1. Introducing Disaster Management
2. Understanding health sector role in Disaster Relief
3. Being able to carry out preparedness by:
   1. Compiling situational analysis
   2. Preparing organization
   3. Compiling plan of action
   4. Being able to prepare response and recovery

Alarming and Declare

Morning at 05.50

Catastrophic earthquake struck Bantul and Klaten. Sardjito Hospital which is located in northern Yogyakarta only suffered from minor damages. Night- shift hospital staff had known the earthquake strike from the media, personal contact, and experienced themselves the massive quake. In the mean time, the hospital was in the Merapi eruption preparedness. First patient was a motorist who felt down on a street due to the quake.

Question:

1. Did a disaster happen?
2. Who should warn the possibility of disaster occurrence and to whom?

At 07.00

The hospital teams for Merapi Disaster were arriving. Then, patients from Bantul were arriving to the hospital and were handled simply in the emergency unit. The patients grew larger in number. And at 10.00 the number of patients had become 500 patients

Question:

1. Who should declare a disaster state?
2. Who should take the command at that state?

Strategy in Chaos

At 10.00

Patients had reached 500 people. The disaster team coordinated and divided jobs. Needs outnumbered the resources. Some members of the core disaster team were not present. It was to be known that most of the surgeons and anesthetists were not present because they attended some meeting in Bandung , Surabaya and Makassar .

At 14.00

Patients had reached 1500 people. Chaos happened in the patient relief. Patients and hospital staffs were terrified to enter the building due to the quake; and therefore, it was decided to build tents outside. The inpatients were empty because they were all evacuated outside or they chose to go home. Surgeries in the Emergency Unit started at 14.00. Logistics for the patients were distributed.

At 16.00

The patients were 2000 people. Surgeries had been performed in OK Emergency Unit and Emergency OK in the new polyclinic building. The staffs who served were the night- shift ones having no chance to go home, the morning shift staffs and other staffs voluntarily coming to the hospital. Many other staffs became the life victims of the disaster. As an example, in the central surgery installation there were only 3 staffs in duty. The condition was quite chaotic because isolation for the incoming victims and the visitors could not be managed. The central surgery room was not used for security reason/ worry about the building strength.

Question:

1. What did happen/ what was the problem at that time?
2. What should be done by the hospital disaster team?

Internal Coordination and Assistants

At 18.00

Consultant team arrived from Jakarta . All hospital units performed their activities themselves, reactively, as far as they could, without any coordination centralized by the hospital. Triage was imprecisely led; mobilization did not run well. Only at night, re- triage was performed after 18.00.

At 20.00

Coordination meeting was organized by hospital disaster team and medical volunteers. The meeting resulted in: carrying on the works done by assigning a personnel as the leader and completing the disaster team which was actually originated from Merapi disaster team. The head of Emergency Unit was assigned as the contact person of medical assistance. Patient recording had been done since morning coordinated by Medical Record Division. Triage process did not run well because the patients outnumbered the competence.

At 21.00

Medical team from Surabaya / East Java had arrived in the hospital. Communication in and out Yogya still failed. Medical assistance from other areas agreed to help through various personal contact persons (uncoordinated) besides through the hospital contact person. Three rooms at OK Emergency Unit had been operated for 7 patient tables and 4 emergency surgical tables in the new polyclinic building.

At 23.00

Local staffs could not perform any works any longer. Medical services were performed by the assisting medical team and some newly arriving local staffs.

At 24.00

More patients were administered to the hospital. The building was still considered inappropriately safe. Until late Saturday, the hospital still considered that the buildings were still inappropriately safe although the consultant team from Jakarta declared that the hospital buildings were safe. Medical facility usage was not maximized. Zoning by the use of corridors and others run situational, unlike planned or zoning principle. Hospital area could not be isolated. Most of the victims suffered from fracture (around 80%), internal bleeding 10%, head injury 5%, others 5%. No intensive care unit because ICU was not being functioned.

Question:

1. What did the hospital actually need at that moment?
2. How to coordinate hospital staffs and assisting team?
3. Where is the proper location for a disaster post?
4. Who should lead the patient relief?
5. Who should coordinate the assisting team?
6. What problems to coordinate?
7. Who should access the function and properness of the hospital building? How?
8. What action to take in facing the concern of hospital building?
9. Who do the zoning?
10. Does the hospital need to coordinate with other health units?
11. Does the hospital need to seek help?
12. What possibly happens with such health service?
13. Which hospital unit needs to be functioned immediately?
14. What medicolegal aspect might occur?
15. How to perform triage, medical treatment and extended treatment for patient?

Crisis Management during Disaster

At 00.00

New patients still arrived at the hospital. It was difficult to move patients to rooms because there were not any transporters. The hospital was dirty. When adult patients were administered to the inpatient wards, they refused it. Surgery service and patient relief decreased because the staffs were too tired.

At 03.00

It was succeeded to move patients to the inpatient wards. There were 40 patients and were helped by volunteers. Patients who were willing to stay in wards were not significant in number.

At 04.30

Last patient surgery at OK Emergency Unit

At 08.00

There was an instruction to evacuate patients to big cities because the hospitals in Yogya were not considered competent enough in serving patients.

At 09.00

Medical service activity increased. The staffs were too tired, and there was not any substitution.

At 12.00

Patients in wards did not increase. Some patients were evacuated to PSIK building, MF GMU.

At 20.00

More assisting staffs came. Some were transported to outside hospital and DIY because the hospital staff increased and OK room had not functioned yet. There were transporter difficulty and cleaning service difficulty. Coordination for non- medical volunteers had not worked well. Food help increased. Medical recording had been continued. Rain forced patients to enter the room. Certain medical materials such as ATS and antibiotics started to decrease. ICU was functioning.

Question:

1. Was evacuation necessary/ unnecessary? What was the basis of the evacuation?
2. What is zooning? Was it done properly? Was it necessary to take care of the family victim? Who should take care of them?
3. What problems may emerge on the second day concerning the patient, patient family, staffs, volunteers and hospital disaster?

Undirected Management

At 08.00

• GBST could not be functioning because the water pipe was broken. NGOs began to arrive in Sardjito Hospital . More helps came, but they could not be coordinated well.
• There was problem due to the abandoned number of the assisting medical teams.
• There was competence gap between the general surgeon and orthopedic, and among other specialists (inter- disciplinary)
• There was problem in the job division in team; de facto differed from de yure, because Merapi team setting differed from Bantul team setting.
• The hospital made statement that the building was in proper condition, but the patients and the medical staffs doubted it.
• Medicinal supply and medical material were abandoned
• PSIK building, Microbiology building, Paracitology park in Medical faculty and Soedomo Dental Hospital were occupied by patients going home (transitory places)

At 12.00

• Coordination meeting decided that the evacuation would be executed today if GBST could not perform any surgery.
• There was hardly any obvious strategy to solve the problem
• Medical record kept running, but the detail of medical training was not recorded well
• Coordination of non- medical volunteers (individual, group, and organization) was put in order, transporter and cleaning service were solved
• There emerged some problem in controlling logistics and medical devices
• Regular service had not run yet; such circumstance would last for two weeks
• There was problem in the daily treatment of the patients in the hospital
• Infectious complication emerged on the patients
• ICU could not serve any patients

Question:

1. How should the assistances be better coordinated?
2. What is the further treatment when tetanus emerges?
3. What immediate target to be achieved?

Balance Achieved

At 08.00

90% of the patients were in wards, corridors were clean, tents on the hospital yards had been demolished, green patients were sent home.

At 13.00

GBST run with 15 surgery rooms operating with proper staffs because they were assisted by medical volunteers. GBST functioned for elective OK. Temporary OK in the new polyclinic was closed; Emergency Unit was only for emergency surgery. Prof. Soedomo Dental Hospital was closed because the patients had been treated in the hospital and medical faculty. Foreign medical teams who were just arrived and could not serve in the hospital were sent to Bantul.

Question:

1. What is meant by medical emergency phase?
2. Has the medical emergency phase been passed that day?

Transition to Normal Situation

New problem emerged: the patients to be sent home did not have any place to live, no family, and no transportation; so, many of them did not want/ could not go home. New parking building was used as the in- patient ward. Patient relief had been programmed, the hospital was able to receive referral patients from other hospitals to perform surgeries.

Question :

1. When could normal regulation be executed?
2. When should “regular” patients be served?
3. What is the consideration to determine the situation status?
4. Who determine it?

Normal Situation Resolved

• Patient transfer to wards had been finished; all patients had got their ward
• The problem for routine, non- earthquake patients emerged because clinics were not open
• Complication frequently occurred
• Buildings in Medical faculty were evacuated
• It had been considered to end the medical emergency phase
• Problem in medical logistics emerged: some of the required medicines were out of stock; there were plenty of unnecessary medicines; improperness, expiration; storage, documenting; the authority to receive the medicines (receive flow)

Question:

1. Was it necessary for the hospital to have external sweeping?
2. Was it necessary for the hospital to follow- up patient?
3. Was it necessary for the hospital to consolidate with other hospitals?
4. Was it necessary for the hospital to be active in recovery- development process?