Empowering Health System
Health Care Management

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Health & Finance
Volcanic Eruption - Merapi
Air Crash Investigation
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In a mass disaster, surely there will be victims. They are classified into:
▶ Non-injured : may have psychological trauma
▶ Injured : physical & psychological trauma
▶ Dead : how many? who? causes?

An event will be called a mass disaster if the number of dead victims is more than 12 in a single event.

So, what we should do when there's dead bodies everywhere?... (caused by the disaster)

Well, surely we have to identify whose bodies are them.

What if there are dead bodies which can't be recognized? Be it severely burnt, damaged facial/physical characteristics, or even... skeletonized!

Introducing... the DVI *tadaaa* ...

It's the DISASTER VICTIM IDENTIFICATION. There are 5 steps to be done:

... ... ... ... ... ... ... ... ...

1) In the Scene of Incident
❧  Secure - Police border line
❧  Collect - Evidences, bodies evacuation
❧  Documentation - Photograph, labelling
❧  Team members : Police, MD, SAR, army, trained volunteers
❧  Work scheme:
... ... ... ... ... ... ... ... ...
2) Post-Mortem (PM)
❧  Collect PM data - photo, medical exam, fingerprinting, forensic odontology & anthropology, DNA
❧  Prevent PM changes
❧  Work scheme:


... ... ... ... ... ... ... ... ...
3) Ante Mortem (AM)
❧ Collect AM data: from family, neighbours and friends.
❧ Data analysis
❧ Resume






... ... ... ... ... ... ... ... ...
4) Reconciliation
❧ To compare & cross-match between PM & AM data.
❧ Identification - Forensic pathologist, dentist, fingerprint, recognize the property, photographer.

... ... ... ... ... ... ... ... ...
5) Returning to the Family / Burial
❧ Ensure care, do reconstruction if needed for best cosmetic/condition.
❧ Medicolegal & administrative procedures - death certificates, insurances.
❧ Mass / Temporary burial, or return the body to the family.


The end.
What we should know here is that, the success indicator of a disaster victim identification work is not the speed, but the accuracy. However, the good speed may add up a DVI level of quality, given that their accuracy level is maintained good or even better. ッ

℘.s. Knowledge is power.
and He is the Most Powerful, for He knows everything :)
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Posted by ana - - 0 comments

If a baby were born,
what important identification document should be issued?
✔ a birth certificate .......

Then the baby grew up,
what important identification document should be issued?
✔ an identification card .......

When his/her time has come to the end,
what important identification document should be issued?
✔ a DEATH CERTIFICATE .......

Why should a death certificate be issued when there's a death of a person?
✏ to prevent from being buried illegally
✏ pension
✏ insurance
✏ inheritance
✏ debt
✏ law
✏ et cetera


MD roles?
☛ Determine the death (circulation, respiration & neurology stop, plus no secondary post-mortem changes after 2 hours incubation period - this is needed to exclude coma)
☛ Autopsy (done if difficult to find out the cause of death)
☛ Forensic Identification (if unidentified, or to confirm identification)

Let's see what are the details that should be written in a death certificate:
❧ Name
❧ Age (at time of death)
❧ Gender
❧ Address
❧ Date of death
❧ Cause of death

However in Indonesia, there's no standard guidelines taken. Most of the death certificates here don't have the 'cause of death' part. It will only be written if the late person was a patient who had died after receiving a long term care & treatment in a hospital. Oh, here's an example of the 'cause of death' part.


Cause of Death??
❦ Written in 'chain of events'. For example, events occurred minutes, hours, days and years before the time of death, which may be linked to each others, and resulted death of the person.


Knowledge is power.
and He is the Most Powerful, for He knows everything :)
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Posted by ana - - 0 comments


Before I continue writing about this, perhaps some of you wondered what 'Mx' is. Well, it's a short medical abbreviation for the term 'management' ...

Right, now we're talking about Disaster Phase. What's the most important in this phase?

RAPID RESPONSES !!
Yes, rapid responses should be the utmost priority when there's a disaster occurred.

So, what we must have to ensure a rapid response? It's the Action Plan! I mean, the Disaster Plan!!

We may divide the big Disaster Plan into Pre-Hospital, Hospital and Regional Disaster Plans.

Let's see one by one. Brief points!

---[Pre-Hospital]----------------------

✩ DISASTER PLAN:
-- Major incident
-- Exact location
-- Type of injury
-- Hazard
-- Access
-- No. of cases
-- Emergency services, present & required

✩ MEDICAL RESPONSES:
-- Triage
-- Treatment (Resuscitate & Stabilize)
-- Transfer & Transport


---[Hospital Disaster Plan]----------------------------------------------------------------------------------

✩ MANAGEMENT SUPPORT
-- Command
-- Safety
-- Communication
-- Assessment

✩ MEDICAL SUPPORT
-- Triage / Re-triage
-- Treatment (Resuscitate & Stabilize & Definitive Treatment)
-- Transport, Transfer & Refer


---[Regional Disaster Plan]---------------------------------------------------------------------------------

-- Coordinating Team
-- Medical team
-- Surveillance
-- Management back up
-- Logistic

Example:
[sorry, this part is to be remained in Indonesian language]

[click to enlarge]

Then, the management between regions will be under the Sectoral Management. The link between Pra Hospital DP in different regions will be under the Pusbankes-118.

Among important medical skills used in Pusbankes-118 (Emergency Service) services are:
-- Advanced Trauma Life Support
-- Advanced Cardiac Life Support
-- Basic Life Support
-- Emergency Physician
-- General Emergency Life Support

Knowledge is power.
and He is the Most Powerful, for He knows everything :)
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Posted by ana - - 0 comments


DISASTER, what's that?
Can a volcano eruption, or earthquakes, or tsunami, or flood, or an airplane crash, or landslides, or a hurricane, called 'disaster'??

Haha, usually, that's what we heard from the news and et cetera. However actually, those events can't alway be called a disaster.

Why? Let's define the meaning of a 'disaster'.

Disaster is a "sudden ecological phenomenon of sufficient magnitude to require external assistence" -World Health organization [WHO]

So, an event like an earthquake with 7.0 Richter, cannot be called as a disaster if it happens in a place where nobody lives there, because there's no external assistance needed to counteract with the effects & damages caused by the earthquake. It is just an event.

It will only be called as a disaster only if the 7.0R earthquake happened in a big city, with a big population. Imagine how many damages there would be.. How many lives would have gone with it.. How many recoveries needed to be done.. Until local people and the governor would require external assistance, then the event should be called as a DISASTER.

Now that we understand the meaning of a disaster. Now the question is, how to cope with it? Any plans?? Imagine if suddenly a disaster occurred in your place (nauzubillahiminzalik).. What would you do? (or at least the government do..)

Okay, here's the plan...


owh, before that, let's learn a little bit about those terms...


Hazard -------- Something that contents energy, which may results something bad to happen.
Mitigation ---- Effort(s) to lessen the impact of an event.
Risk(s) -------- Probability that something negative will occur.
Preparedness - Effort(s) to increase resilience.
Event --------- Realization of hazard.
Impact -------- Contact between an event & society.
Damage ------ Negative results from the impact of an event.
Resilience ---- The 'daya tahan' in Indonesian & Malaysian language.
Capacity ------ Numbers affected from the event / needed to be protected.
Absorbing Capacity -- Capacity to absorb the power of an event (e.g. earthquake-proof buildings).
Buffering Capacity --- Capacity of reservation (e.g. keeping rice for famine preparation).
Response ------- Capability of local people to response to the after-effect of the event.
Disaster -------- Events that require external assistence.
Recovery ------- To make things back to normal (like previously).
Development -- To rebuilt, better than before.

Generally, the Disaster Management includes Prevention, Mitigation & Preparedness in PreDisaster phase, Responses in Disaster phase, and Recovery & Development in PostDisaster phase.

Knowledge is power.
and He is the Most Powerful, for He knows everything :)
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Here are some pictures taken during the Mount Merapi eruptions time.
Why pictures? ...because a picture is worth a thousand words! ♫♪♥♫♪~

*warning: some of the images might contain explicit/objectionable realistic graphics for some people!

Stumps are all that remain of trees felled by an eruption of Mount Merapi, at Kinahrejo village in Sleman, Indonesia on October 27, 2010. (Ulet Ifansasti/Getty Images)

An Indonesian veterinarian tends to a cow injured after Mouth Merapi's eruption in the village of Umbulharjo, in Sleman, central Java, on October 29, 2010. (ADEK BERRY/AFP/Getty Images)

Residents ride their motorcycles in Yogyakarta, blanketed by volcanic ash falling from Mount Merapi's latest eruption early on October 30, 2010. (CLARA PRIMA/AFP/Getty Images)

A woman wearing a raincoat, rides a bicycle on an ash-covered road after another eruption of Mount Merapi volcano, in the city of Yogyakarta October 30, 2010. (REUTERS/Andry Prasetyo)

Indonesian soldiers of Special Force of Kopassus evacuate an elderly woman who refuses to leave her home during an evacuation after a new violent explosion in Umbulharjo, Sleman on October 30, 2010. (ADEK BERRY/AFP/Getty Images)

Mount Merapi volcano spews smoke as seen from Deles village in Klaten, near the ancient city of Yogyakarta, November 1, 2010. (REUTERS/Dwi Oblo)

A melted radio-cassette tape recorder sits covered with volcanic ash from the eruption of Mount Merapi in the abandoned village of Kaliadem, Yogyakarta, Indonesia on Nov. 1, 2010. (AP Photo/Trisnadi)

Residents leave a danger zone as Merapi volcano releases ash clouds above Balerante village, Klaten on November 1, 2010. (ADEK BERRY/AFP/Getty Images)

Villagers escorted by police carry a suspected looter caught in an abandoned village in Sleman located in Mount Merapi's danger zone on November 1, 2010. (ARYA BIMA/AFP/Getty Images)

Mount Merapi, viewed from Sidorejo village in Klaten on November 1, 2010. (REUTERS/Beawiharta)

A pair of shoes sit covered in volcanic ash from the eruption of Mount Merapi in the abandoned village of Kaliadem, Yogyakarta, Indonesia on Nov. 2, 2010. (AP Photo/Trisnadi)

A pet bird, killed during the eruption of Mount Merapi, lies in its cage in the abandoned village of Kaliadem, Yogyakarta, Indonesia on Nov. 2, 2010. (AP Photo/Trisnadi)

Molten lava flows from the crater of Mount Merapi captured in this long exposure photograph taken from Klaten district in Central Java province late on November 2, 2010. (SONNY TUMBELAKA/AFP/Getty Images)

People watch Mount Merapi spewing volcanic materials in Deles on November 2, 2010.

Mount Merapi spews lava and smoke as it erupted again on Wednesday as seen from Sidorejo village in Klaten on November 3, 2010. (REUTERS/Beawiharta)

A farmer stands in a rice field as volcanic material from Mount Merapi erupts, in Klaten, Central Java on November 4, 2010 near Yogyakarta, Indonesia. Over 70,000 people have now been evacuated with the danger zone being extended to over 15km as the volcano continues to spew ash and volcanic material. (Ulet Ifansasti/Getty Images)

Mount Merapi erupts, as seen from Wukirsari village in Sleman, near the ancient city of Yogyakarta, November 4, 2010. (REUTERS/Beawiharta)

Refugees look out from inside a tent during rain at a temporary evacuation center set up as a result of the repeated eruptions of Mount Merapi, in Keputran village, Klaten, Central Java on November 4, 2010. (Ulet Ifansasti/Getty Images)

A view from a domestic flight from Denpasar to Yogyakarta that was subsequently diverted to Surabaya airport shows a plume of gas and ash billowing some 10 km (six mi) high from Mount Merapi, during an eruption on November 4, 2010. (CLARA PRIMA/AFP/Getty Images)

Houses are in flames as volunteers rescue burned victims of an eruption of Mount Merapi in Argomulyo village early on November 5, 2010. (SUSANTO/AFP/Getty Images)

Volunteers rescue burned victims of Mount Merapi eruption in Argomulyo village, devastated by deadly hot clouds of volcanic ash early on November 5, 2010. (SUSANTO/AFP/Getty Images)

Survivor Sri Sucirathaasri, 18, stands beside her injured sister Prisca in a hospital in Yogyakarta, Indonesia on Nov. 5, 2010. The hospital at the foot of Indonesia's most volatile volcano is struggling to cope with victims brought in after the mountain's most powerful eruption in a century. (AP Photo/Achmad Ibrahim)

Bodies of victims of an eruption of Mount Merapi rest amongst ashes and debris in front of a house in Argomulyo village, Cangkringan, in Sleman November 5, 2010. (REUTERS/Aditia Surya)

Rescuers remove the charred remain of the body of a victim of Mount Merapi eruption in Argomulyo, Yogyakarta, Indonesia, Friday, Nov. 5, 2010. (AP Photo/Trisnadi)

Villagers flee their homes following another eruption Mount Merapi in Klaten ,Indonesia, Friday, Nov. 5, 2010. (AP Photo/Achmad Ibrahim)

A woman prays in a temporary shelter at Maguwoharjo Stadium in Yogyakarta, November 5, 2010. (REUTERS/Beawiharta)

A girl weeps at a temporary shelter for those who are affected by the eruption of Mount Merapi in Bawukan, Indonesia, Friday, Nov. 5, 2010. (AP Photo/AK Hendratmo)

The hand of a victim of the eruption of Mount Merapi, among body bags at a hospital morgue in Yogyakarta, Indonesia, Friday, Nov. 5, 2010. (AP Photo/Slamet Riyadi)

Detail of a dead body swept by Mount Merapi's hot clouds gas ' Wedus Gembel' in the village of Cangkringan, Indonesia, 06 November 2010.

An Indonesian policeman pats a surviving monkey after the village was swept by Mount Merapi's 'Wedhus Gembel' hot gas clouds, Cangkringan, Indonesia, November 6, 2010.

Lightning strikes as Mount Merapi erupts, as seen from Ketep village in Magelang, Indonesia's Central Java province November 6, 2010. (REUTERS/Beawiharta)

Dead trees and ash cover a damaged house with the erupting Mount Merapi in the background in Sleman, Yogyakarta province, central Java, on November 6, 2010. (BAY ISMOYO/AFP/Getty Images)

A villager takes a stroll at Ketep village in Magelang, Indonesia's Central Java province, November 6, 2010, as Mount Merapi volcano erupts spewing out towering clouds of hot gas and debris in the background. (REUTERS/Beawiharta)

Dead trees and mud clog a river as clouds of hot ash spew from the erupting Mount Merapi in Sleman, central Java, on November 6, 2010. (BAY ISMOYO/AFP/Getty Images)

A kitchen is covered by ash in Cangkringan village off the Indonesia's Central Java province, November 6, 2010. (REUTERS/Dwi Oblo)

Lava and ash spews from the top of Mount Merapi, viewed from Klaten district in Central Java province before dawn on November 6, 2010. (BAY ISMOYO/AFP/Getty Images)

Villagers gather at the grave of the victims of Mount Merapi eruption for a mass burial at Sleman, Yogyakarta, Indonesia, Sunday, Nov. 7, 2010. (AP Photo/Achmad Ibrahim)

Volcanic ash from the eruption of Mount Merapi covers a village in Muntilan, Central Java, Indonesia, Sunday, Nov. 7, 2010. (AP Photo/Trisnadi)

A search and rescue team looks for victims at Wukirsari village in Sleman district in the Indonesian Central Java province November 7, 2010. (REUTERS/Sigit Pamungkas)

Refugees rummage through second-hand clothes that were distributed at a refugee camp in Yogyakarta, Central Java November 7, 2010. (REUTERS/Sigit Pamungkas)

Search and rescue team members from Yogyakarta carry a victim of Merapi volcano's eruption at the village of Ngancar in Sleman on November 8, 2010. (CLARA PRIMA/AFP/Getty Images)

A farmer walks through his corn field covered in volcanic ash from Mount Merapi eruption in Muntilan, Central Java, Indonesia on Monday, Nov. 8, 2010. (AP Photo)

*credits to all of the photographers! ...all of those photos were found in the internet.

Knowledge is power.
and He is the Most Powerful, for He knows everything.
:)

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