Emergency Medical Service Reference Model for Low Impact and

High Frequent Disaster in Indonesia

Nur Budi Mulyono, Akbar Adhi Utama, Noorhan Firdaus Pambudi, Marina Natalia Tampubolon,

Niken Larasati and Layung Anindya Prasetyanti

Institut Teknologi Bandung

nurbudi@sbm-itb.ac.id

Keywords: healthcare aid, disaster, emergency medical service.

Abstract: Located in archipelago and intersection of 3 tectonic plates, Indonesia susceptible to the low impact and high

frequency types of disaster such as flood, fire, landslides etc. These disaster types unexpectedly create more

economic losses and disturb stability of social and economic order since less preparation and lack of reference

model. One of the important humanitarian aid of catastrophic event like disaster is healthcare distribution

system. This study aims to find out an appropriate emergency medical service (EMS) model for developing

country like Indonesia considering nature of low impact and high frequency disaster. The EMS has two

famous reference model: Anglo American and Franco German with the difference in the flow of medical

doctor, ambulance, medical equipment, and the use of medicine. We conduct a deductive assessment of those

two reference model and create recommendation of suitable EMS model for developing countries like

Indonesia. The disaster’s stakeholder such as National Board of Disaster Countermeasure (BNPB), Indonesian

Red Cross (PMI), hospital and any other organizations involved in health care aids services can take benefit

of our recommendation.

1 INTRODUCTION

As the world has been witnessing an improvement of

life quality, the importance of emergency medical

service for emergency, disaster, and catastrophic

conditions is getting more recognition nowadays.

Disasters, both natural and manmade disasters, have

high dependency on emergency medical services.

Therefore, humanitarian logistics covering logistics

aid for vulnerable people, in which disaster healthcare

is included (Tomasini and Wasenhove, 2009; Kovacs

and Spens, 2007), also had been gaining considerable

attention.

As a result, there has been needs for emergency

medical service as well as humanitarian aid logistics

for events of disaster. While

humanitarian logistics could partly rely on social and

volunteer activities, emergency medical service fully

rely on the involvement of local government or the

municipals. Therefore, building reliable emergency

medical service to response immediate disaster is a

must for the citizen, rather than rely on the one

operated by volunteers.

Being an archipelago, between two oceans, on

intersection of three tectonic plates, and lying right on

equator, makes Indonesia vulnerable to disasters.

Java Island as the most inhabited island in Indonesia,

bear the risk of both natural and manmade disasters,

especially the small scaled ones.

This research aims to develop emergency medical

service for disasters in Indonesia

considering currently exist response system for

disaster mitigation. As reference model, we will refer

to the two previously mentioned basic model of

emergency medical service.

2 LITERATURE REVIEW

A supply chain is essentially a network consisting of

suppliers, manufacturers, distributors, retailers and

customers that manage material flows, information

flows and financial flows (Wassenhove, 2005). The

Mulyono, N., Utama, A., Pambudi, N., Tampubolon, M., Larasati, N. and Prasetyanti, L.

Emergency Medical Service Reference Model for Low Impact and High Frequent Disaster in Indonesia.

In Proceedings of the 2nd International Conference on Sociology Education (ICSE 2017) - Volume 2, pages 36-40

ISBN: 978-989-758-316-2

difference between supply chain in business context

and supply chain in disaster will face uncertainty, like

when, where, what, how much, where from and how

many times to procure and distribute to disaster area.

2.1 Humanitarian Supply Chain

Humanitarian supply chains provide the response to

disasters. The definition of humanitarian supply chain

is derived from the definition of basic supply chain,

“a set of approaches utilized to efficiently integrate

suppliers, warehouses, and stores, so that

merchandise is produced and distributed at the right

quantities, to the right locations, and at the right time;

in order to minimize system wide costs while

satisfying service level requirements”. This concept

can be used in the humanitarian supply chain when

applied in the disaster relief and excluding the term

“customer” or “store” (Yadav and Barve, 2015)

Thomas and Kopczak (2005) from The Fritz Institute

define there are seven activities include in the

humanitarian supply chain, such as preparation,

planning, procurement, transportation, storage,

tracking and custom clearance. Supply chain in

humanitarian needs to be flexible and able to respond

quickly to unpredictable events effectively (between

life and death) and efficiently (treating great number

of victims) under heavy budget constraints (Heasilp

et al, 2010; Costa et al, 2012).

Humanitarian supply chain consist of more than

just humanitarian organization. The list goes to

donors, aid agencies, NGOs, governments, the

military, logistic service providers and suppliers as

the main actors in HSC. (Sahebi et al, 2016).

2.2 Humanitarian Aid Logistic

Logistics is an important factor in humanitarian aid

operations, to the extent that logistics effort account

for 80 percent of disaster relief (Trunick, 2005;

Kovacs and Spens, 2007). Delivering humanitarian

aid needs to be in rapid response to serve the disaster

victims and minimizing the impacts.

Logistic operations in humanitarians is the

processes and systems involved in mobilizing people,

resources, skills and knowledge to help vulnerable

people affected by disaster (Wassenhove, 2006).

Humanitarian logistics is an umbrella term for a

mixed array of operations (Kovacs and Spens, 2007).

The Fritz Institute (2004) defined humanitarian

logistic as “tasks, all the process of planning,

implementing and controlling the efficient, cost-

effective flow and storage of goods and materials as

well as information, from the point of origin to the

point of consumption for the purpose of meeting the

beneficiary’s requirements and alleviate the suffering

of vulnerable people (Vitoriano et al, 2013)

The purpose of humanitarian aid logistic to aid

people in their survival. There are two main streams

of humanitarian logistics that can be distinguished

named as continuous aid work and disaster relief.

While the focus of disaster relief operations is to

design the transportation of first aid material, food,

equipment and rescue personnel from supply points

to a larger number of destination nodes

geographically scattered over the disaster region and

the evacuation transfer of people affected by the

disaster to the health care centers safely and very

rapidly (Barbarosoglu et al, 2002; Kovacs and Spens,

2007).

Humanitarian aid logistic focus on delivering

rescue team and goods. In disaster relief, the most

needed goods by disaster victims such as water,

medicine, chlorination tablets, tents, blankets and

protein biscuits for malnourished children (Dignan,

2005; Kovacs and Spens, 2007). The procurement

process of humanitarian aid including healthcare is

separated into three phases according to disaster life

cycle, preparedness, response and recovery.

Vaillancourt (2011) mentioned the first phase is

planning the emergencies and prepare the relevant

materials for different types of needs into kits. The

phase continue to deliver the goods to the people in

need, the second phase. This phase can be somewhat

challenging due to infrastructure and unpredictable

demand. In the response phase might focus on

different needs and thus there exists a multitude of

kits such as medical, educational, water and sanitation

and household. The last phase is aim to enables the

postponement of inventory allocations to specific

countries (Scholten et al, 2010).

To reduce the great number of victims, the

Emergency Medical Service (EMS) is employ during

the second phase of disaster, in the response phase.

EMS can be defined as “a comprehensive system

which provides the arrangements of personnel,

facilities and equipment for the effective, coordinated

and timely delivery of health and safety services to

victims of sudden illness or injury. (Al-Shaqsi, 2010).

EMS is really helpful and beneficial during the

disaster because it is an integral part of any effective

and functional health care system that serve medical

and trauma emergencies utilizing advanced clinical

technology. However, previous literature does not

discuss on the suitability assessment of using EMS

model as well as the applicability of EMS in

Indonesian context.

Emergency Medical Service Reference Model for Low Impact and High Frequent Disaster in Indonesia

3 REFERENCE MODEL

The methodology used in this study is exploratory

analysis employing qualitative and literature review

to generate reference model in providing Emergency

Medical Service during disaster. There are two well-

known model implemented in Emergency Medical

Services system, called as the Franco-German model

and the Anglo-American model. The Franco-German

model of EMS delivery is based on the “stay and

stabilize” philosophy (Huiyi, 2007). In the Franco-

German model, physicians and technology are sent to

the scene in the hope of providing a higher level of

emergency care before the patient’s arrival at the

hospital (Arnold, 1998). Figure 2 illustrates medical

service process of Franco-German model.

On the other hand, the Anglo-American model is

based around “scoop and run” philosophy (Dick,

2003). Here, patients are brought to hospital-based

emergency departments so that they may be provided

a higher level of care (Arnold, 1998). Figure 3

illustrates medical service process of Anglo-

American model.

Arnold (1998) argued that most countries

develops new emergency care systems in recent years

following the Anglo-American model, as exemplified

by emergency medicine in the United States.

However, there is no comparative multinational

studies exist to demonstrate the superiority of one

model over the other. Critics have noted several

problems with the Franco-German model: Physicians

are not well trained, not well supervised, and not

subject to the same quality-assurance controls as

physicians in Anglo-American systems (Arnold,

1998).

This study focuses on the former two terminology

of emergency medical services model, Franco-

German model and Anglo-American model as their

applicability in developing countries like Indonesia.

Indonesian Ministry of Health had showed the list of

medicine in the condition of medical post during

disaster whether within or without physician in the

team through Regulation of

Indonesian Ministry of Health No. 059 Year

2011.

The proposed model of healthcare aid supply

chain during disaster in consideration of Emergency

Medical Services as the supporting part on the supply

chain can be seen in Figure 1.

Beside the model that provide the application of

Emergency Medical Services in healthcare aid supply

chain during disaster there also several aspects should

be considered to maintain better performance in the

supply chain. Those several aspects is described in

Figure 2 and can be seen in the following points:

 Demand management;

 Distribution model; and

 Coordination.

Figure 1: The model of healthcare aid supply chain.

Based on disaster life cycle in which EMS

become main role in disaster response.

Figure 2: Aspects, participating parts, and material/data.

Flow of healthcare aid supply chain in Indonesia.

BNPB is acronym for National Board of Disaster,

Countermeasure which responsible to manage

disaster resilience and developed by Indonesian

Government.

3.1 Demand Management

This aspect will be focused on how the supply chain

fulfill the demand of healthcare services during

disaster. There will be a rapid increasing on demand

with limited supply of medicine, medical staff,

physician, and medical equipment’s. This aspects will

be affected by several consideration such as:

 Disaster type and frequency

 Disaster impact (risk and hazard)

 Disaster to diseases mapping

 Demand estimation

ICSE 2017 - 2nd International Conference on Sociology Education

3.2 Distribution Model

This aspect will be focused on how the healthcare aid

collected and disseminated to patients from disaster.

It will be started from funding, sourcing, making or

producing, up to delivering.

 Funding means the activity will be about the

financial support to provide health care aid

during disaster.

 Sourcing means the activity will be about the

vendor selection (i.e. hospital, pharmacies) to

provide medicine and medical staff to help

patients from disaster.

 Make means the production processes of

medical service operation

 Deliver means that the transportation or

mobilization processes of medicine and medical

services.

3.3 Coordination

This aspect will be focused on how the participating

parts on health care aid supply chain coordinated to

perform better medical services to patients from

disaster. There are several consideration such as:

 Actors included hospital, pharmacies, medical

staff, government, community, and other parts

involved in disaster resilience especially in

providing health care aid.

 Information to support demand estimation for

supplying medical services to patients from

disaster.

 Infrastructure to support medical services

during disaster such as road and supporting part

(i.e. fire fighter forces, army forces).

 Funding need coordination to avoid chaotic and

corrupted system during disaster.

Indonesian government already maintain the

system for management of medicine by published a

regulation to overcome all aspects that explained in

this study. Management of medicine based on the

Regulation of Ministry of Health

Number 059 , 2011 as below:

 Requirement planning

 Provision of drugs and medical supplies

 Storage and distribution

 Use and control

 Recording, evaluating, and reporting

 Destruction and disposal

Indonesian government also developed

several considerations regarding provision of drugs

and medical supplies also based on the Regulation of

Ministry of Health Number 059, 2011. The

considerations as follow:

 Type of disaster

 Disaster area and the number of affected victims

 Current medical stock

3.4 Human Resource and

Transportation

Human resources such as doctors and/or paramedics

are needed in disaster responses phase. If the

Emergency Medical Service System adopt the

French-German model then doctors and paramedics

will be needed, otherwise if the Emergency Medical

Service System adopt the Anglo-American model

then only paramedics will be needed as main human

resources. In the transportation, ambulance will help

the doctors and/or paramedics to mobilize from

and/or to disaster area. In the several developed

countries, air support will provided by helicopter as

another transportation mode. In Figure 1 and 2 can be

concluded that in French-German model there is

possibility the number of doctors can be larger and

the number of transportation mode can be smaller,

meanwhile in Anglo-American model there is

possibility the number of doctors can be smaller and

the number of transportation mode can be larger.

3.5 Medicine and Medical Equipment

The information explained in the regulation is the list

of medicine supplies needed during disaster. The

regulation distinguish the list into two type such as:

list of medicine supplies for medical post without

physician or doctor and list of medicine supplies for

medical post with physician or doctor. There are two

possibilities why the regulation distinguish the list

into two terms. First, there is possibility that the

regulation already recognized both model in

Emergency Medical Service system. Second, there is

also possibility that the regulation realize that there is

some lack of physician in several medical post or

clinic in rural area. The regulation itself noted that the

information was adopted from a book entitled New

Emergency Health KITs published by WHO.

3.6 Assessment of Reference Model

There are three phases in current healthcare

distribution system during disaster in Indonesia.

Firstly, the pharmaceutical and medical support

distribution phase from national buffer stock during

disaster. In this stage, all distribution will be

responsible by Indonesian Directorate General of

Pharmaceutical and Medical to support disaster

victims. Secondly, the distribution phase from

province to district. If the district has buffer stock and

receive support from other source, the distribution

can be proceed based on request from head of district

Emergency Medical Service Reference Model for Low Impact and High Frequent Disaster in Indonesia

public health care office. Thirdly, the distribution

process from district to remote hospital, field hospital,

Indonesian armed force healthcare facility and private

healthcare facility. In this phase, all medicine and

medical support distribution will handle by district

public health office to the healthcare unit based on the

data of victims and disease type.

The paramedic personnel will use stock card form

to record and control healthcare inventory during

emergency response. All healthcare inventory

received, usage and latest stock should report daily,

weekly and monthly. This report process will be

evaluate during disaster response phase.

4 CONCLUSIONS

Through limited resources of doctors and ambulance

or transportation modes, EMS will provide medical

services for low impact disaster such as fire and flood

effectively. The problem is there are no specific

model had been used of EMS in Indonesia. There are

two contrary model had been known by worldwide,

French-German model with the concept of ‘bring the

hospital to the patient’ and Anglo-American model

with the concept of ‘bring the patient to the hospital’.

This study provide the necessary information about

both of the model and contextualized to Indonesian

disaster management problems through healthcare

aid supply chain mapping. There is some aspects

should be considered to adopt the model in the future.

There are: (1) demand management; (2) distribution

model; and (3) coordination. By providing this model,

further research can be conducted by starting

considering to mapped cost effectiveness of the EMS

model implemented in Indonesia with consideration

of transportation cost, medicine price (this study

already provide the list of medicine needed with its

prices), and infrastructure condition in Indonesia. In

another perspectives, different research also can be

conducted to mapping the needs of preparing the

model to be implemented in Indonesia.

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