djo 1

Curiculum Vitae
Djohansjah Marzoeki
Full name : Prof. Djohansjah Marzoeki MD, PhD, SpBP
Born : Surabaya 11 March 1940
Wife : Dina Herawati MD, born 10 Feb 1957 Ophtalmologist
Children : 1. Lazula Aneksade S Psi, M Com. Born 16 Aug 1966
Married to Agung Priyatna. SE.MSc
2. Lobredia Zarasade MD. Born 11 Jul 1968
Married to Dandy Prihandono ST.MM
3. Putri Anya Universade. Born 14 oct 1993
Education : Medical Doctor Airlangga University (UnAir)
General Surgeon UnAir
Plastic Surgeron Groningen The Netherlands.
PhD UnAir
Occupation : Head and Professor of Plastic Surgery,
Medical Faculty UnAir/Dr.Soetomo Hospital Surabaya
Head of training Program of Plastic Surgery
djo 2
Other Appointment:
Chairman of National College of Plastic Surgery
Chairman of Sex Change Team of Dr.Soetomo Hospital
Chairman of CranioFacial Team RS Dr Soetomo Cr.Facial Unit Adelaide Australia
Council Member of Asia Pacific Cranio facial Association
Former Chairman of Inodnesia Plastic Surgeon Association (4 Periods, total 12 yrs)
Former Chairman of Asean Federation of Plastic Surgeon
Chairman of Cleft Lip Plaate Foundation
Chairman of Cleft Lip & Palate Center. A project supported by Australia CraniFacial
Foundation Adelaide, and Smile Train Foundation USA
Instructor in Culture of Science Dept. of Surgery Surabaya

Culture preference:
Scientific Culture but also respect any other culture.

Hobby: Philosophy and Politics. Write more than 30 articles in Politics to Newspapers and
Magazine, Kompas, Suara Pemaruan, Jawa Pos, Surya, Tempo,
Appear on TV and Public Discussions.

Book:
Author of several teaching guide books in Plastic Surgery
Hidup ini (this Life; a philosophy of Living) in Indonesia Language (Airlangga University Press)
Scientific Culture and Philosophy of Science in Inodnesia Language (Grasindo-Gramedia
Publishing)
djo 3
EMS
Emergency Medical System


Djohansjah Marzoeki
djo 4
Do we need
a nation wide standard of protocol
for emergency treatment ?


What,, Where, When and How
the system should be implemented ?

djo 5
MCI Terminology

The following terms are useful
when discussing major medical incidents:

M.P.I. -- Multi-patient Incident (up to 25 patients)
M.C.I. -- Mass Casualty Incident (25-100
patients)
Disaster -- Over 100 patients

M.O.I. -- Mechanism of Injury
M.V.C. -- Motor Vehicle Collision



djo 6



START = Simple Triage And Rapid Treatment

START was developed by
the Newport Beach (CA.) Fire and Marine Department .


START quickly distinguishes between
critically ill victims and the less-severely injured.


With START, a triage team of two can assess an average of
one patient every 30 seconds.

At an incident with 40 casualties,
two triage teams will take approximately 10 minutes

djo 7
START has been adopted throughout California,
Arizona, Oregon and Washington.

It was used successfully during the
Trade Center and Oklahoma City bombings.
Foreign countries including France, Saudi Arabia
and Israel have adopted START.

It is the standard of care recognized
by the U.S. Department of Transportation
and widely published in EMT textbooks.

djo 8

using START?


Just remember R P M :

Respiration : were under 30,

Pulse

Mental Status :alert and oriented.




djo 9
the terminology used
to classify patients using START

IMMEDIATE,

DELAYED,

MINOR and

DEAD/DYING.

djo 10
IMMEDIATE patients are those who RPM is altered

DELAYED when RPM is intact..
It also includes patients who have a significant mechanism of injury,
but whose RPM is intact .

MINOR patients are those who were able to leave
the impact area on the instruction of EMS personnel.
The are the walking wounded and should be tagged later


The DEAD/DYING are those who cannot breath after the airway is opened
and are mortally wounded.
The patients will probably die despite the best resuscitation efforts.

djo 11
The three(+ONE) medical treatments
rendered when performing START triage

1. Open an airway or insert an OPA.

2 Stop any visible bleeding.

3. Elevate the extremities for shock.

4. (+ Cooling. Specific for Burned Organ)

djo 12
Triage Priorities
Your initial goal is to find IMMEDIATE patients.
find the red and get it out
Those are the real lives youll save.


Once IMMEDIATE patients have been treated and
transported,
reassess and upgrade any DELAYED patients to
IMMEDIATE-by-mechanism,
depending on their injury, age, medical history,
djo 13
Triage Priorities 2
Victims who have self-extricated
themselves prior to our arrival can be
labeled MINOR,

all other patients should be tagged
IMMEDIATE, DELAYED or DEAD/DYING,
depending on your START assessment.
djo 14
The Arizona Triage System is a pack
containing

35 triage tags,
15 IMMEDIATE labels,
35 nylon ties, 6 assorted OPAs,
3 ink pens and
1 pair of scissors.
djo 15
Complete EMS Tactical Benchmarks=All
Immediates Transported Declaration.

Local MCMAS (Maricopa County Medical
Alerting System) Notification.
NETWORKING with other hospital team.

djo 16
Multi-Patient Incident MPI

(5 to 10 Patients)

Triage Function Assigned
Nearby Hospitals Notified
Consider a Treatment Area
Order Ambulances Early
Complete EMS Tactical Benchmarks=All Immediates Transported
Declaration.




Multi-Patient Incident MPI
(10 to 25 Patients)

Local MCMAS (Maricopa County Medical Alerting System) Notification
Assign Triage Sector
Establish Treatment Area
Complete EMS Tactical Benchmarks
djo 17
Mass Casualty Incident
(25 100 patients)

Full MCMAS Notification
Triage Sector (s) Assigned
Establish Multiple Treatment Areas
Establish Medical Supply Sector
Complete EMS Tactical Benchmarks= All Immediates Transported
Declaration.


In addition, the following may be considered:

ALS Should Stay on Scene
No EMS Forms Completed
Order additional medical supplies for delivery to the scene

djo 18
MCIs Involving More Than 25 Patients


Create the position of an Ambulance Coordinator within the
Transportation Sector.


ALS personnel should remain on scene, usually in Treatment,
to render advanced life support care to patients awaiting transport.
All patients, except those with critical airway difficulties,
should be transported BLS.

Intubation or IV administration treatments
can be monitored by BLS crews en route to the hospital
in critical situations.


djo 19
When the patients are sent only to the
nearest hospital or trauma center,
this quickly overloads those facilities.


Dont relocate the disaster to the nearest,
But follow the plan.
djo 20
mistakes often made

1Improper use of personnel
(BLS does BLS stuff. ALS does ALS stuff)

2Patients not uniformly distributed to hospitals

3Lack of strong, visible Command

4Lack of preparation or training

5Failure to adapt to circumstances

6 Poor communication

djo 21

djo 22
EMS Indonesia
Sudah adakah ?
Bagaimana jaringan network
organisasinya ?
Didalam EMS, dimana tempat dan
bagaimana peran
PPGD; PSB; ATLS; ACLS; BLS ;
ABLS
djo 23
EMS Indonesia -- Usulan
Ter-koordinasi seluruh Indonesia

Jaringan organisasinya oleh DepKes.
Triage sistem seragam S T A R T
BLS; ATLS, ACLS; ABLS dll tetap mandiri
tetapi waktu bencana masal dan disaster
dilaksanakan dalam koordinasi oleh EMS
Indonesia.
djo 24
ORGANIZATION Maricopa

The staff of fourteen full time positions

is organized into two groups:

emergency planners and

support staff.

NOTE: Staff members are assigned as liaisons to incorporated cities
and towns to provide assistance in
the preparation of local emergency plans and training programs.
Intergovernmental Agreements (IGAs)
are used to perform these mandates for them.

djo 25
DEPARTMENT FUNCTIONS
Administration and Personnel
Budget/Fiscal
Communications and Warning Systems
Disaster Assistance and Planning
Emergency Information System (Computer Database)
Emergency Operations Center Activation/Disaster Coordination
Emergency Operations Center (EOC) Maintenance
Emergency Operations Plan
Flood Hazard Mitigation
Hazardous Materials Emergency Response Planning
Hazardous Materials Reporting
Hospital & Nursing Home Disaster Drills
Hospital Mass Casualty Management Assistance
Maintenance
Palo Verde Nuclear Generating Station Response
Public Awareness
Resource Management During Disasters