Humanitarian Assistance

for Flash Flood Disaster

at Wasior District, West Papua

Team of Emergency & Disaster

Faculty of Medicine – University of Brawijaya
 Eurasian
Eurasian Plate
Plate
Pacific
Pacific Plate
Plate

12
12cm/yr
cm/yr

Ring of Fire

5-6
5-6cm/yr
cm/yr India-Australian Plate
India-Australian Plate

Indonesia; The Hypermarket of Disaster

 Disaster Management Cycle
Preparedness
Prevention and Mitigation • Risk forecasting
• Risk assessment • Organization
• Spatial Planning • Planning of resources
• Eco-structural measures • Emergency Planning
• Public Awareness • Training
• Education.. • Public awareness..

Reconstruction
• Permanent rehabilitation
• Infrastructures
Disasters
reconstruction
• Building reconstruction
• Reinforcement of
structures, ..

Post-Disaster
• Damage Assessment
• Follow-up of rehabilitation measures, .. Response
• Alarm
• Life, property saving
Rehabilitation/Recovery • Reduction of impact of disaster
• Temporary rehabilitation • Information dissemination
• Re-establishing Health systems • Communication
• Re-establishing communication routes..
Our
Our Concept
Concept of
of Humanitarian
Humanitarian Assistance
Assistance
IDP’s

Disaster
•injuries
•deaths
•malnutrition
•SAB & environment. (-)
•Paralized health services
•etc

Mass victims Ifrastructures

damage
•injuries
•handycap
•building (hospital/PHC/Pustu) damaged
•deaths
•Health equipment,Transport, communication
equipment damage/missing
•Drugs supplies damage/missing, etc
“The key principle of disaster
medical care is to do the greatest
good for the greatest number of
patients, while the objective of
conventional medical care is to do
the greatest good for the individual
patient.”
Wasior Flood

 4 October 2010, 08.15

hrs

 Triggered by incessant
heavy rains that had
fallen from Sunday to
Monday (Oct 3 and 4)

 Purely natural disaster,

not deforestation
Wasior Flood, 4 Oct 2010
The flood has…
 claimed 159 lives
 left 123 missing
people
 severely injured 250
people
 lightly injured 535
people
 Left 4,000 people
homeless
 forced 4,423 residents
to seek refuge
 Destroyed 90% of the
town
Refugees Camps

BLK Manokwari Kodim Manokwari

1300++ refugees 2000++ refugees
Crisis Reduction Team
1. Rapid Reaction Tim
2. Rapid Health Assessment Team
3. Health Assistant Team (from UB)
Health Assistance Team

 2 emergency
physicians
 1 general surgeon
 2 emergency nurses
 1 disaster management
& environmental
health expert
 1 surveillance &
financial consultant
 2 logistic support
Team of Disaster & Emergency FKUB
The Team
11-17 October 2009

Leader: Dr. Ali Imam

Team Members:
Dr. Ali Haedar
Dr. A. Yusmanedi, MMRS
Dr. Albert Kapitarow
Alfrina Hany, S.Kep, MN
Ns. Heri Kristianto, S.Kep, M.Kep
DR. Kusuma Ratnawati, SE, MM
Wasis
Deny Safleratendra, AMD
Contacts
No. Name Institution Designation Number
1. Dr. Ali Imam FKUB TED 081334663808
2. Dr. Ali Haedar FKUB EM 08123317226
3. Dr. A. Yusmanedi, FKUB EM 081369261975
MMRS
4. Dr. Albert Kapitarow FKUB Bedah 081248901757
5. Alfrina Hany, S.Kep, FKUB PSIK 081805059292
MN
6. Ns. Heri Kristianto, FKUB PSIK 085234068944
S.Kep, M.Kep
7. DR. Kusuma FEUB TED 08123325556
Ratnawati, SE, MM
8. Wasis FKUB TED 081334773332
9. Deny Safleratendra, FKUB TED 085233227600
AMD
10. Dr. Sri Watampone FKUB OBG 081344477976
11. Dr. Habel Pandelaki Dinkes Teluk Wondama Kadinkes 081344030017
12. Dr. Victor Eka Dinkes Teluk Wondama Dinkes 08123181786
Ruined Health Center

Hospital PHC (Puskesmas)

Limited Mode of Access

Remote Area Means of transportation: by air

Advance Medical Service Post
Assigned to set up an ED (& Field Hospital) by
Provincial Health Officer & BNPB

Venue: Social Affair Office Wasior

Equipments
 Tools

• Rapid Health Assessment

• Sign Boards
• Triage Tag
• Medical Record
• Registration Form
• Observation Chart
• Nursing Progress Note
• Emergency Drug List
• Non-emergency Drug List
• Informed Consent
Rapid Health Assessment

 Population
 Health & Illness
 Health Facilities
 Clean Water
 Sanitation
 Shelter
 Food – Nutrition
 Communication
Sign Boards
Triage System for Disaster
RESPIRATIONS Minor ALL WALKING
WOUNDED

NO YES

POSITION AIRWAY
<30/Min. or >30/Min. or
>10/Min. <10/Min.

NO YES
Immediate

Morgue Immediate PULSE

Radial Pulse Absent

Radial Pulse Present

Control
Bleeding

Immediate

MENTAL STATUS

Can’t Follow Can Follow

Simple Simple
Commands Commands

Immediate Delayed
S.T.A.R.T. (Simple Triage And Rapid
Transport) >30/Min.
RESPIRATIONS or Immediate
<10/Min.

Radial Pulse
PULSE Immediate
Absent

Can’t Follow Simple

MENTAL STATUS Commands
Immediate
Medical Record
Registration Form
Observation Chart
Nursing Progress Note
Emergency Drug List
Non-emergency Drug List
Informed Consent
 Patients Flow
at Wasior Field Hospital Unable
VISUAL to P1
TRIAGE walk

Patient TRIAGE

P2
NURSE Walk

Patient Registration P1
comes CHECK:
Respiration P2
Pulse

Waiting Mental Status

Room P3

Ward/
Discharged/
Observe
ED Flow; we are not only dealing with number of patients but
also…

Response Time
Emergency Department
& Field Hospital, Wasior
Emergency Department & Field Hospital,
Wasior

Registration Triage
Emergency Department & Field Hospital,
Wasior

P1 (RED) P2 (YELLOW)
Emergency Department & Field Hospital,
Wasior

P3 (GREEN) Minor OT
Emergency Department & Field Hospital,
Wasior

Observation Ward Ward

Emergency Department & Field Hospital,
Wasior

Nutrition Pharmacy
Emergency Department & Field Hospital,
Wasior

Nurse Station Office

Emergency Department & Field Hospital,
Wasior

Water Source Disposal

Be friendly with new atmosphere…
Hospital Visits

13-10-2010

Dr. R. Bambang Sardjono,

MPH
(Irjen Bina Kesehatan
Masyarakat Kemenkes RI)
Hospital Visits

13-10-2010

Dr. Sanber
(Kepala Bagian Umum Dinas
Kesehatan Kabupaten
Wondama)
Hospital Visits

13-10-2010

Dr. Habel Pandelaki

(Kepala Dinas Kesehatan
Kabupaten Teluk Wondama)
Mr. President visit

 Even tough Mr
President did not visit
our Field Hospital, still
we took picture with
his car…
Significant Patient
Tn. YR/♂/50 th/Wondomawi with Encephalitis dt.
Cerebral Malaria (? Falciparum)

Referred from primary health service post,brought

by ambulance. History of fever since 4/7, LOC
since 4/24, & seizure x1for 30”, lives in malaria
endemic area. Pt’s GCS E1V1M4, respiratory
distress with RR 30x/min, BP 90/70 mmHg, pulse
110x/min, axillar temp 40.5 ºC, cyanosis, SaO 2
76%, severe dehydrated, absent of focal
neurologic, epileptic state.

We decided to intubate pt under RSI method with

Succynilcholine, assist breathing with positive
pressure ventilation, to rehydrate with IV NaCl
0.9% 2 L, to stop the seizure with IV drip
Midazolam & IV Phenitoin, to administer IV loading
Kuinin 1 gr loading & IV drip Kuinin 1 gr w/i 24hrs,
antibiotika, antipiretik, to give enteral feeding via
NGT & to insert urine catheter.
The next 3 days… discharged!

Mr YR said “Thank you very much for curing me, I will never
forget what you have done. God knows…”
Transferring The System

 We handed over the

system to local health
providers

 2 of our doctors (Dr Ali

& Dr Albert) stayed for
another 1 week to
maintain system
sustainability
Why didn’t we dispatch Team 2?

 Time effectiveness; <10 days is considered NOT effective

keep the system runs
 Cost effectiveness; high budget for 1 week project
 We need to empower local capacities to carry on the
established system
 Team’s dependency with key persons within the team &
local key person from Wasior
 2 of our doctors are stayed longer to maintain system
sustainability
Lesson learnt
 Disaster Medicine is clearly a marriage between
Emergency Medicine & Disaster Management
 ED is the best learning ground to manage disaster care,
by performing daily emergency care
 We need to understand and to set up our role during the
disaster
 We should empower local capacities in performing
humanitarian assistance
 Prepare for the best, expect for the worst
 Emergency Medicine & Disaster Medicine need to be
supported & to be improved in Indonesia
Emergency Medicine Specialist Training Programme Curriculum
of FKUB
DAK7007 Disaster Medicine
Principles of Disaster Medicine and Management

Environmental Emergencies

Principles of Pre-Hospital Care

Methods for Disaster Medicine and Management

Major Incident Management & Mass Destruction

Thank You…