MODULE GENERAL EMERGENCY LIFE SUPPORT 2

PROBLEM BASED LEARNING

SCENARIO 2

By:

Group 6A

FACULTY OF MEDICINE

AIRLANGGA UNIVERSITY

SURABAYA 2015

MODUL GENERAL EMERGENCY LIFE SUPPORT 2

PROBLEM BASED LEARNING

SCENARIO 2

TUTOR

M. Saiful Ardhi, dr

SCENARIO COMPOSER

Teguh Sylvaranto, dr., SpAnkIC

EDITOR

Prof. Dr. Nancy Margarita Rehatta, dr., SpAnKIC-KNA

COMPOSED BY

GROUP 6A

LEADER

Ilham Wildan Ahmad 011311133021

SECRETARY

Nurul Aisyah 011311133057

NOTULEN

Tioky Sutjonong 011311133067

MEMBERS

Ayu Liana Gunawan 011211133066

Ismi Ayu Putri 011311133007

Listiana Rizka Pranandari 011311133031

Odi Yoshitaka Anggarda 011311133043

Nathania 011311133100

Ni Ketut Suastini Narada 011311133114

Afi Falizia 011311133125

Moh Erwinsyah H 011311133139

CONTENTS

Cover I

Members of Group

Learning Outcome

Mahasiswa semester 5 Pendidikan Dokter Fakultas Kedokteran Unair, setelah menyelesaikan

modul ini mampu merencanakan tugas seorang dokter dalam Management Disaster bila

terjadi bencana di suatu tempat.

Learning Outcome

After completing this module, 5th semester Medical students Faculty Medicine of Airlangga

University is able to plan the duty of a doctor in Management Disaster if there’s a disaster

happened.

CHAPTER 1

1st TUTORIAL: BRAIN STORMING

1.1. Scenario

Seorang dokter puskesmas X di Kabupaten A mendapat laporan akan adanya

letusan Gunung Z didekat wilayah puskesmas. Hujan abu pekat dan pasir terjadi

beberapa hari, salah satu desa di wilayah puskesmas X tadi diperkirakan sulit dijangkau

karena jalan terhambat oleh abu gunung ditengah hujan deras yang sering terjadi di kaki

gunung tersebut. Desa tersebut merupakan daerah pertanian tanaman dataran tinggi

dengan jumlah penduduk 15.000 orang. Dalam menghadapi bencana tersebut, dokter

puskesmas X, diperintahkan kepala dinas kesehatan kabupaten untuk merencanakan

koordinasi penanganan dampak kegiatan gunung api tersebut.

A doctor of health centre X (puskesmas X) in district A received a report that there

will be an eruption of Mount Z. Dense ash and sand rain occur a couple days, one of the

village in the area of health centre X was expected to be difficult to be reached because

the roads are obstructed by the mountain ash in the middle of the heavy rains that often

happen in foot of the mountain. The village is a highland crops area with a population of

15.000 people. In order to face the disaster, doctor of health centre X, ordered by the head

of district health department to plan the coordination to handle of the impact of the

volcano.

1.2. Main Problem

Coordination in ordered to handle the impact of volcano activity in a village with 15.000

people which was predicted to be difficult to be reached because of the obstructed roads

by the ash of the volcano in the middle of heavy rain.

1.3. Keywords

1.3.1. Coordination

1.3.2. Eruption

1.3.3. Dense ash rain

1.3.4. Heavy rain

1.3.5. Sand rain

1.3.6. Obstructed roads

1.3.7. 15.000 people

1.4. Early Hypothesis

The doctor of health centre X (puskesmas X) can plan the effective coordination to handle

the impact of volcano.

1.5. Additional Information

1.5.1. Physic of the area

1. The temperature increase until 40ºC if there’s no rain

2. The distance from village to the district is 30 km

3. The road from previous village is paved with the bent of road and incline that is

a bit high with the deviation of 1200 mdpl

4. The volcano was greatly erupted 20 years ago and the villagers were been

evacuated. Lately the volcano shows no harmful activities.

5. The volcano has release ashes and sand for the last 1 week

6. BMKG released a warning about the ash rain 2 days ago

7. The rain was sometimes heavy for the last 3 days

1.5.2. The border of the village

1. North and south : forests

2. East and west : other villages with rice fields and husbandries

1.5.3. The composition of area

1. Total of village : 25

2. Total of houses : 1.200

3. Total of house holders : 2.150

4. Total of puskesmas pembantu : 1 with one nurse and one administrator

5. Total of polindes : 1 with one midwifery

6. Total of Mosque : 9

7. Total of Church : 1

8. Total of village hall : 1

1.5.4. The composition of the villagers

1. Man : 10.200 people

2. Woman : 9.800 people

3. Toddler : 1.900 people

4. Elder : 1.100 people

5. Pregnant mother : 250 people

9. Traditional market : 2

10. Total of balai desa : 30

1.5.5. The characteristic of the villagers

1. Occupation : breeder, farmer, farm worker, merchant, and civil servant

2. Education : junior high school, primary school, senior high school, and

university

3. They often defecate in rice field, toilet and river

1.6. Learning Issues One

1.6.1. What is the effort to reduce the total of victims (Mitigation)?

1.6.2. What is the meaning of management of disaster?

1.6.3. What is the impact of volcano activities to the villagers and the environment?

1.6.4. How to recruit the volunteers?

1.6.5. What is the effective communication system in management disaster?

1.6.6. What are the criteria of effective transportation in management disaster?

1.6.7. Who is the person (non-medic) that has role in management disaster?

1.7. Learning Issues Two

1.7.1. How to evacuate the victims?

1.7.2. What is the role of medical personnel in management disaster?

1.7.3. What is the logistic that is needed in a disaster situation?

1.7.4. What is the ideal characteristic of refuge?

1.7.5. What is the classification of the status of volcano?

1.7.6. How to determination the Status of disaster emergency on a national scale

and local scale?

1.8 Early Mind Mapping

signs of volcano eruption

has exploded 20 years

volcanic ash and fine sand

for about 1

vulnerability of the villagers

physical economic

social environment

analyzing impact of the eruption

2 days ago, BMKG give

warning about ash

fall

sometimes rain falls

heavily the last 3 days

count possible victims

count possible damage

Socio-economical impact

area

actions

mitigation to prevent

much damage

allertness

emergency response

restoration

Allocation and division of tasks

CHAPTER 2

2nd TUTORIAL

2.1. Answer of Learning Issues One

2.1.1. The effort to reduce the total of victims (Mitigation)

A volcanic hazard describes the physical characteristics of an eruption. While

a volcano is in eruption it will produce a variety of hazards. Near-vent volcanic

hazards tend to be very destructive, while distal hazards may cause damage to

structures or disrupt everyday life. Even when a volcano is not in eruption,

volcanic hazards such as debris avalanches or remobilized secondary lahars can

still occur.

Mitigation of volcanic hazards can be undertaken during periods of crisis,

while a volcano is in eruption. Studies of recent eruptions have led to the

identification of mitigation measures that were used successfully while an eruption

was in progress. Extensive measures have been identified for the mitigation of

problems caused by ash fall. However, there are still a number of hazards that have

few mitigation options available. For example, pyroclastic flows and surges are so

destructive that the only really viable option is to evacuate the population at risk

prior to the event.

The management and mitigation of volcanic hazards should not only occur

during crisis periods. It is also important that management of volcanic hazards is

initiated and undertaken in periods of non-crisis, prior to an eruption occurring.

Pre-planning will ensure that the mitigation measures employed in response to a

crisis are successful.

Figure 1. Volcanic hazard management during non-crisis (pre-eruption)

and crisis (during an eruption) periods (after Johnston and Houghton,

1995).

2.1.1.1. Pre-eruption: Mitigation Techniques for Non-crisis Periods

Mitigation goals are to prevent loss of life and property resulting from

volcanic eruptions. During periods when volcanoes are not active, planning and

preparation should be undertaken to ensure the effects of a volcanic eruption are

minimized. Planning is important at national, regional, local and even individual

levels. The following aspects should be considered when planning for a volcanic

eruption.

1. Land use development and regulation to prevent development in zones that are

of high risk to volcanic hazards (Johnston and Houghton, 1995).

2. Where thick ash fall is likely to occur, building codes that require roofs to have

steeper pitches could be implemented (Spence et al., 1996; Johnston, 1997a).

This is especially important for critical buildings such as hospitals, fire

stations, police stations, public buildings and schools (Johnston, 1997a).

3. Plans must be established regarding procedures during a volcanic eruption.

Plans may need to detail procedures for notifying the public about the eruption,

procedures for shutting down operations and maintenance and clean up

procedures (Federal Emergency, Management Agency, 1984; Johnston, 1997a;

1997b). Recovery planning should also be considered within the contingency

plan (Johnston, 1997a).

4. Plans and procedures need to be flexible enough to adapt to what may be

rapidly changing conditions during a volcanic eruption (Peterson, 1996;

Johnston 1997a).

5. Sample emergency ordinances should be prepared in advance (FEMA, 1984).

6. Johnston (1997a) suggests making a list of facilities that must be kept

operative, versus those that can be shut down during and after ash fall.

7. It is advisable to consider the need for stress counseling both for the general

publican emergency workers (Finnimore et al., 1995).

8. Pre-test the plan so that people know what roles they must fulfill (FEMA,

1984).

9. The 1996 Mount Ruapehu eruptions confirmed that the preparedness of a

district is based on past experiences. As a result of the 1995 eruption

experience, organizations were able to respond quickly and more effectively. It

is important to pass on information about lessons learnt from past eruption

experiences to new staff in the organizations, so that the too can use

information effectively (Neild et al,. 1998).

10. Evacuation:

Evacuation may be necessary in the event of a volcanic eruption. Near to the

source of the eruption it may be advisable to evacuate the area prior to activity

in order to save lives. It is also important to note that heavy tephra falls may cut

off transport routes after the eruptions, thus hindering any effort to evacuate

people (Johnston and Nairn, 1993). There is need to plan for the transportation,

sheltering, feeding, clothing, and medical and hygiene needs of any evacuees or

those that are stranded by an eruption. In the event of volcanic eruption there

may be a large number of displaced people that need to be cared for, and pre-

planning will mean that those people have places here they can stay (FEMA,

1984; Johnston and Nairn, 1993; Finnimore et al., 1995). Before an eruption. It

is necessary to identify resources that can be used to assist in the evacuation of

large number of residents, for example, this may include towing firms,

mechanical repair films, emergency fuel supplies and bus companies. Other

issue that should be considered include the control of traffic, and animal

transport, and welfare. The early identification of needs during a volcanic

eruption will allow ready arrangement of outside assistance when an eruption

occurs.

11. Spare Parts:

Spare parts or critical equipment that may be needed during a volcanic eruption

should be stockpiled. This may include air filters, cleaning equipment,

protective clothing, face masks and extra fire hoses (Novak et al., 1981; FEMA,

1984; Johnston, 1997a). Extra vehicles for emergency use by police and other

personnel may also be required (FEMA, 1984).

12. Education:

Education of the public about volcanic hazards and how to mitigate against the

effects of a volcanic eruption is important. Education will lessen the

physiological and physical impacts of an eruption on the public. Warnings can

be better understood if the public understands the nature of the hazard. Also,

since communications may be disrupted during and after an eruption, it is

necessary to distribute information before an event so people know what to

expect and what to do (Johnston and Nairn, 1993). The public can be educated

through newspaper articles, television, radio, the Internet, exhibits at

museums, brochures, talks by scientists to clubs and organizations and school

classes. Education about volcanic hazards aimed at school children has the

added benefit that parents become informed too, through their children

(Peterson, 1996).

13. Media:

Most people rely on the media for receiving information. Surveys by Johnston

et al., (1997) show that public knowledge and awareness of events during the

Ruapehu eruptions were derived almost entirely from the media. Effective

management of the media is required so that accurate information can be

conveyed to the public during a volcanic eruption. In a recent survey of

organizations by Paton et al. (1998), 43 percent of respondents reported that

they had suffered “media problems” during the 1995 Ruapehu eruption. These

results highlight the need for organizations to develop an effective media

response, and to provide training for media spokespersons. Paton et al. (1998)

suggest addressing this problem by including a media management component

in training programs. The increased public demand for information during a

volcanic eruption may be supplemented by distributing printed information

(Johnston, 1997b).

14. Networks:

The FEMA (1984) recommend that prior to a volcanic eruption, roles and

responsibilities of the different organizations should be defined, and a network

of authority under which individuals would work in an emergency should be

established. In the survey of organizations by Paton et al. (1998), it was found

that many respondents believed there was a “lack of clear responsibility for co-

ordination” over the duration of the 1995 Ruapehu eruptions. There is

therefore a need to establish inter-organizational networks among those

organizations that may be involved in dealing with a future volcanic eruption.

Paton et al (1998) suggest that more simulations and exercises would help

identify and resolve co-ordination problems. Another recommendation was for

groups to work together in the planning stage to develop their capability to

work as an integrated team (Paton et al., 1998). A volcanic eruption may cover

more than one local authority, and a shift in wind direction may even change

the entire area of impact. Because volcanic eruptions cover wide areas, a

nationally coordinated effort could reduce duplication. Neild et al. (in prep)

suggest that this is particularly true for providing information to the public and

media. However, concerns have been expressed over how Emergency

Management Groups would function without local knowledge if co-ordination

were controlled from an outside centre (Neild et al., in prep).

2.1.2. The Meaning of Management Disaster

Disaster management is the management of the use of existing resources to

face the threat of disaster by planning, preparation, implementation, monitoring and

evaluation at each stage of disaster management, namely pre, during and post-

disaster. Basically, disaster relief efforts include:

1. The pre-disaster phase, consisting of:

a. The situation is not a disaster, namely prevention and mitigation activities

b. Potential disaster situations, such as preparedness activities

2. The current stage of the disaster, the activities are emergency response and

recovery

3. The post-disaster phase, namely the rehabilitation and reconstruction activities

Each stage of the disaster can be described in a cycle. Each phase of the

response can not be restricted strictly. In the sense that pre-disaster efforts must

first be completed before stepping in the response phase and proceed to the next

stage, namely the recovery. This cycle must be understood that at any time, all

stages can be carried out jointly at a certain stage with different portions. For

example, the recovery phase of recovery but the main activity is prevention and

mitigation activities can also be done in anticipation of the impending disaster.

Figure 2. Cycle of Disaster Management

Various disaster relief efforts which can be done at any stage in the cycle of disasters:

1. Prevention and Mitigation

This effort aims to avoid disaster and mitigate risk characteristics. Efforts were

made, among others:

a. Development of policies, legislation, guidelines and standards

b. Manufacture of hazard maps and mapping health problems

c. Brochures / leaflets / posters

d. Disaster risk analysis

e. The establishment of disaster response team

f. Basic training in disaster

g. Building a crisis management system of community-based health

2. Preparedness

Preparedness efforts undertaken to anticipate the possibility of disaster.

Preparedness efforts carried out at the time of the disaster began to be identified

will occur. Efforts that can be done include:

a. Preparation of contingency plans

b. Simulation / rehearsal / training standby

c. Preparation of resource support

d. Preparing the information and communication system

3. Emergency Response

Health emergency response efforts undertaken to save lives and prevent

disability. Efforts are underway include:

a. Rapid assessment of health (rapid health assessment)

b. First aid and evacuation of disaster victims to health facilities

c. Fulfillment of basic needs of health

d. Protection against high-risk groups of health

4. Recovery

The recovery effort includes rehabilitation and reconstruction. Rehabilitation

efforts aimed at restoring the condition of the affected area which is too

uncertain to normal conditions better. Reconstruction efforts aimed at rebuilding

infrastructure damaged by disasters better and perfect. Efforts were made,

among others:

a. Environmental improvement and sanitation

b. Improvement of health care facilities

c. Psycho-social recovery

d. Improved health care functions

2.1.3. The impact of volcanic activity

Volcanic eruption is one of the natural disasters that often occur in Indonesia.

Volcanic eruption has highly influence for human life, both in terms of financial,

economic, social, and health.

When it erupted, the volcano generally spouting water vapor (H2O), carbon

dioxide (CO2), sulfur dioxide (SO2), hydrochloric acid (HCl), hydrofluoric acid

(HF), and volcanic ash into the atmosphere. Volcanic ash contains such as silica,

minerals and rocks. The most common elements are sulfate, chloride, sodium,

calcium, potassium, magnesium, and fluoride. There are also other elements, such

as zinc, cadmium, and lead, but in lower concentrations in this volcanic ash.

Impact of volcanic ash on health can be divided into several categories, such

as acute respiratory distress, interference with the vision, irritation of the skin, and

mechanical disruption due to volcanic ash.

1. Acute Respiratory Distress

Rrespiratory disorders is one of the most major impact of the volcanic ash.

Irritation of the nose and throat, coughing, bronchitis, shortness of breath, and

narrowing of the airways can cause death. Respiratory problems caused by the

volcanic ash would have to be quickly handled, because the respiratory system

is one of the vital things that support human life.

Fine ash particles is certainly disturbing the respiratory system, especially for

those who already have lung problems. In addition, exposure to volcanic ash

also very dangerous for infants, children, the elderly and people with chronic

lung disease such as asthma.

2. Disturbances in Vision

Besides disrupt the respiratory system, the volcanic ash also can disrupt the

visual system. Volcanic ash has a sharp grain, which can cause eye irritation.

The entry of volcanic ash into the eyes can cause eye irritation, conjunctivitis

(inflammation of the conjunctiva) and corneal abrasion (a scratch on the

cornea).

3. Irritation of the Skin

Although rare, cases of skin irritation is sometimes found along the ashfall,

particularly when the volcanic ash is acidic.

4. Mechanical Disruption

Mechanical disruption caused by the volcanic ash caused fall the roof of a house

or an accident on the highway. Roofs may collapse because heavy loads of ash,

especially if the ash is wet and buildings are not built to support heavy loads.

Roof collapse can cause people who are in the house hit so badly, even died

instantly. Injuries that can occur in the form of broken bones, bruises,

lacerations and bleeding requiring further medical procedures.

2.1.4. Volunteers Recruitment

According to Wong (2006) We have three types of volunteers in the Red Cross,

community-based volunteers, functional volunteers and professional volunteers.

Each type of volunteers has different role and characteristics. Community-based

volunteers are those come from the community and have a will to help others. They

may not have any skills or knowledge in disaster response and most of them are

untrained. Functional volunteers are those who possess special skills, such as first

aid, nursing, psychological support, disaster response and so on. If they originate

from a serving Red Cross Department, they will resume their normal volunteer

works after the disaster response while waiting for the next assignment.

Professional volunteers are those with professional qualification, such as doctor,

nurse, engineer and accountant. No matter which types of volunteers one belongs

to, they do play a role in disaster response.

2.1.4.1. Recruitment and retainment of volunteers

During disaster, we need a large number of manpower so we should have

planning in recruitment and retainment of volunteers. If we have better preparation,

we can respond to disaster effectively. Therefore, we should develop a

comprehensive volunteer management system that includes needs assessment,

recruitment, matching, training, supervision and recognition to volunteers. There

are many ways to recruit volunteers; we can do it through promotion in mass

media, website, service program, and referral from professional organizations.

Apart from recruitment, retainment of volunteers is of equal importance because it

can reduce the number of withdrawals.

To retain volunteers, we should develop a trustful working relationship with

them because it prompt us to identify suitable duty to them and show our concern

to their needs and feeling. Besides, we should develop an effective communication

channel with them so that they can grasp the most updated information of the

agency and they can know when they have to lend a helping hand. Apart from this,

we should also provide regular training and sharing to them so that they can refresh

their skill and knowledge and acquire new skills that enhance their capacity. In

addition, we should conduct debriefing session and to collect feedback through

questionnaires after the mission to improve our service. The last but not the least,

to recognize volunteers’ contribution in tangible or intangible ways is also vital to

retain volunteers.

2.1.4.2. Role in disaster management cycle

Although community-based volunteers, functional volunteers and professional

volunteers have different skills and qualifications, they can participate in any part

of the disaster management cycle, namely Disaster Response, Recovery /

Rehabilitation, Risk Reduction and Preparedness. From the view of disaster

management, collective actions are taken before, during and after any disaster

situation to predict, prevent, reduce or cope with its impact. The volunteers can

play a part in these tasks.

According to Steen (2014) some places to find volunteers are:

Colleges and universities are good sources, especially if they have training

programs for doctors, nurses, pharmacists and veterinarians — all people with

skills that are valuable in emergencies.

Churches and fraternal organizations like the Rotary or Lions clubs are also good

places to ask: They have members who know the community and are often

seeking opportunities to help others.

Ask other emergency response groups such as the American Red Cross.

Approach the private sector, since many companies match dollars for volunteer

hours to encourage community service.

Retirees are another good source — with the baby boomers leaving the workforce,

there are a lot of skilled people who may be interested in volunteer opportunities.

After developing a roster of volunteers, it’s important to train them to the job

description, perform background checks on those who may end up working in

situations where that’s necessary like a hospital, and create a database to keep track

of them.

Although we need a huge number of manpower during disaster, the influx of

volunteers may cause troubles at the scene, such as overloading of the volunteer

coordinators, volunteers are eager to help but job-matching is in vain, the scene

may need trained volunteers, but most of the volunteers are untrained, workers use

a lot of time to handle the influx of volunteers which hinder the efficiency of

disaster response. Example of things we can do tocope with this is that we can

assign jobs according to their skills and abilities, and arrange experienced

volunteers work side by side with new volunteers.

Volunteers are assets their contributions are multi-facets, such as service

implementation, management and decision-making. In order to enhance their

capacity and better prepare for disaster response, we should train up community

and also encourage people to join as professional organization volunteer such as

(Korps Suka Rela Indonesia) KSRI.

2.1.5. Effective Communication System in Management Disaster

Education information is a cheap and easy for people in disaster mitigation,

the more information, the right information, will create communication between all

stakeholders in disaster management. Communication is absolutely necessary in

order to carry out the delivery of information and coordination in disaster relief

efforts. In an emergency all communication systems can be used. The term disaster

communication has not become a popular concept in the field of communication as

well as the field of disaster. Awareness of the importance of communication in

disaster management is getting higher these days. In disaster management, accurate

information needed by the public or private organizations that have concern for the

disaster victims.

Communication in a disaster is not only needed in emergency conditions, but

it is also important at the time and pre-disaster. As it is said that communication is

the best way for the success of disaster mitigation, preparedness, response, and

recovery during a disaster situation. The ability to communicate messages about

disasters to the public, government, media and opinion leaders can reduce risks,

save lives and impact from disasters.

According Haddow and Haddow (2008: 2) there are 4 major cornerstone in

building effective disaster communication, namely:

1. Costumer Focus, namely to understand what information is needed by the

customer in this community and volunteers. Must be built mechanism which

ensures the information communication delivered with precise and accurate.

2. Leadership commitment, leadership role in emergency situation must be

committed to effective communication and be actively involved in the

communication process.

3. Situational awareness, effective communication is based on the collection,

analysis and dissemination of information related to disaster controlled.

Effective communication principles such as transparency and can be trusted to

be the key.

4. Media partnership, media such as television, newspapers, radio, and other media

is very important to convey correct information to the public. Cooperation with

the media regarding the understanding of the needs of the media with a team

trained to cooperate with the media to gain and disseminate information to the

public.

2.1.6. Criteria of Effective Transportation In Management Disaster

It has been argued that the success of an evacuation is significantly enhanced

when people and communities participate in evacuation planning. According to

this argument, com- munities are less likely to resist evacuation orders when there

is increased participation in evacuation planning because they will have had a say

in how the evacuations should be conducted. Communities may be able to identify

solutions and resources not immediately evident to the authorities or traditional

disaster responders. In particular, in order to effectively meet the needs of

particular groups within the population, it is important to communicate with each

of these groups to understand their situation, their concerns, and other

transportation and evacuation issues.

This information should then be used to devise evacuation plans that,

whenever possible, effectively reflect the different needs within the population. In

addition, engaging populations strengthens evacuation planning by making use of

local capabilities. Survivors of a disaster, who often serve as the first responders,

play a critical role in a post-disaster evacuation. A well-prepared community can

further reduce casualties. For example, in the 2004 Indian Ocean tsunami the

approximately 80,500 individuals of the Simeulue community in Indonesia,

recognizing the unusual behavior of the sea, fed to the nearby hills before the

disaster struck. Subsequently, only 7 people died, in comparison to the 163,795

casualties experienced elsewhere in Indonesia’s northern Aceh province. By

working with populations to identify and organize their own response capaci- ties,

evacuation planners can considerably enhance the overall response to a disaster.

There will be a number of people who do not have the ability or resources to

make their own way out of the danger zone. Transport arrangements should be

made for those with transport needs. To enhance transportation capacities in an

emergency it is often beneficial to establish transportation networks prior to an

emergency. In some cases, it may be better if people do not use their own

evacuation means due to the potential for traffic congestion. However, it is

important to recognize that deterring evacuation using personal vehicles may be

difficult, because it is often the method preferred by evacuees and would require

significant resources to restrict.

Persons with transportation needs may form part of the following groups:

1. Low income, do not own a vehicle;

2. Visitors to the area without access to a vehicle;

3. Language barriers;

4. Physical or medical conditions affecting mobility (visually impaired, mental

health, oxygen or other medical/mobility device dependent, etc.);

5. Able-bodied individuals who own a vehicle but choose to not self-evacuate

(based on fear or other reasons), and;

6. Other able-bodied individuals who may not be able to self-evacuate.

To identification of available transportation resources and coordination of

those limited resources is paramount to any evacuation’s success. This could

include the use of buses and mini-buses, trains, taxis and volunteer drivers, aircraft,

helicopters and boats, as well as more traditional modes of transport such as

donkeys and carts, depending on the circum- stances and resources available.

2.1.6.1. Evacuation Route

Important characteristics and factors that should be considered when selecting an

evacuation route include:

1. Shortest route to the designated destination areas

2. Capacity of proposed routes to accommodate the mode of transportation to

be used

3. Maximum roadway capacity

4. Ability to increase capacity and traffic fow using traffic control strategies

5. Availability of infrastructure to disseminate real-time conditions and

messages to evacuees en route

6. Number of potentially hazardous points, such as bridges and tunnels

7. Damage assessment of evacuation routes

As some evacuation routes may become blocked in an emergency, it is also

important to plan alternate routes or means of evacuation, in the event that

preferred routes become inaccessible.

2.1.6.2. Traffic Control Measures

In any evacuation, arrangements should be made to keep traffic moving, at

least along key routes. Traffic movements will be particularly difficult in very

built-up urban areas, and also in rural areas with poor roads. Some examples of

traffic control measures that can be used during evacuations include segregation of

pedestrian and vehicle traffic; exclusive bus routes; phased evacuation; use of

designated markings; road barriers; the use of traffic management techniques such

as “contrafow” (making the in-bound and out-bound lanes unidirectional), which

have proven to be very effective. Making provisions, such as fuel, portable

restrooms, and water, available along the route can also positively influence the

effectiveness of an evacuation.

2.1.6.3. Transportation of animals, household pets, livestock

Evacuees will often seek to bring their animals with them, and many will

ignore evacuation orders if forced to leave their pets or livestock behind. This may

be especially true if evacuees

2.1.7. Non Medic Personnel That Has Role In Management Disaster

In implementing disaster management in the region will require coordination

with the sector. Broadly speaking can described the role of cross-sector as follows:

1. Government sector, controlling development activities regional development

2. Health Sector, plan health services and medical including medications and

medical

3. Social Sector, planning needs for food, clothing, andOther basic needs for

refugees

4. Sector Public Works, regional spatial planning,site preparation and evacuation

routes, and recovery needs

5. facilities and infrastructure.

6. Transportation Sector, early detection and informationweather /

meteorological and plan thetransportation needsand communication

7. Sector Energy and Mineral Resources, planning andmitigatif control efforts in

the field of geological disasters andman-made disasters related to

disasterprevious geological

8. Sector Manpower and Transmigration, planningdeployment and transfer of

victims to areasafe disaster.

9. Financial Sector, budget preparation activity costsimplementation of disaster

management in the predisaster

10. Forestry Sector, planning and control effortsmitigatif especially forest/land

fires10. Sector Environment,planning and controlpreventive efforts, advocacy,

and early detection indisaster prevention.

11. Marine Sector planning and control effortsmitigatif in the field of tsunami and

coastal erosion.

12. Sector Research and Peendidikan High, dostudies and research as a material

for planningimplementation of disaster management in the predisaster,

emergency response, rehabilitation andreconstruction.22 Guidelines for

Preparation of Disaster Management Plan

13. TNI / police assist in SAR activities, and securityemergencies including

securing the abandoned locationbecause its inhabitants were displaced (BNPB,

2008).

2.2. Answer Learning Issues Two

2.2.1. How to Evacuate People

According to dictionary, Evacuation is to move people from a dangerous place

to somewhere safe. Tight rules goal and pace of evacuation all victims to

medication first or front and rare post is so needed to prevent overload capacity

health facility. Evacuation victims do in one direction without intersecting. From

location of disaster to first medication post,then to post rare until secondary

medication post. In In a mass disaster is may not transfer with one vehicle for one

person.

At each level of medical posts will be encountered limited resources power

including transport so need to be prepared sufficient transportation to refer the

victim to the next medical post. Every times ambulance from the field medical post

is complete refer to front the medical post, the ambulance must be immediately

returned to the field medical post. This system known as noria system which means

wheel or conveyor system management (conveyor belt management).

Figure 3. Conveyor System Management (Cited from Technical For

Healt Crisis Responses on Disaster)

Before the evacuation, health workers should do:

1. examination of the patient's condition and stability by monitoring vital

signs;

2. examination of equipment attached to the patient's body such as

infusion,pipe ventilator / oxygen, immobilization equipment and

others.

Victims should not be moved before:

1. the victims are in the most stable condition;

2. the victim has prepared adequate equipment for transport;

3. health facilities receiver has been informed and is ready to receive

victims;

4. vehicles used in conditions fit for use.

There are so many ways to carry when evacuation victims:

LIFTS AND CARRIES

ONE RESCUER

ANKLE PULL The ankle pull is the fastest method for moving a victima short distance over a smooth surface. This is not apreferred method of patient movement.

1. Grasp the victim by both ankles or pant cuffs.

2. Pull with your legs, not your back.

3. Keep your back as straight as possible.

4. Try to keep the pull as straight and in-line aspossible.

5. Keep aware that the head is unsupported andmay bounce over bumps and surfaceimperfections.

SHOULDER PULL The shoulder pull is preferred to the ankle pull. Itsupports the head of the victim. The negative is that itrequires the rescuer to bend over at the waist whilepulling.

1. Grasp the victim by the clothing under theshoulders.

2. Keep your arms on both sides of the head.

3. Support the head.

4. Try to keep the pull as straight and in-line aspossible.

BLANKET PULL This is the preferred method for dragging a victim.

1. Place the victim on the blanket by using the"logroll" or the three-person lift.

2. The victim is placed with the head approx. 2 ft.from one corner of the blanket.

3. Wrap the blanket corners around the victim.

4. Keep your back as straight as possible.

5. Use your legs, not your back.

6. Try to keep the pull as straight and in-line aspossible.

ONE-PERSON LIFT This only works with a child or a very light person.

1. Place your arms under the victim's knees andaround their back.

FIREFIGHTER CARRY This technique is for carrying a victim longer distances.It is very difficult to get the person up to this positionfrom the ground. Getting the victim into positionrequires a very strong rescuer or an assistant.

1. The victim is carried over one shoulder.

2. The rescuer's arm, on the side that the victim isbeing carried, is wrapped across the victim's legsand grasps the victim's opposite arm.

PACK-STRAP CARRY When injuries make the firefighter carry unsafe, thismethod is better for longer distances than theone-person lift.

1. Place both the victim's arms over yourshoulders.

2. Cross the victim's arms, grasping the victim'sopposite wrist.

3. Pull the arms close to your chest.

4. Squat slightly and drive your hips into the victimwhile bending slightly at the waist.

5. Balance the load on your hips and support thevictim with your legs.

TWO RESCUERS

HUMAN CRUTCH/ For the conscious victim, this carry allows the victimTWO-PERSON DRAG to swing their leg using the rescuers as a pair of

crutches. For the unconscious victim, it is a quickand easy way to move a victim out of immediatedanger.

1. Start with the victim on the ground.

2. Both rescuers stand on either side of thevictim's chest.

3. The rescuer's hand nearest the feet grabs thevictim's wrist on their side of the victim.

4. The rescuer's other hand grasps the clothing ofthe shoulder nearest them.

5. Pulling and lifting the victim's arms, therescuers bring the victim into a sitting position.

6. The conscious victim will then stand withrescuer assistance.

7. The rescuers place their hands around thevictim's waist.

8. For the unconscious victim, the rescuers willgrasp the belt or waistband of the victim'sclothing.

9. The rescuers will then squat down.

10. Place the victim's arms over their shoulders sothat they end up facing the same direction asthe victim.

11. Then, using their legs, they stand with thevictim.

12. The rescuers then move out, dragging thevictim's legs behind.

FOUR-HANDED SEAT This technique is for carrying conscious and alertvictims moderate distances. The victim must be able tostand unsupported and hold themselves upright duringtransport.

1. Position the hands as indicted in the graphic.

2. Lower the seat and allow the victim to sit.

3. Lower the seat using your legs, not your back.

4. When the victim is in place, stand using yourlegs, keeping your back straight.

TWO-HANDED SEAT This technique is for carrying a victim longer distances.This technique can support an unconscious victim.

1. Pick up the victim by having both rescuers squatdown on either side if the victim.

2. Reach under the victim's shoulders and undertheir knees.

3. Grasp the other rescuer's wrists.

4. From the squat, with good lifting technique,stand.

5. Walk in the direction that the victim is facing.

CHAIR CARRY This is a good method for carrying victims up and downstairs or through narrow or uneven areas.

NOTE: The chair used should be a sturdy one.Don't use aluminum beach chairs, resin patiochairs, swivel chairs, or lightweight folding chairs.

REMEMBER: Chairs with wheels can be used to rollthe victim, but should not be used for a carry.

1. Pick the victim up and place them or have themsit in a chair.

2. The rescuer at the head grasps the chair fromthe sides of the back, palms in.

3. The rescuer at the head then tilts the chair backonto its rear legs.

4. For short distances or stairwells, The secondrescuer should face in and grasp the chair legs.

5. For longer distances, the second rescuer shouldseparate the victim's legs, back into the chairand, on the command of the rescuer at thehead, both rescuers stand using their legs.

IMPROVISED STRETCHER This technique requires two poles/pipes strong enoughto support the victim's weight and at least two shirts.

REMEMBER: Rescuers should not give up clothingif, for any reason, this might affect their health,welfare, or reduce their effectiveness.

1. While the first rescuer is grasping the litterpoles, the second rescuer pulls the shirt off thehead of rescuer one.

2. All buttons should be buttoned with the possibleexception of the collar and cuffs.

3. The rescuers then reverse the procedure andswitch sides.

BLANKET STRETCHER This technique requires two poles and a blanket.

1. Place the blanket down on the ground.

2. Place one pole approx. 1 foot from the middle ofthe blanket.

3. Fold the short end of the blanket over the firstpole.

4. Place the second pole approx. 2 feet from thefirst (this distance may vary with victim orblanket size).

5. Fold both halves of the blanket over the secondpole.

THREE OR MORE RESCUERS

HAMMOCK CARRY Three or more rescuers get on both sides of the victim.The strongest member is on the side with the fewestrescuers.

1. Reach under the victim and grasp one wrist onthe opposite rescuer.

2. The rescuers on the ends will only be able tograsp one wrist on the opposite rescuer.

3. The rescuers with only one wrist grasped will usetheir free hands to support the victim's head andfeet/legs.

4. The rescuers will then squat and lift the victimon the command of the person nearest the head,remembering to use proper lifting techniques.

THREE-PERSON CARRY This technique is for lifting patients onto a bed orOR STRETCHER LIFT stretcher, or for transporting them short distances.

1. Each person kneels on the knee nearest thevictim's feet.

2. On the command of the person at the head, therescuers lift the victim up and rest the victim ontheir knees.

If the patient is being placed on a lowstretcher or litter basket:

On the command of the person at the head, thepatient is placed down on the litter/stretcher.

If the victim is to be placed on a highgurney/bed or to be carried:

At this point, the rescuers will rotate the victimso that the victim is facing the rescuers, restingagainst the rescuers' chests.

3. On the command of the person at the head, allthe rescuers will stand.

4. To walk, all rescuers will start out on the samefoot, walking in a line abreast.

Anticipation and Evacuation Danger Mount erupts:

1. Preparation Facing Volcano Eruption

Recognize the local area in determining a safe place to evacuate.

Create a disaster management plan.

Prepare for evacuation if necessary.

Preparing basic needs

2. If Occurred Volcanic Eruption

Avoid disaster-prone areas such as mountain slopes, valleys and

lava flow area.

In the open, protecting themselves from the ash and hot clouds.

Prepare yourself for the possibility of aftershocks.

Wear clothing that can protect the body such as: long sleeves, long

pants, hats and others.

Do not wear contact lenses.

Wear a mask or cloth to cover the mouth and nose

3. After Volcanic Eruption Occurred

Stay away from areas affected by ash

Clean the roof of the ashes. Due to its weight, can damage or tear

down the roof of the building.

Avoid driving in areas affected by ash can cause engine damage

2.2.2. The Roles of Medical Personnel In Management Disaster

Competence of medical personnel and equipment should be prepared in

accordance with the recommendation of RHA (Rapid Health Assessment). If the

recommendation is needed surgeon and anesthesia for the treatment of severe

injuries that require surgery, TRC or minimal medical assistance team should

consist of surgeons, anesthetists, general practitioners, nurses proficient surgical

and ER (Kementerian Kesehatan, 2011).

Be prepared rescuers trained to perform pre-hospital medical care well in the

field. This field medical teams have the ability to:

1. provide aid life support;

2. perform triage with either;

3. perform radio communication with the well.

In certain circumstances, difficult localization victims as victims trapped in

collapsed buildings, the liberation of the victims will require a longer time. If the

victim's condition worsens, the SAR team leader, through the Command Post may

request assistance from the medical team to stabilize the victim during the

acquisition process is done (Kementerian Kesehatan, 2011).

2.2.3. Logistic Needed In Management Disaster

Loss the sources of power on victims disaster will cause dysfunctional some

elements within the community. Conditions such as these will raise the demand for

assistance addressed to people outside the disaster area. Thus, the logistics system

becomes very important. Logistics is something that is tangible and can be used to

meet the basic needs of human life which consists clothing, food and shelter or

derivatives. Included in the logistics category are consumables such as food,

medicine, clothing and accessories, sleeping suits etc (BNPB, 2009).

According Ahyudin (2005) the variety of logistical assistance, for food and

clothing, should adjust to the culture prevailing in the disaster victims. For

example, it turns out the people in Aceh do not like sardines preserved. Food

should meet the nutritional standards, because the victims are generally inhabit

rudimentary shelter, it causing their physical state very susceptible to disease.

Therefore, the logistics of food that does not have the maximum nutritional value

can cause danger for the victim. Data show that outbreaks of illness and death

affected a lot going on continuously.

Research in the evacuation showed that child mortality is 2-3 times greater

than deaths in all age groups (Kemenkes RI, 2012). Manager of activities nutrition,

Provincial Health Office and District or City is part of a team of health problems

caused by the disaster prevention coordinated Crisis Management Center of Health

(PPKK), PPKK Regional and Sub-regional, the Provincial Health Office and

District-City and Society Organization. Handling of nutrition in disaster situations

consist of nutrient management on vulnerable groups and adults besides lactating

mothers and pregnant women. Such as feeding milk formula in infant,

micronutrient supplementation of vitamin A supplements for children, iron tablets

for pregnant and lactating mothers in addition to fresh food, iron supplementation

for pregnant women, porridge or biscuits for the elderly and others.

As for the logistical in form clothes should also suit the needs and taking into

account the dignity of the victim as a human being. In disaster specially vvolcanic

ash would lead to declining health. Drugs are needed such as eucalyptus oil, wind

starting, vitamins, and other supplements. In addition, cough medicine and

paracetamol is also needed for victims who have a fever and headache. Beside the

three types of logistics before, the victim also require other types of logistics such

as blankets, clean water, sanitary napkins and etc. As for groove of demand

logistical assistance is as follows (BNPB, 2009):

Figure 4. Groove of demand logistical assistance

Logistical assistance implemented by holding pattern involving several

institutions within the institutional system in various areas implemented in an

integrated manner: National, Province, District or city. Each one has a level of

authority:

1. National

 In the case of a disaster at the district/city and province, BNPB deploying

logistical resources of the Technical Implementation Unit (UPT) regional,

institutions, businesses and communities as needed to the disaster site. If this

need is not available or not sufficient, BNPB can mobilization the assistance to

another BPBD province, or other sources both from within and outside the

country. And if there are limitations then BNPB can help through grant

assistance of ready-made patterns specifically used during emergency response.

2. Province

In the case of a disaster in the province, BPBDs deploying logistical

resources of the Institutions, Business and Communities as needed to the

disaster site. If this need is not available or not sufficient, then the provincial

government concerned may request logistical support to other nearby province.

If the province requested assistance does not have the availability of resources

logistics or insufficient, then the provincial governments affected by the disaster

can request assistance to the Central Government (BNPB). Logistic support

deployment costs are covered by provincial governments.

3. District/City

In the case of a disaster at the district/city, BPBDs District deploying

logistical resources of the institutions, Business and Communities as needed to

the disaster site. If this need is not available or not sufficient, the government

districtor city can request logistical support to the government of the District or

City nearby well in one province or another province. If it does not have the

resources available or not sufficient, then City Government affected may request

logistical support to the provincial government concerned. Deployment costs for

this equipment covered by City Government.

2.2.4. The Ideal Characteristic of a Place for Refuge

The victims of volcanic activities at anytime can be or must be evacuated for

their safety. This is some characteristics that can be used as a refuge place.

1. Select the location

When we are going to select a place for refuge at least they have to fulfill

these criteria:

a. The place for refuge or evacuated people must be safe or outside of the

affected area. In this case it must outside of volcano activities;

b. The area (luas) of the place must be adjusted with the number of people that

is evacuated;

c. The potential threat caused by unsafe buildings, the ruins, the slope of the

land, etc;

d. The potential threat in terms of security, health and the risk of natural threats

such as flood, landslides, hurricanes, etc;

e. Easy accesses to the infrastructures such as roads, bridges, river, water

supply, sanitation, lighting, telecommunication, etc.

2. The ownership of the buildings or lands and use permits

Make sure that the owner of the location permits to use their land or buildings as

a place of refuge. Try to get the permission in order to not get in trouble in the

future.

3. Infrastructures

Supporting infrastructure that is needed by the refugees is as follow:

a. Refugees need a clean water supply. The place at least close to clean water

source or water supply and any equipment that can be used by the refugees

to collect, store, and use the clean water;

b. Refugees need fine sanitation. The need bathroom and toilet that is adequate.

The location of the bathroom and toilet should be accessible and easy for

refugees to use the facility;

c. The place for refugees needs lighting at night. This help to make the refuges

feel secure and safe, especially for vulnerable people such as children,

women, and elders;

d. Refuges also need a good health care. In this case, disaster often causes a

great impact to the people health. It can be directly impact the people such as

wounds, injuries and psychological trauma as well as indirect impact to the

people such as increasing of infectious diseases, malnutrition and other

chronic diseases;

e. Security is really needed in order to keep the place secure;

f. Education is needed for the refuges if the disaster long last. Teachers are

needed to help refuges to study.

g. They need a Religious Place

h. The refuges place is dependent on social service. This service related to the

administration and management of refuge.

4. Easy accesses for the transportations

Refuges place is dependent on the easy accesses of transportation to fulfill their

need and the health care provider.

5. Telecommunication accesses

One of the important things in management disaster is communication to make

coordination. The tools can be HT, phone and etc. It’s really helpful to

coordinate in management disaster.

6. Fulfill the needs of refuges

a. Water and sanitation

Clean water is needed during the disaster. Many refuges can get sick because

of unclean water which causes infection.

b. Food and nutrition

Nutrition is one of the factors that affect the health of refuges. Therefore, the

nutrition of those people have to be fulfilled especially those for children,

elderly, pregnant and lactating mother.

c. Clothing and sleeping equipment

We need to provide clothing and sleeping equipments because the people

that are evacuated often don’t bring any of their goods such as clothes or

bed. Refuges need clothes and blankets. For baby they have special needs

such as diapers.

d. Cooking and eating equipments

If the evacuated people long last in the refuges place, preferably every

family has its own cook equipment so that they can cook their own food and

drinking water. Because the volunteers can’t keep feeding them all the time.

e. Personal hygiene

They need to maintain their personal hygiene. With this they can prevent

diseases usually caused by microorganism. Personal needs such as soal,

shampoo, toothbrush, toothpaste, and towel is important. For women there is

also a special needs such as sanitary napkins. Also diapers for baby.

2.2.5 The Classification of the Status of Volcano

There are four status for active volcanoes.

1. NORMAL status (Normal)

Meaning:

1. No symptoms magma pressure activity

2. Basic activities level

Actions:

1. Observation routine

2. Survey and investigation

2. ALERT status (Waspada)

Meaning:

1. There is a rise in activity above the normal level

2. Increased seismic activity and other volcanic events

3. Slight changes in activity caused by magma activity, tectonic and hydrothermal

Actions:

1. Extension / socialization

2. The hazard assessment

3. Checking needs

4. Implementation of limited picket

3. STANDBY status (Siaga)

Meaning:

1. All the data show that activity can immediately proceed to the eruption or lead

to

circumstances that can lead to disaster.

2. Increased intensive seismic activity.

3. If the upward trend continues, an eruption could occur within 2 weeks.

Action:

1. Socialization in regions threatened

2. Prepare emergency need

3. Daily coordination

4. Full picket

4. CAUTION Status (Awas)

Meaning:

1. Indicates volcano erupting or soon or there is a critical situation catastrophic.

2. The opening began with the eruption of ash and smoke.

3. The eruption likely to occur within 24 hours.

Actions:

1. The area endangered recommended to be emptied.

2. Coordination is done on daily

3. Full Picket

2.2.6 Determination The Status Of Disaster Emergency On A National Scale And

Local

Scale

Definition for disaster scale is a condition in a place that was devastated by a

certain type of disaster and assessed based on the number of victims, loss of property,

damage to infrastructure and facilities, coverage areas and socio-economic impacts,

which can be divided into local, regional and national levels. Disaster status divides

into disaster mild, moderate and severe according those indicators. Determination the

status of disaster emergency on a national scale carried out by the President, the scale

of the province by the governor, and district / municipality level by the Regent /

Mayor. Provisions for determination of the status and level of disaster regulated by

Presidential Regulation or known as Peraturan Presiden (PP). Also in Law No.24 /

2007 on Disaster Management, Article 7 (2) mentioned determination of the status

and level of national and local disaster loading indicator number of victims, loss of

property, damage to infrastructure, coverage of the affected area, and socio-economic

impacts posed.

In the Draft of Presidential Regulation, a local disaster (district / city) is this

disaster raises the death toll of less than 100 people, a loss of less than USD 1 billion,

the coverage area of less than 10 km2, the local government is still able to handle

based on human resources, financial resources and the government is still running .

Provincial disaster is a disaster that causes the number of victims is less than 500

people, a loss of less than Rp 1 trillion, the coverage area of more than one district /

city, the provincial government is still running. Meanwhile, the National Disaster

victims indicator of more than 500 people, the loss of more than Rp 1 trillion, its

scope several districts / cities of more than one province, and the provincial and

district government was not able to cope.

Regent / Mayor becomes primary responsibility in disaster management in

their region. Governor with all available resources to provide assistance to districts /

cities affected. Neighboring areas to provide assistance to the affected areas. Central

Government provide assistance that is not owned by the regional extremes, both

managerial, financing, logistics and equipment, and administration. So the local

government has a great responsibility because the authorities regulate the area and its

people with all the authority under existing rules.

In Indonesia, the President declared a national disaster only once, during the

tsunami in Aceh in 2004. The victims at that time is more than 200,000 people dead

and missing. Loss of more than Rp 49 trillion and district government and the

provincial government of Aceh and North Sumatra paralyzed at that time. Based on

historical records in BNPB disaster, only the tsunami disaster in 2004, which declared

the President as a national disaster. There were no other disasters that are classified as

national disasters or no determination of the President of the national disaster.

Karhutla smoke from the disaster of 1997 which affects 47.6 million people are

exposed to, 4.5 million hectares of forest were burned, and economic losses reached

Rp 57.6 trillion. Yogya earthquake in 2006 caused loss of 5,716 people died, a loss of

Rp 29 trillion, and the impact on the provinces of Yogyakarta and Central Java. West

Sumatra earthquake in 2009 caused loss of 1,117 lives, damage in 9 districts / cities,

and a loss of Rp 21 trillion. The eruption of Mount Merapi in 2010 caused fatalities

386 people were killed, four counties and 2 provinces affected, displaced 0.5 million

and a loss of Rp 3.56 trillion.

2.3. Problem Analysis

Management disaster can be divided into 3 phases, pre disaster, during disaster and

post disaster. During the pre disaster we can reduce/minimize the impact of the disaster

(mitigation). We can make a plan that is quite flexible so when the disaster gets worse

they can easily change according to the situation. We can educate the people what to

prepare during the disaster and how to survive. We can also contact/call for help from

government such as the village leaders, SAR, Police, TNI or any other government

institutions that can be helpful to management disaster. Beside government institutions,

we can also call the nearest hospital, media and recruiting volunteers.

During disaster phase, we make sure that everything on the right track and everyone

knows the job. So then we form some posts such as commando post, evacuation post,

health care post, logistic post and general kitchen post. The government institution like

SAR, TNI, etc helps to evacuate the people to the evacuation area. We can use the public

facilities like church, mosques, etc as the evacuation area as long as it big enough to fit

the people. The health care post with the medical team groups the victims use triage

(green, yellow, red and black). Also health care post helps to cure the victims. The

general kitchen post helps to feed the people in the evacuation area. The logistic team

makes sure everyone can get what they need like bed, diapers for baby, etc. Vulnerable

groups such as elderly, pregnant women and children need more attention during this

phase.

After the disaster happened, we come to the post disaster phase those we trying to

recover the place and the victims. Psychiatrists are needed to recover the mental trauma

victims. Beside that we also have to recover the environment and sanitation, improve the

health care facilities and function.

2.4. Final Hypothesis

2.5. Final Mind Mapping

2.6. Group Opinion

In this scenario, a doctor of public health center (Puskesmas) was ordered to plan a

disaster management coordination. The doctor should communicate with other institution

asking for help and also be able to plan the disaster management with existing sources.

The doctor should knows the characteristic of the disaster area. Those are include

geographical conditions, the amount and characteristic of population, how many people

which can help doctor, how many buildings can be used as an evacuation post, etc.

The doctor should communicate with other institution, such as BMKG (to know the

condition of eruption), BPBD and TNI (asking for help in management disaster), Local

Government (asking for logistic in refuge place), Public Health Office (Dinas Kesehatan)

asking for help of health services inrefuge place, medicines, mask for villagers, etc).

The first step, doctor should coordinate with the leader of village to inform that there

are going to be a volcano eruption and it harms the village. There will be an evacuation

and the leader of village should gather villagers in public area, such as mosque, church,

Polindes, Pustu, or other public facilitation. In evacuating the villagers, we should know

where the safe area is, how long the time we have until the volcano eruption, the

evacuation route, and what transportation can be used.

The next step, we should prepare the refuge place. Include the resting place (using the

public facilitation, mosque, church, etc), refuge place, we should doing a suveillance.

Finally is evaluate the disaster management.

2.7. Obstacle

- The communication in online discussion is not effective

- The answer our questions from pbl came late

- Limited synchronous literature

- In online discussion, the response of a member in a long time

- Few friends that understand to determine the management disaster to this scenario

2.8. Conclusion

In this case, as a doctor who have been given the task to plan disaster management of

mountain Z’s eruption, will need help from governnment officials and its institutions

such as BMKG, BNPD, SAR, TNI, local hospitals, and so on to provide man power,

transportation, informations regarding the mountain, security, facilities and provision for

the villagers. With the help of mass media, we can also start recruiting volunteers and

collecting donations. As an early step for Pre-disaster management, we should consult

with village chief regarding the mountain activity, the dangers, and evacuation planning.

The doctor should also learn and consult with other institutions about field data such as

geographical condition, population data, danger zones mapping, transportation routes,

and evaluate resources such as public facilities or nearby safe villages. With help from

hospital and government officials we can start bringing logistics to help villagers in need

such as protective masks and medicines to prevent unnecessary injuries. Start evacuating

the villagers to the outposts and safe places, we can use public facilities, such as mosque,

church, etc. Set up outposts if needed such as commando post, evacuation post, health

care post, logistic post and general kitchen post to fulfill the villager’s needs. Make

flexible plan for disaster phase, and pasca-disaster phase, including education to the

villagers for possible disaster outcomes just in case the disaster happens and gets worse.