FORMULIR SPESIFIKASI KEBUTUHAN ALAT KEDOKTERAN

Tim Medis Reaksi Cepat

Negara Asal/Asal Merk Perkiraan Harga
No. Nama Alat Kedokteran/ Spesifikasi Setara Setara Banyaknya
Satuan Jumlah
1. Laryngoscope (Adult) Jerman 75 3,500,000
Spesification:
262,500,000
Standartd Macintosh with Blade 2,3,4
Battery handle type AA, nonrechargeable
2. Laryngoscope (Pediatric) Jerman 38 3,500,000
Spesification:
133,000,000
Standartd Macintosh with Blade 0,1,2
Battery handle type AA, nonrechargeable
3. Laryngoscope (Neonatus) Jerman 24 3,500,000
Spesification:
84,000,000
Standartd Miller with Blade 00, 0, 01
Battery handle type AA, nonrechargeable
4. Bag Valve Mask (Adult) Eropa/ Amerika 63 1,800,000
Spesification:
For adult
Self-inflating resuscitation device / bag
Silicone material
Includes patient valve, PEEP valve and relief valve
Includes 1500-2000ml Silicone bag
Integrated intake / reservoir valve
113,400,000
See-through mask with unique Multi-function Mask Cover

Includes mask no 4-5 with mask cover

Includes reservoir bag 2600ml
Includes reservoir valve
Latex-free
Display case
Autoclavable
Silicone corrugated extension tube with connetors
Negara Asal/Asal Merk Perkiraan Harga
No. Nama Alat Kedokteran/ Spesifikasi Setara Setara Banyaknya
Satuan Jumlah
5. Bag Valve Mask (Pediatric) Eropa/Amerika 40 1,800,000
Spesification:
For pediatric
Self-inflating resuscitation device / bag
Silicone material
Includes patient valve, PEEP valve and relief valve
Includes 280-550 ml Silicone bag
Integrated intake / reservoir valve

See-through mask with unique Multi-function Mask Cover

72,000,000
Includes mask no 3-4 with mask cover
Includes reservoir bag 2600ml
Includes reservoir valve
Latex-free
Display case
Autoclavable
Silicone corrugated extension tube with connetors
Oxygen Mask
Two guedel airways
6. Bag Valve Mask (Neonatus) Eropa/Amerika 17 1,800,000
Spesification:
For neonatus
Self-inflating resuscitation device / bag
Silicone material
Includes patient valve, PEEP valve and relief valve
30,600,000
Includes 220 ml Silicone bag
Integrated intake / reservoir valve

See-through mask with unique Multi-function Mask Cover

Includes 50 mm mask with mask cover

Includes reservoir bag 100ml
Negara Asal/Asal Merk Perkiraan Harga
No. Nama Alat Kedokteran/ Spesifikasi Setara Banyaknya
Setara Satuan Jumlah
Bag Valve Mask (Neonatus)
 Includes reservoir valve
Latex-free
Display case
Autoclavable
Silicone corrugated extension tube with connetors
Oxygen Mask
Two guedel airways
7. Emergency Trolley Eropa/ Amerika 12 40,000,000
Specifications :
LEC 53 Lifeline Emergency
W=89 cm, H: 91 cm, D=57 cm
Accessories packages : Top capity tray, side Bin (1)-locking,
Adjustable defibrillator tray, suction pump shelf, backboard
front assembly kit, oxygen tank holder, IV pole with carts 480,000,000
mount.

Storage/gel bin, Plastic security seals 100PK

39" (991 mm) cart, 3" (76 mm) drawer, 3" drawer divider kit, 6"
(152 mm) drawer, 6" drawer divider kit, 9" (203 mm) drawer

8. Defibrillator Amerika 9 818,107,500

Specifications:
8.0" x 10.4"x7.9" with handle
Manual and AED mode, SpO2, NiBp, pacing, etCO2, built ini
thermal printer and rechargable lithium battery
Internal and External defibrillation

Paddle controls : Energy select, charge, discharge, recorder

Built in energy select switch on paddles

3-lead, optional 5-lead ECG cable, external hard paddles or
hands-free therapy electrodes 7,362,967,500

Fully defibrillator proff. Special circuitry prevents distortion of

ECG during pacer pulse

Dedicated circuicitry detect most implanted pacemaker spikes

and provides standard display marker of spike on ECG trace

CPR durapadz, reusable defibrillation pads with integrated CPR

sensor
Adult and pediatric reusable airway adapter
Built in charge switch on paddles
Negara Asal/Asal Merk Perkiraan Harga
No. Nama Alat Kedokteran/ Spesifikasi Setara Banyaknya
Setara Satuan Jumlah
8. Defibrillator
Built in shock switch on paddles
Activation and deactivation of recorder through switch on
paddles
Charge control on paddles and unit front panel
Waveform : Rectilinear Biphasic, 10 mSec
Synchronizes defibrillator pulse to patient’s R-wave
Integral pediatric paddles
Reusable adult defibrillation pads
Automatic and manual self test
12 ECG waveform
3/ optional 5 lead / optional 12 lead
See-thru CPR function to see patient’s underlying ECG rhythm
while performing manual CPR

See-thru CPR function that enables the rescuer to see patient’s

underlying ECG rhythm while performing manual CPR

Demand and asynchronous pacing mode

9. Pulse oxymetri Eropa/Amerika 50 1,920,000

Specifications :
Upgradable technology and can check :
Total haemoglobin
Total Hemoglobin (SpHb)
Oxygen content (SpOCTM) 96,000,000
Carboxyhemoglobin (SpCO)
Methemoglobin (SpMet)
Pulse oxymetri for oxygen saturation
 96,000,000

SpO2, Pulse rate, perfusion index, pleth variability index (PVI),

Respiration rate (RRa)
Negara Asal/Asal Merk Perkiraan Harga
No. Nama Alat Kedokteran/ Spesifikasi Setara Banyaknya
Setara Satuan Jumlah
9. Pulse oxymetri
Adult, pediatric and neonate capability Suitable for heart
failure, COPD, Asthma
LCD Display
Powerful data storage capacity
Battery life-up to 48 hours
Real time clock display
Backlight control and automatic power off function
Audible and visible alarm capability
Low battery indicator
10. Tabung Oxygen Indonesia 35 2,640,000
Spesification:
92,400,000
Ukuran 1M3
Regulator/meteran O2
11. Portable Blood Analyser 1 386,974,500
Spesification:
Terdiri dari cartridge dan analyzer
Mampu menampilkan pembacaan hasil pada layar dan hasil
dapat dicetak 386,974,500
Peralatan kalibrasi
Cairan (reagen) penguji kelaikan cartridge
Melakukan pemeriksaan darah : gas darah, kimia darah, laktat,
elektrolit, hematologi, koagulasi, enzim jantung
12. Vein Viewer Amerika 1 216,847,000
Spesification:
Weight : 54 lbs (24.5 kg), Height : 74.8 in (190 cm)
2 cell Lithium Ion, Rechargable battery pack
216,847,000
100-240 VAC, 50-60 Hz
Storage Humidity : 0 % to 90 %, non-condensing
Atmospheric pressure : 700hPa - 1,060 hPa
Operating Humidity : 10 % to 90 %, non-condensing

Negara Asal/Asal Merk Perkiraan Harga

No. Nama Alat Kedokteran/ Spesifikasi Setara Setara Banyaknya
Satuan Jumlah
13. Ventilator Portable Amerika 1 599,938,267
Eagle II MRI conditional
Volume and Pressure Targeted Portable Critrical Care Ventilor
System
Includes : Power Suppply, Inlet Filters, Adult and Infant Circuits,
Operation Manual-CD, oO2 Hose, Pulse Oximetry, Quick
Referance Guide-Laminated
599,938,267
Pulse Oximeter finger sensor adult reusable
Pulse Oximeter finger sensor pediatric reusable
Pulse Oximeter patient cable 4' reusable
Circuits for adult (MRI)
Circuit for infant (MRI)
1 Liter impact Branded test Lung
Portable Ventilator
S.E.T. Pulse Oximeter (Touch Screen) + ROOT Docking System +
14. SEDLine Brain Function Monitoring Module + ISA Capnograph Amerika 1 837,619,750
(EtCO2) and O3 Regional Oximeter
Patient Cable 837,619,750
Adult Reusable SpO2 Sensor
Adult Hb Rainbow Sensor, Resposable
Adult Reusable Rainbow Sensor for SPCO and SpMet
Power Cable
Mini Emergensi Bag Eropa 4 1,600,000
Spesification:
-Made with waterproof durable nylon
-Interesting glaring color equipped with reflective tape so its
15 easy to recognize and can be seen in the dark 6,400,000

-Easy to carry with hold by hands and wear over the shoulder
 15 6,400,000

Dimension: 17.5cm X 37.5 cm x 22.5 cm

Berat maksimal: 1 Kg
16 Portable Monitor Amerika 1 275,005,500

Pulse oximeter with continuous monitoring of SpO2, pulse rate

and PI (Perfusion Index), Total Hemoglobin (SpHb), Oxygen
Content (SpOC), Carboxyhemoglobin (SpCO), Methemoglobin
(SpMet), and Pleth Variability Index (PVI) 275,005,500

Patient cable sensor

Adult Reusable SpO2 Sensor
Adult reusable rainbow sensor for SpCO and SpMet
17 Capnograph
Quantitative capnograph for mainstream CO2 monitoring of Amerika 1 41,233,500
adult, pediatric and infant
Graphic OLED-display shows EtCO2, Respiratory rate and CO2
waveform (capnogram)
CO2 measurements using non dispersive IR absorption
Immediate results and requires no warm-up time
41,233,500
Portable, rugged and water resistant
Can be use in pre-hospital, emergency medicine, operating
room, ICU,and term acute care
No routine calibration required
Defibrillation-proof
Can be connect to patient by endotracheal tube or mask
Using two AAA lithium batteries
Total 11,090,886,017
Terbilang: tujuh puluh empat juta seratus ribu rupiah

Menyetujui Mengetahui Jakarta, 15 Desember 2015

Direktur Medik dan Keperawatn Kepala Bidang Pelayanan Medik Ketua Tim Medis Reaksi Cepat

Dr.dr.Ratna Dwi Restuti Sp.THT-KL(K) Dr. dr. Muharam Sp.OG(K) dr. Riyadh Firdhaus, Sp.An
NIP.1963032811989022001 NIP: 197604151997071002 NIP 197706112009121003
 SPESIFIKASI USULAN KEBUTUHAN ALAT KEDOKTERAN

Negara Asal /Asal

No Nama Alat Kedokteran/Spesifikasi Setara
merk Setara

1. Laryngoscope (Adult) Germany

Spesification:
Standartd Macintosh with Blade 2,3,4
Battery handle type AA, nonrechargeable

2. Laryngoscope (Pediatric) Germany

Spesification:
Standartd Macintosh with Blade 0,1,2
Battery handle type AA, nonrechargeable

3. Laryngoscope (Neonatus) Germany

Spesification:
Standard Miller with Blade 00, 0, 1, 2
Battery handle type AA, nonrechargeable

4. Bag Valve Mask (Adult) Eropa/ USA

Spesification:
For adult
Self-inflating resuscitation device / bag
Silicone material
Includes patient valve, PEEP valve and relief valve
Includes 1500-2000ml Silicone bag
Integrated intake / reservoir valve
See-through mask with unique Multi-function Mask Cover
Includes mask no 4-5 with mask cover
Includes reservoir bag 2600ml
Includes reservoir valve
Latex-free
Display case
Autoclavable
Silicone corrugated extension tube with connetors

5. Bag Valve Mask (Pediatric) Eropa/ USA

Spesification:
For pediatric
Self-inflating resuscitation device / bag
Silicone material
Includes patient valve, PEEP valve and relief valve
 Negara Asal /Asal
No Nama Alat Kedokteran/Spesifikasi Setara
merk Setara

Includes 280-550 ml Silicone bag

Integrated intake / reservoir valve
See-through mask with unique Multi-function Mask Cover
Includes mask no 3-4 with mask cover
Includes reservoir bag 2600ml
Includes reservoir valve
Latex-free
Display case
Autoclavable
Silicone corrugated extension tube with connetors
Oxygen Mask
Two guedel airways

6. Bag Valve Mask (Neonatus) Eropa/ USA

Spesification:
For neonatus
Self-inflating resuscitation device / bag
Silicone material
Includes patient valve, PEEP valve and relief valve
Includes 220 ml Silicone bag
Integrated intake / reservoir valve
See-through mask with unique Multi-function Mask Cover
Includes 50 mm mask with mask cover
Includes reservoir bag 100ml
Includes reservoir valve
Latex-free
Display case
Autoclavable
Silicone corrugated extension tube with connetors
Oxygen Mask
Two guedel airways

7. Emergency Trolley Eropa/ USA

Specifications :
W=± 89 cm, H: ± 91 cm, D=± 57 cm

Accessories packages : Top capity tray, side Bin (1)-locking,

Adjustable defibrillator tray, suction pump shelf, backboard front
assembly kit, oxygen tank holder, IV pole with carts mount.

Storage/gel bin, Plastic security seals 100PK

± í39" (991 mm) cart, 3" (76 mm) drawer, 3" drawer divider kit,
6" (152 mm) drawer, 6" drawer divider kit, 9" (203 mm) drawerý

8. Pulse oxymetri Eropa/USA

Specifications :
 Negara Asal /Asal
No Nama Alat Kedokteran/Spesifikasi Setara
merk Setara

Pulse oxymetri for oxygen saturation

SpO2, Pulse rate
LCD Display
Backlight control and automatic power off function

9. Tabung Oxygen Lokal

Spesification:
Ukuran 1M3
Regulator/meteran O2

10 Defibrillator USA