INTEGRATED EMERGENCY

MEDICAL SERVICES SYSTEM

Respati S Dradjat

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• Urban setting
• Increased population density
• Violent crime, traumatic injuries, motor
vehicle accidents, cardiorespiratoty illnesses

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• Hazardous and poorly regulated work
environment
• Unsafe roads and motor vehicles
• Lack of well trained emergency medical
personal

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 WHO (2005)
• The importance of EMS and prehospital
trauma care system in reducing morbidity and
mortality from violence and injury
• Priority for development of EMS systems
worldwide

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• Prompt communication and activation of the
system
• The prompt response of the system, and the
assessment, treatment, and transport to
formal health care facilities
• Should be provided to all injured patients
regardless of economic status of the country
or municipality rendering care and treatment

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 The Role of Prehospital Care
• Minimizing the poor outcomes, mortality and
long term morbidity
• Proper wound care, immobilization of
fractures, availability of oxygen, IV fluids,
prompt recognition of life threatening
condition, and transport to definitive care

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1. National system
2. Local or regional system
3. Private system
4. Hospital base system
5. Volunteer system
6. Hybride system

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 SPGDT
• Sistim koordinasi multisektor dan multiprofesi
dalam pelayanan gawat darurat sehari-hari
maupun bencana yang meliputi pelayanan pra
rumah sakit, pelayanan di rumah sakit dan
pelayanan antar rumah sakit

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• Diperlukan penguatan sistem pelayanan gawat
darurat dan penataan kewenangan layanan
gawat darurat yang mampu memberikan
pelayanan secara komprehensif dan terpadu
serta efisien dan efektif , sehari-hari, mencakup
prarumah sakit, di rumah sakit dan antar rumah
sakit, yang ditunjang oleh komponen; SDM pada
semua jenjang pelayanan, fasilitas sarana dan
prasarana termasuk transportasi dan komunikasi

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• The EMS system is the entire system in place
to provide care to emergency patients from
the initial call to definitive care
• Extension of emergency medical care into the
community

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 The EMS System
1. Personnel 10. Transfer to care
2. Training 11. Standardization of
3. Communication patients records
4. Transportation 12. Public information and
5. Facilities education
6. Critical care unit 13. Independent review
7. Public savety agency and evaluation
14. Disaster linkage
8. Consumer participation
15. Mutual aid agreement
9. Acces to care
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 Personnel
Urban area
• Public savety
• Ambulance personal
Rural area
• Citizen volunteers
• Park rangers
• Ski patrols

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 Training
• First Responder
• Emergency Medical Technician (EMT) Basic
• EMT intermediate (EMT-I)
• EMT paramedic (EMT-P)

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 First responder
• CPR
• Automated external defibrilator (AED)
• Safe extrication
• Immobilization
• Transportation

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 EMT-B
• Nitroglycerine
• Epinephrine
• Inhaler
• Advance airway technique; endotracheal
intubation, advanced airway adjunct

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 EMT-I
• Patient assessment
• Intavenous therapy
• Defibrillation
• Basic ECG interpretation
• Some cardiac medication

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 EMT-P
• Understanding of the pathophysiology and
pharmacology needed for intervention in
various medical condition

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 Communication
• The universal emergency telephone number
• Is the essential front door of the EMS system
• To obtain initial medical information properly
• Dispatch appropriate personal
• Offer first aid information

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 Call center
• Public access
• Dispatch of the appropriate vehicles and
personnel
• Hospital notification
• Online medical control

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 Transportation
• Basic life support ambulances, EMT-B level
• Advanced life support ambulances, EMT-P
or other health care personnel

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 Facilities
• Emergency patients should be transported to
the closest appropriate hospital

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 Critical Care Units
Tertiary care facilities
• Trauma
• Neonatal intensive care
• High-risk obstetrics
• Burn
• Spinal cord injury
• Neurosurgical
• Cardiac care
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 Public savety agency
• The EMS system should have strong ties with
police and fire department

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 Consumer participation
• Public support; political and financial
• Lay public first aid training and the
implementation of a universal telephone
number system

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 Access to care
• All individuals have access to emergency care
regardless of their ability to pay or type of
insurance coverage
• The EMS system is a patients only point of
entry into the emergency care system

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 Transfer of care
• Transferring and receiving facilities
• Transfer agreement

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 Patient records
• Use a similar reporting form
• The record systems should facilitate data
extraction for trauma registries, severity
scoring, and cardiac arrest outcome studies

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 Public information and education
• The benefit from excellent EMS system
• Prepared to first aid care
• Know how to quikly access the EMS system
• Understands that patients may not be
delivered to the hospital of their choice under
life threathening condition

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 Independent review and evaluation

• Review of EMS system

• Review of communication
• Review of response time
• Review of patient care and quality control
• Review of outcome studies of several entities
as cardiac arrest, multiple trauma etc.
• Hospital participation

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 Disaster linkage
• The EMS system is an integral part of disaster
preparedness
• Should be involved in planning and practice drill
• The EMS system informed of potential disaster
situation and hazards
• The EMS system informed of hospital capacity
to recieve certain kinds of pastients under
disaster condition

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 Mutual aid agreements
• Uninterrupted emergency care is available
when local agencies are overwhelmed or
unable to provide services

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 Research
• Is needed to determine which therapeutic
interventions are beneficial and which are not
• Is the key to improve EMS practice

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 Medical Control
A save and effective EMS system requires
considerable physician input and surveylance
• Development of protocol (medical treatment,
the use of medical devices and equipment)
• Development of medical accountability
• Development of ongoing education

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 Medical basis for EMS
• Emergency cardiac care
• Trauma care
• Adult medical care
• Pediatric care

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 Peralatan
• Began as hospital equipment that was
extrapolated to the field
• Did not always perform under the more
rigorous conditions of out-of-hospital care
• Scrutinized for effectiveness
• Adapted to field use in term of size, weight,
and durability

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 Communication
• Wireless communication
• Use specific frequency
• Cellular/personal communication system

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 Patient record
• Electronic medical record
• Software specific
• Essential for prehospital research

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 Universal precautions
• Protected against exposure to blood and other
body fluids from patient

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 Personal protective equipment
• When personnel are exposed to hazardous
material or biologic or chemical weapons

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 Resuscitation equipment
• Defibrillators
• Airway and ventilatory adjuncts
• Vascular access equipment
• MASTs

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 Spinal immobilization
• Spinal boards and cervical collars

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 Extremity immobilization
• Traction splint

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 Pharmaceutical equipment
• Nitroglycerine for chest pain
• Inhaled beta agonist for bronchospasm
• Glucagon for hypoglycemia
• Epinephrine preloaded injection for
anaphylaxis

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The drug that can make difference
• Oxygen for hypoxia
• Glucose for hypoglycemia
• Nitroglycerine for chest pain
• Inhaled beta agonist for bronchospasm
• Naloxone for narcotic overdose
• Morphin for pain
• Benzodiazepines for seizures, extreme
agitation, or intubation
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• Furosemide for fluid overload
• Epinephrine for cardiac arrest and anaphylaxis
• Lidocaine, magnesium, and amiodarone for
cardiac arrest
• Adenosine and diltiazem for rate control of the
various tachycardias
• Calcium and sodium bicarbonate for hyperkalemia
• Paralytic drug are used for RSI

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• The equipment used in prehospital care
includes the vihicles

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 Sistem Rujukan
• Klasifikasi RS / Klasifikasi IGD RS
• RS Khusus

• The right patient on the right time to the right

hospital
• Closed appropriate hospital

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 Transportasi
• Ground ambulances
• Helicopters
• Fixed-wing aircraft
• First-response vehicle

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 The ground ambulance
• Type I, a standard truck chassis with a
separate a modular box
• Type II, an enlarged van-type vehicle
• Type III, a van chassis with an integrated
modular box
Have warning devices (lights and siren)

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 4. Transportasi medis udara
• Helicopter (rotor-wing)
• Air-plane (fixed-wing)

Fast-speeds
100-200 miles/h for helicopter
500 miles/h for airplane
Not limited by traffic or road quality

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Transportasi neonatal, pediatric dan lansia

• Intensive care in neonatology and pediatric

care are expensive and high technology
• The interfacility transport is conducted by
specialized transport services

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 Special problem
• Hypothermia
• Hypoxemia (RDS, PPHN, CHD)
• Hypoglycemia
• Vascular access
• Infection
• Viability (gestational age, weighing)

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 Perkumpulan massa
• Mass gathering defined as any voluntary and
temporary collection of greater than 1000
people at one site or location for a common
purpose
• The injury and illness rates are greater than
the average non-gathered population
• Create medical treatment and transportation
challenges

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• Densely clustered crowds and physical barriers
prevent access to on scene care of timely safe
evacuation of patient

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 Medical direction
• Inspect event venue and anticipate medical
demand
• The medical care plan should be discussed
with the event manager
• Agreement should be documented and
contractual, because of the risk medicolegal
implication

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• The physical setting
• Expected population and hazardous exposure

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• Planning
• Patient care path
• Personnel
• Equipment
• Communication

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......barangsiapa yang memelihara kehidupan
seorang manusia, maka seolah-olah dia telah
memelihara kehidupan manusia semuanya.
(QS 5:32)

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 References
• Tintinalli JE, Kelen GD, Stapczynski JS. 2006:
Emergency Medicine a comprehensive study
guide, 6th Ed. USA : The McGraw-Hill

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