Hospital & ICU

Pandemic Response Plan

 Why plan?
• Sistematisasi
• Menghindari chaos
• Efisiensi
• Evaluasi
Comprehensive Hospital Disaster Plan
(Hospital Disaster Risk Management Plan)

“... comprehensive disaster plan is

considering all phases of disaster-
management cycle : (1) mitigation
and prevention, (2) preparedness (3)
response, and (4) recovery and
rehabilitation.”
(Djalali in Ciottone, 2016; ASTM, 2009; Adini et.al, 2006)
 Comprehensive Hospital Disaster Plan
(Hospital Disaster Risk Management Plan)
Hazard Control Preparedness & Response
Integration Management
• Natural • Training/Edu/Exercise
• Biological • Participation
• Technological • Properly Equipped
• Societal • Emergency Operation
Center
Reduce Vulnerability • Emergency System
• Building
• Response Plan
• Equipment
• Physical Layout
• Lifelines
• Access Route
Improvement in • Security
Recovery Integration Management
“Build Back Better” • Coordination, Cooperation,
Collaboration
(illustrated from Djalali, in Ciottone, 2016)
 Pre-Event
Event
Geological

Damage
Change in Function
Relief
Recovery
Waktu
Pre-Event
Event
Biological

Damage
Change in Function
Relief
Recovery
 Comprehensive Hospital Disaster Plan for Pandemic
Hazard Control Reduce Vulnerability
Integration Management
• Tracing/Testing -> Triage • Vaccine
• Isolation • Disease control
• Route Management • Safety

Preparedness & Response

• Self-Assesment
• Standards of care
• System: Leadership, Response Plan, Communication
• Staff: Count, Capability, Participation,
• Stuff: Supplies & Equipment
• Space: Access/Route, Layout & Surge Capacity
• Support Management

Integration Management
• Coordination, Cooperation,
Collaboration
10S
• Security & Safety
• Sensitive Issues: Ethics
• Special Issues: Paediatric & Obstetric
ICU Preparedness & Response Plan
ICU 1. ICU jarang terdampak bencana.
Merupakan unit yang
• kompleks Sekali terdampak, konsekuensinya
• rentan sangat besar
• sensitif
• stressfull 2. Persiapan ≠ Belanja barang
• risiko rugi
– Pembiayaan BPJS
– Tidak bisa overstock
– Biaya alat mahal
 (S1) - Self-Assesment
• Penting untuk mengetahui seberapa siap kita
• Identifikasi batasan kemampuan dan
pengembangannya
• Fondasi 9S lainnya
• Standards of care, System, Support Management, Staff, Stuff & Supplies, Space,
Security & Safety, Sensitive Issues, Special Issues
 (S2) - Standard of Care
• Triage
– Menentukan status pasien kritis, non-kritis, palliatif
– Menentukan ruang rawat
• Treatment
– Menentukan jenis dan tingkat intervensi
– Menentukan timing dalam treatment
• Transport
– Menentukan timing dalam rujukan
– mentukan metode rujukan
– Menentukan tujuan rujukan
(S2) - Standard of Care

Shang, Y., Pan, C., Yang, X. et al. Management of critically ill patients with COVID-19 in
ICU: statement from front-line intensive care experts in Wuhan, China. Ann. Intensive
Care 10, 73 (2020). https://doi.org/10.1186/s13613-020-00689-1
 SPO/CP terkait treatment di ICU
1. SPO masuk ICU
2. SPO keluar ICU
3. SPO serah terima pasien di ICU
4. SPO pemasangan ETT
5. SPO pelepasan ETT
6. SPO indikasi pasang lepas ventilator
7. SPO penggunaan venti
8. SPO perawatan pasien dgn venti
9. SPO pemasangan CVC
10. SPO defib
11. SPO balance cairan
12. SPO MBO
13. SPO manajemen klinis px covid dgn kondisi kritis
14. SPO assessment lanjutan px covid
 (S3) - System
• Leadership system
– Aktivasi HICS (Hospital Incident Command System) / ICU-
ICS
– Penambahan kapasitas (bed, SDM, alkes)
– Penolakan pasien jika kapasitas bed sudah penuh
– Tipe ICU :
• Single-ICU → modifikasi ruang ICU bila ada temuan kasus C19
• Multi-ICU → pengalihan ruang rawat bila hasil PCR sudah negatif
– Deaktivasi ICU-ICS
 (S3) - System
• Communication system
– Eksternal
• responder lain, masyarakat
– Internal
• HICS & antar unit layanan
• ICU team
• dengan staf yang tidak/kurang terlibat
– Perlengkapan
 (S3) - System
• Response Plan
– Perencanaan utama & cadangan
– Penulisan
– Evaluasi
 (S4) - Staff
• Count
– Perbandingan antara kapasitas pasien dan jumlah tenaga medis
– penambahan dan pengurangan staff dalam waktu yang memadahi

• Capability
– Tingkat pendidikan dak keterampilan staf

• Participation
– Dilibatkan semua vs sebagian
– kriteria staf yang terlibat: risiko, bidang kerja, pengalaman

• Well-being (JM/insentif, makanan, kenyamanan ruang, mental)

 (S4) - Staff
• Contoh
– SPO mobilisasi SDM internal
– SPO aktivasi SDM alternatif
– SPO manajemen relawan
– SPO Demobilisasi SDM internal
– SPO Demobilisasi SDM alternatif
 (S5) - Stuff & Supplies
• Critical Supplies & Nice to ready supplies
– Obat, Alat kesehatan, Alat non-kesehatan, Oksigen

• Penataan yang efektif dan efisien

• Surge Capacity
– Stok, penyimpanan, akses oleh staf,
– Kerjasama dgn pihak lain
 (S6) - Space
• Access/Route
– Kelancaran
– Keamanan dari kontaminasi

• Layout
• Surge Capacity
– Ruang yang sama vs Ruang lain
– minimal 300%
 (S7) - Support Management
• Pembiayaan
 (S7) - Support Management
• Fasilitas penunjang
– IPSRS, Elektomedik, Gizi
• Unit/SMF Terkait
– IGD, Bangsal isolasi, Keamanan dll
– IPD, Paru, JAntung, Emergency, Anestesi, THT, Radiologi
– Rekam medis dan system pelaporan -> klaim
• Relawan
 (S8) - Security & Safety
• APD: Standard & ketersediaan
• Fasilitas dekontaminasi
• Ruangan terisolasi
• Pengamanan dari tindak kekerasan
• Contoh :
– SPO APD
– SPO Skrining Covid-19
– SPO Pengunjung/keluarga untuk pasien ICU Covid
 (S9) - Sensitive Issues
• Ethics: Standars & Commitee
– Akuntabilitas, inklusifitas, transparansi,
reasionableness, responsifitas.
• Patients & family knowledge Case:
• Triage &
• Communication/Education Intervention Triage
• Isu mengcovidkan
pasien
• Isu Ventilator
membunuh
 (S10) - Special Issues
• Paediatric
– Triage & Terapi spesifik
– Family bonding
– Kesehatan mental & tumbuh kembang
– Ketersediaan fasilitas

• Obstetric
– 2 nyawa
– risiko tinggi pada usia kehamilan “tanggung”
– “anak mahal”