Medical and evacuation procedures for Indonesia 2013

Transcription

1 Medical and evacuation procedures for Indonesia 2013

2 Contents 1. Introduction... 2 Medical screening...3 Medical questionnaire...3 PADI...3 Screening...3 Roles in the event of an emergency...3 Medium Priority...4 High Priority...4 Emergency Medical facilities in country... 5 Facilities in Wanci...5 Facilities in Bau Bau...5 Facilities in Makassar...6 Facilities in Bali Medical cover Evacuation from the forest sites... 7 Overview...7 Medium and High priority evacuations...8 Emergency evacuations...8 Evacuation times from forest camps to Bau Bau Evacuation from the marine sites... 9 Medium and High Priority evacuations...9 Emergency evacuations Reporting and logging Mass evacuations and disaster management...11 Major incident with no prior warning Important Contacts for Indonesia Introduction

3 Medical screening As with all expeditions careful planning is essential to ensure that individuals enjoy a safe and successful trip. Medical questionnaire As some members of the expedition team may have pre-existing health problems or concerns, all participants will be required to complete a medical questionnaire prior to their departure to Indonesia. This questionaire will be included in the expedition confirmation pack that is sent out to all volunteers and must be returned once completed. Responses to questions will, where necessary, be assessed by professional medical staff in order that the implications of any pre-existing medical condition can be properly understood and prepared for once on site. PADI All expeditioners who wish to dive during the expedition will also be required to complete a PADI (Professional Association of Dive Instructors) medical questionnaire which must be returned to Operation Wallacea. Those volunteers who have answered yes to any of the questions contained within the PADI medical questionaire are also required to seek further assessment from a suitably qualified clinician and will not be allowed to dive unless the declaration on the reverse side of the PADI form has been signed by the assessing clinician thereby acknowledging the expeditioner as being medically safe to dive. Screening All medical forms are assessed prior to the expedition commencing in order to understand pre-existing medical conditions and to best plan for potential medical issues once on site. If deemed necessary, an expeditioner may be asked to seek further medical consultation prior to their expedition commencing. Medical forms need to be photocopied with one copy being taken by the expeditioner to site, one copy remaining with Operation Wallacea UK and a final copy being sent to the field. Operation Wallacea has purchased Medical and Repatriation insurance cover to a value of 1 million for all volunteers and staff. Roles in the event of an emergency Carefully planned evacuation protocols are in place for both forest and marine sites in Indonesia. These protocols are well understood by senior staff working on site in the event that a medical evacuation should be necessary. Due to the variable nature of potential injuries and other limiting factors (such as the availability of high level medical facilities) a number of different evacuation scenarios

4 must be prepared for prior to the expedition commencing. All staff are fully briefed in these scenarios with this report describing the most likely evacuation options. Once a serious medical incident is identified the relevant Site Manager will take control as the Incident Coordinator coordinating the evacuation up until the point there has been a full hand-over of the patient to the Indonesia Country Coordinator (usually in Bau-Bau). The Medical Officer and Site Manager will decide the level of evacuation required for the patient in consultation with the Indonesia Country Coordinator. Evacuations are to be classified as either Medium Priority, High Priority or Emergency. Medium Priority Cases in which the patient is in no immediate danger but on-site medical facilities are considered to be unable to cope with the patient s existing condition and that without seeking outside medical attention the patient s condition is likely to deteriorate. Such a scenario requires the patient to be moved as quickly as possible, usually without the need to hire special vehicles or boats (ie rely upon public transportation only) to the nearest appropriate medical facility. Typically a Medium Priority evacuation would see a patient evacuated to either Bau Bau or Makassar. High Priority Cases where the patient s health is at risk if immediate action is not taken. An example of this is a broken bone. This normally requires departure on a scheduled flight from either Bau Bau or Wanci to Makassar or Bali and may require the use of chartered vehicles or boats if deemed necessary. Emergency Cases where the patients life is at risk if immediate action is not taken. This requires the fastest possible route and will almost certainly require the use of charter vehicles and boats and may also include the use of a chartered plane should it be considered necessary and possible. In all cases where a patient is being transferred to a medical facility they should be accompanied either by a site Medical Officer or someone considered appropriate to accompany the patient. The absence of a Medical Officer from the site whilst the patient is accompanied off-site may require the suspension of activities at the site until the Medical Officer has returned or alternative medical personnel cover exists. It is the responsibility of the senior Medical Officer at the relevant site in conjunction with the Site Manager to determine if an evacuation is required the level of the evacuation and to ensure the patient is stabilized and properly prepared prior to evacuation. The senior Medical Officer in conjunction with the Indonesia Country Coordinator will discuss and agree as to the nature of the evacuation (destination, medical assistance being sought) as early as possible in the evacuation process.

5 Operation Wallacea has purchased Medical and Evacuation Insurance cover for all expedition participants in the unlikely event an evacuation from site be required. Where an evacuation is deemed necessary, the Indonesian Country Coordinator will be responsible for contacting the insurance company and informing them of the need for an evacuation including condition of the patient and planned route of evacuation. This evacuation will be along the evacuation routes that have been discussed and agreed with the insurance company. The Indonesian Country Coordinator may be required to pass on specific medical information relevant to the patient to the insurance company as well as seek further medical opinion from the insurance company. Maintaining good lines of communication between the Site Medical Officer and Site Manager, the Indonesia Country Coordinator and the insurance company is critical to ensuring a successful evacuation. All senior staff involved in a major accident or emergency procedure should keep detailed notes of times, actions taken, communications and costs incurred. After the incident has been closed it is the responsibility of the Site Medical Officer in conjunction with the Site Manager and Indonesia Country Coordinator to compile a detailed report of the incident and medical procedures followed. 2. Medical facilities in country This information below has been updated and is valid for Facilities in Wanci Wanci has the only operational recompression chamber in the region and is where expeditioners suffering from decompression illness will be taken in the first instance. In the case of Hoga this will enable treatment to take place within just a few hours of the incident occurring. A speedboat remains permanently on standby on Hoga for evacuations purposes. In the case of Bau-Bau, patients suffering decompression sickness will either need to be transferred via public speed boat departing Bau-Bau daily (approximately 4 hours) or if deemed necessary charter a vessel from Pasar Wajo to Wanci. Rumah Sakit Umum Daerah Wakatobi Lead Medic: Dr Kartini or Head of Hospital: Dr Irfan Chamber Operator: MrMaman Facilities in Bau Bau These facilities can be used for Medium Priority evacuations from Hoga, Bau-Bau, Labundo or Ereke. The medical facilities in Bau Bau are considered basic,

6 Rumah Sakit Umum Buton (Hospital) Address: Jl, Jend. Sudirman No.20, Bau Bau Telephone: Facilities in Makassar These facilities can be used for evacuations from Hoga or Labundo. Where there is a serious illness or incident where a patient may require non-minor surgery, the patient will be taken to Makassar, which is the home of the best medical facilities in the region. Here there are plenty of western standard hospitals and all the facilities you would expect from a major city. Most medical situations can be handled here. There are also two decompression chambers in the city, one at the general hospital (RS Wahidin Makassar) and another at the Navy hospital. Makassar would therefore be the backup for any decompression accidents should the facilities at Wanci be unavailable. Rumah Sakit Akademis Address: Jl, Bulusaraung No.57, Makassar Telephone: This large private hospital is to western standards. It is very clean and has highly qualified doctors and surgeons, mostly educated in Europe and the US. It is equipped to a high specification and is ideal for all non-specialist treatment and operations. Rumah Sakit Wahidin Makassar Address: Jl, Perintis Kemerdekaan No.11, Makassar Telephone: This is the main hospital for the whole of Sulawesi and as such contains all the equipment you would associate with a major hospital including a decompression chamber. There is a range of specialist doctors capable of dealing with most conditions, highly trained surgeons and proper intensive care facilities. Facilities in Bali Recompression facilities are also available in Bali, and these can also be accessed if required. RSUP SANGLAH, Jl Diponegoro Denpasar Bali Emergency Phone: Switchboard Operator: Fax or a (Dr Etty Herawati Head of Hyperbaric Unit RSLP SANGLAH) b (Dr Kadek Sosiawati) Hyperbaric Doctor

7 c (connects to Operator) d (Peter Manz Hyperbaric Health Representative) The air evacuation company, Air Bali is also based in Denpasar 24 Hour Emergency Numbers: or Office Contact Dewa Ruci Building No 2 Jalan By Pass Ngurah Rai Simpang Siur, Kuta Denpasar Tel : Fax: Mobile: mars@airbali.com Web: Currently operate a Bell 206B turbine helicopter, a Piper Chieftain PA twin engine aircraft and a twin turbine Cheyenne 400LS. 3. Medical cover Up to five forest camps and two marine sites will be operational in Indonesia 2013 with a qualified medic to be based at each camp / site. Such medical staff will be practising professionals such as a doctor, paramedic, or nurse with accident and emergency experience. A medical kit is provided at each site, the content of which is determined prior to the expedition commencing in consultation with professional medics. These kits are designed to deal with as many non-emergency medical situations as is reasonably possible and to also support emergency incidents necessary for stabilization of a patient prior to transfer to a suitable medical facility. A spinal board will be with the Canopy Access team at the location they are operating in central Buton. 4. Evacuation from the forest sites Overview There is no possibility of an air evacuation from either the Central Buton or North Buton sites meaning the first step in a forest-based evacuation will be to get the patient overland to Bau Bau. On arrival in Bau Bau the patient can be stabilised in the local hospital before transferring to better medical facilities located elsehwere in Indonesia or overseas if considered necessary. The main challenge with all forest evacuations is getting the patient out of the forest and to a vehicle. At each forest camp there is a team of Indonesian staff who have the skills and equipment necessary to transport the patient to the nearest road access point to a waiting vehicle. At the forest base of Labundo a vehicle can be

8 accessed immediately whilst it take approximately 1-3 hours for road access to be reached from a forest camp. Medium and High priority evacuations Medium or High Priority evacuations will initially be evacuated to the Bau Bau hospital for treatment and/or to be stabilised whilst ongoing travel arrangements to Makassar or Bali are organised if deemed necessary. The procedure is as follows: The responsible medical officer at Labundo base or a forest camp will assess the patient and in conjunction with the Site Manager a decision will be made to evacuate the patient; The Site Manager will notify the Indonesian Country Coordinator of the decision in order that he can contact the insurance company to inform them of the situation; The patient will be taken to the nearest road as quickly as possible where they will be picked up by a suitable vehicle and driven to Bau Bau. The overland transfer of a patient to road points that are the nearest to the various forest camps would likely take from 1 3 hours depending on the camp. There are always a large number of very fit and disciplined guides trained to carry a stretcher and the transfer times from any of the camps would not exceed 3 hours and for most camps would be closer to 1 hour. A medical officer would normally accompany the patient to Bau Bau in all High Priority cases but designated staff members may be used for Medium Priority cases. The Indonesian Country Coordinator will ensure that preparation for the patients arrival in Bau-Bau is undertaken and that accomodation as well as an appointment to see a doctor have been confirmed upon arrival of the patient; The Indonesia Country Coordinator will contact Operation Wallacea s UK office to inform them of the situation and the UK office will in turn liaise with the patiuent s next of kin to inform them of developments; Onward travel to Makassar will be arranged using scheduled flights; there are several scheduled flights each day from Bau Bau to Makassar. It is also possible to get twice daily speedboats to Kendari, and then onwards flights to Makassar. Emergency evacuations The medical officer in Labundo or the forest camps will assess the patient and with the Site Manager make a decision to undertake an Emergency evacuation. The Site Manager will immediately notify the Indonesian Country Coordinator of the situation. The Indonesian Project Manager will contact the insurance company to inform them of the situation and to decide upon the most appropriate mode

9 of transportation and medical facility to which the patient should be transferred. Under certain critical conditions this may require the insurance company organising a chartered medi-vac flight from Bau-Bau. The patient once stabilised at the forest camp will be taken to the nearest road from where they will be picked up by a suitable vehicle and driven to Bau Bau. A medical officer will accompany the patient initially to Bau Bau and onwards until the patient is deemed to have received appropriate medical attention and care. The Indonesian Country Coordinator will contact the UK office to inform them of the situation and the UK office will liaise with the patient s next of kin to inform them of the situation. Regular updates of the patient s condition will be relayed by the Indonesia Country Coordinator to the UK office. Evacuation times from forest camps to Bau Bau Labundo: Lapago: Bala: North Buton: Approximately 2 ½ hours by motor vehicle Approximately 1 ½ hours by stretcher, 2 ½ by motor vehicle. Total 4 hours Approximately 3 hours by stretcher, 3 hours by motor vehicle. Total 6 hours Approximately 2 hour by stretcher, 1 hour by boat, 5 hours by motor vehicle Total 8 hours 5. Evacuation from the marine sites Overview Operation Wallacea s marine sites in Indonesia are Hoga Island located inside the Wakatobi National Park and at Pantai Nirwana, just outside the main town of Bau- Bau. Hoga Island in particular poses particular challenges to evacuations due to the remote location of the site and challenging weather conditions that often occur at that time of the year. Both Hoga (speedboat) and Bau-Bau (vehicle) have transportation means permanently located on site specifically for the purpose of an evacuation. Medium and High Priority evacuations Medium priority evacuations would normally be sent to Bau-Bau or Makassar for treatment. The procedure would typically be as follows:

10 The medical officer on site will assess the patient and following consultation with the Site Manager make a decision to evacuate the patient. The Site Manager will inform the Indonesian Country Coordinator of the impending evacuation who will in turn inform the insurance company and the UK office. The Indonesia Country Coordinator will ensure that preparation for the patients arrival in Bau-Bau is undertaken and that accommodation as well as an appointment to see a doctor have been confirmed upon arrival of the patient; If the evacuation is from Hoga, the patient will likely depart on the public speedboat to either Wanci or Bau-Bau. The patient will then take a commercial flight to either Makassar or Bali for further medical treatment if deemed necessary. A medical officer or someone deemed appropriate to accompany the patient will travel with the patient at all times. If the evacuation is from the Bau-Bau site, the patient will be stabilized in the Bau-Bau hospital prior to flying to Makassar or Bali to seek further medical treatment if required. Emergency evacuations The medical officer on site will assess the patient and following consultation with the Site Manager make a decision to evacuate the patient. The Site Manager will inform the Indonesian Country Coordinator of the impending evacuation who will in turn inform the insurance company and the UK office. If the evacuation is from Hoga, a chartered speedboat will be used to transport the patient to either Wanci or Pasarwajo on the main island of Buton from where the patient will be transferred to Bau-Bau and stabilised prior to taking a flight to Bali or wherever it is deemed suitable medical treatment can be found. If the evacuation is from the Bau-Bau site, the patient will be stabilized in the Bau-Bau hospital prior to flying to Bali or elsewhere to seek further medical treatment if required. The medical officer will accompany the patient to the medical facilities in Bali or until the patient is able to receive expert medical attention. The Indonesian Project Manager will discuss with the insurance company the most appropriate mode of transportation and medical facility to which the patient should be transferred. Under certain critical conditions this may require the insurance company organising a chartered medi-vac flight from Bau-Bau or Wanci. The Indonesian Country Coordinator will contact the UK office to inform them of the situation enabling the UK office to liaise with the patient s next of kin and inform them of the situation. Regular updates of the patient s condition will be relayed by the Indonesia Country Coordinator to the UK office.

11 6. Reporting and logging During evacuations it is crucial that a log is kept by both the Site Manager and the Indonesia Country Coordinator detailing times, personnel involved and all other details relevant to the evacuation process. All medium priority evacuations must be logged by the Site Medical Officer and included in the post-season medical report. For High Priority and Emergency level evacuations the Site Medical Officer, relevant Site Manager, and Indonesian Country Coordinator must each make a detailed report immediately following the incident. A full safety assessment must be carried out after all evacuations and if a similar incident is likely all activities must be stopped until the situation has been rectified. The Indonesia Country Coordinator will collate the reports of all High Priority and Emergency evacuations for submission to Operation Wallacea. The Indonesia Country Coordinator will also submit relevant medical documentation and a summary of evacuation costs to the insurance company to enable a claim to be processed. 7. Mass evacuations and disaster management There is the possibility, albeit incredibly small, that a large scale incident could occur which would require a large number of Operation Wallacea volunteers and staff being repatriated. Such incidents could include political unrest, natural disaster and terrorist attacks. These incidents can be broken into two types, those with prior warning and those without. Major incident with prior warning Some major incidents come with a degree of prior warning. A good example of this is political unrest resulting in violence, which would have a build up period. We constantly monitor the political situation of the area we work in and if our experienced field operatives decide that the political situation has become unsafe they would order a full evacuation. In such an incident the Indonesian Country Coordinator would liaise with the insurance company and relevant embassies to agree the best route for repatriation. Major incident with no prior warning Some incidents, such as a terrorist attack or natural disaster, would have no prior warning. In cases such as these the field staff would get all volunteers and staff to a place they deemed safe by which ever means they decide best. From here the Indonesian Project Country Coordinator would contact the volunteers embassies to coordinate an evacuation strategy. The details of such an evacuation would vary

12 dramatically depending on the situation and as such it is impossible to produce more detailed 8. Important Contacts for Indonesia Name Position Number Air Bali Air evacuation company or +62 contracted by CEGA Wakatobi Divers N/A +62 (0) (Crispin) +62 (0) (Office) WWF Wanci N/A +62 (0) (Weda) +62 (0) (Office) Air Bali (Medivac) N/A +62 (0) (0) Global Assistance N/A +62(0) (Medivac) Bali International Medical N/A +62(0) Centre (Medivac) Tim Sar Kendari N/A +62(0) (Coastguard) KPPP Bau Bau N/A +62(0) (Coastguard) Intel Polres (Police) Bau Bau N/A +62(0) (La Izu) Bau Bau Airport N/A +62(0) (0) (Pak Mustafa) British Embassy Jakarta N/A +62(0) US Embassy Jakarta N/A +62(0) Canadian Embassy Jakarta N/A +62(0) Irish Embassy Singapore N/A +65(0) Australian Embassy N/A +62(0) Jakarta Makassar Recompression Chamber Dr.H.Abdul Muis Sp.S (K) Specialist in Neurobehaviour Praktek: Tel: (0411) HP: