WHOWHO ConferenceConference onon HealthHealth AspectsAspects ofof TsunamiTsunami DisasterDisaster inin AsiaAsia

PhuketPhuket,, ThailandThailand 44––66 MayMay 20052005 RECOVERY & REPAIR IN ACEH AFTER THE EARTHQUAKE & TSUNAMI

Indonesian Disaster Medical Relief Committee Aryono D.Pusponegoro President: Indonesian College of Surgeons Chairman:118 Emerg.Amb.Service Foundation ACEH Recovery & Repair : Aceh EQ & Tsunami Ä Á Disaster Response Ä Late. Á Management Support Ä Chaos. Á Medical Support Ä Makassar, Bali, Surabaya, Malang, Jogyakarta, , , Palembang Ä 118 IEMSS. ÄÄÄ Predictable !!! Á Our Day To Day Emerg. Care Ä Bad ACEH Recovery & Repair : ÎÎÎÎ Disaster Management

Á Day to Day Emergencies.

Á Disaster / Mass Casualties.

ÄIt Is Imposible To Manage Disasters Properly If The Day To Day Emergency Care Is Bad !!! Disasters & Mass Casualties In 1980 – 2005 : 1. Mt Galunggung 1980 8. Toll RD Crash 1985 2. Food Poisening West 9. Jakarta Atmajaya Hosp. Jakarta 1981 Flood 1986 3. Harbor Fire Tg Priok 10.JKT Hosp. North Jakarta 1981 Evac.Munition Explosion. 4. Gas Leak Tg Proik Jakarta 1987 1982 11.JKT Bintaro Train Crash 5. EQ 1983 1987 6. Hotel Fire Jkt 1985 12.JKT Koja Hosp. Isolation (Tg 7. Plane Crash Krawang Priok Riots) 1987 West Java 1985 13.Food Poisening JKT Factory 1988 Disasters & Mass Casualties In Indonesia 1980 – 2005 : 14.EQ Flores 1991 21.Riots PDI-P Political 15.JKT Riots 1992 Party Jkt 1996 16.Jkt Floods 1991&1992 22.EQ & Tsunami Biak 17.Tsunami Lombok 1993 1997 18.EQ Liwa 1993 23.EQ South Sulawesi 19.Mt Merapi Eruption 1997 Jogya 1995 24.Ethnic Riots Pontianak 20.EQ Kerinci 1995 1997 25.EQ Bengkulu 1997 26.Ethnic Riots Sampit 2001 Bencana & Korban Masal Di Indonesia 1980 – 2004 : 27.Displaced Persons in 32.Floods Pekalongan & Madura, Poso, West & East Semarang Middle Java 2002 Nusa Tenggara, Papua, West 33.Relegious Conflict / Riots Java, Middle Java, Molucus, Ambon 1999–2002 North Molucus, North 34.Relegious Conflict / Riots Sulawesi 2001 Palu South East Sulawesi 28.Drought In Sampang Borneo 1999 –2002 2001 35.Papua Riots 1999–2002 29.Mt Papandayan Erruption 36.Terorist Bombings (32x) Jkt 2002 1998-2002 30.Train Crash Brebes 37.Political Riots Jkt 1998-2002 Middle Java 2002 31.Land Slide East Java 2002 32.Flood 2002 Bencana & Korban Masal Di Indonesia 1980 – 2004 : 38. Jkt 3 weeks Floodings 2002 45. EQ Nabire Papua (2X) 39. Nunukan Displaced Migrant 2004 Worker 2002 46. Aceh EQ & Tsunami 40. Bali Terrorist Bombing 2002 2004 41. Htl Marriott Jkt Terrorist 46. EQ Palu South East Sulawesi Bombing 2003 2005 42. Gresik East Java Chemical Factory Explosion 2004 47. Drought East Nusa Tenggara 43. Australian Emb. JKT Terrorist 2005 Bombing 2004 48. EQ West Java 2005 44. Gempa Karang Asem Bali 49. Trash Dump Landslide 2004 Bandung 2005 50. EQ Nias & Simulue 2005 Response Time :

¾ Bintaro (Jkt) Train Crash 1987 Æ8 – 10 min ¾ Liwa EQ 1993 Æ 24 hrs. ¾ Kerinci EQ 1995 Æ 48 hrs. ¾ 1st Mt.Merapi Erupt. 1995 Æ -- ¾ 2nd & 3rd Merapi Erupt. 1996 Æ 30 min. ¾ Biak EQ / Tsunami 1997 Æ 7 days. ¾ Bengkulu EQ 2000 Æ 12 hrs. ¾ Nunukan 2002 Æ 5 days. ¾ Bali Bomb 2002 Æ 12 hrs. , ¾ Marriott & Aus Emb 2004 Æ 10 – 30 ¾ Aceh 2004 Æ 24 hrs ¾ Nias 2005 Æ ? hrs IEMSS & Safe Community :

¾All Kind of Disaster : ÎMan Made. ÎNatural. ¾Jakarta Î Western Part of Indonesia. ¾Surabaya ÎEastern Part. ¾Makassar. ÄÄ WE ARE ALWAYS TOO LATE !!! ¾ Bengkulu / Nunukan. Aceh Response Ä Medical Support : • 1st Medical Team : Prof Aryono D.Pusponegoro & Prof Idrus Paturusi & Med.Team ÄÄ 24 Hrs • Med. Teams from ¾ Makassar, Denpasar, Malang, Jakarta, Palembang, ( B Aceh, Aceh Jaya, Aceh Besar, West Coast) ¾ Bandung &Jogyakarta (Meulaboh), ¾ Surabaya & North Sumatra (EastCoast) ÄÄ 48 – 72 Hrs. • Foreign Med.Teams ÄÄ 72 Hrs & > Hrs. • Ind & Foreign NGO Med Teams ÄÄ ??? Aceh Response Ä Management Support : • Chaos Ä No Coordination. • Indonesian Disaster Medical Relief Team Ä WHO ÄÄÄ Management Support Ä Unofficial Command & Control Center ( EAS 118) Ä Logistics from Pharmaceutical Companies. Ä Coorditanions ÄÄÄ ¾ Medical Teams. ¾ Military, Faqinah & Zaenal Abidin Hospitals, Meulaboh, East Coast, Swiss & Danish Field Hosp. ¾ 3rd day Faqinqah Hosp. Reopened & Zaenal Abidin Started Cleaning Up 4th day. ¾ 118 Emergency Ambulance Service from Jakarta ÄÄÄ Refugee Camps, Inter Hosp Transport, Medevac, Aero Medevac NIAS & SIMULUE :

Nias Ä ¾ North Sumatra ¾ IDMRC (Prof Idrus), Bdng, TNI, Asing, WHO Simulue Ä NAD, WHO ™ Sibolga Ä Medical Support ? Management Support ? ™ Medan Air Force Base Ä Á Medical Support / Triage Officer (-) Á Management Support (-). ™ RS Pirngadi & H Adam Malik IEMSS & Safe Community : ÁIndonesia Î No EMS / System. ÁCommittee on Trauma (1997 SBY) Æ Integrated Emergency Medical Service System (IEMSS) (Pre Hosp & Hosp Phase ÁComm.on Trauma, MOH, Other Proff. Org. Æ Makassar 2000 Declaration : Safe Community Æ Safe & Healthy in Urban / Rural Areas. Police Fire Brigade E.D. I.C.U Ward Security Guard Emergency Layman Civil Defense Ambulance Scouts Service Red Cross

Rehabilitation

DISASTER Access Public Emergency Health Telephone Number Center

Pre-Hospital Phase Hospital Phase Post Grad. Educ. Course :

ATLS (1995) Æ Comm. On Collapsed Structure Trauma Ind. Surg. Ass. Æ Search & Rescue PHTLS, BTLS (CSSR) Æ USAID / ACLS (1996) Æ PHCLS, OFDA (2002). BCLS. Major Incident Medical APRC / APLS (1999) Æ PET / & Management Support NET, BPLS. (MIMMS) 2001. ANLS (2002) Æ PHNLS, Hosp. Emerg. Incident BNLS. Command System Medical First Responder (HEICS). (MFR) ÆUSAID / OFDA (2000). Hospital Preparedness For Emergencies Urban / Rural Emergencies Æ (HOPE) & Disasters Æ Spain (2002). USAID / OFDA (2003). IEMSS & Safe Community :

TRAINING : ¾ BLS (Layman) ¾ MFR (Paramedic EMT Basic). ¾ Paramedic I, II, III = EMT Basic, Intermediate, Paramedic. ¾ “Emergency Nurse” (BTLS, BCLS, BNLS, BPLS & Disaster Management). ¾ “Emergency Physician” (ATLS, ACLS, ANLS, APLS & Disaster Management. ¾ HOPE Ä For Hospital Managers : ‰ Risk Assessment & Management ‰ Structural & Functional Collapse ‰ Management & Medical Support Medical Resourches & Geo Mapping : 1999 Æ Indonesia : ¾6020 Public Health Centers. ¾4280 Public Health Center Ambulances ¾7267 Doctors in Public Health Centers. ¾12602 Doctors in Hospitals. ¾1145 Hospitals. Medical Resourches & Geo Mapping : 2005 Jakarta : ¾331 Public Health Centers. ¾ 45 Public health Center Ambulances. ¾591 General Physicians. ¾109 Hospitals. ¾50 118 Emerg. Ambulaces & 10 Motorcycle Ambulances Post Grad. Educ. Course :

¾Post Grad. Educ. Courses & ¾Medical Resourches

IEMSS & Safe Community ACEH Recovery & Repair :

Current Situation : ‰ 14 Functioning Hospital. ¾ 6 Hospitals in Banda Aceh. ¾ Sigli, Bireun, Langsa, Takengon, Meulaboh, each 1 Hospital. ¾ Lokseumawe 3 Hospitals. ‰ Red Cross Fascilities. ‰ 52 Refugee Camps with 5000 – 10.000 Inhabitants Ä Primary Health Care Only, No Specialistic Care. Safe Community, IEMSS, 118 IEAS Î

City Î City Í International (Safe Community) Ï Distric Ï Province A1 Phases of Disaster Response

I. Acute phase Ä Surgical Cases ÄRapid Response Disaster Ambulance. II. Non Surgical Cases Ä Field Hospital III. Chronic phase Ä Chronic Cases, Refugees Camps Ä Mobile Clinic Slide 23

A1 ARYONO, 2005-02-15 Indonesian Disaster Medical Relief Committee (IDMRC): ‰ Supported by 20 Indonesian Medical Professional Association / Colleges ‰ Organ of the Ind.Doctors Assc. ‰ Programe : SHORT TERM Ä ACEH ¾ Mobile Clinic. ¾ Training. ¾ Planning for the rebuilding of hospitals & Teaching Hospital in Aceh. ¾ Safe Communitty for Aceh (118 IEMSS & Emerg. Departments Network) LONG TERM : ¾ Preparedness for future disasters. Short Term Programe Ä ACEH 1. Mobile Clinic Personel : • 118 Emergency Ambulance & Nurse Paramedics. • Pediatrician. • Obgyn. • Medical. • Dermatologist. • Psychiatrist. • Surgery. • Public Health. • Rehabilitation Medicine. • Drugs & Vaccines Mobile Clinic :

• Six Wheeler. • Double Cabin Ä 7 – 9 personel. • Back Cabin Ä Minor Surg. & Obgyn. • Medical Equipment Storage. • Drugs Compartment Ä Dispensary. • Foldable Tents on the Right, Left & Back Ä Examinations. • Generator. Short Term Programe Ä ACEH 2. Safe Communitty: • 118 IEMS. • Emergency Dept (Banda Aceh 8 Hospitals) / Public Health Centers • Radio Communication. • 110 Ä Security (Police). • 113 Ä Rescue (Fire Brigade). • 118 Ä 118 Emergency Amb. Service. Short Term Programe Ä ACEH 3. Training : • BLS Ä Layman (8 Hrs). • Paramedic Basic Ä MFR (1 week). • “Emergency Nurse” Ä BTLS, BCLS, BNLS, BPLS & Disaster Management (14 days). • “Emergency Physician” Ä ATLS, ACLS, ANLS, APLS & Disaster Management (14 days). • HOPE Ä Hospital Management (4 days). Long Term Programe : Ä Future Disasters • Medical Support : (Makassar, Denpasar, Surabaya, Malang, Jogyakarta, Jakarta, Bandung, Palembang) ¾ Rapid Response Disaster Ambulance. ¾ Field Hospital. ¾ Mobile Clinic

• Management Support : ¾ Coordination. ¾ Logistics. ¾ Manpower. Etc. Thank You