevitable but the devastation is not. From the fact above, it shows that Indonesia must have an excellent disaster management system. By this movie, first of first we intend to raise awareness of people in Indonesia that disaster can happen anytime and anywhere, so we need to be prepared for that and secondly, we intend to raise awareness of the government and the national coordinating board for disaster management in Indonesia that there are many aspects still need to be maintained. We shouldn’t be concentrating in emergency care only but also the care afterwards and even the care before a disaster happens. This is our responsibility together as one united, Indonesia. Synergism of Individual and Community Effort to Reduce Loss from Flood Dewa Ayu Megayanti , Athaya Febriantyo Purnomo, Nurul Cholifah Lutfiana Medical Faculty of Brawijaya University

When the flood happened, there will be many financial loss which occurs both to individuals and governments. Those loss includes loss in terms of psychology, economy, health and others. In terms of economy, that loss can include loss of household furniture, securities, etc. which will join drifting on the flood. In terms of health, flood somehow followed many cases, for instance diarrhea and other diseases that could be life-threatening. Moreover, when flood happened at that time, food and drug will be very difficult to obtain because they left behind at home or maybe

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building that affected by floods. Many loss occurs during the flood often due to lack of vigilance and the readiness of individuals and groups to face that disaster. Actually the government in Indonesia has already publish programs include disaster relief, to cover and to reduce losses from flood. The government itself more concern toward preparing to rescue victims in order to save the people namely, the logistic , while the step that related to the preparation with flood itself that carried so many victims have not been much published. In addition, the independence and individual and community awareness is essential in this effort as well as flood protection efforts to reduce losses that occur due to flooding. This video is meant to increase improving self-reliance, awareness, readiness of each individual in society in order to prevent the flood, and also to urge the others who are not exposed to disasters also provide their hand. Because of that condition, we will use the preventive efforts of the campaign HOPE for disaster medicine. H for Health Management, O for Own responsibility. Health management and Own responsibility is come from individuals that have prevention effect both of prevent the flood and prevent further losses. P for psychological support, E for Environmental repair come from another hand to support and repair psychological and environment aspect that damaged by the flood. Also, we use threat method to make them aware about this. Due to the disaster, we should not only rely on the help of others, but we must start the preparations as well as from yourself. So if both of these things can be read by well, hopefully there will be a synergy between individuals and other groups whose results would be better in an effort to prevent and to decrease the loss due to the number of disasters that occur.

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Public Poster High Five Against After Flood Diseases Ervina Rosmarwati, Tita Dwi Cahyaningtyas, Khrisna R.P. Universitas Brawijaya Malang, Indonesia

This poster is made to convince the victims of Flash Floods all over the world to keep their awareness after the disaster. Many diseases can happen, therefore the prevention should be taken. Here are the steps : 1. Wear mask whenever going to crowded place or evacuation area. This is to protect us from URI (Under Respiratory Infection) 2. Ask the doctor about illness that you feel after the flash floods 3. Take clean water for drinking, cooking, bathing, and washing clothes to prevent diarrhea and dermatitis 4. Evacuation to higher place is important to avoid humidity which can causes dermatophyte infection 5. Repellent daily to keep the Aedes Aegypti away.

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No Mask No Protection Ervina Rosmarwati, Tita Dwi Cahyaningtyas, Khrisna R.P. Universitas Brawijaya Malang, Indonesia

Indonesia has many volcanoes. The activity of some volcanoes are dangerous. We have ‘Merapi’ and ‘Bromo’ for example. Their activity were increased rapidly. When volcano eruption happened, volcano materials came out from the top of the mountain contains big rocks, fire, sulfur, and hot clouds. Hot clouds are very dangerous. The speed is about 200-300 kilometers/hours and the temperature is more than 600 degrees Celcius. We have to keep away from the hot clouds, besides that we also have to protect ourselves with mask. We suppose to wear mask everyday after eruption time. This is to protect ourselves from free radicals and harmful substances of hot clouds. If we don’t use mask, then we have high risk to suffer from URI (Under Respiratory Infection), skin iritation, eye iritation, dyspneau, or even death. Therefore, it is really necessary to convince the people to use mask for protection.

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Healthy Soul for Brighter Life Ervina Rosmarwati, Tita Dwi Cahyaningtyas, Khrisna R.P. Universitas Brawijaya Malang, Indonesia Terrorism is common lately in Indonesia. Many bomb explosion have been reported. One of the biggest bomb was exploded in Bali Island on 2002 and 2005. Hundreds people passed away, many people loose their family and friends. Psychological trauma/stress were left for the people who live there and the foreign tourists. From this poster, we would like to make them free from the psychological trauma by convincing them that only a few people have the mission to kill. Hundreds victims were passed away and a thousand people become eyewitnesses, but there are millions people outside there that want everyone in Bali to live longer, healthier, and happier. We all hope people in Bali will have their spirit and psychological health back, then they will ready to face brighter life

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tsunami? raise our awareness for future happiness! Ervina Rosmarwati, Tita Dwi Cahyaningtyas, Khrisna R.P. University of Brawijaya Malang, Indonesia Tsunami caused the biggest victims in Indonesia's history as a tremendous disaster. This poster is made to raise the awareness for all people in Indonesia. Aas we know tsunami happened 2 times in Indonesia, tsunami of Aceh and North Sumatera in 2006 and tsunami of West Java in 2009. These two tsunami caused the biggest victims in Indonesia compared to other disasters (flash flood, earthquake, landslide). Tsunami awareness is important to avoid increasing of the victims and damaging of many infrastructure and buildings. We offer three steps to cope that issue: 1. Education and training about tsunami Education and training by the government of Indonesia, involving profesional personnels from all over the citizens. This is especially to educate the people who live near the ocean and those who ever be the victims of the past tsunami to increase their knowledge about facing tsunami, so they will be more prepared in case of tsunami attack in the future. 2. Cooperation between community organizers All of community organizers from all areas should be united as one to handle after tsunami problems, for instance, medical problems, education problems and infrastructure problems. These can be realized dividing task for community organizers based on their speciality. Medical personnels handling medical and mental problems. Technician experts handle infrastucture problems, government handles the rules and policy for citizens to make them know and taking steps against tsunami attack and also preparation before tsunami including evacuations, so the amount of the victims can be minimized even there will be no victims. 3. Environmental management and protection Tsunami can't be predicted because it's pure natural disaster, but we can minimize the damage because of it. We can plant the plants in the side of seashore to prevent the wave of tsunami and drainage in the city system for second protection so the wave can flow and it doesn't make a big damage. So, it can minimize the number of victims and infrastructure damage.

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Help Yourself, Help Others. Christian Julio, Eliana Susilowati, Cathrine Theodora Sukotjo Medical Faculty of Brawijaya University, Malang There have been quite lots of incidents which could be categorized as disasters happening recently throughout Indonesia. Among these disasters, those with the highest possible damages and the most probable to commonly take place are natural disasters. Indonesia, being a country with hundreds active volcanoes on land and active plates moving under the ocean, is considered never actually safe from destructive natural disasters. To be sure, during the last 6 years, the disasters occurring through that period are potentially called dangerous and very harmful for people living in the affected areas. In December 2006, an extremely gigantic earthquake and tsunami in Aceh still can be clearly remembered and the worst effects it had left can also be found up to now. Another proof is the volcanic eruption of Mount Merapi in 2010 which had made several villages deserted and forced thousands of people evacuating themselves to more secure areas. Looking at this critical situation of Indonesia, it is very urgent to prepare everyone with certain method to anticipate the possibility of disaster. From past history of several disaster managements, troubles from unprepared volunteers can still be pointed out. Large amount of willing workers were involved in the efforts to reduce disasters’ bad impacts, but many of them did not prepare like professionals do. They just came down to the damaged areas without bringing any required equipments which are useful both for the sake of their safety and their ability to provide medical aids though threats among us and like what old proverb said “ he who fails to prepare , prepares to fail “. So, in the end, those people did not really come to assist and even can burden the real professional teams working there. Our poster catches this crucial requirement and thus we try to deliver such an important notice in an easy way. Our poster shows a volunteer who wants to help volcano earthquake disaster, and he is remembered to prepare some equipments and items need to be brought for his own safety. Hopefully, as a result of this small act we do, many Indonesian volunteers and workers, especially medical officers, can improve themselves and , in the end, have better consciousness for their safety before helping other, so they can help people safely and efficiently .

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Be Calm Protect Yourself during Earthquake Shaking Drop, Cover, and Hold On Muhammad Hafidl Hasbullah, Lailatul Purwasih Putri, Jurita Purnama Sari Brawijaya University

Indonesia as a country where often happen earthquake. Our past experience in earthquakes may give us a false sense of safety, we didn't do anything, or you ran outside, yet we survived with no injuries. Or perhaps we got under our desk and others thought you overreacted. However, we likely have never experienced the kind of strong earthquake shaking that is possible in much large earthquakes: sudden and intense back and forth motions of several feet per second will cause the floor or the ground to jerk sideways out from under you, and every unsecured object around us could topple, fall, or become airborne, potentially causing serious injury. This is why we must learn to immediately protect ourself after the first jolt. don't wait to see if the earthquake shaking will be strong! In MOST situations, we will reduce our chance of injury if we: DROP down onto your hands and knees (before the earthquakes knocks you down). Drop to the floor. This position protects you from falling but allows you to still move if necessary. COVER your head and neck (and

your entire body if possible) Take cover under a sturdy desk or table.under a sturdy table or desk. If there is no shelter nearby, only then should you get down near an interior wall (or next to low-lying furniture that won't fall on you), and cover your head and neck with your arms and hands. HOLD ON to your shelter (or to your head and neck) until the shaking stops. Hold on to it firmly Be prepared to move with your shelter if the shaking shifts it around. This public poster is showing how we can survive from earthquake. This poster focus on children who still don’t have independency to protect theirselves, especially in Indonesia which often happen of disaster. The background of this poster is black/greenboard, which symbolize of the school term children. The 2 children icon are indicate that this poster is a poster aimed at children. In this poster also shows some slogan to inform and raise awareness of children to earthquakes. BRAINs |

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Take Your Mask! Protect From Respiratory Illness Muhammad Hafidl Hasbullah, Ludya Wahyu Pratiwi Brawijaya University Merapi is one of the most beautiful scenery. But active volcano is a danger situation. Volcanic eruption is one of the most dangerous disasters in Indonesia that need to be concerned in health-related issue especially are respiratory illness, especially Merapi Volcano eruption which is really dangerous. Many people have died from volcanic blasts of Merapi and the most common cause is suffocation and burn. Merapi spews gases, ash, lava, and rock that are powerfully destructive.. Two main materials that adverse in respiratory illness are volcanic ash and gases. Volcanic ash is harmful. Ash particles contain crystalline silica that causes silicosis, a respiratory disease. Volcanic gas contains sulfur dioxide, carbon dioxide, hydrogen chloride, carbon monoxide, and hydrogen fluoride. Sulfur dioxide cause breathing problems. People who are close to the volcano or who are in the low-lying areas downwind may be exposed to levels that may affect health. Gases can irritate the eyes, nose, and throat. And the higher levels, gases can cause rapid breathing, headache, dizziness, swelling and spasm of the throat, suffocation and finally death. One of the early important preventive steps is wearing a mask. Mask will prevent people from adverse health effects of volcanic eruption and also keep people from death The poster showing a man who have 2 part. One part is a dusty condition as effect of eruption, and other is his shadow when wear a mask. It show the part of our self in 2 conditions and show the importance of wearing the mask. An old dusty paper and Borobudur silhouette is Yogyakarta and Center Jave ethnical symbols. The Yogyakarta and Center Jave are the place of Eruption Spreads. In these province a lot of victims dead and suffer. By this poster will raise the people awareness to wearing the mask.

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Talk Therapy Anggadha Y Saputra, Amanda Andika, Yurike Mandrasari, Dea Nathania Indonesia is a country that prone to natural disasters. Indonesia already owns a special team, which has big number of people involving in it. Yet, the long-term care of post-natural disasters condition hasn’t been noticed very well by the government. We chose “post-traumatic stress disorder” or “PTSD” as our main focus. PTSD is a complicated mental problem that can affect people’s daily activity. PTSD often arises from seeing, hearing, and experiencing a traumatic event, such as natural disasters. By making this poster, we, medical students, suggest several approaches to meet the physiological needs of the natural disasters’ victims. We simplify the treatments of PTSD as “TALK”, because the main idea of the treatment is “talk therapy”, which allowed the patient and the therapist to communicate in order to overcome the problems. Talk therapy consists of two main approaches: Psychotherapy 1. Exposure therapy: This therapy helps people face and control their fear. It exposes them to the trauma they experienced in a safe way. It uses mental imagery, writing, or visits to the place where the event happened. The therapist uses these tools to help people with PTSD cope with their feelings. 2. Cognitive restructuring therapy: This therapy helps people make sense of the bad memories. Sometimes people remember the event differently than how it happened. They may feel guilt or shame about what is not their fault. The therapist helps people with PTSD look at what happened in a realistic way. Medication • Antidepressant: sertraline (Zoloft) • paroxetine (Paxil)

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Proportionate your team, maximize your potential Christian Julio; Catherine Theodore Sukotjo; Eliana Susilowati Indonesia is a very unique country graced with numerous natural wonders and such beautiful landscape. However, those beauty also stands as great opportunity for harm to come. As we know, Indonesia is very famous for having enormous amount of volcanic mountains spreading through the whole country. 240 volcanic mountain in Indonesia are ready to erupt anytime! Indonesia is also a place where the Eurasian Plate and the Indo-Australian Plate collided. The actions of these plates twenty-five thousand years ago created what is now available to be seen as Indonesiaâ&#x20AC;&#x2122;s mountains. These two geologic conditions keep maintaining dangerous possibilities for the deadly natural hazards to occur. such as Merapi, erupted at 5th August 2004 and 25 October 2010, Kerinci, at 22th June 2004, and still many. As a part of management done during or after the disaster takes place, making a good emergency team consists of professional medical and non medical workers is very necessary. With the existence of skillful teams handling the problems caused by the disaster, an immediate and efficient help can be given to the victims. Besides, people who suffer from physical and mental injuries can be relieved soon afterwards. Unfortunately, starting a dependable team with a good teamwork is the main trouble of Indonesianâ&#x20AC;&#x2122;s disaster management. Some cases showed that many disaster management did not have a proportional team. The reason is there are still workers who choose works according to their liking, not to importance or the highest required help the victims needs. Our poster aim to raise the consciousness of medical workers and volunteers from the university about creating a proportional disaster team The unbalanced scale in our poster represent the unbalance proportion of most disaster teams. The heavier part is the example of the fields where many people like to do. In this poster we make an example that medics are more favored, and the other weight that represents non-medics as cooks, drivers lack of people so we place the picture of people with question mark to ask the viewer to fill that role. The volcano picture represent the volcano as one of the most dangerous disaster in our country. The hands below represents the victims that ask for good help which can be provided through proportionate disaster management team. BRAINs |

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ONE PATH FOR ONE HOPE Nuralisa Safitri Sriwijaya University Indonesia is one of the most disasterprone countries in the world. According to UNISDR 2009, Indonesia has the higher number of people living in areas potentially affected by tsunamis in the world (more than 5,000,000), ranks Second in the world (only after India) in number of people exposed to landslides triggered by precipitation or earthquake per year (with more than 200,000) and third in number of people exposed to earthquakes and exposed to drought. The country is also at very high risk of floods. It ranks sixth in the world in number of people exposed to floods per year. During the last century, earthquakes caused 43% of deaths and missing people and landslides 21% and tsunamis 17%. Earthquakes generated 68% of houses destroyed and damaged, floods 18% and landslides and tsunamis 6%. This fact shows that many natural disasters in Indonesia caused death, missing people, houses destroyed etc. Itâ&#x20AC;&#x2122;s our fear that if these children lose their houses, schools or even parents due to natural disasters in Indonesia, they might also lose their hope in the future due to mental and psychological disorder such as post-traumatic stress disorder (PTSD). We need to build a good disaster management which is including four phases: Preparation, Mitigation, Responding, and Recovery. We should think not only about the emergency care but also about the care afterwards. By this poster, we intend to invite all of the target community to work hand in hand for the new start towards recovery for the hope of children. The time to resurge their hope is not the day after a disaster, but from now. This is not only the duty of the Government, but this is our duty together as human being.

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Umbrella of Love Arifiani. K., Marsudi. B. A. Natural and man-made disasters have caused significant harm throughout history. And as time goes by, the frequency and level of devastation caused by disasters will only continue to increase. Disasters not only cause loss of life and property, but also cause tremendous psychological damage, affecting the society and culture of the area. As a result, a common outcome of disaster especially in developing countries is poverty, famine, suicide etc. To quickly combat the acute, devastating harms, both government and non-government organization conduct assessment, identification of needs and lastly prioritization before deployment of an intervention. However, a major problem within these essential key steps lies in the fact that each organization tends to make individual assessments without consideration or even cross check collaborating with others. Besides this, not all levels of society participate within the relief phase. What results is underassessment, and in turn causes a lack of an appropriate intervention to meet the affected society’s needs. Thus, this poster aims to raise awareness on two key aspects. First, everyone needs to be involved. Academics, Businesses’, Community and Government and “You” represent all the layers of society which all have numerous roles to play within in a disaster setting. These representative layers of society give the basic framework of the umbrella. The roles and actors in society make the body of the umbrella giving it great coverage and girth. Secondly and most importantly, all layers of society must collaborate with one another to produce effective interventions and relief to minimize the many harms of a disaster. Collaboration also acts as a bridge that channels and sorts the aid to the victims and meet the appropriate needs. Through this poster we encourage and involve all layers of society to play their roles whatever they may be, without forgetting that collaboration is at its upmost importance to channel the appropriate aid for the affected. Only by playing our roles and collaborating, can we protect the affected and minimize the devastation of disasters.

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Donâ&#x20AC;&#x2122;t Let Everything You Love Turns into Ashes Ahmad Aulia Rizaly & Julia Jolanet Syafrianty Adam AMSA Hasanuddin University / AMSA Indonesia

In 2011, hundreds of fire in residential area occurred. Billions of rupiahs were lost and hundreds of lives were burnt into ashes. Most fires start with small fire, then the fire gets bigger because most people do not know how to handle fire properly. Most people are panicked and lacked of knowledge in facing case of fire. For example, they do not know how to contact firefighter by calling 113 and paramedic by calling 118. This panic and ignorance cause billions of rupiahs and hundreds of lives burn into ashes. In order to answer this call, we make this poster: to educate people about what must be done in case of fire. With effective steps to face fire, we hope people can get our message and apply these steps in their real life. Through this poster, we hope no more husband that losses his wife, no more wife losses her children, and no more children loss their parents in the case of fire.

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Keep Calm When the Earth Starts to Quake RIZNA ARIANI SAID AMSA INDONESIA – HASANUDDIN UNIVERSITY, MAKASSAR

Unlike other countries, Indonesia has not well prepared for facing an earthquake. Most of the citizens do not know what to do about it while we know earthquake strikes Indonesia every year. That is the main reason I made this poster. This poster can be put everywhere, can be seen by everyone. First of all, the best thing to do during an earthquake is: try to stay calm. This may be difficult, but remaining calm and thinking clearly will go a long way toward keeping you and other people safe. Remaining calm can help you to stay focus. For your own safety, when you feel the building or ground begin to shake, remember these steps: DROP to the ground wherever you are – COVER yourself by getting under a table – HOLD ON to something sturdy until the shaking stops. In this poster, I do not only show the problem (shown by picture of panic people running), but I also propose the solutions (shown by the message “Keep Calm” and “Drop – Cover – Hold On”). Since the target of my poster is people in public places, they should understand about the message of this poster by making it simple but clear and meaningful.

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“Learn Not To Burn!” Abstract:Indonesia is part of the lungs of the world as 46,33% of its total area covered by forests. That being said, since 1990, it has been recorded that Indonesia has lost a quarter of the total forest area as a consequance of wildfire, deforestation and mining development. In addition, it is recorded that the population is at 259 million people and are unevenly distributed throughout Indonesia, because mainly are focused in the capital city, Jakarta. People migrate to Jakarta with the hope of finding their dreams to make up a lack of income, however, without adequate knowledge and skills they will go in the opposite direction. This triggers people to live in minimal condition and they have to thrive to survive the day, ignoring their safety and health being. For instance, in an overly densed population of certain parts of Jakarta they use incorrect electricity installation to supply their ‘houses’. These are the reasons that have caused fire cases throughout Indonesia, particularly in Jakarta where the incident increased by 100 cases since early 2012. Thus far, mandate no. 25/PRT/M/2008 (PERMEN PU) that is associated with fire prevention according to the cities districts, consists of two main points of appcroach: 1. Fire management; 2. Fire hazard analysis. This poster is one way to remind the public to learn not to cause fire and act with preparedness when there’s fire set ablaze. Keywords: fire, disaster, population, forest, Indonesia

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ENOUGH? Andi Rama Sulaiman & Abinisa Inaya Taim Universitas Indonesia Based on the WHO (1948), Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity. There are 4 important phases of emergency management made to fulfill the requirements to build a stable and healthy post-disaster society, which are mitigation, preparedness, response, and recovery. The cycle starts before the disaster happens and ends long after it did in order to acquire a complete health recovery. Typical problem to happen in multiracial developing country such as Indonesia in facing disaster is most of the people and the local disaster management providers are not prepared to obtain the objectives needed. Natural disasters cause significant psychological and social suffering to affected populations. A research in 2005 conducted by the World Health Organization said that 85% of disaster victims suffer from post-traumatic stress disorder and most of them are children. These impacts may threaten peace, human rights and development. Therefore, one of the priorities in emergencies is to protect and improve people’s mental health and psychosocial well-being in order to achieve the casualties’ optimum quality of life. Achieving this priority requires coordinated action among all government and nongovernment humanitarian actors. Significant gap of the absence of a multi-sectoral interagency framework that enables effective coordination, and the confusion of different approaches to mental health and psychosocial support has been seen in many disaster focal in developing country such as Indonesia. Those gaps lead to unrighteous distribution of aid and minimum interest in mental health and psychosocial issues. Then, the aid given is neither efficient nor effective when it comes to regain the casualties’ quality of life. Moreover, we only focus on the acute phase of disaster management and the casualties’ physical problems; it makes our country susceptible and unprepared to face disasters. As the result, holistic health recovery is unable to obtained. This poster is made to raise awareness among government and nongovernment humanitarian actors about the importance of preparation, adequate distribution and mental health & psychosocial issues in building a stable and healthy post-disaster society. It shows that the support we were giving isn’t enough and needed to be improved. So, the government has to evaluate the current system and revitalize all their tools that related to disaster management. The renewed system ought to have an adequate coordination and cover all aspects of disaster management in order to obtain the objectives needed.

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Achmad Randi, Nahda Yaumil Chair Haq, Uswah Hasanuddin AMSA-Unhas Nowdays, fire still being the urban phenomenon which until now still not be absolutely prevented or overcame enough. Tendency of the increasing of this case, handling that we could say aren’t covering enough, and also the big impacts of this case should make us realize that prevention and rescue lifes of risk caused fire rationally are needed. But In fact, in our country this case doesn’t get enough attention from government, and lack of education of society and lack of good fire management systems. Fire phenomenon is unique and special event in Indonesia that seen as a consequence of residential improved or densely populated settlements in urban slums often resulting in less attention to the terms and conditions of safety against fire. Makassar, one of biggest city in Indonesia, fire remains the most often disaster that happened in. Makassar is the urban area that has a dense residential area. Every year there are more than 100 cases of fires in Makassar. That impact a lot of harm, such as life, material, and psychological. Requires a long process of repair and requires a lot of funds. So, we could see that there is no integrated system in prevention and management of fires in the Makassar, that making it difficult to reduce the number of fires in Makassar. One of the solution of this case that we could find nowdays on Kepmeneg PU no. 11/KPTS/2000 about term of technical management of urban fire prevention is Fire Management Area (FMA). In that term, FMA concept regulating the management of regional security system involving a home or building security management, environmental management and the management of urban areas housing against fire. But, once again this isn’t make any different for better to our country. In the other side research on fire has never been held before, especially in Indonesia, so things are included in the issues such as the definition of fire and the elements that trigger the fire should be specified. With tendency of increasing of fire caused by intent element, research and big attention to this case are worth. From the description above, we can conclude that the fire prevention, handling of fire, even fires can occur due to several factors and also require the assistance of a number of factors. In this case there are factors that responsible for preventing and mitigating the effect of the fire. First, the government. They should make anything to improve the density of living people in Indonesia and grow the great urban planning. Second, the fire department . They need to change into better in coordinate in handling fire. And the society, they need to be more aware for their installation of electrical equipment, get to know more about fire management area in education.

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Disaster Recovery Lidya Fransiska Suherman, Mai Norryslla, Maysella Suhartono Tjeng Maranatha Christian University This poster is public-oriented, especially for non-medical and health professions. In this poster, we would like to inform that management of victims after natural disaster is not just about emergency care, but we have to support their psychosocial aspects too. Post-traumatic stress disorder (PTSD) can develop following any traumatic, catastrophic life experience. Emotional recovery is needed to prevent worsening of PTSD. the erupting volcano is the center of the poster, which cause that middle aged woman on the bottom right hysterically shed tears and the man on the bottom left holding his son's dead body. The survivors desperately in need of hope/care/affection, despite the emergency care. They want their lifes back just like before the eruption happened, they want peace after this sudden mess, and need affection. And here we come to help. To heal their aching hearts, served by a caring hearts, and to be fixed. Our poster hopefully can urge public awareness.

BRAINs |

Vol. II February 2014

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POSKO FC (POSKO for Children) : special refuge for children Muhammad Hafidl Hasbullah and Lailatul Purwasih Putri Medical Faculty, University of Brawijaya, Indonesia This poster is made to raise awareness among health professional about Post Trauma Syndrome Disease in children. The prevalence of disease causing high rates of mortality. In disaster area, health professional sometimes focused in healing sick person or injured patient. Health professional made sure the children're safe. In fact, disaster event can cause children feel trauma, especially whose parents or family member are not found in disaster area. This condition is risk for Post Trauma Syndrome Disease. We suggest our strategy POSKO FC (POSKO for Children: special refuge for children). POSKO is a tent for victims of disaster. In POSKO FC, there's only children who allowed to stay because there will be doctors, nurses, psychiatry, etc who will help children not to be sad about disaster or worry about their parents whose has not found yet. POSKO FC is one of holistic care special for children who suffering from disaster. Holistic care means physical and psycological health care. Children are our future generation...

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Live Longer Share to Others Chrisandi Yusuf, Puspita Widyasari, Khrisna R.P, Anggoro Satrio B, Elmi Alfia M. Universitas Brawijaya Malang This poster is made to convince people all over the world to keep their awareness before earthquake come. Many diseases can happen, therefore the prevention should be taken. Here are the steps : 1. Drop when earthquake comes, find any furniture like tables, desks 2. Cover Hide under the tables , desks, make sure that whole of your body covered 3. Hold On hold your head with both of your hands and wait until the earthquake stop 4. Stay Calm is important in order for you to think clearly and find any helps or food supplies This is a proof of an act that medical students are also responsible in preparing a countermeasure for disaster like earthquake. We must always be aware anytime because earthquake can happen anywhere anytime. If you know that it’s dangerous, shouldn’t we be thinking on how to protect ourselves and our families in case if an earthquake’s happening soon? Be ready for any conditions, share this methode to your surroundings. Earthquake may happen, sooner or later. Make use of this information, rather than regretting everything in the end.

BRAINs |

Vol. II February 2014

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IT IS TIME TO “CARE” OTHERS Sofi Nur Fitria, Ilmania Norma Aini, Yesita Rizky F.P. Medical Faculty of Brawijaya University, Indonesia Republic of Indonesia is one of the most beautiful country with its natural view of mountains and sea in the world. Indonesia has maritim territory of 7.9 million km, which is the biggest water area in this world. It also has fertile soils as the effect of volcanic ashes. Beyond those beauties and nature richness of Indonesia, there are disasters await. Tectonically, Indonesia is highly unstable. It lies on the Pacific Ring of Fire where the Australian Plate and the Pacific Plate are pushed under the Eurasian plate where they melt at about 100 km deep. A string of volcanoes runs through Sumatra, Java, Bali and Nusa Tenggara, and then loops around through to the Banda Islands of Maluku to northeastern Sulawesi. The unstable area of Indonesia leads to unpredictable disasters. Those are volcanic eruption, earthquake, tsunami, and flood. It makes each person in Indonesia has the risk factor to be a victim of disaster. In Tsunami Aceh in 2006, there are reports that at one point there were more international NGOs than national and local NGOs involved in the response operations in the tsunami-affected areas. While the other countries cared about Indonesia, what do we do as Indonesian people? It is time for us to “CARE”. Care to others by joining hands to prevent the disasters (for preventable disasters like flood). Care to others when the disaster comes by volunteering or giving some needed stuffs. Care to others by reminding that we must be aware about disasters around us. Through this poster, we want to make Indonesian people aware to unpredictable disasters and care. It is time to show the world that Indonesia is a big country with the biggest sense of family. Especially for the young generations. Hence, our target population is all catagories of age and this poster should be placed in all of Indonesia public facilities. As we see more, we’ll remember more. To achieve our poster’s goals, government and NGOs needs to publicy their programs about preparation before disasters. Then as a medical student, we can help the government by making publication to some communities about the important of disaster awareness.

BRAINs |

Vol. II February 2014

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BE AWARE, BE PREPARED Sofi Nur Fitria, Ilmania Norma Aini, Yesita Rizky F.P. Medical Faculty of Brawijaya University, Indonesia This poster tells you about the disasters that await us. Mostly indonesian people have already known about this situation and its risks. But still, they neglect it. As the young generation, we would like to improve the awareness of people, not only in Indonesia but around the world. There are a lot of concept to improve people awareness by using poster. In this poster we use “meme” character inspired by 9gag society. There are a lot of “meme” character and every character have their own expression. Why do we use this unique concept and character? Because 9gag is a fun social media, which is very friendly especially teenager. Everyday, almost 900.000 people around the world access it. We would like the friendly and acceptable publication, especially for 10-25 years old citizens. It describes the emotional feeling when you think that it’s already too late to fix it when the disaster already occurs, then you have just realized. That’s why the” meme” (character names of 9gag cartoon) said : ‘ Y U No Prepared?” which means : “ Why didn’t you prepared?’. Also, the other colorful meme describe the response of individual. Some people might be poker face, which is feeling very sad and don’t know what to do back then or in present time. There might be some people feels ‘okay’. It’s a regret feeling, when you know it, but you don’t react to it and other stories behind the meme expression. But, the mount eruption only describes the disaster. We took mount eruption because of Indonesia tectonical condition, named ring of fire. Indonesia is surrounded by active volcano mountains. But, it can be changed into the other picture of disaster. So, what are you waiting for? Let’s do something about our future starts from now. Disaster is often unpredictable. It keeps coming , you can’t avoid it but you can be prepared of it. Hopefully, people around the world will be touched after seeing our poster.

BRAINs |

Vol. II February 2014

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Synergism of Individual and Community Effort to Reduce Loss from Flood Dewa Ayu Megayanti, Athaya Febriantyo Purnomo, Nurul Cholifah Lutfiana Medical Faculty of Brawijaya University When the flood happened, there will be many financial loss which occurs both to individuals and governments. Those loss includes loss in terms of psychology, economy, health and others. In terms of economy, that loss can include loss of household furniture, securities, etc. which will join drifting on the flood. In terms of health, flood somehow followed many cases, for instance diarrhea and other diseases that could be life-threatening. Moreover, when flood happened at that time, food and drug will be very difficult to obtain because they left behind at home or maybe building that affected by floods. Many loss occurs during the flood often due to lack of vigilance and the readiness of individuals and groups to face that disaster. Actually the government in Indonesia has already publish programs include disaster relief, to cover and to reduce losses from flood. The government itself more concern toward preparing to rescue victims in order to save the people namely, the logistic , while the step that related to the preparation with flood itself that carried so many victims have not been much published. In addition, the independence and individual and community awareness is essential in this effort as well as flood protection efforts to reduce losses that occur due to flooding. This poster is meant to increase improving self-reliance, awareness, readiness of each individual in society in order to prevent the flood, and also to urge the others who are not exposed to disasters also provide their hand. Because of that condition, we use the preventive efforts of the campaign HOPE for disaster medicine. H for Health Management, O for Own responsibility. Health management and Own responsibility is come from individuals that have prevention effect both of prevent the flood and prevent further losses. P for psychological support, E for Environmental repair come from another hand to support and repair psychological and environment aspect that damaged by the flood. Also, we use threat method to make them aware about this. Due to the disaster, we should not only rely on the help of others, but we must start the preparations as well as from yourself. So if both of these things can be read by well, hopefully there will be a synergy between individuals and other groups whose results would be better in an effort to prevent and to decrease the loss due to the number of disasters that occur.

BRAINs |

Vol. II February 2014

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Management of Victims after Natural Disaster Lidya Fransiska Suherman, Mai Norryslla, Maysella Suhartono Tjeng Maranatha Christian University This poster is public-oriented, especially for non-medical and health professions. In this poster, we would like to inform that management of victims after natural disaster is not just about emergency care, but we have to support their psychosocial aspects too. Post-traumatic stress disorder (PTSD) can develop following any traumatic, catastrophic life experience. Emotional recovery is needed to prevent worsening of PTSD. The background picture is volcano eruption, which cause the old man, one of the survivors, is desperately in need of life, peace, and love, in addition to emergency care. He wants his life back just like before the eruption happened, he wants peace after this sudden mess, and he needs affections from us. And there comes the helping hand, gives him water drop consists ‘life, peace, love’. Our poster hopefully can urge public awareness.

BRAINs |

Vol. II February 2014

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FLOOD, RECOVER FASTER PREPARE BETTER Khrisna Rangga Permana, Yeni Purnamasari Brawijaya University Malang, Indonesia This poster is made to raise awareness of the importance of preventing for disaster because we can't know when disaster happens. The medical support for disaster has been increasing, but not completed yet. So, we thought we had to promote the involvement of medical students and medical personnel to disaster. The prevalence of diseases causing high rates of mortality and morbidity, and the lack of skilled health personnel, financial resources and health systems that are responsive to the needs of society, are among them. We suggest four strategies to cope the issues and these cover not only the preparation before disaster, but also transition from emergeny care to routin/longterm medical care in the context of overall health recovery and development after disaster : 1) Infrastructrure restoration and rebuilding, open the gate to access medical support such as hospital and other facilities to recover. 2) Inter-disciplinary cooperation to provide proper health services for prevention and recovery among all organizations and community organizers by working together such as medical students, medical personnels, government and any others which participate in it such as . 3) Mental retrieval and integrative education, to recover victim's mental after disaster for trauma and education to recover and prepare better for the same disaster if it happens again in the future 4) Environmental sustainability, for a good nature protection for disaster. We can't predict when disaster comes, but we can prepare and minimize its effect.

BRAINs |

Vol. II February 2014

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Earthquake Management Eiko Bulan Matiur and Vanesia Steviany Diauw Faculty of Medicine Universitas Indonesia Main Problem

Earthquake is a natural phenomenon. It is a rapid shaking on earth caused by the layers of earth’s crust grate and scratch each other. These layers are moving very slowly, but when they collide, they release the energy restored in rocks causing tremor on the surface of earth. Earthquake is a common disaster in Asia as Ring of fire surrounds Eurasian plate. Ring of fire, also known as CircumPacific belt, is the earthquake zone which surrounds the area of Pacific Ocean. About 90% of world’s earthquakes happen in Pacific Ocean. The main problem of this disaster is destruction. Destruction can occur everywhere. On buildings, bridges, or other structures. Some people are even wounded or worst, losing their lives because they got hit by falling objects like buildings or materials. Earthquake can trigger flood and if the earthquake occurs under the ocean, it can even cause tsunami. All of these, of course, cause suffering among people. There are four main stages in handling earthquake disaster, they are: • Preparedness Preparation is important in facing earthquake disaster. In order to handle earthquake, we need to understand the disaster’s impact on community, outreaching, educating and training people. Response When earthquake happens, we need to manage the consequences caused by this disaster. We have to manage the possible threats by treating wounds, providing supplies, cleaning up, and assesing damages. One of the response is the triage effort in which the patients are being categorized into three groups according the level of their injuries and treatment prioritized. The categorization used colors to mark the level of injury: red for immediate treatment, yellow for delayed treatment, and green for minor treatment. Recovery Restoring all of the aspects of disaster’s impact on the community. There are two terms of recovery: short term and long term. Short term lasts for six months until twelve months, in those times people make temporary solution such as temporary houses or

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clean ruins. Long term can lasts for decades or until the condition returns to normal again, in this phase people already make permanent buildings, repair roads, stabilize economy and politic, and other efforts. â&#x20AC;˘ Rebuild Reduce the possibilities of disaster effect such as fortifying buildings, zone revising, managing the use of land, and increasing the durability of public infrastructure. Conclusion Earthquake is a major disaster which needs proper management that includes preparedness, response, recovery, and rebuild.

BRAINs |

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Learning From Past, Give The Best Future Chrisandi Yusuf, Anggoro Satrio, Khrisna R.P, Puspita W, Elmi Alfia M. Universitas Brawijaya Malang, Indonesia

This poster is made to convince disaster victims all over the world to keep their awareness and increase their power to build their country better than before. Because many people are mentally and physically down after the disaster happened. If it happens, they won’t grow better to improve their quality of life . This case will make them destroyed by the same things on the same ways. Therefore the prevention and steps to do it should be taken by motivating them to learn from the past in order to build a better system, thus a better world. This poster is not merely to teach you the danger of a disaster. This poster is telling you, telling us all, that we should learn. A better world won’t be just a dream if we could pass on this message. It may seem vague at first, but we all need to realize that someday we will left this world to our children. If we left them without knowing nothing, it’ll be fatal for their future. Know the fact, learn the differences, find a way to improve the quality of life. For our world, for us, and for our children.

BRAINs |

Vol. II February 2014

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“Stay Alert and Be Prepared” Abstract: Soil and mud falling from the sky illustrate the movements of soil and rocks in susceptible areas such as the steep slopes combined with high rainfall travelling rapidly and destroy everything comeacross their path. The poorly built house with a see-through umbrella describe the condition in some rural parts of Indonesia where they built houses from bamboos andrattanthat are impossible to provide protection from such things. This conceptual public poster is the interpretation of some cases of landslides in 2012 occur in parts of Indonesia such as in Bali (district of Sukadana), West Sulawesi (district of Onang Sendana) and Manado (district of Wanea) where citizens are still utterly unaware of the danger of living in conditions like this and receives lack of attention from the government. This poster is the initial step to change their mind-settings on the ways of living especially in areas that are vulnerable to landslides with the aim to keep them alert and always be prepared or even move to safer area. Keywords: landslides, conceptual, Indonesia, rural

BRAINs |

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Tsunami Disastrous impact Radius Hartanto University of Tarumanegara

There are several immediate health concerns after the extraction of survivors, such as water, food, shelter and medical care for tsunami victims. The large volume of water may lead to water contamination and depletion of food supplies. The low temperature cause by the cold sea water will increase the risk of several diseases related to the exposure of cold temperature such as hypothermia and such. If not handled carefully the impact will be catastrophic, thus it is vital for every nation to fully understand what to do in order to deal with disastrous incident such as tsunami, not only to aid their own nation but also to lend a helping hand to other nation undergoing such incidents. There are no such preventive method, but some precautions and compensative acts can be executed in order to minimize the casualties.

BRAINs |

Vol. II February 2014

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“When Landslide Strikes…” Abstract:Indonesia is a unique country with a large total of area and abundant of natural resources. Aside from all this greatness, she also has many drawbacks, one of which is having common natural disasters. A disaster that recieves much attention from the media is landslide due to its impact on the victims such as loss of loved ones; materials and destructions of infrastructures, which is caused by the movement of the soil and/or rocks. With characteristics of having lowlands, relatively high rainfall and located along the Ring of Fire makes Indonesia very susceptible for landslides to occur. Between 2005 and 2011, its been recorded that landslides have occurred in 809 locations throughout Indonesia and have caused death to 2484 people. The gorvernments role for disaster management is stated in the legislation no. 24 year 2007, which focuses on the actions before disasters happen. However, many people are still ignorant due to low socialisations from the governments. For the near future, it would be useful to heightened their sense of awareness by socialising upon this issue in terms of providing education towards others, especially for those who live on the slopes of mountains throughout the country. Keywords: landslides, Indonesia, disaster, management

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BRAINs EAMSC 2013  

Broaden your mind by reading the works of PCC EAMSC 2013 participants

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