Fathy Zuandi Pohana
Disaster Management Task Force Indonesian Pediatric Society, Jakarta, Indonesia
Indonesia is a country which has high risk of disaster an has high incidence of disaster. National Disaster Management Agency of Indonesia has recorded an average of 1900 disaster events per year since 2010 and has increased almost 2 times on 2018. In 2018, there were 3,349 people died, 1,432 missing, 21,064 injured including children.1 Global data estimated 50% of victims were children.2 Due to its anatomic, physiologic, clinical, developmental, and psychological characteristics, children are uniquely vulnerable to disaster. For example, children become dehydrated easyly when exposed to agents that may cause diarrhea or vomiting and they are exposed to realtively greater dosage of inhalant substances and will suffer the effects much more rapidly than adults. Infants, toddlers, and young children do not have motor skill to escape from the site of disaster event.4 Therefore, the role of pediatrician is needed to address these pediatric considerations.2,4
The readiness of the medical team during emergency response is urgently needed, including the readiness of pediatricians to serve child victims. Indonesian Pediatric Society (IPS) has a long history in disaster management response team, especially since it became institutionalized to be Disaster Management Task Force after Aceh?s tsunami in 2004. Disaster Management Task Force has played active role several times in disaster management in Indonesia, up to the last two earthquake in Lombok and Palu.5
The process of disaster management involves pre-disaster, disaster, and post-disaster phases that continuously and simultaneously done. The phases are divided into mitigation phase, preparedness phase, response phase, and recovery phase.5-7 Disaster management has experienced a paradigm shift into multisectoral management. The World Health Organization (WHO) has adopted this cluster system since 2005 which aims to strengthen coordination by clarifying the division of responsibilities and roles of each organization or institution.8 The National Disaster Management Agency (NDMA) of Indonesia builds coordination with other ministries and institutions in applying multi sectoral management in disaster management.7 The Ministry of Health, as the coordinator of the national health cluster, has tasks in supporting and facilitating local goverment in carrying out efforts to overcome the health crisis.8
The World Health Organization has classified the Emergency Medical Team based on its capabilities as: EMT1 mobile and fixed to serve outpatient cases in areas that are difficult to reach and in refugee camps, EMT2 (hospital-based) which can service minor and major surgery, EMT3 which provide referral level care including intensive care facilities, and specialist cells that provide supplementary specialist care services. Pediatricians play a role in this specialist cell.9
During response phase, Disaster Management Task Force of IPS will establish coordination with NDMA and Center for Health Crisis Indonesian Ministry of Health. When a disaster has been stated as national disaster, Disaster Management Task Force will take following steps: appoint a coordinator of medical volunteers to recruit and mobilize volunteers to the disaster location; ask coordinator of logistic to prepare and arrange the delivery of medicines, medical devices, and other logistics; ask funding coordinators to manage the receipt and expense of disaster relief funds; and appoint field coordinators (chief on location) who manage the activities of emergency medical teams in the disaster location and coordinate with health clusters and other institutions. The role of emergency response team is described in figure 1.10
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1. Data Informasi Bencana Indonesia. Available at: http://dibi.bnpb.go.id/. Accessed on August 2, 2018.
2. Rothstein. Pediatric care in disasters. Pediatrics. 2013;132:602-5.
3. AAP Disaster Preparedness Advisory Council. Medical countermeasures for children in public health emergencies, disasters, or terrorism. Pediatrics. 2016;137:e20154273
4. Markenson D, Reynolds S. The pediatrician and disaster preparedness. Pediatrics. 2006;117:e340
5. Satuan Tugas Penanggulangan Bencana Ikatan Dokter Anak Indonesia. Pedoman penanggulangan bencana. Jakarta: Ikatan Dokter Anak Indonesia; 2010.
6. Chung S, Foltin G, Schonfeld DJ, editors. Pediatric disaster preparedness and response. Topical collection: Part one. Illinois: American Academy of Peditrics; 2019.
7. Kementerian Kesehatan Republik Indonesia Pusat Krisis Kesehatan. Buku tinjauan penanggulangan krisis kesehatan tahun 2017. Jakarta: Kementerian Kesehatan; 2017.
8. Pusat Krisis Kesehatan Kementerian Kesehatan Republik Indonesia. Modul pelatihan penanggulangan krisis kesehatan. Jakarta: Kementerian Kesehatan RI; 2015.
9. World Health Organization. Emergency Medical Team Coordination Cell (EMTCC) Coordination Handbook. Geneva: WHO; 2016.
10. Satuan Tugas Penanggulangan Bencana Ikatan Dokter Anak Indonesia. Modul penanggulangan bencana. Jakarta: Ikatan Dokter Anak Indonesia; 2019.