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[accordion] [acc_item title=”General”] Capital – Jakarta
Area – Land: 1,811,569 sq km; Water: 93,000 sq km
Population – 242,968,342
Language(s) – Bahasa Indonesia (official); English, Dutch, Javanese and local dialects

[/acc_item] [acc_item title=”Overview”]
  • ŸVast geography, consisting of over 11,000 islands, located on Pacfiic rim “Ring of Fire”; equally diverse demographic make-up
    • High incidence of natural disasters (e.g., earthquake, tsunami, volcano, flood, landslide), political instability, terrorist activity and social uprisings
      • “They have a wealth of experience in dealing with natural disaster that we are less exposed to, as a rule” (Pitt, 147)
  • Ÿ“In 1991, 50,000 people died of injuries but only 4000 of them in hospital – raising the question ‘where did the rest die?’” (Pitt, 145)
  • Ÿ“The ultimate aim of the prehospital professionals in Indonesia is to form a national regionalised trauma and ambulance system with a coordinated and effective community based emergency system. … Indonesia is keen to bring internationally agreed standards and training into its system of prehospital care.” (Pitt, 147)
[/acc_item] [acc_item title=”History”]
  • Ÿ1969 – Indonesian Surgeon’s Association (ISA): “acknowledged that despite 70% of the country’s trauma deaths resulting from traffic accidents, it had no prehospital system to deal with this” (Pitt, 145)
  • Ÿ1972 – Pilot ambulance project established; unable to progress due to financial difficulties and focus on infectious diseases by Dept. of Health
  • ŸLate-1980s/1990s – re-acknowledgement by gov’t for need of prehospital system and expansion of existing resources
    • 118 Emergency Ambulance Service:
      • Foundation developed by ISA, working with municipal offices of 5 biggest cities (Jakarta, Palembang, Yogyakarta, Surabaya, and Makasser; Malang and Denpasar included later)
      • Headed development of public system for paramedic-staffed ambulances
[/acc_item] [acc_item title=”EMS System Model”]
  • ŸAnglo-American – 118 Emergency Ambulance Service
    • Sole public ambulance service
[/acc_item] [acc_item title=”Lead Agency”]
  • ŸDepartment of Health
[/acc_item] [acc_item title=”Funding”]
  • Ÿ118 Service “is not government funded but charges those who can afford to pay … occasionally the municipal council contributes” (Pitt, 144-5)
    • 50% from patients that can afford payment
    • 50% raised from courses taught by 118 members
[/acc_item] [acc_item title=”Levels of Care”]
  • ŸThree levels of Paramedic
    • See below: Table 2
  • ŸJakarta
    • 26 ambulances & 12 motorcycles located at 10 strategic posts in north and center of city
      • Ÿ100 ambulances and 20 posts required for adequate coverage (aiming for 2004 fulfillment)
        • Number decided by committee formed after 2000 bombing showed lack of available resources to treat injured
      • ŸMotorcycles deployed during rush hour only in N. Jakarta due to manpower shortages
        • Used only for stabilization prior to ambulance arrival
    • Poor response times due to lack of ambulances, high traffic congestion and large response areas
    • 150 EMS providers working 24hr shifts
  • ŸAmbulance & Equipment
    • O2, defib, ventilator & stabilization equipment
    • “The 118 service often designs and produces their own equipment as it is cheaper than importing foreign kit and can be made to their own specific requirements” (Pitt, 145)
      • Ÿe.g., “Spinal boards, traction splint,  wheelchair/stretcher, neck collars, and even ambulances”
    • Ambulances commonly carry little more than a stretcher
      • ŸBecause of road conditions, foreign-manufactured vehicles are often unusable
      • Ÿ118 Service has also recently created two ambulance prototypes, made of fiberglass – “easy to clean, cheaper, lighter, and cool… [with] long stable wheelbase and … slightly raised, so remaining reliant in floods” (Pitt, 145)

Pitt E, Pusponegoro A: “Prehospital care in Indonesia.” Emergency Medicine Journal 2005;22:144-147.

[/acc_item] [acc_item title=”Education and Training”]
  • ŸParamedics are new profession in Indonesia
  • Ÿ118 Service recruits nurses to be trained as Paramedics (almost exclusively women)
    • Nurses have received 3yrs training at nursing college previous to recruitment as Paramedics
    • “Courses such as ATLS and ACLS are well established in Indonesia” (Pitt, 146)
  • ŸTaught by doctors and other medical professionals
    • “Currently the paramedics are accredited as nurses but it is hoped that the 118 Jakarta center soon will be recognized and accredited as a paramedic college [by Department of Health]” (Pitt, 145)
    • Hope to recruit high school graduates and raise profile or paramedics as well as standard of training
[/acc_item] [acc_item title=”Medical Direction”]
  • ŸDocumentation
    • Treatment rendered
    • Revised trauma score
    • Response time
    • Receiving facility
  • ŸPlanning for new record sheets: one-page run reports including primary and secondary survey with pictorial representations of call.
[/acc_item] [acc_item title=”Dispatch”]
  • Ÿ118 – Toll-free number (where available)
  • ŸJakarta call center receives approx. 50-75 calls/day (in city with pop. of 10-12 million)
    • Calls taken by trained paramedic using call triage system
      • Obtains clinical info, may provide advice, dispatches nearest ambulance
[/acc_item] [acc_item title=”Emergency Medicine”]
  • ŸJakarta
    • Approx. 104 civilian hospitals w/EDs of “varying standards and size” (Pitt, 145)
      • Gov’t & Private hospitals
      • 5 military hospitals (that also receive civilian patients)
    • Hospitals have own ambulances and are “predominantly used for inter-hospital transfers” (Pitt, 145)
[/acc_item] [acc_item title=”Disaster”]
  • ŸDisaster Response Brigade
  • Established by Dept. of Health
  • Comprised of MDs and RNs with interest in disaster response
    • Jakarta Brigade – 150 staff (as of 2005)
  • Training
    • 3wk course, including trauma, resuscitation, ped and obstetric emergencies, triage, disaster planning and exercises/drills
    • “They are expected to deal with all sorts of incidents from earthquakes to riots” (Pitt, 146)
  • 2002 Bali Bombing
    • Demonstrated management gaps in disaster response by Brigade (arrived long after prehospital phase had ended)
    • 13 more Brigade centers formed in teaching hospitals in 13 cities
    • “A proposed step … is to introduce the [Major Incident Medical Management and Support Course] to give training to in organizing medical resources at such incidents” (Pitt, 146)
[/acc_item] [acc_item title=”Future Challenges”]
  • ŸVast geographic areas outside of city centers
  • ŸWidespread abuse of 118 phone number, including up 200 hoax calls/hour during school breaks
    • “It is estimated that up to 50% of all calls in Jakarta are hoaxes” (Pitt, 147)
  • Ÿ“There is a culture of accepting accidents as fate in Indonesia and often there is no real impetus to improve the state of prehospital emergency care. Linked to this can be the attitude and ignorance of the public about the role of the paramedic, the ambulance service, as well as other emergency services. There is rarely any effort by traffic to pull over or give way to ambulances (possibly because ambulances were previously used mainly to transport those already dead!). Add to this the huge volume and chaotic nature of Jakarta traffic as well as the massive area to be covered by only a few ambulances and it is no wonder the response times are so poor” (Pitt, 146)
[/acc_item] [acc_item title=”References”] [/acc_item] [/accordion]
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Comments
  • Hayley

    Hi, do you employ overseas applicants as paramedics? I have recently completed a Paramedics degree in Australia and wish to live somewhere new and begin my career.

    Kind regards,

    Hayley

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