PERFORMANCE OF HOSPITAL-BASED EMERGENCY AMBULANCE SERVICE IN INDONESI

THE PERFORMANCE OF HOSPITAL-BASED EMERGENCY AMBULANCE SERVICE IN INDONESIA : PREPARING FOR HOSPITAL NATIONAL AND/OR INTERNATIONAL ACCREDITATION

1. 1
CURRICULUM VITAE
DATA PRIBADI
Nama : dr.ADIB ABDULLAH YAHYA,MARS
Pangkat : Brigjen TNI (Purn)
Tempat/tanggal lahir : Magelang,16 Februari 1949
Jabatan : DIREKTUR UTAMA RUMAH SAKIT MMC
Agama : Islam
ALAMAT : Jl. Punai H-24,Kel.Tengah,Jakarta Timur –13540
Telp : [phone]
Fax : [phone]
HP : 08161803497
E-MAIL : [email protected]
PENDIDIKAN UMUM
SMA Negeri Magelang 1966
S1 : Fakultas Kedokteran Universitas Gajah Mada (UGM),
Yogyakarta, 1973
S2 : Fakultas Kesehatan Masyarakat, Universitas Indonesia (UI), Jakarta,
Program Kajian Administrasi Rumah Sakit ( KARS )
PENDIDIKAN MILITER
Sekolah Staf dan Komando TNI Angkatan Darat (SESKOAD), 1987/1988
PELATIHAN
Combined Humanitarian Assistance Response Training, oleh Singapore Armed Forces (SAF), Singapura, 2000
Health as a Bridge for Peace Workshop, oleh World Health Organization (WHO), Yogyakarta, 2000

2. 2
PENGALAMAN JABATAN
Komandan Detasemen Kesehatan Pasukan Pengamanan Presiden (Paspampres), 1987 -1991
Kepala Rumah Sakit “Muhammad Ridwan Meuraksa”, Jakarta, 1992
Kepala Kesehatan Daerah Militer (Kakesdam) Jaya, Jakarta, 1993
Komandan Pusat Pendidikan Kesehatan TNI –AD,1995 –1999
Wakil Kepala Pusat Kesehatan TNI, 1999 –2000
Kepala RSPAD Gatot Soebroto, 2000 –2002
Dekan Fakultas Kedokteran UPN, Jakarta, 2000 –2002
Wakil Ketua Tim Dokter Kepresidenan RI, 2000 –2002
Direktur Kesehatan TNI Angkatan Darat (Dirkesad), 2002-2004
Wakil Ketua Tim Pemeriksaan kesehatan untuk calon Presiden dan calon Wakil Presiden RI Th.2004
DOSEN Pasca Sarjana FKM UI, Kajian Administrasi Rumah Sakit (KARS)
DOSEN Pasca Sarjana URINDO
DIREKTUR UTAMA RUMAH SAKIT MMC
ORGANISASI
Ketua Ikatan Rumah Sakit Jakarta Metropolitan (IRSJAM), 2000-2003
Ketua Umum Perhimpunan Rumah Sakit Seluruh Indonesia ( PERSI), 2003-2009
PRESIDENT OF ASIAN HOSPITAL FEDERATION ( AHF ) 2009 –2011
Anggota Komnas FBPI.
Surveyor KARS
Ketua Umum PERMAPKIN
Ketua Komtap Bidang Kebijakan Kesehatan KADIN Indonesia
Angggota TNP2K.
Dewan Pakar Perhimpunan Rumah Sakit Seluruh Indonesia ( PERSI)
Dewan Pakar IDI
Anggota Majelis Kehormatan Etik Kedokteran (MKEK) IDI Pusat
Tim Konsultan Institut Manajemen Risiko Klinis ( IMRK )
Anggota KNKPRS
Koordinator Bidang 1 : KAJIAN KESELAMATAN PASIEN, IKPRS -PERSI
Instruktur HOPE ( Hospital Preparedness for Emergencies and Disasters}

3. THE PERFORMANCE OF HOSPITAL -BASED
EMERGENCY AMBULANCE SERVICE IN INDONESIA :
PREPARING FOR HOSPITAL NATIONAL AND/OR
INTERNATIONAL ACCREDITATION
Dr. ADIB A YAHYA, MARS
DIREKTUR UTAMA RS MMC
SEMINAR & WORKSHOP PELAYANAN PRA RUMAH SAKIT
“ THE EMERGENCY CARE MANAGING AN UPGRADING HOSPITAL -BASED EMERGENCY
AMBULANCE SERVICE NETWORK “
SURABAYA,1 NOVEMBER 2015

4. PERFORMANCE STANDARDS

5. Access to Care and Continuity of Care
(ACC)
STANDARDS
1.Screening for Admission to the Hospital
2. Admission to the Hospital
3. Continuity of Care
4. Discharge, Referral, and Follow-Up
5. Transfer of Patients
6. Transportation

6. Transportation
Standard ACC.6
The process for referring, transferring, or discharging
patients, both inpatients and outpatients, includes
planning to meet patients’ transportation needs
Medical
Transportation

7. Measurable Elements of ACC.6
1. There is an assessment of transportation needs when any patient is
referred to another source of care, transferred to another care setting,
or ready to go home following an inpatient admission or outpatient
visit.
2. The transportation provided or arranged is appropriate to the needs
and conditionof the patient.
3. Transport vehicles owned by the hospital meet relevant laws and
regulations related to their operation, condition, and maintenance.
4. Transportation services, including contracted services, meet the
hospital’s requirements for quality and safe transport.
5. All vehicles used for transportation, contracted or hospital owned,
comply with the infection control program and have appropriate
medical technology, supplies, and medicationsto meet the needs of
the patient being transported.
6. There is a process in place to monitor the quality and safety of
transportation provided or arranged by the hospital, including a
complaint process.

8. STANDAR FISIK, PERLENGKAPAN
AMBULANS
GAWAT DARURAT MEDIK

9. STANDAR FISIK, PERLENGKAPAN AMBULANS
GAWAT DARURAT MEDIK
Landasan Hukum:
Kepmekes No. 0152/YanMed/RSKS/1987, tentang Standarisasi
Kendaraan Pelayanan Medik.
Kepmenkes No 143/Menkes-kesos/SK/II/2001, tentang Standarisasi
Kendaraan Pelayanan Medik.
Diperlukan standarisasi perlengkapan umum dan medik pada
kendaraan ambulans AGDT, khususnya untuk keseragaman dan
peningkatan mutu pelayaan rujukan kegawatdaruratan medik.
Yang diatur dalam Kepmenkes adalah jenis kendaraan :
1. Ambulans transportasi;
2. Ambulans gawat darurat;
3. Ambulans rumah sakit lapangan;
4. Ambulans pelayanan medik bergerak;
5. Kereta jenazah.
6. Ambulans udara.

10. AMBULANS GAWAT DARURAT ;
TujuanPenggunaan:
PertolonganPenderitaGawatDaruratPraRumahSakit
Pengangkutanpenderitadawatdaruratyang sudahdistabilkandarilokasikejadianketempat
tindakandefinitifataukeRumahSakit
Sebagaikendaraantransport rujukan.
Persyaratan:
TeknisKendaraan
1.Kendaraanrodaempatataulebihdengansuspensilunak
Warnakendaraan: kuningmuda
2.Tandapengenalkendaraan: di depan-gawatdarurat/ emergency, disampingkanandan
kiritertulis: Ambulansdanlogo : Star of Life, bintangenambirudanulartongkat.
3.MenggunakanpengaturudaraAC denganpengendalidi ruangpengemudi.
Pintubelakangdapatdibukakearahatas.
4.Ruangpenderitatidakdipisahkandariruangpengemudi
Tempatdudukpetugasdi ruangpenderitadapatdiatur/ dilipat
Dilengkapisabukpengamanbagipengemudidanpasien
5.Ruangpenderitacukupluasuntuksekurangnyaduatandu. Tandudapatdilipat.
Ruangpenderitacukuptinggisehinggapetugasdapatberdiritegakuntuk
melakukantindakan

11. 6.Gantungan infus terletak sekurang-kurangnya 90 sm di atas tempat
penderita
Stop kontak khusus 12 V DC di ruang penderita
Lampu ruangan secukupnya/ bukan neon dan lampu sorot yang dapat
digerakan
7.Meja yang dapat dilipat, Lemari obat dan peralatan
8.Tersedia peta wilayah dan detailnya
Penyimpan air bersih 20 liter, wastafel dan penampungan air limbah
9.Sirine dua nada , Lampu rotator warna merah dan biru ,
Radio komunikasi dan telepon genggam di ruang kemudi ,
Buku petunjuk pemeliharaan semua alat berbahasa Indonesia
10.Peralatan rescue, Lemari obat dan peralatan
Tanda pengenal dari bahan pemantul sinar
Peta wilayah setempat
Persyaratan lain menurut perundangan yang berlaku
Lemari es/freezer, atau kotak pendingin.

12. Sarana Medis
1.Tabungoksigendenganperalatanbagi2 orang
PeralatanmedisPPGD
2.Alatresusitasimanual/automatic lengkapbagidewasadananak/ bayi
Suction pump manual danlistrik12 V DC
3.Peralatanmonitor jantungdannafas
Alatmonitor dandiagnostik
4.Peralatandefibrilatoruntukanakdandewasa
5.Minor surgery set, Obat-obatangawatdaruratdancairaninfussecukupnya,
KantungmayatSarungtangandisposable , Sepatu boot
Persyaratan Petugas
1.1 (satu) pengemudiberkemampuanPPGD danberkomunikasi
2.1 (satu) perawatberkemampuanPPGD
3.1 (satu) dokterberkemampuanPPGD atauATLS/ACLS

13. Tata tertibberkendaraan :
1.Saatmenujuketempatpenderitabolehmenghidupkansirinedan
lampurotator. Selamamengangkutpenderitahanyalampurotator yang
dihidupkan
2.Mematuhiperaturanlalulintasyang berlaku
Kecepatankendaraankurangdari40 km di jalanbiasa, 80 km di jalan
bebashambatan.
3.Petugasmembuat/ mengisilaporanselamaperjalananyang
disebutdenganlembarcatatanpenderitayang mencakupidentitas,
waktudankeadaanpenderitasetiap15 menit.
4.Petugasmemakaiseragamambulansdenganidentitasyang
jelas.

14. EMERGENCY AMBULANCE
STANDARDS
(2014)

15. 1. Definitions :
-“Emergency Ambulance” means a conveyance, including ground, air
or sea craft that is used or intended to be used for transport of
Emergency patients.
-“Emergency Ambulance Service” means a service provided by
Ambulances that is available to the public for the conveyance of
Emergency patients.
-“Emergency patient” means a patient who has or sustain s a
medical emergency. Such patients include those being conveyed to
emergency departments of hospitals for immediate attention or
critically ill patients being transferred from one hospital to another
for continuation of medical treatment

16. 2. Emergency Ambulance Unit
The Emergency Ambulance Unit must have the following to run the Emergency
Ambulance Service:
a. A qualified person (Emergency Medicine specialist), to supervise and advise on
the patient care provided and to ensure the required training, competency and
certification of the emergency ambulance staff.
b. A system compatible for communicationwith the Civil Defence Force or other
designated medical dispatch system for ambulances.
c. Written protocols of care for patients transported and a training programme to ensure
the proficiency of ambulance staff in carrying out these protocols in accordance with such
standards/guidelines issued by the Director of Medical Services.
d. Ambulance medical equipment and medical supplies.
e. A system for performance monitoring, reporting and evaluationof the services
provided.
f. A medical record system and an ambulance log system (manual and/or electronic
recording system) for purposes of quality assurance and audit.
g. Safety standards to ensure that patients and the Emergency Ambulance Service crew
are protected from unnecessary risks as provided under any written law .

17. The Emergency Ambulance Unit shall have in place a system for
infection control, including:
a.Protocols for handling patients with infectious diseases,including
instructions on appropriate action to take in the event of an
exposure to blood or body fluids/substances including needle-
stick injuries and other incidents.
b.Protocols for training and use of Personal Protective Equipment
(PPE) such as N95 mask, hair cover, gloves, gown/apron, face
shield/goggles, disinfectants.
c.Decontamination of vehicles after transport of patients with
infectious diseases, or in event of contamination by body fluids, and
protocols for storage, transportation and disposal of waste in
accordance with any written law or such standards/guidelines
issued by the Director of Medical Services from time to time.
d.Immunisationsfor vehicle crew as stipulated by MOH for health
care workers.

18. Desinfeksi
Ambulans?

19. 3. Emergency Ambulance Service Vehicle
Each Emergency Ambulance vehicle shall meet such vehicle
specifications, including any requirements for inspection and
maintenanceto ensure that the vehicle is fit for its purpose.
The minimum equipment in each vehicle shall be maintained . Such
equipment shall be functional and effective at all times when the
Emergency Ambulance is in operation.
Each Emergency Ambulance shall bear the letterings
“EMERGENCY AMBULANCE ” on the front, both sides and
rear of the vehicle.
The Emergency Ambulance vehicle may use the siren and beacon
lights only when transporting an emergency patient

20. VEHICLE MOCK-UP FOR FAÇADE SPECIFICATION

22. Ambulance Type
•Type I
•Box shaped passenger compartment
•Mounted on truck style chassis
•Type II
•Van style vehicle
•Raised roof
•Extended rear compartment
•Type III
•Modular box like a Type I
•Mounted on a van chassis
TYPE 1
TYPE 2
TYPE 3

23. Daily Truck Inspection
•Fuel
•Oil
•Engine Cooling System
•Battery
•Brakes
•Wheels/tires
•Headlights
•Stoplights
•Turn signals
•Emergency lights
•Wipers
•Horn
•Siren
•Doors closing/latching
•Communication systems
•AC/Heat
•Ventilation system
•Seat belts
•Equipment
•Checked/maintained
•Restocked/repaired
•Batteries for –AED –Suction –O2, etc

24. 4. Emergency Ambulance Service Crew
1Each Emergency Ambulance Service vehicle shall be staffed by at least a 2-
man crew; a 3-man crew is recommended.
This could be:
At least one Medical Transporter/Emergency Medical Technician
(EMT)/Paramedic, with one crew leader who is an Ambulance
Paramedic/Nurse/Doctor or similar combinations.
2 Medical Transporter/Ambulance Driver
The Medical Transporter shall have the minimum qualifications/experience
as follows:
i.Possess a valid licenceto drive the vehicle
ii.Trained in defensive driving and be well aware of the use of sirens and
beacon lights during conveyance of emergency patients
iii.Be currently certified in Cardio-Pulmonary Resuscitation (CPR) and
Automated External Defibrillation (AED) usage by a National Resuscitation
Council-(NRC-) accredited agency
iv.Understand the usage of stretchers and able to assist in the care of and
evacuation of a patient/casualty

25. SAFETY
AND
DEFENSIVE DRIVING..
?

26. 3Emergency Medical Technician (EMT)
a.The EMT shall be certified through an EMT course, approved by
MOH.
b.The EMT shall also be currently certified in Basic Cardiac Life
Support (BCLS) and AED usage by an NRC-accredited agency
and in first aid by an NRC-or a National First Aid Council-
(NFAC-) accredited agency.
c.The EMT shall undergo recertificationby agents approved by
MOH at least once every two years.
d.The EMT shall be able to:

27. The EMT shall be able to:
i.Use all equipment on board and be familiar with the relevant medical protocols.
ii.Use various types of stretchers and body immobilisation devices.
iii.Perform basic life support on infants, children and adults.Proficient with the use of
bag valve mask.
iv.Independently initiate the use of an AED.
v.Perform standard first aid and give oxygen supplement.
vi.Measure and monitor the patient’s vital signs, i.e. pulse rate, blood pressure,
temperature and respiratory rate and give SaO2.
vii.Monitor intravenous peripheral lines and flow of drip of stable patients.
viii.Transfer and maintain patients with nasogastric tubes, tracheostomy tubes,
and/or urinary catheters.
ix.Perform basic emergency procedures such as control of external bleeding and
application of dressings, bandages, slings and splints.
x.Establish contact with the receiving hospital if the need arises.
xi.Appropriately use PPE and apply standard precautions to prevent the transmission
of infectious agents during patient care.
xii.Assist the Emergency Ambulance Paramedic or Nurse or Doctor in the conduct of
the various procedures for the care of the patient who is being managed by
the Emergency Ambulance Service

28. 4Ambulance Paramedic
a.The Ambulance Paramedic shall be qualified under a paramedic
course approved by MOH .
b.The Ambulance Paramedic shall also be currently certified in
Basic Cardiac Life Support (BCLS) and AED by an
NRCaccredited agency.
c.The Ambulance Paramedic shall undergo recertification by
agents approved by MOH at least once every two years.
d.The Ambulance Paramedic shall be able to :

29. i.Assess and independently manage trauma and nontrauma emergencies in patients of all
age groups within the framework of medical protocols provided by the Emergency
Ambulance Service.
ii.Organise and prioritise treatment and evacuation in multiple casualty incidents.
iii.Use various types of stretchers and body immobilisation devices provided by the Emergency
Ambulance Service.
iv.Carry out emergency basic procedures to control external haemorrhage, apply dressings,
bandages, slings and splints.
v.Provide immediate care to casualties during the process of extrication and disentanglement from
entrapments.
vi.Assess and maintain the patient’s airway, including the use of adjuncts such as the
oropharyngeal airway or Laryngeal Mask Airway (LMA).
vii.Perform basic life support on infants, children and adults.
viii.Be currently certified in CPR and AED usage by an NRCaccredited agency.
ix.Perform a 12-lead electrocardiogram, monitor the patient’s electrical rhythm and transmit the
12-lead electrocardiogram to the receiving hospital, if appropriate and required.
x.Independently initiate the use of an AED.
xi.Obtain intravenous access, administer designated intravenous medications and perform
intravenous infusions as per ambulance care protocols.
xii.Obtain capillary blood glucose sample and institute treatment for hypoglycaemia.
xiii.Assess and manage an emergency childbirth.
xiv.Administer basic emergency medications including nebulisation.
xv.Auscultate chest for abnormal chest sounds.
xvi.Appropriately use PPE and apply standard precautions to prevent the transmission of infectious
agents during patient care.
xvii.Manage patients with nasogastric tubes, intravenous plugs or urinary catheters or other tubes
and cannula.

30. 5AmbulanceNurse
a.MustbearegisteredStaffNursewiththeNationalNursing
Boardandhaveclinicalcapabilityequivalenttoorexceedingthe
AmbulanceParamedic,includingcurrentBasicCardiacLife
Support(BCLS)/AEDcertification.
6AmbulanceDoctor
a.MustberegisteredwithMedicalCouncilBoardandhaveclinical
capabilityequivalenttoorexceedingtheambulanceparamedic
(see4.4dabove),includingcurrentBCLSandAdvancedCardiac
LifeSupport(ACLS)certification.

31. (BLS)
Layman
(MFR,
CSSR)
Police
Fire Brigade
Security
Guard
Civil
Defense
Scouts
Red Cross
(Paramedic,
CSSR)
118
Emergency
Ambulance
Service
E.D. I.C.U Ward
Access
/ CRISIS CENTER
Emergency
Telephone Number
110,113,118
Pre-Hospital Phase
Public
Health
Center
Rehabilitation
DISASTER
Hospital Phase
•HOPE
•“Emergency Nurse”
(BTLS, BCLS, BNLS, BPLS)
•“Emergency Physician”
(ATLS, ACLS, ANLS, APLS)
• Surgeon / Trauma
Surgeon
(ATLS, BSS, DSTC, Peri OP CC)
•DISASTER MANAGEMENT

32. 5.Emergency Ambulance Vehicle and Medical Equipment
1 . Each Emergency Ambulance service vehicle shall contain the
following vehicle and medical equipment:
a. Vehicle Equipment
i.Siren and Wail Sound Horn or Two Tone-Horn
ii.Red Beacon Light
iii.VHF Radio Network Communication or Mobile Phone or Other
Ambulance to Hospital Communication Equipment
iv.Fire Extinguisher
v.Current Street Directory or electronic equivalent
vi.Passenger Seat and Safety Belts
vii.Attendant Seat and Safety Belts
viii.Frosted or Tinted Side and Rear Window Glass (excluding
the front side windows)
ix.Global Positioning System (GPS) /Automatic Vehicle Location/
other navigation system
x.Any other equipment specified by MOH or any other
authority
b. Medical Equipment

33. Equipment
•Basic Medical Supplies
•Pttransfer equipment
•Airways
•Suction equipment
•Artificial Ventilation devices
•Oxygen inhalation devices
•Cardiac compression equipment
•Basic wound care supplies
•Splinting supplies
•Childbirth supplies
•Medications
•AED
•Non-medical
•Personal Safety Equipment
•Street maps, etc

34. MEDICAL EMERGENCY

35. MEDICAL EMERGENCY
DEFINITION
A “Medical emergency” is an injury or a condition of
acute or sudden onset that poses an immediate threat
to a person's life or long term health. These include
bleeding, severe or increasing pain or a change in the
vital signs of life, such as the level of consciousness or
signs of difficulty in breathing. A chronic condition or a
condition for which a patient is currently receiving
treatment may suddenly deteriorate into a medical
emergency.

36. Common Situations Involving Medical Emergencies
Road traffic accident
Industrial accident
Fall from heights
Mass casualties
Transfer of critically ill patients between hospitals/nursing homes
Severe burns
Stroke
Heart attack
Poisoning
Breathing difficulty from a variety of causes
Altered mental states

37. Common Causes of Medical Emergencies
All limb or life threatening cases, or any case of doubt
Multiple injuries
Large or open wound
Head injury
Fracture or dislocation
Laceration, stabbing or other penetrating injury
Burn (thermal or chemical) or scald
Near-drowning, poisoning or suicide
Bee and insect sting, snake or animal bite
Acute coronary syndrome
Haemorrhagic or ischaemic stroke or other acute neurological
disorders
Acute, non-traumatic surgical emergencies

38. Examples of Medical Emergencies
Acute chest pain, including angina or acute myocardial infarct
Difficulty breathing
Acute abdomen
Internal bleeding, including haematuria, haematemesis or melena
Loss of consciousness or acute change in mental state or behaviour
Sudden onset weakness or paralysis
Seizures
Severe allergic reaction (anaphylaxis)
Severe pain or increasing pain
Sepsis

40. EMS Star of Life
Detection
Reporting
Response
On Scene Care
Care in Transit
Transfer to Definitive
Care

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Thank you
Everybody will be happy

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