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Curiculum VitaeDjohansjah Marzoeki

• Full name : Prof. Djohansjah Marzoeki MD, PhD, SpBP• Born : Surabaya 11 March 1940• Wife : Dina Herawati MD, born 10 Feb 1957 Ophtalmologist• Children : 1. Lazula Aneksade S Psi, M Com. Born 16 Aug 1966

Married to Agung Priyatna. SE.MSc• 2. Lobredia Zarasade MD. Born 11 Jul 1968• Married to Dandy Prihandono ST.MM• 3. Putri Anya Universade. Born 14 oct 1993• Education : Medical Doctor Airlangga University (UnAir) • General Surgeon UnAir• Plastic Surgeron Groningen The Netherlands.• PhD UnAir• Occupation : Head and Professor of Plastic Surgery,

Medical Faculty UnAir/Dr.Soetomo Hospital Surabaya Head of training Program of Plastic Surgery

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• Other Appointment:Chairman of National College of Plastic SurgeryChairman of Sex Change Team of Dr.Soetomo HospitalChairman of CranioFacial Team RS Dr Soetomo – Cr.Facial Unit Adelaide AustraliaCouncil Member of Asia Pacific Cranio facial AssociationFormer Chairman of Inodnesia Plastic Surgeon Association (4 Periods, total 12 yrs)Former Chairman of Asean Federation of Plastic SurgeonChairman of Cleft Lip Plaate FoundationChairman of Cleft Lip & Palate Center. A project supported by Australia CraniFacial Foundation Adelaide, and Smile Train Foundation USAInstructor in Culture of Science Dept. of Surgery – Surabaya

Culture preference:Scientific Culture but also respect any other culture.

Hobby: Philosophy and Politics. Write more than 30 articles in Politics to Newspapers and Magazine, Kompas, Suara Pemaruan, Jawa Pos, Surya, Tempo,

Appear on TV and Public Discussions.

Book:Author of several teaching guide books in Plastic SurgeryHidup ini (this Life; a philosophy of Living) in Indonesia Language (Airlangga University Press)Scientific Culture and Philosophy of Science in Inodnesia Language (Grasindo-Gramedia Publishing)

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EMSEmergency Medical System

Djohansjah Marzoeki

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Do we need a nation wide standard of protocol

for emergency treatment ?

What,, Where, When and Howthe system should be implemented ?

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MCI Terminology

The following terms are useful when discussing major medical incidents:

M.P.I. -- Multi-patient Incident (up to 25 patients)M.C.I. -- Mass Casualty Incident (25-100

patients)Disaster -- Over 100 patients

     M.O.I. -- Mechanism of InjuryM.V.C. -- Motor Vehicle Collision

 

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START = Simple Triage And Rapid Treatment

START was developed by the Newport Beach (CA.) Fire and Marine Department .

START quickly distinguishes between critically ill victims and the less-severely injured.

With START, a triage team of two can assess an average of one patient every 30 seconds.

 At an incident with 40 casualties,

two triage teams will take approximately 10 minutes

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START has been adopted throughout California,Arizona, Oregon and Washington.

It was used successfully during the Trade Center and Oklahoma City bombings.

Foreign countries including France, Saudi Arabia and Israel have adopted START.

It is the standard of care recognized by the U.S. Department of Transportation and widely published in EMT textbooks.

 

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using START?

Just remember R P M :

Respiration : were under 30,

Pulse

Mental Status :alert and oriented.

 

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the terminology used to classify patients using START

IMMEDIATE,

DELAYED,

MINOR and

DEAD/DYING.

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IMMEDIATE patients are those who “RPM” is altered

DELAYED when “RPM” is intact.. It also includes patients who have a significant mechanism of injury,

but whose “RPM is intact .

MINOR patients are those who were able to leave the impact area on the instruction of EMS personnel.

The are the “walking wounded” and should be tagged later

The DEAD/DYING are those who cannot breath after the airway is opened and are mortally wounded.

The patients will probably die despite the best resuscitation efforts.  

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The three(+ONE) medical treatments rendered when performing START triage

1. Open an airway or insert an OPA.

2 Stop any visible bleeding.

3. Elevate the extremities for shock.

4. (+ Cooling. Specific for Burned Organ) 

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Triage Priorities• Your initial goal is to find IMMEDIATE patients. “find the red and get it out” Those are the real lives you’ll save.

 • Once IMMEDIATE patients have been treated and

transported, reassess and upgrade any DELAYED patients to “IMMEDIATE-by-mechanism,” depending on their injury, age, medical history,

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Triage Priorities 2• Victims who have self-extricated

themselves prior to our arrival can be labeled MINOR,

• all other patients should be tagged

IMMEDIATE, DELAYED or DEAD/DYING, depending on your START assessment.

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The Arizona Triage System is a pack containing

35 triage tags,

15 IMMEDIATE labels,

35 nylon ties, 6 assorted OPAs,

3 ink pens and

1 pair of scissors.

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• Complete EMS Tactical Benchmarks=All Immediates Transported Declaration.

• Local MCMAS (Maricopa County Medical Alerting System) Notification.

NETWORKING with other hospital team.

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Multi-Patient Incident MPI

(5 to 10 Patients) 

·      Triage Function Assigned·      Nearby Hospitals Notified

·      Consider a Treatment Area·      Order Ambulances Early

·      Complete EMS Tactical Benchmarks=All Immediates TransportedDeclaration.

 

Multi-Patient Incident MPI (10 to 25 Patients)

·      Local MCMAS (Maricopa County Medical Alerting System) Notification

·      Assign Triage Sector ·      Establish Treatment Area

·      Complete EMS Tactical Benchmarks

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Mass Casualty Incident(25 – 100 patients)

 ·      Full MCMAS Notification

·      Triage Sector (s) Assigned·      Establish Multiple Treatment Areas·      Establish Medical Supply Sector

·      Complete EMS Tactical Benchmarks= All Immediates TransportedDeclaration.

  

In addition, the following may be considered: 

·      ALS Should Stay on Scene ·      No EMS Forms Completed

·     Order additional medical supplies for delivery to the scene 

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MCIs Involving More Than 25 Patients

 Create the position of an Ambulance Coordinator within the

Transportation Sector.

 ALS personnel should remain on scene, usually in Treatment,

to render advanced life support care to patients awaiting transport. All patients, except those with critical airway difficulties,

should be transported BLS.

Intubation or IV administration treatments can be monitored by BLS crews en route to the hospital

in critical situations.  

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When the patients are sent only to the nearest hospital or trauma center,

this quickly overloads those facilities.

Don’t relocate the disaster to the nearest, But follow the plan.

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mistakes often made

1·Improper use of personnel (BLS does BLS stuff. ALS does ALS stuff)

2·Patients not uniformly distributed to hospitals

3·Lack of strong, visible Command

4·Lack of preparation or training

5·Failure to adapt to circumstances

6· Poor communication 

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EMS Indonesia

• Sudah adakah ? • Bagaimana jaringan network

organisasinya ?• Didalam EMS, dimana tempat dan

bagaimana peran PPGD; PSB; ATLS; ACLS; BLS ;

ABLS

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EMS Indonesia -- Usulan

• Ter-koordinasi seluruh Indonesia

• Jaringan organisasinya oleh DepKes.• Triage sistem seragam S T A R T• BLS; ATLS, ACLS; ABLS dll tetap mandiri

tetapi waktu bencana masal dan disaster dilaksanakan dalam koordinasi oleh EMS Indonesia.

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ORGANIZATION – Maricopa

The staff of fourteen full time positions

is organized into two groups:

emergency planners and

support staff.

NOTE: Staff members are assigned as liaisons to incorporated cities and towns to provide assistance inthe preparation of local emergency plans and training programs. Intergovernmental Agreements (IGAs)are used to perform these mandates for them.

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DEPARTMENT FUNCTIONSAdministration and PersonnelBudget/FiscalCommunications and Warning SystemsDisaster Assistance and PlanningEmergency Information System (Computer Database)Emergency Operations Center Activation/Disaster CoordinationEmergency Operations Center (EOC) MaintenanceEmergency Operations PlanFlood Hazard MitigationHazardous Materials Emergency Response PlanningHazardous Materials ReportingHospital & Nursing Home Disaster DrillsHospital Mass Casualty Management AssistanceMaintenancePalo Verde Nuclear Generating Station ResponsePublic AwarenessResource Management During Disasters