IMPLEMENTASI EMS DI INDONESIAs2keperawatan.fk.ub.ac.id/wp-content/uploads/2020/09/... · 2020. 10. 9. · IMPLEMENTASI SISTEM EMS DI INDONESIA PERMENKES RI NO. 19 Tahun 2016 Tentang

IMPLEMENTASI SISTEM EMS DI INDONESIA

Tantangan dan Solusinya

ANGGUN SETYARINI,S.Kep.,Ns.,M.Kep.

DOSEN JURUSAN KEPERAWATAN

POLTEKKES KEMENKES MALANG

PENDIDIKAN

▪ S1 PSIK FK UNIVERSITAS GADJAH MADA

▪ S2 PSMK FK UNIVERSITAS BRAWIJAYA

PELATIHAN KEGAWATDARURATAN

▪ BTCLS EMT 118 SURABAYA

▪ BLS/ACLS AHA

▪ TRIAGE OFFICER

▪ CODE BLUE

SEMINAR DAN SIMPOSIUM

▪ EMNAS and 1st PARAMEDIC ASIA, MALAYSIA, 2019

▪ ASMEN HIPGABI, YOGYAKARTA 2019

ANGGUN SETYARINI,S.Kep.,Ns.,M.Kep.

[email protected]

OUTLINE

KONSEP EMS

IMPLEMENTASI DI INDONESIA, TANTANGAN & SOLUSI

KIAT MENYIAPKAN PUBLIKASI HASIL RISET

PERNAHKAH KITA MENJUMPAI KEJADIAN SEPERTI INI?

DATA KASUS PREHOSPITAL DI

DUNIA

SISTEM EMERGENSI

MEDICAL SERVICES (EMS)

Sistem komprehensif yang

menyediakan personil, peralatan

dan fasilitas untuk memberikan

pelayanan dan keselamatan, yang

terkoordinasi, efektif dan tepat

waktu pada korban yang

mengalami trauma maupun pasien

yang tiba-tiba menderita serangan

akut dari penyakitnya.

(Al-Shaqsi,2010).

MODEL EMS DI DUNIA

Model Franco-German Anglo-American

Jumlah pasien • Mayoritas dirawat di

tempat kejadian

• Prinsip “stay” and

“play”

• Mayoritas dibawa

ke RS

• Prinsip “load” and

“go”

Petugas Dokter di bantu

paramedis

Paramedis dengan

pengawasan dokter

Tujuan utama Membawa pelayanan RS

ke rumah

Membawa pasien ke

RS

Unit yang dituju

saat transport

pasien

Instalasi perawatan IGD

Negara yang

menerapkan

Jerman, Perancis, Yunani,

Ausrtria

US, Kanada, Australia

Al-Shaqsi, S. (2010). Models of International Emergency Medical Service

(EMS) Systems. Oman Medical Journal, 25(4). doi: 10.5001/omj.2010.92

Swedia mengembangkan

NURSE-LED MODEL , yaitu

menghadirkan perawat dalam

pelayanan EMS (Jonas,2018)

14 KOMPONEN PENDUKUNG

BAGI BERJALANNYA SISTEM EMS

1. INTEGRASI SISTEM LAYANAN KESEHATAN

2. RISET

3. LEGISLASI & REGULASI

4. SISTEM KEUANGAN

5. SDM

6. MEDICAL DIRECTION

7. SISTEM PENDIDIKAN

8. EDUKASI MASYARAKAT

9. PREVENTION

10. AKSES PUBLIK

11. SISTEM KOMUNIKASI

12. PELAYANAN KLINIS

13. SISTEM INFORMASI

14. EVALUASI

Chapleau, W. (2010). Emergency First Responder: Making The

Difference. Canada: Mosby.

IMPLEMENTASI SISTEM EMS DI

INDONESIA

PERMENKES RI NO. 19 Tahun 2016 Tentang Sistem

Penanggulangan Gawat Darurat Terpadu

Pasal 5

(1) Untuk terselenggaranya SPGDT dibentuk:

a. Pusat Komando Nasional (National Command Center); dan

b. PSC

(2) Pusat Komando Nasional (National Command Center)

sebagaimana dimaksud pada ayat (1) huruf a berkedudukan di

Kementerian Kesehatan, berada di bawah dan bertanggung

jawab kepada Direktur Jenderal.

(3) PSC sebagaimana dimaksud pada ayat (1) huruf b harus

dibentuk oleh Pemerintah Daerah Kabupaten/Kota.

TANTANGAN IMPLEMENTASI SISTEM EMS DI

INDONESIA

Permenkes No. 19 Tahun 2016 Pasal 2

SPGDT bertujuan:

1. Meningkatkan akses dan mutu pelayanan Kesehatan

2. Mempercepat waktu penanganan (respon time)

Korban/Pasien Gawat darurat dan meruunkan angka

kematian serta kecacatan

Semakin pendek respon time berarti semakin cepat dan baik

pelayanan yang diberikan (Coster et al,2017).

Time is brainTime is life Time is

muscles

RUMUSAN MASALAH & TUJUAN PENELITIAN

MenganalisisHubungan

faktor lingkungan

“Apakah faktor yang berhubungan

dengan total waktu prehospital pada

pasien yang ditangani PSC 119 Kabupaten Purworejo?”

Rumusan Masalah

faktor klinis

Faktor yang paling dominan

Faktor sistem

Tujuan :

5

Memperluas manfaat sosial dan ekonomi

4

Kesehatan dan sektor Kesehatan

3

informasikebijakan & pengembanganproduk

2

Penelitian di masa yang akan

datang

Produksi pengetahuan

1

MANFAAT PENELITIAN(Donovan & Hanney, 2011; Frank & Nason, 2009)

MERANGKUM LITERATUR

440 | pISSN: 1858-3598 eISSN: 2502-5791

Jurnal Ners Vol. 15, No. 2, Special Issue 2020 http://dx.doi.org/10.20473/jn.v15i2.19786

This is an Open Access article distributed under the terms of the Creative Commons

Attribution 4.0 International License

Systematic Review

Influence Factors of Emergency Medical Services (EMS) Prehospital Time Interval Variety: A Systematic Review

Anggun Setyarini1, Heni Dwi Windarwati2

1 Health Polytechnic of Ministry of Health, Malang 2 School of Nursing, Faculty of Medicine, Universitas Brawijaya

ABSTRACT

Introduction: Prehospital time interval was one of important indicators of EMS performance. It consisting of total prehospital time (TPT), response time (RT), on-scene time (OST) and transport time (TT) in the world is very diverse. Many factors were able to affect the duration of prehospital time. The purpose of this systematic review was to identify internal and external EMS factors that affect prehospital time which was useful as a predictor of the prehospital time interval variety.

Methods: This study was conducted with a systematic method by reviewing the literature obtained from four electronic databases namely ProQuest, PubMed, ScienceDirect, and Google Schoolar. Seven keywords were used to get some of relevance literatures. Using PRISMA flow diagram, the literatures were screened by three inclusion criteria: original research article, published in the 2007-2018 timeframe, discusses EMS prehospital time interval and the factors that influence it.

Results: Seventy-five literature were obtained, of which 14 articles met the requirements for analysis. Factors influencing prehospital time variations can be classified as two. First, internal factors which include: facilities and infrastructure, human resources, and service protocols. Second, external factors which include: natural and non-natural environment, and the patient's clinical condition.

Conclusion: Investigation at prehospital time intervals and influential factors is useful in developing evidence-informed in assessing EMS performance and correcting the obstacles found. This review also identifies the gaps in the existing literature to inform future research efforts.

ARTICLE HISTORY

Received: Feb 27, 2020 Accepted: April 1, 2020

KEYWORDS

EMS; influencing factors; prehospital time

CONTACT

Anggun Setyarini [email protected] Health Polytechnic of Ministry of

Health, Malang

Cite this as: Setyarini, A., & Windarwati, H, D. (2020). Influence Factors of Emergency Medical Services (EMS) Prehospital Time Interval Variety: A Systematic Review. Jurnal Ners, Special Issues, 440-451. doi:http://dx.doi.org/10.20473/jn.v15i2.19786

INTRODUCTION

Prehospital emergency services are fast becoming the needs of all countries in the world. The speed of prehospital time (PT) and Emergency Medical Services (EMS) are important to be assessed and discussed (Brown et al., 2016; Golden & Odoi, 2015). There are three compelling reasons to investigate the achievement of prehospital time in the world. First, the achievement of PT or EMS total prehospital time (TPT), which includes response time (RT), on-scene time (OST), and transport time (TT), varies greatly in each country, so different studies on the various

causes are needed. Second, the speed at which officers provide assistance determines patient safety. The speed of staff time is correlated with "time is life" in out-of-hospital-cardiac-arrest (OHCA) patients, "time is brain" in stroke patients, and "life-saving and limb-saving" for trauma patients (Paravar, Hosseinpour, Mohammadzadeh, & Mirzadeh, 2014; Puolakka, Vayrynen, Erkkila, & Kuisma, 2016b). Third, achieving prehospital time can be an important indicator in evaluating EMS performance (Rahman et al., 2015). In the past, response time was the only reliable indicator of performance because it was objective, easily measured and easily understood by

KERANGKA KONSEP PENELITIAN

POPULASI

• Seluruh catatan

pasien th 2018 =

385

• PSC 119

• PSC 119

Purworejo

• Januari s.d.

Februari

2019

LOKASI & WAKTU PENELITIAN Desain

Retrospective

Chart Review (Vassar &

Holzmann, 2013)

METODE PENELITIAN

ANALISIS DATA

Univ

ari

at

Biv

ari

at

Multiv

ari

at

RESEARCH FINDING

FAKTOR LINGKUNGAN

✓ Ada hubungan antara

faktor lingkungan (lokasi)

dengan TWP.

FAKTOR KLINIS

✓ Tidak Ada hubungan

faktor klinis (Jenis

kasus, dan level triase)

dengan TWP.

FAKTOR YANG DOMINAN

✓Lokasi merupakan

faktor yang paling

berhubungan dengan

TWP.

FAKTOR SISTEM

✓ Ada hubungan waktu

pelayanan & integrasi unit

respons dengan TWP.

✓ Tidak ada hubungan antara

jumlah intervensi dengan

TWP.

SOLUSI

Improving Response Units Integration a Related Factor to

Total Prehospital Time (TPT) on Patients of Public Safety

Center (PSC) 119 in Purworejo Regency, Indonesia

Anggun Setyarini1, Respati S Dradjat2, Heni Dwi Windarwati2

1Nursing Postgraduate Program, 2School of Nursing, Faculty of Medicine, Universitas Brawijaya

ABSTRACT

Background: RapidresponseandappropriatemanagementofPublicSafetyCenter(PSC)119teamisvery

necessary for patients who experienced trauma or serious illness in prehospital area. The aim of this study

wastoidentifytheresponseunitsintegrationasrelatedfactorswithtotalprehospitaltime(TPT)ofPSC119

inPurworejoRegency.

Material and Method: ThisresearchwasconductedbyRetrospectiveChartReview(RCR)designon105

patientswhotreatedbyPSC119inPurworejoRegency.BivariatetestwasconductedbyusingSpearman

correlation test to investigate the correlation with response unit integration.

Results: Themajorityofpatientsweretraumabytrafficaccident(57.1%).ThefastestTPTwas9minutes

and the longest was 105 minutes with an average of 30.85 minutes. Bivariate test results demonstrate that

responseunitsintegrationhadavalueofp=0.000(r=0.387).Itmeantthattherewassignifica ntcorrelation

between response units integration with TPT.

Conclusion: ThisstudysuggeststhePSCleaderstoimprovetheintegrationbetweenthecallcenterunitwith

responseunits.Theimprovementofnurses’capacitythroughnursingspecialisteducationandadvancedlevel

trainingofprehospitalemergencywereveryimportantforoptimizingthequalityofprehospitalintervention.

Theresultofthisstudywasusefulinthefutureasthebasicinformationforresearch,educationandservice

of prehospital emergency.

Keywords: Public Safety Center ,Total Prehospital Time, Indonesia Prehospital Management

Corresponding Author:

Anggun Setyarini

NursingPostgraduateProgram,

FacultyofMedicine,UniversitasBrawijaya

Email:[email protected]

Introduction

Trauma contributed for 12% of disease burden in the

world,withthenumberofpatientsreachupto5million

(1). Most of trauma patients dead in prehospital phase (2).

Dataofmedicalcaseshowsmorethan356,000patients

who suffe

r

edout-of-hospitalcardiacarrest(OHCA)

annually in the US (3).Coronaryheartdiseaseandstroke

are expected to increase up to 23.3 million in 2030 (4).

Traumaduetotrafficaccidents(TA)inIndonesiaduring

2016reached108,696cases,31,195peopledied,35,285

inhabitantsgotsevereinjured,and108,945inhabitantsgot

mildinjuries(5). Data of medical case shows the number of

diagnosed patients with coronary heart disease at the age

15yearsoldisestimatedat2,650,340millionpeople(4).

The patients with hypertension that are not diagnosed in

societytotaled63.2%oftotalexistingprevalence(25.8%)

(6). People who are diagnosed with diabetes mellitus (DM)

totaled2.1%,increasefromthedatain2007.Thisindicated

thattheriskofcardiacemergencyduetohypertensionand

diabetes also increase.

The potential for emergencies due to trauma

or serious illness in prehospital area increase the

community’sneedforEmergencyMedicalServices

(EMS) system. The EMS service starts from the call

centeroffice rthatreceivesemergencycall,thenconduct

dispatchtheEmergencyMedicalTechnician(EMT),

paramedic or nurses who has been trained to intervene

in Basic Life Support (BLS) or Advanced Life Support

DOI Number: 10.5958/0976-5506.2019.02142.9

KEBIJAKAN & PENGEMBANGAN PRODUKq Penguatan perda,

q Pengembangan pelatihan gadarprehospital

q pengembangan Strategi model pelayanan PSC

q Penguatan & penambahan jejaring first responder.

KESEHATAN & SEKTOR KESEHATANq Supervisi TWP membantu

pe pelayanan

q Survival rate

q Tersedia data untuk upaya

kes. preventif di

prehospital.

PENELITIAN YANG AKAN DATANG

q Dasar pengembanganpenelitian selanjutnyamix methods

KELUASAN MANFAAT SOSIAL & EKONOMI

qMendorong pembiayaanuntuk peningkatankapasitas petugas

q Mendorong peningkatananggaran yang memadaibagi tersedianya alat danbahan untuk pertolongandasar dan lanjutan.

PRODUKSI PENGETAHUAN

qpublikasi nasionaldan internasioanal

qBahan kajian ilmiahdi seminar danbuku-buku panduanprehospital

IMPLIKASI PENELITIAN

MENYIAPKAN PUBLIKASI

PENELITIAN

1. Menyiapkan topik yang menarik, unik dan bermanfaat.

2. Mengumpulkan referensi dari data base yang terpercaya (misal:

Proquest, EBSCO, Pubmed, Sciencedirect)

3. Lakukan critical appraisal pada artikel yang akan kita gunakan

sebagai referensi.

4. Mempelajari gaya penulisan pada artikel yang dimuat dalam

jurnal bereputasi yang akan kita tuju.

5. Menulis artikel dari bagian yang termudah yaitu Metode, hasil,

Introduction, dan Discussion.

6. Perbaiki kebiasaan menulis kita. Gunakanlah format S-P-O-K. Hal

ini sangat membantu dalam proses alih Bahasa (translation).

7. Menggunakan citation manager (seperti: aplikasi End-note, atau

Mendeley)

8. Pilih jurnal yang akan kita tuju, IKUTI AUTHOR GUIDLINE-nya.

9. Jangan ragu untuk berkomunikasi dengan editor bila ada masalah

atau hal yang tidak dipahami.

10.BERANI MENCOBA, DAN TIDAK BOSAN BELAJAR